Week 2-Causality in mental distress

Question 1

Define aetiology or causality

Answer 1

The study of factors, mechanisms/relationships between factors and mechanisms that cause mental distress

-Constant debates in philosophy about the nature of causality e.g., David Hume: ”causality is something we have in our minds constructed on previous experiences”

Question 2

What are causal attributions?

Answer 2

Everyday common sense explanations of behaviour and its consequences

Question 3

Why do clinical psychologists develop causal models that try to explain relationships between variables that could cause mental distress?

Answer 3

-Clinical Psychology is predicated on notions of causality (i.e., causality is central to clinical psychology)

-E.g., most clinical interventions assume that changes in one variable e.g., dysfunctional thoughts will lead to changes in mental distress e.g., reduced anxiety

-So causal models are then used to inform psychological assessment and clinical interventions

Question 4

What are the 3 causal influences on mental distress?

Answer 4

1.Relational: family relationships, early experiences and trauma and abuse

2.Biological: neurotransmitters, brain structure and genetics

3.Social: social inequalities, gender and ethnicity

-Less clear which ones are for mental distress and how they achieve this

Question 5

Give 4 examples of biological factors of mental distress

Answer 5

1.Neurotransmitters- Insufficiency of monoamine neuro mediators in definite structures of the CNS

2.Brain structure- Disturbance or decreased neurogenesis, structural abnormalities (frontal lobe, thalamus, striatus) impaired circuit

3.Genetics- Coordinated action of many genes and their interaction with each other

4.Hormones- Hyperactivity of the hypothalamic-pituitary-adrenal axis

-Some of our brain structures have developed in a different way e.g., smaller hippocampus which THEN causes mental distress

-Not one gene that maps onto mental distress more a combination of gene e.g., different expression of gene=different level of neurotransmitter=mental distress

Question 6

Give biological causes of schizophrenia

Answer 6

-Excess of dopamine receptors in the brain resulting in symptoms such as hallucinations

-Genetic component (estimates range of 4-46% heritability), some genes have been associated with schizophrenia diagnosis

-Abnormalities in the temporal lobe which processes auditory information and encodes memories (could explain hallucinations)

-Smaller hippocampus associated with schizophrenia

Question 7

What are + and - symptoms of schizophrenia?

Answer 7

-Positive adds to experiences e.g., hallucinations

-Negative causes a reduction in behaviour e.g., asocial, reduced motivation

Question 8

Give a brief history of biological explanations and treatments of mental distress

Answer 8

-Psychopharmacological ‘revolution’ in the 1950s-1960s and the introduction of the chemical imbalance theory of depression 🡪 Psychiatry moves towards a biomedical view of mental distress

-Publication of DSM-III in 1980 introducing diagnostic criteria for mental distress

-Marketing of biomedical advances and growing collaborations with the pharmacological industry

-Growing ties between patient advocacy groups, APA, and National Institutes

Question 9

Why could the biomedical model benefit mental distress?

Answer 9

-If biological processes are a cause of mental distress, targeting biological “dysfunctions” could help alleviate symptoms

-A biomedical framework could help reduce stigma around mental health and help explain or legitimise mental distress (i.e., it’s out of their hands)

-Future science and technological advances might help to uncover the role of biological factors in mental distress

-Medical framework helped solidify psychiatry as an “exact science”

Question 10

What are 6 criticisms of the biomedical causal model?

Answer 10

1.Research has not identified a single biological ‘marker’ or cause for any form of distress

2.Diagnostic categories might not be valid

3.Role of Big Pharma in promoting and funding biomedical research

4.Reductionist: can we ignore non-biological factors?

5.Biomedical beliefs might increase stigma rather than reducing it

6.If the chemical imbalance theory is correct, why does psychotropic medication not work for everyone?

Question 11

How could causal models interact?

Answer 11

Negative early life experiences could alter brain structure in the future e.g., Traumagenic model of Psychosis

Question 12

What could be an issue for the Bio-Psycho-Social Model?

Answer 12

We can’t look at mental distress without accounting for all 3 factors BUT practitioners aren’t specialised in all 3 factors so patients tend to get focused with one factor moreso

Question 13

How should we understand causality in mental distress?

Answer 13

-Causality in mental distress is probabilistic which means that causal influences change the likelihood of mental distress occurring (doesn’t determine)

-There are many possible causes of mental distress and often there is more than one causal influence

-Mental distress can often be explained in more than one way meaning that causality is often “over-determined” (means for any type of distress, there will be different causal influences but individuals will have different sets of causal influences)

-Causal influences on mental distress operate contingently meaning that they interact with each other in ways that are difficult to predict and identify (means the effect of one causal influences another they don’t work independently)

Question 14

What are the 4 steps of mental distress?

Answer 14

1.Covariation- mental distress should occur more often than not when the causal influence is present

2.Temporal precedence- the causal influence should occur prior to the onset of mental distress

3.Alternative explanations- we should be able to rule out alternative explanations

4.Logical connections- we should be able to explain how X affects Y

Question 15

What’s sufficient cause?

Answer 15

1.Y (outcome) always occurs after X (variable)
-For example, consumption of carbohydrates and glucose-rich food (X) can lead to raised blood glucose levels (Y) in people who have diabetes

2.But Y can also occur in the absence of X
-There are NO identified sufficient causes for mental distress. For example, depression does not always occur after abuse, low serotonin, poverty, inequality, bullying etc.

Question 16

What’s necessary cause?

Answer 16

1.Y never occurs without the prior occurence of X
-For example, a sexually transmitted disease (Y) never occurs without the prior occurrence of sexual contact (X)

2.But X can also occur without leading to Y
-For example, not everybody who is depressed have low serotonin, bullying, abuse, poverty etc.

Question 17

What’s insufficient cause?

Answer 17

Y occurs only after X occurs with another variable (Z). Y does not occur when X occurs alone

-For example, a person might develop a particular condition such as schizophrenia (Y) only when they carry a genetic susceptibility (Z) and are exposed to a life stressor (X)

-For mental distress, there are only insufficient causes!

-And, there are MANY insufficient causes that interact with each other

Question 18

Give an example of schizophrenia in relation to the 3 causes

Answer 18

-Not all individuals diagnosed with schizophrenia have excess dopamine levels

-Excess dopamine often occurs in tandem (combination) with stressful life events in individuals diagnoses with schizophrenia

-Medication enhancing dopamine levels does not work for around 1/3 of people diagnosed with schizophrenia

Question 19

What are the difficulties in establishing temporal precedence and alternative explanations?

Answer 19

-Many studies are cross-sectional rather than prospective and longitudinal (it’s difficult to prospectively study important influences e.g., the impact of parenting practises only becomes apparent years later)

-It’s impossible for studies to include ALL important influences (many influences occur over different time periods, happen in different places and interact with other variables)

-Practical and ethical limitations in manipulating causal influences on mental distress in order to establish cause and effect e.g., SES, gender or ethnicity

Question 20

What are the difficulties in asking participants about causal influences?

Answer 20

-Many important influences are sensitive and difficult to talk about e.g., factors on trauma and abuse

-It’s likely impossible to articulate all causal influences on one’s distress (often unaware of all factors leading to distress AND some might only lead to this in certain contexts/situations making it even harder to identify)

-Meaning plays an important role as many important influences are mediated by their meaning in people’s lives and are interpreted differently making it difficult to measure

Question 21

What are some measurement problems in causality?

Answer 21

-Can be difficult to measure causal relationships with self-report questionnaires administered at a single point in time

-Researchers and clinicians may have unconscious biases that influence measurements and models (causal attributions are always influenced by social and cultural norms and values + it’s important to consider alternative explanations especially when causal models are in line with a researcher or clinician’s own causal beliefs

-How we measure mental distress can limit the conclusions we draw (some argue there’s a lack of validity of diagnostic categories used in research)

Question 22

Define a deductive approach

Answer 22

Tests a theory of causality using pre-determined variables that are thought to influence mental distress (surveys and experiments)

Question 23

Define an inductive approach

Answer 23

Explores experiences and links them to causal theories OR devises new causal theories (Qualitative and case studies)

Question 24

Define an epidemiological approach

Answer 24

Studies determinants and distribution of health-related topics (Epidemiological studies)

Question 25

What can survey methods involve?

Answer 25

1.Asking participants directly about the occurrences of variables associated with distress

2.Can involve clinical interviews or self-report questionnaires (can be large-scale)

3.Face-to-face, via the phone or online

4.Participants are often sampled via quasi-random sampling (e.g., the electoral register)

5.Uses a predefined range of variables of interest e.g., demographics, life events or traumatic experiences

Question 26

What are 3 advantages of survey methods?

Answer 26

1.Useful if large random samples are used together with valid and reliable clinical instruments (can give reliable information)

2.Explores real variation in influences and mental distress (measuring what’s already there)

3.Cross-sectional surveys can be useful, but can also be used longitudinally

Question 27

What are 3 disadvantages of survey methods?

Answer 27

1.Data depends on the questions being asked and the preconceptions of the researcher

2.Self-report depends on what participants are able and willing to tell the researchers

3.Some people with relevant mental health experiences might be excluded if quasi-random sampling is used

Question 28

What do experimental methods involve?

Answer 28

1.The manipulation of a variable (X) to explore its effect on another variable (Y)

2.Participants are sampled in a random way

3.The same sample is then divided into an experimental and control group

4.Differences are compared between the groups in a set of relevant measures

Question 29

What are 2 advantages of experimental methods?

Answer 29

1.They can provide the strongest inference of causality

2.They have high internal validity since they can provide a controlled environment

Question 30

What are 4 disadvantages of experimental methods?

Answer 30

1.Low external validity since it’s difficult to generalise a controlled environment to the ‘real world’

2.We can’t control many other confounding variables

3.Convenience sampling (e.g., students samples, hospitals, schools) means that we might miss important causal influences in other groups

4.There are practical and ethical constraints in experimentally manipulating important causal influences

Question 31

What do qualitative studies consist of?

Answer 31

1.Deals with language, images and non-numerical data rather than measures, scales and questionnaires

2.Is concerned with what people say

3.Does not intend to test pre-conceived hypotheses

4.There are many different qualitative approaches

5.For example ethnography combines diaries and researcher/participant observations, memos, documents

Question 32

What are the 5 advantages of qualitative studies?

Answer 32

1.Explores how the meaning of causal influences impacts people’s experience

2.Can help identify the causal order or temporal precedence

3.Can tell us something about how different influences interact in mental distress

4.Good for generating new hypotheses for quantitative studies

5.Good for studying complex cases (that you need a lot of detail on)

Question 33

What are the 3 disadvantages of qualitative studies?

Answer 33

1.Can’t be generalised to the entire population

2.Does not test hypotheses

3.Can be difficult to relate back to quantitative findings

Question 34

What are case studies?

Answer 34

In-depth analysis of a single case

Question 35

What are the 4 advantages of case studies?

Answer 35

1.Useful to generate new hypotheses

2.Helpful to explore complex phenomena

3.Can help to identify rare occurrences

4.Can help to identify some of the meanings associated with quantitative findings

Question 36

What’s the disadvantage of case studies?

Answer 36

Can’t be generalised to the entire population

Question 37

What’s involved in epidemiological studies?

Answer 37

1.Studies the determinants and distribution of health-related topics

2.Provides most of the available evidence on causality and mental distress

3.Frequently uses clinical information gathered by doctors and other professionals

4.Studies how frequently diseases occur in different populations

5.Allows to link variations in the prevalence of diseases to other variables such as SES, lifestyle choices and employment history

Question 38

What are the 3 advantages of epidemiological studies?

Answer 38

1.Often provides the most comprehensive picture of associations between demographic characteristics, lifestyle variables and distress

2.Can access in-patient, clinic and hospital populations (and community samples)

3.Can be more effective than survey methods due to its access to clinical information

Question 39

What are the 2 disadvantages of epidemiological studies?

Answer 39

1.Data is based on diagnostic categories which are argued to lack validity

2.Prone to pre-existing biases that are difficult to measure

Question 40

How do causal beliefs affect how we think about mental distress?

Answer 40

-Biomedical beliefs are associated with increased perceptions of dangerousness and increased pessimism about whether mental distress can be’cured’

Question 41

Causal beliefs affect how we think about mental distress: What did Larkings and Brown (2017) find in a systematic review of 55 studies?

Answer 41

-Participants with biomedical beliefs reported more fear and lower empathy towards people with mental distress, higher levels of self-blame and more pessimism around treatment prognosis

-Biomedical causal beliefs are often seen as associated with increased stigma

-Yet some studies suggest biomedical beliefs are associated with placing less blame on the individual

Question 42

What did Pescosolido et al. (2010) and Schomerus et al. (2012) find on the analyses of public attitudes towards mental distress?

Answer 42

-Increased awareness in the public about the biological correlates of mental distress

-BUT this increase does not coincide with a reduction in stigma (e.g., blame, social distance, perceptions of dangerousness) towards individuals suffering from mental distress

-At best, biomedical causal beliefs might not increase all forms of stigma, but also does NOT reduce stigma

Question 43

How do causal beliefs affect treatment preferences?

Answer 43

-There is an increased treatment acceptance in the general public, particularly for biological treatments (Shcomerus et al., 2012)

-Biomedical causal beliefs can be associated with a preference for biological treatments, but a reduced confidence in psychotherapy

Question 44

What did Read et al (2015) find surveying participants in treatment for depression with anti-depressants?

Answer 44

-They found that participants held a wide range of causal beliefs although the most common were biomedical causal beliefs

-Participants with biomedical beliefs thought of anti-depressants as more effective

Question 45

How do causal beliefs affect treatment expectations?

Answer 45

Biomedical causal beliefs associated with pessimism about one’s prognosis for example:
-P’s with biomedical causal beliefs on depression expect to be depressed for longer
-P’s with symptoms of generalised anxiety reported a more negative prognosis when exposed to a biomedical explanation for anxiety

-Similar effects are reported for other forms of mental distress e.g., eating disorders (this is important as treatment expectations influence treatment engagement and can be a positive driver for improvement)

Question 46

How do causal beliefs affect treatment progress?

Answer 46

Causal beliefs affect clinician’s perceptions of service users:
-Biomedical causal beliefs are associated with reduced empathy for the service user
-More evidence is needed for the impact on clinician’s stigma

Causal beliefs affect service users’ perceptions of the clinician:
-Service users can perceive biomedical explanations as lacking warmth and compassion

Therefore, these perceptions can affect the therapeutic alliance, which is crucial in treatment and recovery