Week 7/8 Psych Health Flashcards
what are psych health problems
experiences/emotions/perceptions/judgements/thoughts/sensations/urgers/motivations/behaviours
–> that cause distress to self/others
positive effects of receiving a diagnosis
can make sense
reduce self-blame
access services
find supprot
negative effects of receiving a diagnosis
stigma
sense of different
defeat
may feel trapped
abnormal?
psych health problems = recurring patterns of human experience
not statistically/qualitatively abnormal
‘abnormal’ = biomedical view
stigmatising
diagnostic classification
based on recurring and reliable patterns of human experiences
categorises + classifies them into discrete entities called ‘diagnoses’ of ‘disorder’
aims of classification systems
reliability
underlying assumption: having such ssstems furthers understanding mechanism + cause –> treatment
classification systems
diagnostic + statistical manual of mental disorders (DSM5)
international classification of diseases - 11th
major depressive disorder symptoms
experiece 5+ symptoms during 2-week period: 1) depressed and/or 2) loss of interest
all most of day, every day
- depressed mood
- diminished interest in all activities
- weight loss when not dieting/weight gain/appetite changes
- thought has slowed + physical movement decreased
- fatigue/low energy
- feeling worthless/inappropriate guilt
- diminished concentration/indecisiveness
- thoughts of death/suicidal ideation/suicide attempt
- impairment in social, occupational, functional areas
- not resulting from substance abuse/medical condition/bereavement
diagnostic system criticisms
- dont known if diagnoses are discrete things
- no confirmation tests
- ultra-common comorbidity
- diagnostic differences among clinicians
dsm5 critiques - scientific, practical, ethical
- lack of validity - based on consensus about clusters of clinical symptoms (not objective laboratory measure)
- minor changes to criteria = big diff in diagnostic rates
- diagnoses have proliferated but arbitrary deletions too
- DSM book = income stream for APA
psychological formulation
use existing psycho knowledge to understand origins/mechanisms/maintenance of individual problems
five p’s formulation
predisposing + precipitating + perpetuating + protective factors = presentation or problem
theory-specific formulation
harder to integrate various elements
can be more precise
can be linked more to specific evidence-based practice
can be limited by diagnosis, blind-spots in theory
can straddle diagnoses
CBT formulation
early life events
core beliefs
conditional assumptions
critical incident activates negative auto responses
behaviour + physiological + emotions interact with each-other and negative responses
using formulation for intervention
- built collaboratively over time with person
- not imposed, instead explained, encouraged
put meaning - put meaning/understaanding into problems
- highlight places to intervene in therapy
macrolevel influences
poverty
social exclusion
discrimination
multiply discriminated identities
poverty stigma and social exclusion
negative perceptions
stereotypes abound
stigma can be internalised
childhood poverty damaging
intergenerational transmission of poverty
large-scale factors require
policy
influence
advocacy
campaigning work
intrapersonal influences on psych processes
personal historical factors
cog factors
behavioural factors
cognitive processes distorted in psychopathologies
info processing distortions along the chain
selective attention - threat stimuli in anxiety
memory - neg self-rated info in depression
overly general memory - depression
absence of selective in anxiety
interpretation - selective
cog products - intrusive repetitive thinking
inhibition - difficulties with control
general processes (4)
unprocessed memory intrusions
formation of neg expectancies and self-beliefs
disruption of dev pathways + social bonds
behavioural processes
classical: avoidance, escape create habituation, prevents extinction
safety behaviours: mixed evidence
interpersonal influences on psychopathology
attachment: insecure = avoidant, disorganised, ambivalent (strange situation test)
family dynamics
peer groups
leadership figures
social support
alienation
insecure attachment
general risk for poor psych health
childhood sep anxiety
pathological grief
personality disorders:
- anxious attachment = emotional dysregulation
- avoidant attachment = avoidant, inhibited personality
requires interplay with other factors
factors influencing a negative family emotional climate
high negative emotional expression
poorly managed parental emotion
psychologically controlling behaviours
little warmth/positivity, much criticism
cumulative risk factors for child psychological health problems (5)
40% parenting practices
20% parental verbal conflict, mood problems
15% disturbed, antisocial parental behaviour
10% instability, adverse life events
0% family structure, SES
social support buffering hypothesis
stressor
–> appraisal (support prevent negative appraisal)
–> response (support facilitate reappraisal, maladaptive response inhibition / inspire adaptive responses)
–> expression in symptoms/behaviour
offsetting mechanism
perceived stigma of psych health diagnosis –> neg mental health –> social support –> pos psych health
4 positive psych interventions
- expressing gratitude
- acts of kindness
- smiling
- meditations
4 areas that are pathways to flourishing
wellbeing
quality of life
good health
life meaning
issues with the concept of ‘flourishing’
very broad
measurement problems
contradictions
lack of critical thinking
implicit value judgements
means of attaining ‘balanced’ positive psychology
avoid extremes
develop complementarity among areas
temper construct definitions
require contextual sensitivity
acknowledge both: conscious, unconscious phenomena
more positivity in CBT
less focus on symptom reduction
more focus on building adaptive behaviours
retraining maladaptive processes
train positive approaches e.g. self-acceptance + compassion
compassionate mind training
based on paul gilbert
highly shame-prone, self-critical people
trains, cultivates soothing stance towards self
buddhist conceptualization
3 systems in compassion focused therapy
threat
drive
soothing
psych flexibility + acceptance and commitment therapy
updated form of CBT
emphasises accepting unpleasant thoughts + letting them go
articulates personal values
garners commitment to actions
teaches ‘open, aware, engaged’ responses
the power threat meaning framework
brings together macro factors
brought into useable explanatory framework
proposed as alt to diagnostic classification
questions in the power threat meaning framework
what role did power play
what kind of threats did this pose
what meanings did/do these experiences have for you
what kinds of response are you using
what access to power resources do you have
case: marko
early forties, eastern european, happily married, young child, labourer in construction
–> arrived in UK as refugee
- war experiences:
- ethnic crime + attempted genocide experiences
- held in internment camp (beaten, malnourished)
–> after liberation = reunited with family + another child
- marko not working due to poor psych health
(neighbourhood harassment, kept within refugee community)
marko presentation of psychopathology
flat mood
poor motivation
frequent panic attacks
no sense of future
some suicidal thoughts
how has power affected marko’s life
state violence against his ethnic group
forced removal from home
daily abuse
forced refugee status
ethnic minority in UK
harassment
unemployment, social stigma + exclusion
what did the power that affected marko do to him?
robbed of security, identity sources: work, community, family, culture, fun
marko threat response
hypervigilant
startled
nightmares
anxious/angry/frustrated
feeling unwelcome and afraid
what sense did marko make of his life
cant trust
people are evil
could not protect family
cant see future life + supporting family
refugee paradox: grateful for safety + resent dependency
what is marko doing to survive
numb feelings, avoid past
avoid news
ashamed - dont talk to others
what are marko’s strengths
wife, family very supportive
loving, caring father
aware of social injustice
how can marko’s story be integrated?
symptoms = responses to repeated trauma + systematic powerlessness + destruction of life
marginalization in UK made adaption more difficult
foreshortened future sense + numbing = rational ways of dampening intense fear
how was marko helped
not PTM based treatment
cog therapy/exposure to build understanding of trauma
classical trauma bind
traumatic events
–> extreme threat appraisals
–> fear activated
–> avoids cues, stimuli
–> memories, event narratives unprocessed
–> intrusions i.e. nightmares/flashbacks trigger cycle
early sessions for marko
found it hard to talk
more fearful
more intrusions
trusted consultant: felt more comfortable: revealed more
–> expressing anger at injustices
mid sessions for marko
understood numbing was coping mechanism
understood his hopelessness + disconnection + not going outside = avoiding further loss
BUT costing connections with his children + wife + dev. of his own life
later sessions for marko
find courage to risk /experiment again
went out more
talked to wife more
encouraged others in community to talk about experiences
started to come to terms with his trauma
recognised UK must be his home
power threat meaning marko
needed safe place to express rage at injustices
needed to acknowledge feelings of marginalization as refugee
–> realisation of his disonnection from UK society was perpetuating that
–> allowed refugee paradox to be contained
–> understood numbing was trapping him in his history
conclusions about marko
- work consistent with PTM framework
- outlined mechanisms at work in his situation
- narrative and meaning making helped
- consultant guided by PTM type model of trauma: acknowledge exposure, reduce avoidance of further threat, adaptive narrative of meaning
- underlying mechanisms linked to DSMV - defined disorder PTSD
definitions of disorders and underlying mechanisms
- definitions of disorders have articulated mechanisms –> models
- model of mechanisms = useful
- conceptualizing mechanisms aids understanding but intervention optimally ultimately individual
definition of psych flexibility
human abilities to:
adapt to situational demands
shift mindsets/behaviour
maintain balance among life domains
be committed to behaviours congruent with values
diff between psych flexibility and acceptance commitment therapy ACT
flexibility generalised behavioural response style
- all adaptive human functioning
ACT transdiagnostic, non-diagnostic
- theoretical clinical model articulates it
outline of the ACT model
6 interdependent processes
called ‘hexaflex’
outline of ACT inflexibility model
- dominance of past/future
- lack of clarity with values
- lack of effective action
- attachment to a self-story
- cognitive fusion
- experiential avoidance
outline of ACT flexibility model
open:
willingness/acceptance
cog defusion
engaged:
contact with present moment
flexible perspective about ‘stories’
aware:
clarity with values
committed actions towards values
ways to increase awareness
mindfulness meditation
daily diary tracking psych flexibility
pay attention while multitasking
ways to increase openness
acknowledge + validate experiences
sing difficult thoughts
say them in a funny voice
uncertainty of recovery from psych health disorder diagnoses
clinical approach = primarily relieve overt suffering
research focus on understanding risks
few measures of flourishing used
long-term follow-ups = difficult + expensive
implicit beliefs among
8 variables linked to good outcomes after ‘trouble’
- cultural community + family resources
- treatment variables
social interactions and relationships - personal goals
- habits / self-regulation
- emotional cognitive resources
- temperamental and genetic factors
- premorbid functioning
roadmap for progress
- measure good outcomes thoroughly
measure good function as potential protective factor - don’t focus on risk factors alone
- no implicit attitude that full recovery doesn’t happen
