U4 AOS 2 - Mental Wellbeing

mental health/wellbeing

a beneficial emotional state in which a person realises their abilities, copes with the normal stresses of life, works productively and contributes to their community

a positive state of wellbeing where people

• are productive and able to function efficiently on a day to day basis

• have healthy confidence and self-esteem

• interact well with others an their environment in an appropriate and adaptive way

mental health continuum

degrees of severity between positive and negative states that can fluctuate over time

not black and white

mental healthy

implies optimal performance across all aspects of life, functioning at a satisfactory level of emotional and behaviour adjustment

• psychological wellbeing

• able to cope with normal stressors

• able to form positive relationships

mental health problem

can disrupt individual’s thoughts, feelings or behaviours for a short period of time

• mild to moderate stres

• temporary impairment

• difficulties in coping

• some changes in sleep patterns

• difficultiy concentrating

mental health disorder

a condition that affects everyday functioning and causes distress for a prolonged duration

• psychological dysfunction

• marked distress

• ongoing impairment

• excessive anxiety

common characteristics of mental disorder

psych dysfunction

distress

impairment - decreased ability to meet demands of daily life

atypical behaviours - responding in ways that are unusual, uncommon or inappropriate

mental health influenced by internal factors

biological - genetic inheritance, neurotransmitter/hormone activity, substance use

psychological - attitudes, beliefs, decisions, emotions, learning & memory

mental health influenced by external factors

social - interpersonal relationships, family, friends, cultural traditions, support networks

environment - poverty, pollution, access to community services & natural resources

characteristics of mentally healthy person

high level of functioning

social and emotional wellbeing

resilience to life stressors

high levels of functioning

how well an individual can independently operate in their environment , evident by adapting to and meeting the demands of daily life

independently productive - meeting daily demands

• daily living skills - hygiene, eating, dressing, commuting

• interpersonal activities - managing relationships and interacting well with others

• productivity and goal achievement - high self-efficacy

opposite is no high levels of functioning

adaptive behaviour

an ability to change one’s behaviour to meet the daily demands of everyday life

maladaptive behaviour

refers to a disruption or impairment to one’s ability to carry out daily tasks in an effective way

biopsychosocial framework

approach that considers the holistic combination and interaction of these three domains ensures nothing is ignored in diagnosis and treatment

resilience to life stressors

the ability to cope and adapt to life stressors and the capacity to maintain or restore positive functioning

resilient people have

effective communication skills

emotional awareness

social competence

problem solving skills

sense of self-confidence and belief

resilience & mental health can be improved by

• connecting with others

• establishing healthy diet, exercise and sleep routines

• mindfulness exercises/ living in the moment

• challenging yourself

social & emotional wellbeing

refers to our mental state of mind and feelings we have towards ourselves and our lives in general

social wellbeing - having meaningful and satisfying interactions with others

• developing & maintaining healthy relationships

• respecting different individuals and cultures

• resolving conflicts with loved ones

emotional wellbeing - the ability to express and control our feelings appropriately and effectively

• awareness and understanding of our emotions as they are experienced

• ability to regulate and manage emotional responses

domains of SEWB

body

mind & emotions

family & kinship

community

culture

country

spirituality & ancestors

SEWB framework

example of modelling

holistic

strengths-based

vary across different groups

interconnected, multifaceted, extending across time,
person, place, living and inanimate

SEWB - body

feeling strong, healthy, able to participate fully in life

risk factors

• alcohol, smoking, drugs

• poor diet

• lack of housing/medical resources

protective factors

• healthy diet and exercise

• hunting and gathering on Country

• access to culturally safe health care

SEWB - mind and emotions

ability to manage thoughts and feelings

feelings of positive wellbeing

risk factors

• unemployment

• over-incarceration

• social disadvantage

protective factors

• education/belonging

• access to culturally safe health care

SEWB - family & kinship

interpersonal relationships with respect for reciprocity and sharing between generations

risk factors

• domestic violence, neglect, grief

• lack of access to education

protective factors

• education/adequate income

• connection to elders & family

SEWB - community

Connection to wider social systems, providing individuals and families the ability to connect with and support each other.

risk factors

• domestic violence, neglect, genocide

• lack of access to education

• social exclusion

protective factors

• education/income

• connection to elders and family

• cultural practices including yarning circles etc.

SEWB - culture

A strong sense of identity, values, tradition, and connection between the past, present, and future that drives behaviour and beliefs.

yarning circles, dance, song, ceremony, fire management

risk factors

• death of elders, unable to transmit knowledge

• genocide

protective factors

• cultural institutions, education and events

SEWB - country

country is sentient & alive - basis of spiritual belief - knowledge is patterned on country

The traditional lands of a particular language or cultural group, both geographically and the spiritual, emotional, and intellectual connections to and within it.

underpins identity and sense of belonging

risk factors

• removal and lack of access to country

• environmental degradation, pollution of land and waterways

• destruction of sacred sites

protective factors

• land rights and sovereignty claims

• traditional land management and protection practices

SEWB - spirituality and ancestors

Spirituality refers to a concept that connects all things, and shapes beliefs, values, and behaviour. It guides knowledge systems, culture, and all that is life for Aboriginal people, including connections to
ancestors, the past, the present, and the future.
Ancestors refer to a belief that a family and community’s ancestors are interconnected with Creation spirits and Country and watch over, guide, and protect families and communities in the physical and spiritual world.risk factors

• reduced spirituality and loss of ancestral knowledge from assimilation

• intergenerational trauma

protective factors

• contemporary expressions of spirituality and mindfulness practices

• more opportunities to attend cultural events and ceremonies

SEWB - cultural determinants

strengths-based perspectives that relate to connection to community, culture and Country

strongest protective factors for indigenous people’s social and emotional wellbeing

connection to country and community

self-determination and Indigenous psychological systems that privilege indigneous

SEWB - historical determinants

include ongoing influence of past events, policies, and intergenerational trauma

oppression & displacement from colonisation

SEWB - political determinants

the distribution of resources and power such as land rights, cultural security and promoting human rights for self-determination

Including the unsolved issues of land, control of resources, cultural security, the rights of self-determination and sovereignty

SEWB - social determinants

the circumstances by which people grow, live and work, such as the impact of poverty, unemployment, housing, incarceration, education and discrimination

ensuring equity

stress

a physiological and/or psychological state of tension and arousal

stress vs anxiety vs phobia

mentally healthy —> mental health problem: stress/anxiety

mental health disorder = anxiety disorders, specific phobia

anxiety

a state of physiological arousal associated with feelings of worry or uneasiness that something wrong or unpleasant is about to happen

perceived future threat

can be adaptive as it activates the sympathetic fight/flight response

however, if level of anxiety is counterproductive and impacts our ability to function effectively, it is problematic

severe anxiety

usually accompanied by intense physiological reactions that interfere with out ability to think clearly and act appropriately

phobia

persistent, intense and irrational fear of an object or event that is maladaptive and causes dysfunction

usually result in high levels of distress and anxiety

phobia characteristics

Irrational = the fear is not realistically a substantial threat.

Intense = the response to the sight of the phobic stimulus is dramatic. This is likely to be the
direct influence of sympathetic nervous system activation; eg. heart pounding (increased HR), blood pressure skyrocketing (increased BP) and nervous sweating.

Fear = a negative association with the phobic stimulus.

stress & anxiety - internal (bio & psych) factors

stress & anxiety - external (social) factors

phobias - internal factors

phobias - external factors

4P

predisposing

precipitating

perpetuating

protective

risk vs protective

protective - alleviate

risk - excacerbate

predisposing factors

underlying susceptibility that could lead to or increase vulnerability to develop mental disorders

• family history (inherited genetic traits)

• poor physical health (chronic illness often linked to mental unwellness)

• neglect, abuse or trauma

• disorganised attachment (inability to form secure relationships due to poor emotional development)

• poor self-efficacy (low confidence in your own abilities to achieve goals)

precipitating factors

triggering events that can induse mental illness

• substance abuse (addiction to drugs or alcohol could result in awakening dormant symptoms)

• stressful life events (job loss, death of a loved one)

• confronting news (disturbing media reports)

• poor sleep

perpetuating factors

prolongs suffering

• poor response to medication

• avoidance behaviours (ignoring symptoms, denying issue, rejecting help)

• rumination (negative ‘overthinking’)

• lack of social support

• unemployment

protective factors

minimise negative/maximise positive effects

• resilient attitude

• positive social experiences

• physical health (diet, exercise and sleep)

• stability & security (employment and accommodation)

specific phobia (leads to)

irrational fear of a certain stimuli that often leads to

avoidance behaviour - going to great lengths to minimise potential encounters

panic attacks - sudden terror episodes (physiological manifestation)

anticipatory anxiety - rising sense of fear from overthinking the possibility of exposure

stimuli include:

• animals (snakes, spiders, birds)

• situations (public speaking, confined spaces)

• environmental conditions (injections, blood, vomiting)

biological contributing factors - gaba dysfunction

gaba dysfunction - disruptions to balanced neurotransmitter activity can often impact our responses and play a major role in our experience of anxiety

• without calming, inhibitory effects of GABA, glutamate dominates which means the activation of PS neurons might get out of control leading to overstimulation and anxiety

• fight-flight-freeze responses are more easily triggered with less GABA

• can result from:

  • a lack of GABA being released

  • inability for GABA to bind to receptor sites

  • the over production of glutamate

biological contributing factors - long-term potentiation

the strengthening of neural pathways as a result of learning through experience

• Watson’s Little Albert Experiment when an infant was taught to fear a white rat by repeatedly associating it with a scary noise over time

phobias are usually learned responses, hence LTP neurologically increases the synaptic connection between the phobic stimulus and the fear response

over time - increased encounters with phobic stimulus or thinking about past/future encounters strengthens synapse & makes it less likely to be forgotten

amygdala plays a crucial role in acquisition and expression of emotional fear responses

psychological contributing factors - behavioural models (two factor learning theory)

1. precipitated/developed by classical conditioning (repeated association)

2. perpetuated/maintained by operant conditioning (rewards and punishment)

precipitation by classical conditioning

development of a specific phobia occurs when a neutral or unconditioned stimulus (NS/UCS) is associated with an irrational, unconditioned fear response (UCR)

hence, an unreasonable, exaggerated sense of harm, danger or unpleasant outcome, the fear response (CR) becomes triggered by something irrelevant and benign (CS)

only needs one pairing if traumatic event

NS IS PRESENTED PRIOR TO UCS

e.g.

clouds (NS) PRESENTED PRIOR TO:
storm (UCS)

irrational fear (UCR)

clouds (CS)

irrational fear (CR) of dying in storm

perpetuation by operant conditioning

avoidance strategies are an example of how negative reinforcement maintains specific phobia

negative reinforcement increases the likelihood of repeating a certain behaviour by removing an unpleasant stimulus, resulting in you feeling better (positive outcome) but remaining scared of it

positive reinforcement increases behaviour by providing a reward

INCREASES LIKELIHOOD OF BEHAVIOUR BEING REPREATED

psychological contributing factors - cognitive bias

cognitive models - refer to how individuals perceive, think, feel and act towards phobic stimuli based on experience, memories, appraisals, attitudes, expectations & abilities

phobias - result of cognitive bias

• memory bias

• catastrophic thinking

cognitive bias

the tendency to think in a way that involves errors of judgement and faulty decision making

cognitive bias - memory bias

‘selective memory’

refers to the distortion of present thoughts, actions and feelings by inaccurate recollections of previous experience

suggests we remember negative information more readily than positive information

reconstruction of past autobiographical memories becomes embellished and exaggerated to justify the irrationality of the fear

cognitive bias - catastrophic thinking

conceptualising and believing worst case scenarios - magnifying the negatives and ignoring the positives

social contributing factors

specific environmental triggers

parental modelling

stigmatisation

social contributing factors - specific environmental triggers

direct negative experiences or traumatic events involving a specific stimulus will result in a phobia to it

triggers sympathetic NS/stress/fear response

causes extreme stress reaction which has a large impact on a person

or

creates a negative memory bias towards the NS/CS which contributes to development of phobia

social contributing factors - parental modelling

Bandura’s social learning theory - suggests we model our responses off those we observe

• if we see others react with fear to stimuli, we might learn to respond in the same way

• parents’ phobias, media representations

social contributing factors - stigmatisation

the feeling of shame or disgrace associated with a personal characteristic that indicates you belong to a culturally devalued group in society – this can be real or imagined

labelling someone with a diagnosis or putting them into a category of disorder often results in them being though of and treated differently

acts as a barrier to seeking treatment

• perceptions of weakness

• preceptions of dangerousnness

• feelings of guilt, shame, embarrassment, low self-esteem

social contributing factors - stigma around seeking treatment

• because phobias are irrational may sufferers are overreacting or exaggerating their experience and don’t take their condition seriously

• embarrassed to ask for help

• disapproval or disbelief of the impact of specific phobias by others can exacerbate the condition

biological interventions

medication - benzodiazepines

breathing retraining

biological intervention - benzodiazepines

act as GABA agents/agonists that amplify the impact of GABA’s inhibitory effect

work by attaching to receptor sites on the post synaptic neurons, making them less likely to fire

reduces the excitability of neurons reduces communication between them = calming effect/relaxation

benzodiazepines side effect/weakness

can be highly addictive & therefore are not recommended for long-term use

treat symptoms but not the cause

biological intervention - breathing retraining

teaching correct breathing habits helps manage abnormal respiration experienced when exposed to the phobic stimulus

breathing rate is often increased during a phobic response

people with specific phobia can often develop abnormal breathing patterns

excessive or over-breathing can upset the balance of oxygen and carbon dioxide in the blood

psychological interventions

cognitive behavioural therapy

systematic desensitisation therapy

psychological interventions - cognitive behavioural therapy

implies that changing the way a person thinks will change their actions

replacing maladaptive thoughts & behaviours with adaptive thoughts & behaviours to help people overcome their fear response

exposure to the threat object is usually rare and that catastrophic thinking is not based on reality.

good for cognitive biases

1. Changing unhelpful/maladaptive
   thoughts into more helpful/adaptive
   ones

2. Changing unhelpful/maladaptive
   behaviours into more
   helpful/adaptive ones

3. Changing thoughts, influences
   behaviours or vice versa

psychological interventions - systematic desensitisation

a person is progressively exposed to the fear inducing stimulus in a series of steps under relaxed conditions

assumes most phobias are acquired to classical conditioning

therefore, eliminating an irrational fear can be achieved through counter-conditioning/weakening the association between the conditioned stimulus and the conditioned response

systematic desensitisation - steps

1. 1. A relaxation technique needs to be practiced (without the phobic stimulus present)
   2. A fear hierarchy is created from least-fear inducing stimuli to most-fear inducing stimuli
   3. Gradual exposure to the phobic stimulus from least fear-inducing to most fear- inducing
   4. Relaxation technique is practiced at eachlevel of the fear hierarchy until exposure to the fear-stimulus produces no fear response/a relaxation response. This
   continues until eventually exposure to the phobic stimulus does not produce a fear response

social interventions - psychoeducation

provides information to the client, their family and friends to better understand the condition, symptoms and treatment options available

challenge unrealistic or anxious thoughts (links to CBT)

• establish balanced and rational perspective

not encouraging avoidance behaviours (links to systematic desensitisation)

• help family & friends understand avoidance behaviours are common but maladaptive

• find opportunities for the client to encounter stimulus (gradual exposure)

biological risk factors

• genetic vulnerability

• sleep

• diet

• substance use

• medication

biological risk - genetic vulnerability

individuals can inherit physiological predispositions to certain disorders

family history does not guarantee susceptibility (not causal)

biological risk factors - medication

some people have greater resistance to certain medications - drugs may not work or not in the way intended

side effects may result in people not taking medication

can be predisposing or perpetuating

biological risk factors - sleep

bidirectional link between sleep quality/quantity and mental disorders

Sleep provides restorative functions that enhance wellbeing by replenishing
biological resources

biological risk factors - substance use

50% of people with mental disorders are affected by substance abuse

drugs used to self medicate

drugs can trigger (precipitate) and prolong (perpetuate) a disorder

psych risk factors

• rumination

• poor self-efficacy

• stress & distress

• impaired logic and reasoning

psychological risk factors - rumination

thinking about a problem without trying to come up with a solution

compulsively focus their attention on symptoms, causes and consequences instead of finding constructive ways to improve on situation

psychological risk factors - poor self-efficacy

lack of self-confidence in your own ability to achieve the goals set for yourself

negative beliefs about one’s capacity to accomplish tasks impact wellbeing and prevent people from effectively dealing with difficult situations

learned helplessness can increasing vulnerability to anxiety & depression

could be predisposing & perpetuating

psychological risk factors - stress & distress

stress impedes our ability to adapt, cope and perform at optimal levels of functioning

distress can make us more susceptible or prolong our experience of mental disorders

effects of chronic stress:

• emotional problems - anger, depression, anxiety

• cognitive - attention, concentration

• behavioural - sleep, eating

psychological risk factors - impaired reasoning and memory

reasoning enable us to apply logic to solve problems, make sound judgments and good decisions

memory allows us to learn from our mistakes and remember effective practises

without both, we are likely to make poor choices, not anticipate consequences or act in ways that are maladaptive

social risk factors

• disorganised attachment

• loss of significant relationship

• stigmatisation

social risk factors - disorganised attachment

the bond formed with one’s primary caregivers during infancy influence whether or not people form healthy productive relationships

if caregivers are abusive, neglectful, unreliable, people will form disorganised attachments resulting in:

• insecure relationships

if early interactions are loving, trusting & reliable - people develop secure attachment

predisposing

social risk factors - loss of significant relationship

death, break up, terminal illness etc

if grief is unresolved, it can manifest into mental illness and prevent people moving forward with their lives

precipitating

social risk factors - stigmatisation

negative attitudes and discriminatory behaviour targeted towards and experienced by sufferers of mental illness

act as a barrier to seeking help

biological protective factors

adequate nutritional intake

adequate hydration

adequate sleep

psychological protective factors

cognitive behavioural strategies

mindfulness meditation

psychological protective factors - cognitive behavioural strategies

techniques that utilise traits of cognitive behavioural therapy, particularly recognising and changing
dysfunctional/maladaptive thought and behavioural patterns to more adaptive ones

equipping them with strategies to manage challenging situations

• Encouraging someone to recognise the difference between productive and unproductive worries

• Teaching relaxation and breathing techniques, particularly muscle relaxation

psychological protective factors - mindfulness meditation

Mindfulness meditation is a secular practice where an individual pays attention to the present moment with acceptance.

Linked to lower levels of stress & anxiety

• Pay attention
  Focus on each of your senses and what they tell you
  about the environment around you

• Live in the moment
  Try to intentionally bring an open, accepting and
  discerning attention to everything you do
  Find joy in simple pleasures

• Accept yourself
  Treat yourself the way you would treat a good friend

• Focus on your breathing
  When you have negative thoughts, try to sit down, take a deep breath and close your eyes.
  Focus on your breath as it moves in and out of your
  body
  Sitting and breathing for even just a minute can help

social protective factors

authentic support - genuine interactions with others with integrity, truly listening, connecting and caring for one another

energising support - interactions that are encouraging, require enthusiasm and determination to achieve goals and/or involve participating in physical activities together

cultural determinants

protective factors that maintain wellbeing

cultural continuity

self determination

self-determination

autonomy and involvement in decisions that impact one’s self and their community

cultural continuity

reviving and preserving traditions, ancestorial practices and spiritual beliefs to connect the past to future generations

helps to maintain the culture domain of SEWB, thus is a crucial cultural determinant and protective factor