[UTS] Caring for the self & Mental Health

Stress

• Managing one’s health through managing one’s stress

• Refers to a pressure 

• An internal alarm system in response to a real or perceived threat, a combination of a stressor and a stress response, can be useful or harmful, energizing, or exhausting

Disstress

• Negative stress

• Too much pressure or trauma, and you are unable to cope with it

Eustress

• Positive stress

• Acceptable levels of stress help you to focus better and achieve your goals

Environment Stressors

• Overcrowding, unsafe living conditions, pollution, extreme temperatures

Lifestyle Stressors

• Poor diet, substance use and abuse, lack of exercise, or sleep

Psychological Stressors

• Negative self-talk, perfectionism, pessimism, unrealistic expectations

Financial Stressors

• Debt, unexpected expense, limited funds

Life Events Stressors

• Death of a loved one, job loss, marriage, birth of a child (even positive events)

Interpersonal Stressors

Conflicts with family or friends, isolation, discrimination

Work or School Stressors

• Heavy workload, deadlines, job insecurity, and academic pressure

Physiological Stressors

• Illness, injury, hormonal change, or chronic pain

General Adaptation Syndrome Theorist

Hans Selye

General Adaptation Syndrome

• The body’s response to stress

  • When you perceive a situation or event to be a threat, your body begins a stress response

  • How your body and mind react is your stress response

• The nervous and endocrine systems become active during the body’s response to stressors

• The body’s response:

  • Is largely involuntary or automatic

  • Happens in three stages 

    • Alarm, resistance, and exhaustion

  • Can occur whether the stress is physical or emotional, positive or negative

• There is no specific time frame for each stage of the GAS, as duration varies based on several factors, such as the nature of the stressor and individual factors

Alarm Reaction Stage

• Body’s initial response to stress

• The body detects a stressor and prepares the body to either comfort (fight) or escape (flight) the threat

• The sympathetic nervous system is activated by the adrenal glands

Resistance Stage

• The body attempts to resist or cope with the stressor

• The body tries to adapt to the stressor to restore physiological balance, but is still expending high energy as cortisol remains elevated

• Resources are deplete; the body is worn out

Exhaustion Stage

• The body’s resources are depleted after prolonged exposure to the stressor, it’s overwhelmed, and can no longer maintain resistance

Type A & B Theorist/s

Meyer Friedman & Ray Rosenman

Type C Theorist/s

Lydia Temoshok & Henry Dreher

Type D Theorist/s

Johan Denollet

Type A

• Described as a competitive, high achieving personality type most likely to develop heart disease or other significant health problems

• Self-driven 

• Competitive

Type B

• Seen as a “laid back,” non-competitive personality type less likely to suffer from heart disease 

• Charismatic

• Easy-going

Type C

• Tend to be very pleasant and try to keep the peace but find it difficult to express emotions, especially negative ones

• Introverts

• stress-prone

Type D

• Have the tendency to experience increased negative emotions across time and situations and tend not to share these emotions with others because of fear of rejection or disapproval

• Love routine

• Follows orders

Tensiyon

Isang emosyonal at pisikal na reaksiyon sa pagbabago

Hiya

• Filipinos are very aware of the opinions of others and what people think of them

Utang na Loob

• Debt of gratitude

• Can cause stress as it refutes unconditional positive regard

Pakikisama

• The pressure to conform can cause stress

Karangalan

• Attack to self-esteem and dignity causes stress

Katarungan

• Lack of justice causes stress

Kalayaan

• Absence of “freedom and mobility” causes stress

Bahala na

• “God will take care of things,” improvisatory skills of Filipinos

Lakas ng Loob

• Courage in the face of difficulties and uncertainties

Pakikibaka

• Recognizing one’s convictions resistance or concurrent clashes

Physical Problems

• Illness

  • E.g., infectious, cardiovascular, gastrointestinal diseases

Social Problems

• Adjustment problem

  • E.g., school and peer

• Substance abuse

  • E.g., alcohol, cigarette & drug

• Behavioral problem 

  • E.g., aggression & bullying

Psychological Problems

• Anxiety and depression

• Suicide and non-suicidal self injury

Humor

• Can moderate the negative effect of stress

• Can raise the level of immunoglobulin A (a measure of the functioning of the immune system), boosting immunity

• Laughter stimulates the production of endorphine (happy hormone), enhancing the immune system

• Humor is associated with positive cognitive shifts and positive emotions 

Mental Health

• A  state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community

Lusog-isip

Tumutukoy sa lagay ng ginhawa na anag isang tao ay nakapagpapamalas ng kaniyang sarili galing at gilas, nakakaangkop nang sapat sa mga normal na hamon ng buhay, nakapagpapakita ng tatag sa pagharap sa matinding dagok sa buhay, nakakapag trabaho nang mahusay at mabunga, at nakakapag-ambag ng tulong sa pamanayan

Health

A state of complete physical, mental & social well-being, not merely the absence of disease or infirmity

Stigma

• The negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency

• Implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual 

Acedia

The indifference to one’s duties to God, manifests as a form of despair or melancholy

Moon and Stars

Paracelsus (Swiss physician) proposed that the movement of the moon has profound effects on the mind

Treatment of Mental Illness in the 14th Century

Exorcism, hanging people over a pit full of poisonous snakes, trephination (drilling a hole in the skull), and institutionalising individuals (chains and shackles in an asylum)

Demons and Witches

A deviant, unexplainable, and irrational behaviour reflects a battle between good and evil, where evil prevails

Social Stigma

• Negative attitude from others

  • E.g., being judged or rejected by peers, discrimination in daily life, avoidance by friends and family

Self-Stigma

• When a person believes the negative labels

  • E.g., feeling shame and worthlessness, avoiding help-seeking, assuming failure due to condition

Structural Stigma

• Stigma embedded in systems or institutions

  • E.g., limited funding for mental healthcare, poor insurance coverage for mental health, laws that discriminate or lack protections 

Labeling

• Defining a person only by their condition

  • E.g., “siraulo,” “crazy person,” 

    • “ abnormal.”

Stereotyping

• Unfair beliefs and negative generalisations

  • E.g., “dangerous,” “weak,” “unpredictable.”

Discrimination

• Treating people unfairly due to their mental health

  • E.g., losing a job or not being hired, denied housing, unfair treatment at school

Social Isolation

• Excluding or avoiding someone

  • E.g., losing friends, not being invited to social gatherings, feeling cut off from family

Self-Stigma

• Internalising negative beliefs and feeling shame

  • E.g., feeling “broken,” low self-esteem, being afraid to ask for help

Mental Distress [1]

• Slightly, transient stresser

• Normal reaction to stress

• Temporary & functional

• Is a natural reaction that passes

Mental Disorder [1]

• Biological or medical break

• Persistent clinical distress & neurochemical change

• Health condition

• Long-term or impaired function

• Disorder is a medical condition that needs support

Mental Distress [2]

• Common

• Caused by a problem or event that may just be overhwleming the individual

• Usually not severe (may be severe)

• Usually short-lasting

• Professional help not usually needed, but can be useful

• Diagnosis not needed

Mental Disorder [2]

• Less common Caused by having a vulnerability to a disorder, and then triggered by significant stress

• Often with high severity

• Usually long-lasting

• Professional help is usually needed for recovery

• Needs to be diagnosed by a professional

Distress

• A negative stress response, often involving negative affect and physiological reactivity: a type of stress that results from being overwhelmed by demands, losses, or perceived threats

• It has a detrimental effect by generating physical and psychological maladaptation and posing serious health risks for individuals

Disorder

• A condition characterized by cognitive and emotional disturbances, abnormal behaviours, impaired functioning, or any combination of these

• Such disorders cannot be accounted for solely by environmental circumstances and may involve physiological, genetic, chemical, social, and other factors

Diathesis-Stress Model

• Mental disorders develop from a genetic, biological, and environmental predisposition (diathesis) combined with stressful conditions that play a precipitating or facilitating role

Diathesis-Stress Model

• Genetics

  • E.g., family history of a mental illness

• Biological factors

  • E.g., malnutrition or physical illness

• Childhood experiences

  • E.g., isolation, bullying & abandonment

Diathesis-Stress Model Precipitating Factors

• Stresses Minor daily stress

  • E.g., long commute & traffic

• Life events

  • E.g., family death, starting school

• Short-term & long-term factors

  • E.g., school assignments & financial problems

BioPsychoSocial Model (BPS)

• Determinants of mental health

• Biological

  • Genetic predisposition

  • Physical health

  • Drug effects

  • Neurochemistry

• Psychological

  • Coping skills

  • Self-esteem

  • Personality

  • Beliefs

• Social

  • Family circumstances

  • Socioeconomic factors

  • Friendships and peers

  • Culture

• Biological, psychological, and social factors can add up across a person’s life to lead to times of mental ill-health

BPS Model Theorist

George Engel

BioPsychoSocial Model

• A model that attempts to integrate psychological and social factors into the traditional biomedical model of health and illness

• Bio: physiological pathology

• Psycho: thoughts, emotions, and behaviours such as psychological distress, fear or avoidance beliefs, current coping methods, and attribution

• Social: socio-economic, socio-environmental, and cultural factors such as work issues, family circumstances, and benefits or economics

Bio

• The brain is made up of cells, connections among the cells, and various neurochemicals (“neurotransmitters”)

• The neurochemicals provide a means for the different parts of the brain to communicate

• Different parts of the brain are primarily responsible for doing different things

  • E.g., thinking, feelings & movement

• Most things the brain does depend on many different parts of the brain working together in a network

  • Thinking or cognition

  • Perception or sensing

  • Emotion or feeling

  • Signalling or reaction to the environment

  • Physical or somatic

  • Behavior 

Social

• The social aspects of health were described in terms of:

  • Social norms of behavior

    • E.g., the social norm of smoking or not smoking

  • Pressures to change behaviour

    • E.g., peer group expectations, parental pressure

  • Social values on health

    • E.g., whether health was regarded as a good or a bad thing

  • Social class

  • Ethnicity or culture

  • Spirituality 

Psycho

• The psycho aspects of health and illness were described in terms of cognitions, emotions, and behaviours

• TEA principle

  • Thoughts > Emotions > Actions

  • Thoughts create feelings > feelings create behaviour> behaviour reinforces thoughts 

Cognitive-Behavioral Model Theorist

Aaron Beck

Cognitive-Behavioral Model

• Thoughts

  • Negative focus, gloomy, self-critical

  • I’ve messed up again

  • There’s no point

  • No one likes me

• Behaviors

  • Withdraw & isolate

  • Stay home

  • Cut off from others

  • Not go out

  • Not do much

• Feelings

  • Depressed

  • Tired, no energy

  • Not motivated

  • Not interested 

  • Slowed down

Polarized

• Extreme thinking

• The “all or nothing” mindset

• Seeing situations as either purely good or purely bad, with no middle ground

• If an effort isn’t perfect, it’s considered a complete failure

• The voice in your head: “If I’m not perfect, I failed”

• The vibe: black & white, no middle ground

  • “I didn’t get everything done, but I finished the most important part. That’s a 70% success, not a zero”

Jumping to conclusions

• Assuming others’ thoughts

• Predicting the future 

• Mind reading: assuming you know exactly what others are thinking without evidence

• Fortune telling: predicting a negative future outcome, even when a positive one is possible

• The voice in your head: “They think I’m boring”

• The voice in your head: “It’s going to be a disaster”

• The vibe: acting like a psychic without actual evidence

  • “I don’t actually know what they’re thinking. They might just be tired. As for the event, I can’t predict the future; I’ll just focus on what I can control right now.”

Negative Filter (Selective Attention)

• Ignore all positive feedback

• Dwelling on it while ignoring the positive aspects

• Dismissing achievements, talents or positive feedback

• Negatively picking out a single negative detail

• Discounting the good (dismissing achievements)

• The voice in your head: “No one noticed my contribution”

• The voice in your head: “I just got lucky this time”

• The vibe: seeing only the “dirt” on a clean window

  • “It’s true one person didn’t comment, but three others thanked me. My hard work played a role in this success; it wasn’t just luck”

Overemotional Reasoning

• Focus on internal feelings (anxiety)

• A variety of actions and traits

• Assigning a label based on a single trait

• Ignore actual facts (safe)

• Assigning a label based on a single trait

• Emotional fact-checking: 

  • feeling is true

  • Believing that because you feel strongly, it must be true, ignoring evidence

• Labelling: 

  • applying a negative label

  • Applying a rigid, negative label to yourself or others based on a single act

• The vibe: letting feelings dictate the facts of reality

  • “I feel like a failure right now because I’m upset. I made a mistake, but one mistake doesn’t define who I am.”

Baby Boomers

• The boomers

• 1946 - 1964

• Born after WWII

• Radically changed society at every age

• Grew up in an era when mental health issues were not discussed

• One in four adults 65 or above deal with a mental health issue, including:

  • Depression

  • Anxiety disorder

  • Dementia

  • Substance abuse or misuse

Gen X

• The lost generation

• Also known as the Sandwich Generation

• 1965 - 1979

• Small demographic between Boomers & Millennials

• Compared to Boomers, Gen X suffer from poorer mid-life mental health

• Overburdened by conflicting responsibilities of child care and ageing parents

Gen Y

• Millennials

• 1980 - 1999

• Highly educated & tech savvy

• Witnessed and adapted to rapidly changing technology

• Caused a cultural shift & destigmatized mental health issues

• Stress of millennials: work + money

• 52% say stress keeps them awake at night, BUT, they are willing to seek help

Gen Z

• iGen

• 2000 - 2016

• Mostly in their tweens or teens

• Growing up slower than previous generations, putting off traditionally “adult” activities like working, driving, drinking, etc.

• Digital natives

• Socially isolated

• Politically aware

• Three in four are worried about:

  • Getting a job

  • Debt 

  • Terrorism

• BUT they are willing to seek help

Anxiety

• At least three of the symptoms:

  • Increased muscle aches or soreness

  • Impaired concentration

  • Irritability

  • Difficulty sleeping

  • Excessive anxiety and worry

  • Fatigue

  • Restlessness

• Worry occurs more often than not for at least six months and is clearly excessive

• The worry is experienced as very challenging to control 

• The worry in both adults and children may easily shift from one topic to another

• The symptoms must also not be a result of substance abuse or another medical condition

Depression

• At least five of the symptoms:

  • Persistent feelings of sadness

  • Loss of interests in activities

  • Trouble sleeping or oversleeping

  • Appetite or weight changes

  • Fatigue or decreased energy

  • Difficulty thinking clearly or quickly

  • Irritability, frustration, or pessimism

  • Physical aches & pains

  • Recurrent thoughts of death or suicide

• Feelings of sadness, low mood, and loss of interest in their usual activities must mark a change from a person’s previous level of functioning and have persisted for at least 2 weeks

• These symptoms must cause a clinically significant distress or impairment in social, occupational, or other important areas of functioning

• The symptoms must also not be a result of substance abuse or another medical condition

Non-Suicidal Self-Injury (NSSI)

• To feel better

• Cause damage to the surface of the body

• Often used regularly or off and on to manage stress and other emotions

• Unintentional death is not common; shorter improvement in sense of well-being and functioning

Suicide

• To end feeling and life altogether

• Much more lethal

• Much more frequent

Deviance

• A behavior that significantly deviates from the norm

Dysfunction

• There is a significant dysfunction across life domains

Distress

• The extent to which the issue distresses the individual

Danger

• The individual is posing significant danger to self or to others

RA 11036

Philippine Mental Health Law

Philippine Mental Health Law RA 11036

• Secures the rights and welfare of persons with mental health needs as well as mental health professionals

• Integrates psychosocial, psychiatric, and neurological services in regional, provincial, and tertiary hospitals

• Provides mental health services all the way down to barangays

• Improves mental healthcare facilities

• Promotes mental health education in schools and workplaces

Psychiatrists

• ‘-iatry’ refers to medical treatment

• Medical doctor

• Assess both mental and physical aspects of psychological problems

• Conduct and prescribe medical treatments

Psychologists

• ‘-ology’ refers to the study of a topic

• Advanced degree

• Extensive training in research or clinical practice

• Specialize in psychological testing and evaluation

Psychometrician

• Administers objective and structured personality tests; conducts preparatory intake interviews of clients for psychological intervention sessions

Guidance Counselor

• Focus is on client’s potential and resolution of problems; common in education and career setting

Psychiatric Nurses

• Focus is on signs, symptoms, and complaints of clients; serves as case managers in clinical setting

Social Worker

• Focus is on the process of integration of clients in the community

Occupational Therapist

• Focus is on resumption of activities of daily living; integration with community by honing occupational skills

Life Coach

• Focus is on everyday life concerns that are not clinical in nature, can be specific to certain contexts such as business, executive, academic, and sports science

Emotion-focused Coping

• Involves efforts to regulate emotions experienced due to the stressful event

  • E.g., exercise, take a bath, give yourself a pep talk, meditate

Problem-focused Coping

• involves attempts to do something constructive about the stressful condition

  • E.g., work on managing time, ask for support, establish a healthy boundary, create a to-do list 

Approach

• Confrontative & vigilant

• Approaching is characterised by wanting to address the problem, get it out in the open, and deal with it

Avoidant

• Minimizing

• The reverse, where removing the stressor and avoiding it in the future is preferred