Defining mental wellbeing

Being mentally healthy involves

●being in a generally positive state of mental wellbeing,

●having the ability to cope with and manage life’s challenges,

●working productively,

●striving to fulfil one’s goals and potential,

●and having a sense of connection to others and the community in general.

Mental health is a desirable quality in its own right and is more than the absence of mental ill-health.
Mental health is a positive concept related to the social and emotional wellbeing of people and communities. The concept relates to the enjoyment of life, ability to cope with stress and sadness, the fulfilment of goals and potential, and a sense of connection to others (Hunter Institute of Mental Health, 2015).

Characteristics of mental wellbeing

Mentally healthy people demonstrate high levels of:

●functioning

●resilience to life’s stressors

●social and emotional wellbeing

Functioning

Refers to how well an individual independently performs or operates in their environment, in terms of:

●interpersonal relationships e.g. ability to interact with and get along with other people

●school and work/occupational settings e.g. productive and achieving goals

●leisure/recreational activities e.g. participation in extracurricular activities at school, hobbies/interests/structured or unstructured activities in ‘free’ time outside school/work

●daily living skills e.g. participation in self-care and independent living activities such as personal hygiene, dressing, eating, remembering to take any prescribed medications, fulfilling household responsibilities, ability to access private and public transportation and travel/commute safely

●cognitive skills e.g. learning and applying knowledge, understanding and communicating, logical and clear thinking, planning and decision-making

●emotions e.g. self-regulation of a range of emotions, dealing with positive and negative emotions, keeping daily worries, hassles and other stressors under control

Social wellbeing

Is based on the ability to have satisfying relationships and interactions with others (APS, 2015).

A person with a high level of social wellbeing is likely to be willing and able to:

●develop and maintain healthy relationships with family and friends

●socially interact with others in appropriate ways

●respect and understand other individuals

●respect the cultural identities of others

●competently resolve conflicts with others

●effectively manage unhealthy relationships

●spend time with loved ones

●feel self-confident alone or with others (AIHW, 2012; NIHCE, 2009).

Emotional wellbeing

Is based on the ability to control emotions and express them appropriately and comfortably (APS, 2015).

A person with a high level of emotional wellbeing is likely to be willing and able to:

●develop awareness and understanding of their own emotions

●regulate their emotions and exercise control when appropriate

●express a range of emotions in a suitable manner

●identify emotions in others and empathise

●have a positive attitude about emotions, their experience and expression

●consider thoughts and behaviour as well as feelings when making personal choices and decisions

●accept mistakes or setbacks and learn from them

●make decisions with a minimum of worry, stress or anxiety

●manage their stress reactions using appropriate coping skills

●live and work independently while realising the importance of seeking and appreciating the support and assistance of others

●take on challenges, take risks and recognise conflict as being potentially healthy

●take responsibility for their actions (AIHW, 2012; University of California, 2014).

Resilience

The Study Design defines resilience as the ability to cope with and manage change and uncertainty.

It is the ability to cope with and adapt well to life stressors and restore positive functioning.

It means ‘bouncing back’ from adversity or difficult experiences that are stressors — such as family and relationship problems, school or workplace stressors, rejections, failures, threats or even tragedy—and restoring positive functioning.

Adaption through resilience may involve either adjusting to or overcoming the stressor (APA, 2016).

Several characteristics that resilient people demonstrate:

●a strong belief in their abilities to accomplish tasks and succeed (self-efficacy);

●high self-esteem;

●approaching adversity and stress with a sense of optimism, opportunity and hope;

●being adaptable and flexible;

●being organised;

●having problem-solving skills;

●and having the ability to make realistic plans and carry them out.

Social and emotional wellbeing (SEWB) for Aboriginal and Torres Strait Islander people

Social and emotional wellbeing (SEWB) can be understood in a more specific sense as it relates to Aboriginal and Torres Strait Islander people as multidimensional and holistic framework for wellbeing. See p.482 of the textbook for a description of each.

●body

●mind and emotions

●family and kinship

●community

●culture

●Country

spirituality and ancestors

Mental wellbeing as a continuum

If we see mental health as a continuum, this implies:

•Two opposite ends, in this case, optimum mental health and mental disorder

•A person be anywhere between the two ends, representing that mental health can be experienced to different degrees

•A person can move up and down the scale over time, irrespective of whether they have a diagnosed mental illness

Mental health problems

Adversely affects the way a person thinks, feels and/or behaves, but typically to a lesser extent and of a shorter duration than a mental disorder.

e.g. relationship, school, work or health-related stress; trouble making friends; lack of motivation to complete specific tasks

(None of these things on their own would be considered a disorder.)

Mental disorder

A mental health state that involves a combination of thoughts, feelings and/or behaviours which are usually associated with:

●significant personal distress

●significant impaired functioning

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorder) contains strict diagnostic criteria for every recognised mental disorder. If you don’t fit the criteria, you don’t have  mental disorder.

Internal and external factors with the biopsychosocial model (BPS)

The biopsychosocial model (BPS) is a way of describing and explaining how biological, psychological and social factors combine and interact to influence a person’s mental health (and disorder).

Biological and psychological factors are both internal.

Social factors are external.

Biological factors

Physiological, anatomical and genetic factors, such as:

●neurotransmitters

●hormones

●brain structures

●age

family history

Psychological factors

Factors relating to a person’s unique behaviours and mental processes, such as:

●perceptions

●personality

●thoughts and thinking styles

●emotions

●coping strategies

Social

Factors that are external to the person, such as

●family and friends

●societal expectations

●support services

●early experiences

●physical environment

Cumulative risk

Refers to the increased risk of developing a mental disorder that occurs as a result of exposure to multiple biological, psychological and/or social risk factors simultaneously.

●Sometimes a risk factor may in itself not be particularly influential, but has a significant effect within the context of other influences (sometimes, 1+1=3)

●An individual risk factor may also provide the breaking or tipping point, resulting in onset of mental health disorder

●Generally, the more risk factors to which we are exposed the greater our vulnerability to a mental health disorder

●Protective factors also factor into the ‘equation’ when considering cumulative risk; more protective factors = more resilience to mental disorder

Stress

is a state of physiological and psychological arousal produced by internal or external stressors that are perceived by the individual as challenging or exceeding their ability or resources to cope.

Anxiety

A state of physiological and psychological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or something unpleasant is about to happen. It is normal to experience anxiety in certain situations.

Severe anxiety

Generally accompanied by intense physiological sensations and responses, such as shortness of breath, sweating, trembling, nausea, stomach cramps, dizziness, feelings of suffocating, feelings of losing control and/or feelings of impending doom.

Specific phobia

A mental disorder characterised by excessive, marked, irrational fear or anxiety about a specific object or situation (the phobic stimulus), often leading to avoidance behaviour. The first symptoms of a specific phobia usually arise in childhood or early adolescence. It is estimated that as many as 10% of Australians may have some type of phobia (APA, 2013; Beyond Blue, 2015).

Exposure (or even thinking about) the phobic stimulus causes anxiety and/or panic attack. Anticipatory anxiety is the gradual rise in anxiety level as a person thinks about, or ‘anticipates’, being exposed to a phobic stimulus in the future. Most people have experienced a mild form of anticipatory anxiety when they have an ‘attack of nerves’ before making a presentation to an audience. For those with a phobia, their anxiety may rise to a level where they are incapacitated by it.

Differences between the three- stress, anxiety, and specific phobia

●Stress is a normal physiological reaction to the perception of threat, anxiety may or may not be a symptom of a mental disorder (depending on intensity and frequency).

●Stress (and phobia) is linked to an identifiable stimulus (the stressor), whereas anxiety is not necessarily linked to a specific stimulus - it is a more general feeling of apprehension / discomfort. People often don’t know why they are feeling anxious.

●Stress can be good (eustress) or bad (distress), whereas anxiety is always unpleasant to experience.

●Neither stress nor anxiety are, on their own, mental disorders. Specific phobia is a diagnosable mental disorder.

DSM-5 diagnostic criteria

●Marked fear or anxiety about a specific object or situation

●The phobic object or situation almost always provokes immediate fear or anxiety

●The phobic object or situation is avoided or endured with intense fear or anxiety

●The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context

●The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

●The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

●The disturbance is not better explained by symptoms of another disorder

Types of specific phobia

Common types of specific phobia include:

●animal e.g. spiders, snakes, dogs, insects, birds, fish, mice

●situational e.g. aeroplanes, elevators, enclosed spaces, tunnels

●natural environment e.g. heights, storms, darkness, thunder, lightning, being near water

●blood–injection–injury e.g. seeing blood, having blood taken, having an injection, getting a cut, any invasive medical procedure

●other phobias e.g. choking, vomiting, loud noises, costumed characters, falling down, becoming ill, dying

Panic attack

In specific phobia, exposure to the phobic stimulus may cause a panic attack.

A panic attack is period of sudden onset of intense fear or terror, often associated with feelings of impending doom.

During the attack, there are physiological or psychological changes such as

●shortness of breath or smothering sensations

●a racing or pounding heart

●sweating

●trembling

●tightness in the chest

●feeling dizzy, unsteady, lightheaded or faint

●nausea

●feelings of going crazy, losing control or even dying.

An attack may be a result of a trigger or seems to occur ‘out of the blue’. A panic attack can occur when in a calm state or an anxious state.

Symptoms of panic attacks

Panic attack is defined in the DSM as four or more of the following symptoms that develop suddenly and reach a peak within 10 minutes:

●palpitations, pounding heart or accelerated heart rate

●sweating

●trembling or shaking

●sensations of shortness of breath or smothering

●feeling of choking

●chest pain or discomfort

●nausea or abdominal distress

●feeling dizzy, unsteady, lightheaded or faint

●de-realisation (feelings of unreality) or

●depersonalisation (being detached from oneself)

●fear of losing control or going crazy

●fear of dying

●paresthesias (numbness or tingling sensations)

●chills or hot flushes

What is a strength of representing mental health on a continuum?

It allows for early signs of mental health problems to be identified.

Explain why a continuum is a useful and appropriate way of representing stress, anxiety and phobia.

Stress, anxiety and phobias vary in amount or degree within and between individuals at any point in time, so a continuum is considered a useful and appropriate representation as it does not require fixed, permanent, arbitrary dividing lines between categories or even end points.

Can stress, anxiety and phobia all be mapped on the same single continuum?

Despite sharing characteristics, stress, anxiety and phobia are different constructs/concepts that each vary in amount or degree within and between individuals at any point in time. Consequently, all three could not be mapped on a single ‘mental health/wellbeing’ continuum such as Figure 8.9a, e.g. each is more appropriately mapped on its own continuum of this type.

Anxiety can be distinguished from phobia because only anxiety

Can be helpful in mild amounts.

One difference between stress and anxiety is that

Stress occurs when a person perceives they cannot cope with a current stressor, whereas anxiety occurs when a person perceives they cannot cope with a stressor that may occur in the future.

When Ambreen was a young child, she developed a fear of the dark. She started using a night light as a child and continued to use one as an adult. When Ambreen was 20 years old, she moved into a share house with new housemates. Her housemates noticed after a few months that Ambreen always watched movies with the lights on and would not leave the share house in the evening, even to visit friends. One night, the power went out in the share house while Ambreen was home alone. Several hours later, her housemates returned home from a party to find Ambreen sitting on the couch in a highly distressed state.

Is Ambreen likely to be suffering from a phobia or from anxiety? Justify your response by comparing phobia and anxiety in relation to Ambreen.

Ambreen has a phobia, rather than anxiety. Phobias are characterised by a persistent, intense and irrational (PIR) fear of a specific event or situation that adversely impacts functioning. In Ambreen’s case, she is specifically and intensely afraid of the dark to the extent that it prevents her from socialising at night. In contrast, anxiety is a normal response to a perceived future threat.

A mental illness is best described as (learn on)

A diagnosable psychological condition that significantly disrupts how a person usually thinks, feels and behaves.

Explain the meaning of holistic in relation to the social and emotional wellbeing (SEWB) framework.

TheSEWB holistic concept refers to the wellbeing of the individual and the wellbeing of their community. Wellbeing is not just the physical wellbeing of an individual but the social, emotional, spiritual and cultural wellbeing of the individual’s family community, thereby bringing about the total wellbeing of their community.

Anticipatory anxiety

The gradual rise in anxiety level as a person thinks about, or ‘anticipates’, being exposed to a phobic stimulus in the future. Most people have experienced a mild form of anticipatory anxiety when they have an ‘attack of nerves’ before making a presentation to an audience. For those with a phobia, their anxiety may rise to a level where they are incapacitated by it.

Risk factors for forming specific phobia
(Ch 9A)

BIOLOGICAL- •GABA dysfunction

•Long-term potentiation (LTP)

PSYCHOLOGICAL

•Precipitation by classical conditioning

•Perpetuation by operant conditioning

•Cognitive biases including memory bias and catastrophic thinking

SOCIAL

•Specific environmental triggers

•Stigma around seeking treatment

Interventions for specific phobia

(Ch 9B)

BIOLOGICAL-

•Short-acting anti-anxiety benzodiazepine agents (GABA agonists)

•Breathing retraining

PSYCHOLOGICAL-

•Cognitive behavioural therapy (CBT)

•Systematic desensitisation

SOCIAL-

•Psychoeducation for families / supporters, with reference to challenging unrealistic / anxious thoughts and not encouraging avoidance behaviours

Protective factors for maintaining wellbeing

(Ch 10A)

BIOLOGICAL-

•Adequate nutritional intake and hydration

•Adequate sleep

PSYCHOLOGICAL-

•Cognitive behavioural strategies

•Mindfulness meditation

SOCIAL-

•Support from family, friends and community that is authentic and energising

Which neurotransmitter stimulates brain activity, and which one dampens brain activity?

glutamate; GABA

GABA and GABA dysnfunction

Is the primary inhibitory neurotransmitter in the CNS. It decreases the frequency of the postsynaptic cell firing an action potential, and can be thought of as the ‘brakes’ of the CNS, balancing the effects of excitatory glutamate.

GABA dysfunction (low levels of GABA) are associated with increased anxiety, such as that experienced during phobia. Without GABA to function as a calming agent, the stress response can become overactive.

What factors influence GABA levels?

Research studies have implicated factors such as:

●genetic inheritance,

●central nervous system damage,

●exposure to prolonged stress,

●nutritional deficiencies in vitamin B6 and citric acid,

●high caffeine intake.

These types of influences have been found in some studies to either:

●inhibit GABA release,

●inhibit its ability to bind to GABA receptors on postsynaptic neurons,

●or to stimulate overproduction of glutamate in some way.

Describe how there is GABA dysfunction

●Exam questions about GABA dysfunction are likely to require the following pieces:

GABA is an inhibitory neurotransmitter that dampens brain activity / calms the nervous system. When there are inadequate amounts of GABA, nervous system excitation is not calmed. Therefore, GABA dysfunction causes an overactive stress response. Therefore, it can increase anxiety in relation to a phobic stimulus

Long-term potentiation (LTP)

Long-term potentiation strengthens synaptic connections in the neural pathway formed during the learning process, resulting in enhanced or more effective synaptic transmission within that pathway.

Long-term potentiation can neurologically strengthen the association between a phobic stimulus and a fear or anxiety response through its activity at the synapse.

The more that the connection is activated through each encounter with a phobic stimulus, the more the connection is strengthened.

The more the connection is strengthened, the more the relevant neural pathway is strengthened, increasing the efficiency in transferring fear information along the pathway and decreasing the likelihood that what has been learnt will be forgotten.

●Exam questions about LTP are likely to require the following pieces:

○LTP is the long-lasting strengthening of neural synapses through repeated co-firing of neurons

○When we experience anxiety in response to a phobic stimulus, the neural networks associated with fear/anxiety and the phobic stimulus are activated concurrently

○This strengthens the association between the phobic stimulus and anxiety over time, contributing to the development of specific phobia

Precipitation vs perpetuation

●Predisposing factors increase susceptibility to specific phobia, based on your background / genetics.

●Precipitating factors mean the events that trigger specific phobia to actually occur. We look at classical conditioning to show how phobia can be precipitated by negative experience/s with the phobic stimulus.

●Perpetuating factors keep people from recovering once they already have phobia. We look at how operant conditioning can cause people to be stuck in a self-reinforcing cycle of phobic anxiety.

●

●Protective factors reduce your risk of phobia and/or make it more likely you will recover from phobia.

Precipitation by classical conditioning

The original trigger for a phobia can be a specific experience (or set of experiences) in which a previously neutral object or event is paired with something frightening, painful or otherwise traumatic, leaving the person with an automatic learned association between the object / event and fear.

e.g.   NS = ocean

  UCS = drowning episode  UCR = fear / panic

  CS = ocean  CR = fear / panic

N.B. Watching someone else in fear / screaming can be the UCS, so sometimes phobias are obtained through the social transmission of threat information.

Perpetuation by operant conditioning

The phobia can be strengthened over time through operant conditioning. We are motivated to avoid unpleasant consequences such as anxiety.

●Avoidance behaviours are negatively reinforced when the person experiences relief from their anxiety (removal of an unpleasant stimulus).

A cognitive bias

A cognitive bias is a predisposition to think in a certain way.

In general, cognitive biases have evolved in us to help us process information more efficiently. However, they can also lead to erroneous thinking.

The Study Design specifies that you know about how two different cognitive biases contribute to specific phobia:

●Memory bias

●Catastrophic thinking

Memory bias

It has been suggested that fearful individuals preferentially attend to, interpret, and remember threat-relevant information.

●More likely to ignore information that the phobic stimulus is benign, and focus on evidence that the phobic stimulus is harmful

●More likely to interpret ambiguous information about the phobic stimulus as being threatening

●More likely to recall evidence that the phobic stimulus is harmful than information that it is not

For example, research into individuals with spider phobia show enhanced memory for spider-relevant information compared to non-phobic individuals (Watts & Cole, 1992), selective attention to spider information (van den Hout et al., 1997), and interpret ambiguous information about spiders in a threatening way (De Jong & Muris, 2002).

Catastrophic thinking

Catastrophic thinking is defined as ruminating about irrational, worst-case outcomes. A stimulus or event is anticipated to be far worse than it is realistically likely to be.

For example, a person with specific phobia may obsess over the pain and damage that will be caused by an injection, think that they might die if bitten by a spider, imagine everyone in the class laughing cruelly at them during a presentation, etc.

Remember that much of phobic anxiety is anticipatory, therefore catastrophic thinking contributes to the phobic response.

Specific environmental triggers for specific phobias

Refer to stimuli or experiences in a person’s environment that prompt an extreme stress response, leading to the development of a phobia.

●Most people with a diagnosed phobia can recall a negative, traumatic experience which caused a fear response

●Might be a direct experience with a traumatic stimulus, the observation of another person having an experience with a traumatic stimulus, or learning of fear information indirectly (e.g. films)

●Initial fear response becomes conditioned fear response, and is produced whenever the specific or generalised phobic stimuli is encountered

●The more severe the trauma associated with the initial fear experience, the more likely a phobia will develop and the more likely take only one exposure

●Not the only factor, because not everyone with the same experience develops a phobia

●Subsequent exposure is also a factor, after the initial fear response – better to get back on the horse straight away

Stigma around seeking treatment

Refers to the decreased likelihood of accessing interventions to prevent or treat their phobia due to experiencing shame, disgrace or social disapproval.

This is likely to perpetuate specific phobia.

●Decreased help-seeking behaviour and resulting lack of treatment and support makes it more likely symptoms of the disorder will continue or worsen

●People may be ridiculed for their fears

●Because phobias are, by definition, irrational, people find it hard to empathise

●This is especially true if the feared object is harmless - eg balloons

●Also, they function normally outside of the phobia, so specific phobia is seen as ‘less severe’ or ‘not a real mental disorder’

Social stigma

Refers to any aspect of an individual’s identity that is devalued in a social context.

●Involves the negative attitudes, beliefs and behaviour in the community that cause people to exclude, reject, fear and discriminate against people with a mental disorder

●e.g. ‘People with depression should be able to snap out of it.’

Self-stigma

Refers to the stigmatising views that individuals hold about themselves.

●Occurs when individuals with a mental disorder accept negative attitudes and beliefs held by others and internalise or apply them to themselves

e.g. ‘Having depression makes me weak’

Distinguish between specific phobia and ordinary fear

Unlike ordinary fear that can be rational, not necessarily excessive, variable in relation to different stimuli, and serve to protect us from actual harm, specific phobia involves fear that is often irrational/unreasonable and excessive/disproportional to the real risk involved and persistent in relation to a specific stimulus. Furthermore, ordinary fear may be considered part of good mental health (e.g. adaptive), whereas a diagnosable specific phobia is considered a mental health disorder.

Biological factor	What is it?	How it may contribute
gamma-amino butyric acid (GABA) dysfunction
long-term potentiation

Biological factor	What is it?	How it may contribute
gamma-amino butyric acid (GABA) dysfunction	failure to produce, release or receive sufficient amount of GABA to regulate neuronal transmission in the brain, particularly to counterbalance the excitatory activity of glutamate	Cannot adequately counterbalance the excitatory effect of glutamate associated with anxiety e.g. GABA is believed to control the fear or anxiety experienced when neurons are overexcited
long-term potentiation	the long-lasting strengthening of synaptic connections through activity at the synapse, resulting in enhanced or more effective synaptic transmission	The more that the connection is activated through each encounter with a phobic stimulus, the more the connection is strengthened, increasing the efficiency in transferring fear information along the relevant neural pathway and decreasing the likelihood that the fear response can be forgotten

VCE 2022 Psychology Exam, Section B, Q.7d; © VCAA

Eloise is a five-year-old girl who developed a mouse phobia after one crawled on her and woke her from her sleep six months ago. Now, she cannot tolerate being anywhere near a mouse and refuses to enter her bedroom.

Workboard

d. Explain how one biological factor may act as both a risk factor and a protective factor in the development of Eloise’s phobia.

Genetic vulnerability / family history is an example of a biological factor. (1 mark for correctly identifying one biological factor) If a (biological) parent / family member has a phobia, Eloise might be more likely to develop a phobia too. (1 mark for identifying how it is a risk factor with an acknowledgement of how it led to the development of a phobia for Eloise.) If her (biological) parents don’t have a phobia her inherited genes could act as a protective factor against developing a phobia. (1 mark for identifying how it is a protective factor with an acknowledgement of how it led to the development of a phobia for Eloise.)

OR

Sleep is an example of a biological factor. (1 mark for correctly identifying one biological factor). Eloise might not be thinking rationally if she is sleep deprived which could increase her chance of developing a phobia (risk factor). (1 mark for identifying how it is a risk factor with an acknowledgement of how it led to the development of a phobia for Eloise.) With adequate sleep she might be calmer when confronting the mouse so it could protect her from developing a phobia (protective factor). (1 mark for identifying how it is a protective factor with an acknowledgement of how it led to the development of a phobia for Eloise.)

VCAA Assessment Report note:

For this question, students needed to:

• Identify one biological factor (e.g. GABA, genetic vulnerability, brain chemistry, sleep, diet, LTP, substance use, role of the stress response).

• Explain how it is a protective factor, with an acknowledgement of how it led to the development of a phobia for Eloise.

• Explain how it is a risk factor, with an acknoweldgement of how it led to the development of a phobia for Eloise (but doesn’t have to specifically reference mice).

Psychological factor	What is it?	How it may contribute
Behavioural models classical conditioning
operant conditioning
Cognitive biases memory bias catastrophic thinking

Psychological factor	What is it?	How it may contribute
Behavioural models classical conditioning	A type of learning that occurs through involuntary association of two (or more) different stimuli	A specific phobia may be precipitated (i.e. acquired, onset hastened) through the three-phase learning process e.g. a stimulus with no particular significance (i.e. a neutral or UCS) becomes, by association, a sign of impending threat, danger or some other unpleasant event (i.e. a CS); the innate, involuntary fear response (UCR) eventually becomes a conditioned fear response (CR)
operant conditioning	A type of learning for which the consequences (e.g. reward or punishment) of a behaviour (e.g. response to a phobic stimulus) determine the likelihood that it will be performed again in the future	Avoidance behaviour for a phobic stimulus may be perpetuated/ maintained through negative reinforcement
Cognitive biases memory bias	The distorting influences of present knowledge, beliefs and feelings on the recollection of previous experiences, often resulting in selective memory	Tendency to recall the fearful or negative experiences relating to the phobic stimulus while minimising or even forgetting more positive or contradictory information that might challenge the fear
catastrophic thinking	A thinking style which involves overestimating, exaggerating or magnifying an object or situation and imagining the worst possible outcome	Tendency to believe/expect the worst possible outcome when exposed to a phobic stimulus, thereby promoting avoidance behaviour (and perpetuating the phobia through negative reinforcement)

Watson and Rayner classically conditioned 11-month-old ‘Little Albert’ to produce an emotional response to a white rat by pairing a loud noise with the presentation of a white rat.

During conditioning, Little Albert’s response to the white rat was to startle and breathe heavily. After conditioning, he trembled and cried in fear every time he saw a white rat and, later, in response to other white, furry objects.

Outline the processes required during conditioning for the acquisition of Little Albert’s emotional responses. JACPLUS

The process during conditioning involved the repeated pairing of the neutral stimulus (white rat) with the unconditioned stimulus (loud noise) (1 mark for identifying the repeated pairing of the NS and UCS) to create an association This association led to the neutral stimulus becoming a conditioned stimulus (1 mark for identifying that the association of the NS and UCS led to the NS (white rat) becoming the CS) capable of eliciting a fear response from Little Albert. (1 mark for noting the result of this conditioning - fear) This experiment demonstrated the principles of classical conditioning and how emotional responses can be learned through association.

It is necessary to outline the classical conditioning process required for acquisition of Little Albert’s emotional responses by including the following information:

• the neutral stimulus (NS) (white rat) was paired withthe unconditioned stimulus (UCS) (or loud noise)

• the repetition in pairing of the stimuli (NS and UCSwere paired or associated multiple times)

• the NS or white rat was presented before the UCS or loud noise.

• The association between the rat and loud noiseleading to fear response

• 
  

During conditioning the NS/white rat would have to be repeatedly presented just before the UCS/loud noise to form an association between the rat and the loud noise.

JACPLUS Leanne plays the drums in a band with her friends. The band was asked to perform at her cousin’s 21st birthday party. Leanne felt very stressed about performing in front of an audience and, on the evening of the party, she felt sick and asked the band members to perform without her. Leanne stayed at home instead of going to the party. The next time the band performed at a party, Leanne began playing with the band but immediately experienced sweaty palms, an increase in her breathing rate and a rapid pulse as she stood in front of the audience. She stopped playing with the band, said that she felt sick and went home. Leanne has subsequently continued to make excuses and stay at home every time she has been asked to perform with the band at a party because, every time she thinks of playing in public, she experiences feelings of intense fear and worry, shortness of breath, sweating, trembling, nausea and dizziness.

According to behavioural models, it is likely that Leanne has

a phobia of performing in public that involved precipitation by classical conditioning and perpetuation by operant conditioning.

Eloise is a five-year-old girl who developed a mouse phobia after one crawled on her and woke her from her sleep six months ago. Now, she cannot tolerate being anywhere near a mouse and refuses to enter her bedroom.

Workboard

b. Explain how a specific environmental trigger contributed to the development of Eloise’s phobia. JACPLUS

The mouse (1 mark for identifying the mouse as the specific environmental trigger) waking her up triggered the release of adrenaline. This enabled her to form an emotional memory and contributed to the development of her phobia of mice. (1 mark for explaining how the mouse, as the specific environmental trigger, contributed to Eloise’s phobia)

OR

The specific environmental trigger was the mouse (1 mark for identifying the mouse as the specific environmental trigger) in her room that woke her up. This could have created a negative memory bias towards mice and led to the development of a phobia. (1 mark for explaining how the mouse, as the specific environmental trigger, contributed to Eloise’s phobia)

Explain the meaning of ‘evidence-based intervention’.

Evidence-based intervention: a treatment that has been found to be effective on the basis of scientific evidence/valid and reliable, peer reviewed, research studies

What are benzodiazepines?

A group of drugs that work on the central nervous system, acting selectively on GABA receptors in the brain to increase GABA’s inhibitory effects and make postsynaptic neurons resistant to excitation; may be used in the treatment of phobic anxiety; commonly referred to as sedatives, tranquilisers or depressants

Why are benzodiazepines classified as agonists rather than antagonists?

Benzodiazepines stimulate activity of the targeted neurotransmitter and are therefore agonists, whereas antagonists inhibit neurotransmitter activity e.g. benzodiazepines are agonists that imitate GABA’s effects and therefore stimulate the inhibitory action of GABA at GABA receptor sites on postsynaptic neurons.

Explain how benzodiazepines work in alleviating anxiety.

They are GABA agonists. Benzodiazepines work by stimulating the activity at the site of the postsynaptic neuron where GABA is received from the presynaptic neuron. This reduces the symptoms of anxiety by amplifying the influence of GABA’s inhibitory effects on the postsynaptic neuron. By reducing the excitability of neurons, overall brain function becomes slower and calmer, reducing the arousing effects of anxiety.

GABA dysfunction

Failure to produce, release or receive the correct amount of GABA needed to regulate neurotransmission in the brain.

Breathing retraining

Breathing retraining is a method used to teach someone to help calm anxiety. Someone with specific phobia can learn how to control their breathing when in the presence of their phobic stimulus. This prevents the accompanying sympathetic nervous system responses and spiralling anxiety.

Psychotherapy

Treatments administered by a psychologist, counsellor or psychiatrist that addresses the patient’s thoughts, feelings and behaviours. It is sometimes known as ‘talk therapy’ because the treatment is primarily delivered through interaction between the patient and the clinician (as opposed to medical treatments which are prescribed and then ‘taken’).

There are two psychotherapeutic treatments listed in the Study Design:

●Cognitive behavioural therapy (CBT)

●Systematic desensitisation

These treatments are different from just chatting with a counsellor or getting things off your chest – they are evidence-based interventions that are delivered by properly trained clinicians as treatments for mental disorder.

Cognitive behavioural therapy (CBT)

A psychotherapeutic treatment that helps someone replace their dysfunctional thoughts (cognitions) and behaviours with more helpful ones. It is grounded in the understanding that thoughts and behaviours are linked.

●Therapist will help patient understand the mechanisms by which their phobia operates, such as the biological stress response (what we have been studying in this topic) so they can identify and consequently control their responses

●Identify thoughts that perpetuate the phobia, including memory bias and catastrophic thinking, stigma etc.

●Identify behaviours that perpetuate the phobia, including avoidance of the phobic stimulus and not seeking help

●Learn to understand the relationship between thoughts and behaviours, such as their triggers for both helpful and unhelpful behaviours

●Learn strategies to replace the unhelpful thoughts with more helpful ones, and practice habits that improve behavioural responses

Systematic desensitisation

A psychotherapeutic treatment used to overcome phobia that involves a patient being exposed incrementally to increasingly anxiety-inducing stimuli, combined with the use of relaxation techniques.

●Helps to break the cycle of perpetuation by operant conditioning

●Classically conditions a new association between the phobic stimulus and relaxation, instead of the phobic stimulus with fear

Steps in systematic desensitisation

1.Learn relaxation technique (e.g. breathing retraining)- MUST SAY

2.Development of a hierarchy of fear

3.Gradual step-by-step exposure to each item of the fear hierarchy beginning with the least anxiety-inducing stimulus, paired with practise of the learned relaxation techniques with each exposure.

4.Continue until the most fear-inducing stimulus can be faced without producing the phobic response

Psychoeducation for families/ supporters

The provision and explanation of information about mental disorders to individuals diagnosed with the disorder, or in this case their families / supporters, to increase knowledge and understanding of the disorder and its treatment.

Increased understanding of symptoms, treatment and services will enable families to support individuals to cope more efficiently.

For specific phobia, two things families / supporters can help with are:

●Challenging unrealistic or anxious thoughts

●Not encouraging avoidance behaviours

What are two possible goals of a CBT treatment plan for a specific phobia? JACPLUS

• changing thoughts and behaviour that perpetuate the phobia e.g. assisting the individual to develop a new understanding that their feared stimuli are not (or unlikely to be) dangerous, so their avoidance and safety behaviours are unnecessary and unhelpful in the long-term

• improving coping skills.

Adequate nutritional intake and hydration

Refers to eating a varied diet that meets all your nutritional needs (macronutrients, micronutrients like vitamins and minerals, as well as overall energy intake) and drinking enough water to maintain good physical health and feel mentally well as a result.

e.g. salt is required for action potentials to occur; iodine is important for the nervous system; fats are important for neuron structure

Having an adequate diet contributes to a person’s mental wellbeing because it provides the baseline level of physical and mental health that allow for a person to adapt and change when faced with stressors.

Adequate nutritional intake and hydration recommendations

A diet that benefits mental health is very similar to one that benefits your physical health, because mental and physical wellbeing are interrelated.

●Eat a variety of foods (to ensure macro and micronutrient needs are met)

●Drink lots of water (amount varies by person/activity; enough to prevent thirst)

●Reduce intake of soft drinks, alcoholic drinks and caffeinated beverages (as these result in lows when they wear off)

●Eat regularly throughout the day, including breakfast (to prevent being low in energy and maintain stable blood sugar)

●Eat processed foods high in salt, sugar and fat in moderation (they take up space in the diet that reduces our intake of more nutritious unprocessed foods and wholegrains)

Adequate sleep

Getting adequate (both quality and quantity) sleep is important for maintaining good mental health and increasing resilience.

Recall from earlier in the Study Design:

●the restorative theory of sleep and its role in repairing and replenishing the physical body and mental processes

●the affective, behavioural and cognitive effects of sleep deprivation

Sleep is a precipitating and perpetuating risk factor for many mental disorders. Insomnia is a common comorbidity (someone having 2 or more mental h. disorders at the same time) with anxiety disorders; 1 in 4 people with insomnia also have an anxiety disorder, and 14% also have major depressive disorder.

Cognitive behavioural strategies (CBS)

The use of cognitive behavioural strategies draws on techniques from CBT that can be applied by individuals as part of managing their own mental health in order to increase resilience.

Note that unlike CBT, ‘cognitive behavioural strategies’ are NOT a psychotherapeutic treatment, although both recognise the interconnectedness between cognitions and behaviours.

●Replace unhelpful thoughts with more functional ones

●e.g. journaling to keep track of thoughts and how they affect your mood

●e.g. the growth mindset (cognition: ...yet, behaviour: increased trying)

Exam questions: Make sure you define cognitive behavioural strategies, then provide examples (relating to the scenario, if applicable) that address both cognitions and behaviours – preferably showing how these are linked together.

Mindfulness meditation

Mindfulness is the quality or state of being conscious or aware of one’s internal states and surroundings.

2023 exam: ‘Mindfulness meditation refers to a type of meditation where an individual focuses their attention on their breathing in the present moment, fully allowing themselves to experience their thoughts, sensations and feelings in the present moment without judgement. It is a psychological protective factor that enhances wellbeing, as it is a relaxation strategy that is shown to decrease anxiety and racing thoughts, therefore reducing stress levels.’

●Focused on the present moment

●Anxiety is future-focused, so therefore reduces anxiety

●

Meditation refers to the practice of focusing or clearing your mind using a combination of mental and physical techniques

●

●Mental techniques include visualisations or subvocalisations

●Physical techniques include particular postures or movements

●These rituals aid in achieving focus

Mindfulness meditation is a type of meditation in which a person focuses attention in the present moment, on their breathing, thoughts, feelings and sensations in a non-judgemental way.

Social support

Social support refers to the assistance, care or empathy provided by people to each other. Support from family, friends and community increases resilience. Support from family, friends and community that is authentic and energising

Support from family:

●Unconditional love

●Emotional, financial or physical support when things are difficult

●Sense of belonging and familiarity

Support from friends:

●Fun experiences and distractions from stressors

●Talking about personal issues

Support from community:

●Opportunities for interaction, e.g. sports clubs and festivals

●Sense of belonging and connectedness; sense of contributing to something important

●Facilities and programs that support you when times are tough e.g. neighbourhood house

Cultural continuity

Refers to the preservation of Aboriginal and Torres Strait Islander cultures over time.

•Provides a sense of history, identity and belonging for Aboriginal and Torres Strait Islander peoples

•Includes the preservation of Indigenous languages, customs and rituals, food, art and access to traditional Country

•Many of these things are under threat (e.g. language endangerment and extinction) due to intergenerational effects of colonisation and racist policies of removing children from community (the Stolen Generation)

•Disconnection from culture have been found to lead to and perpetuate poor mental wellbeing outcomes

Self-determination for ASTI peoples

Refers to the right of Aboriginal and Torres Strait Islander communities to freely determine their political status and freely pursue their cultural, social and economic development.

•“Nothing about us, without us”

•Aboriginal and Torres Strait Islander consultation and leadership on issues affecting them, their communities, and their land

•A key motive for establishing an Indigenous Voice to Parliament

Policies applied without proper consultation and involvement of Indigenous people have been disastrous, e.g. Northern Territory Intervention and cashless debit cards

What does a protective factor for mental wellbeing do

It decreases the risk or impact of a problem that may adversely affect mental wellbeing.

Using your knowledge of mindfulness meditation, explain the results collected in this study:

Fifty participants completed nine months of mindfulness meditation training. They did the training for 30 minutes per day, six days a week. The amount of cortisol in hair is considered a suitable measure of exposure to prolonged stress. The longer that stress lasts, the more cortisol accumulates in hair. Researchers analysed the amount of cortisol in the hair of participants every three months.

Cortisol levels in hair compared to pre-training levels

-After 3 months of training cortisol reduces by 5%

-After 6 months of training cortisol reduced by 25%

-After 9 months of training cortisol reduced by 25%

Mindfulness meditation refers to a type of meditation where an individual focuses their attention on their breathing in the present moment, fully allowing themselves to experience their thoughts, sensations and feelings in the present moment without judgement. It is a psychological protective factor that enhances wellbeing, as it is a relaxation strategy that is shown to decrease anxiety and racing thoughts, therefore reducing stress levels. As a result, after 6 months and 9 months of training cortisol levels reduced by 25% compared to pre-training levels, as cortisol levels increase during periods of chronic stress and therefore a reduction of cortisol levels indicates that the mindfulness meditation reduces stress as a protective factor for mental wellbeing.

2023 exam: 2 Marks.

Fifty participants completed nine months of mindfulness meditation training. They did the training for 30 minutes per day, six days a week. The amount of cortisol in hair is considered a suitable measure of exposure to prolonged stress. The longer that stress lasts, the more cortisol accumulates in hair. Researchers analysed the amount of cortisol in the hair of participants every three months.

Cortisol levels in hair compared to pre-training levels

-After 3 months of training cortisol reduces by 5%

-After 6 months of training cortisol reduced by 25%

-After 9 months of training cortisol reduced by 25%

What makes mindfulness meditation a more appropriate IV than adequate nutritional intake for this study?

To gain full marks for this question, students needed to ensure they provided a reason that mindfulness meditation was more appropriate as well as a reason that adequate nutritional intake was not appropriate.

Some reasons why mindfulness meditation was a more appropriate IV:

·       smaller set of skills in which to train people

·       participants were more likely to use it consistently as it was only 30 minutes per day

·       fewer baseline variables involved with implementing mindfulness meditation

·       increases validity of experiment as there are fewer variables to control

·       researchers wanted to study a psychological IV, which is what mindfulness meditation is.

The following are some reasons why adequate nutritional intake was a less appropriate IV:

·       more comprehensive training/understanding needed

·       participants more likely not to follow through as it is a significant daily lifestyle change

·       more baseline variables are involved in measuring impact of diet

·       decreases validity of experiment as there are more variables to control

·       researchers did not want to study a biological IV, which adequate nutritional intake is.

Compare and contrast between Social and emotional wellbeing with reference to an example for each

Identify the approximate percentage of signals sent from the gut to the brain and vice-versa

Gut to brain 80-90%

Brain to gut 10-20%