Clinical psych

108psych test3

Clinical psych?

Applied branch

Focus on mental health and works closely with medicine but offers different perspective

How thoughts and feelings affect mental health?

• Uses "talking therapies"

• works with people

• Applies across the life span

Who typically comes to see clinical psychologists?

People with:

1. Phobias or anxiety disorders

2. Depression

3. Difficulties with emotional regulation

4. Relationship problems

5. Eating disorders

6. Psychosis and other serious mental difficulties

7. Physical illness

8. Family issues

9. Brain injuries

Psych myths

Mind readers, All the answers, give medication, Counselling, talk therapy isn't helpful, Diagnose people

Prevention and wellbeing

Promoting mental wellbeing early. Parenting programs, mindfulness in schools and resilience skills

Assessment

Understanding difficulties

Formulation

Making sense of how and why difficulties developed and are maintained

Diagnosis

Identifying patterns of symptoms. (Depression, anxiety, ptsd)

Therapy/Intervention

Supporting people to make changes using evidence-based therapies (CBT, ACT, DBT)

Psychological disorders

"A mental health disorder is a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. These disorders are usually associated with distress or impairment in important areas of functioning."

Distress examples

• "I feel constantly on edge"

• "My brain never switches off"

• "Everything feels exhausting"

• "I don't feel like myself anymore"

• "I'm struggling to cope"

• "I feel overwhelmed all the time"

Difficulties/impairment in functioning

Interfere with important areas of life like work, relationships, self-care and leisure

Aytpical

Not culturally expected
For something to be considered a disorder, the experience is usually outside what would normally be expected in that person's cultural or social context

Why is that important

• Talking to deceased ancestors may be culturally/spiritually meaningful in some cultures

• Grief is different for different cultures

• Eye contact norms

• Spiritual experiences are not automatically psychosis

How common are mental health issues?

1-in-4 people

Diagnosis

Psych disorders are typically diagnosed based on established criteria in diagnostic manuals

• Diagnostic and statistical manual of mental disorders (DSM-5) or international classifications of diseases (ICD-10)

• These criteria include specific systems, duration and impact on functioning

Pros of Diagnosis

Validation, treatment, communication, access and research

Cons for diagnosis

Stigma, misdiagnosis, reductionism, problems with reliability, cultural sensitivity, self-identity, over-reliance on medication, comorbidity

Mental health disorders: Biological

Biological factors influence brain functioning and physical health

Mental health disorders: Psychological

Psychological factors influence thoughts, emotions and behaviours

Mental health disorders: Cultural

Cultural factors shape beliefs, values and ways of understanding mental health

Mental health disorders: Social & Environmental

Social and environmental factors influence relationships, living conditions and access to support

Biological/medical models

Mental disorder are illnesses caused by biological abnormalities

Genetic heritability

Genetics can increase a person’s vulnerability to some mental health difficulties - bipolar disorder has strong genetic component

Brain chemistry and neurotransmitters

Researchers look at levels of brain chemicals like serotonin and dopamine
Low serotonin - Depression
High serotonin - psychosis

Brain structure and function

Depression - smaller hippocampus
Schizophrenia - enlarge ventricles, less grey matter

Other biological features

Brain scans show how active areas are at rest or during tasks
Anxiety/PTSD - overactive amygdala (fear)
Depression/ADHD - Underactive prefrontal cortex

Psychodynamic model

Behaviour is shaped by unconscious drives and early experiences

Behavioural model

Behaviour is learned through conditioning and can be unlearned

Cognitive model

Thoughts influence feelings and behaviour; distorted thinking leads to problems

Humanistic model

People strive for growth and fulfilment; focus on self-actualisation and personal meaning

Cultural models

Cultural factors influence mental health

Indigenous models of wellbeing

Te Whare Tapa Wha (Māori model)

Fonofale model (Pasifika model)

Social and environmental models

Mental health is shaped by social and environmental factors

How poverty affects mental health?

Chronic stress, Limited access to services and support, Social exclusion, stigma and isolation, Unstable housing and childhood adversity

How mental health affect poverty?

Depression, anxiety or psychosis makes work harder and treatment and medication add to financial cost

Trauma?

Abuse (Physical, emotional, sexual), Child neglect, Bullying, Rape and physical assault and War trauma

Female patients

SA: 50%, PA: 48%, SA or PA 69%

Male patients

SA: 28%, PA: 51%, SA or PA: 60%

Child abuse in adults

Suicidality, Inpatient admissions, Dissociative disorders, Psychosis, PTSD, BPD, Depression substance abuse, ED and Sexual dysfunction

Gender differences

Almost all mental health problems are more common in females
47% of NZ are likely to experience a mental disorder in their lifetime

50% more likely to experience depression than men and more likely to experience anxiety, mood and eating disorders

Men experience more substance use disorders

Social and cultural factors

Gender roles, stigma around emotional expression, differences in help seeking, poverty and social pressures

Biological factors

Hormones, reproductive changes, stress response system, genetics, brain and body development

Vulnerability stress model

This model integrates different factors; assumes mental health problems result from a biological or psychological vulnerability together with stressful life event(s)

Biopsychosocial approach

Evidence points to mental health problems arising from combination of biological, psychological, social factors

Why Understanding Causes Matters

Causes point to Prevention, Address social conditions, Personalised approaches and Challenge stigma

MDD (Major depressive disorder)

A. Five (or more) of the following symptoms have been present during the same 2-week period and

represent a change from previous functioning; at least one of the symptoms is either (1) depressed

mood or (2) loss of interest or pleasure:

1. Depressed mood most of the day, nearly every day

2. Markedly diminished interest or pleasure in most activities

3. Significant weight loss or gain, or appetite disturbance

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Feelings of worthlessness or excessive/inappropriate guilt

8. Diminished ability to think or concentrate; indecisiveness

9. Recurrent thoughts of death, suicidal ideation, or suicide attempt

Cognitive sense model

Event - Emotion

Cognitive model

Event - Cognition - Emotion

Cognitive theory of depression

People become depressed because of negative thinking

Levels of cognition

Unhelpful thoughts and worries, Assumptions and Core beliefs

Unhelpful thoughts and worries

The thoughts going through your mind day to day

Assumptions

The rules and expectations you have about yourself others and the world

Core Beliefs

Deep down beliefs about yourself, others and the world

Becks cognitive triad

Core belief, Intermediate belief and Automatic thought

Emma’s cognitive triad of depression

Negative view of the world, Negative view of the future and Negative view of self

Behavioral aspects of depression

Depression is linked to withdrawal, avoidance and reduced positive experiences

Common changes

Withdrawn, stops fun activities, reduced motivation, avoids places, spends time alone and changes in sleep, eating and routines

CBT five part model

Thoughts, Emotions, Behaviour, Physiological response and all are connected and repeated in cycle

Thoughts

Not good enough mother

Emotions

Saddness, gulit and hopelessness

Behaviour

Withdrawing

Physiological response

fatigue, low energy, disrupted sleep

Treatments

Psychological therapies: CBT, Medication, Combination treatments, Lifestyles interventions, Social and Whanau awareness and Other interventions

Psychological therapies: CBT

• Focuses on breaking cycles of negative thoughts and behaviors

• Strong evidence for depression across the lifespan, online and in-person,

and NZ context (see references)

• Basic principle: to feel better you must change the way you think

• Focuses on current thoughts and behaviour

CBT: Basic techniques

• Psychoeducation (incl. explanation of cognitive model)

• Identify negative/irrational thoughts or cognitive distortions (keep diary)

• Challenge those thoughts (e.g., cognitive restructuring) and replace them

with more accurate/reasonable, “balanced” thoughts

• Behavioural activation – increase opportunities for meaningful, enjoyable

and rewarding activities.

Interpersonal therapy (IBT)

Focuses on relationship difficulties and life transitions

ACT & Mindfulness-Based Therapies

Emphasises acceptance, values, and present-moment awareness

Medication

SSRIs and SNRIs are first-line antidepressants

• Selective Serotonin Reuptake Inhibitor

• Serotonin-Norepinephrine Reuptake Inhibitor

• Often effective, especially for moderate to severe depression

• Side effects: fatigue, sleep disturbance, sexual dysfunction

Combination Treatments

Medication + CBT often more effective than either alone (especially for moderate to severe depression)

Lifestyle Interventions

Exercise, sleep hygiene, nutrition, and routine can significantly support recovery.

• Psychoeducation and support from family/whānau are also valuable

Social and Whānau Interventions

Strengthening relationships, whānau involvement, and social connectedness

Other Interventions

Electroconvulsive Therapy (ECT): Used in severe or treatment-resistant cases.

Key messages

• Depression is not just symptoms to be measured but lives to be understood.

• Biological, psychological, social, and cultural factors all play a role.

• Our role as clinical psychologists is to hold evidence and empathy together

• Depression is treatable.

Evolutionary alarm system

Anxiety and it triggers fight, flight, freeze or flop responses

Anxiety exists on a continuum

It’s not an all or nothing. We feel it sometimes, but it becomes a concern when intensity, duration and impact start to grow, when the body’s alarm system gets stuck on high alert

Normal anxiety

Clear and realistic, mid to moderate but manageable, short term, enhance performance focus, butterflies, generally controllable and responses to self-care, reassurance

Problematic anxiety

Unclear, strong and distressing, lingers even after stressor is over, interferes with sleep, ongoing restlessness, harder to calm and needs structured coping strategies

Anxiety disorder

Often occurs without trigger, intense, persistent, significantly impairs daily life, chronic symptoms, feels uncontrollable and may require professional treatment

Can anxiety be healthy?

Yes, but becomes a disorder when it controls us

Common?

Anxiety disorders are very common, 1 in 5 adults aged 15 years and over are diagnosed with a mood or anxiety disorder (ministry of health, 2019)

Kessler et al (2012)

Most common psychological problem and the most treatable

Common factors

• Tendency to catastrophize

• Uncertainty

• Feels dangerous leads people to believe that feeling anxious is the same as being in danger

• What matters most is not when someone feel, but how they feel about what they feel

Causes

Biological factors, Psychological factors, Environmental and social factors, Learning and conditioning