Psych- chapter 8

Mental wellbeing

Well-being is the state in which an individual is mentally, physically and socially healthy and secure.

Mental Well-being is an individual’s psychological state including their ability to think, process information and regulate emotions.

Ways of considering mental health (LRS)

1. levels of functioning

2. Resilience

3. Social and emotional wellbeing

-Levels of functioning is the degree to which an individual can complete day-to-day tasks in an independent and effective manner.

-Resilience is the ability to cope with and manage change and uncertainty.

-Social well-being is the ability of an individual to form and maintain satisfying and meaningful relationships with other and adapt to different social situations.

-Emotional well-being is the ability of an individual to appropriately control and express their own emotions as well as understand the emotions of others.

Aboriginal and Torres strait island people’s (SEWB)

-Social and emotional well-being (SEWB) is a framework that includes all elements of being and therefore wellbeing for Aboriginal and Torres Strait Islander people.

-Multidimensional is made up of different component.

-Holistic is an approach to wellbeing that considers the whole person and includes their mental, physical, spiritual and social needs.

Dimension of social and emotional wellbeing framework (7-BMF CCC S)

1. Connection to body

2. connection to mind and emotions

3. connections to family and kinship

4. connections to community

5. connection to culture

6. connection to country

7. connection to spirituality and ancestors

Dimension number 1

Connection to body

Connection to body is a connection to physical body and helath in order to participate fully in all aspects of life.

e.g: MAM

• Maintain healthy weight

• Access to good nutrients.

• Manage illnesses and disability.

2. connection to mind and emotions

Connection to mind and emotions is the ability to effectively manage thoughts and feelings.

e.g: MCHM

• Maintain self-esteem

• connecting to values and motivation

• Having high levels of confidence

• Maintain strong identity

3. Connection to family and kinship

Connection to family and kinship is the connection to the immediate and wider family and groups and community.

e.g: SC

• spending time within family groups promotes connections and therefore wellbeing.

• Caring for ill is the responsibility of all, not just one’s biological parent or offspring.

4. Connectionto community

Connection to community is a connection to the wider social system, providing individuals and families to connect with and support each other.

e.g: CT

• Community service and support networks.

• The ability to maintain community connections plays anintegral role in mainatining the wellbeing of individuals.

5. Connection to culture

Conection to culture is a strong sense of identity and values and connection to the past, present an future that drives the behaviour and beliefs.

e.g: ESAP

• Elders passing on informations and traditions to the future generations.

• speak local language.

• attend culturla events

• participate in traditional rites and rituals which enables children to learn abou their culture’s values systemn.

6. Connection to country

Connection to country is the traditional land of a particular language or cultural group both geographically and spiritual, emotional and intellectual connections to and within it.

e.g: AE

• Aboriginal and TSI people beliefs are tied heavely to the land and show one live son it. one shuld and does not take more that one needs so the land continues to thirve.

• Each person belongs to certain territories within familhy adn clan groups.

7. Connection to spirituality and Ancestors

Connection to spirituality refers to a concept that connects all things, and shapes beliefs, values and behaviours. IT guides the knowledge system, culture adn all things that is life for Aboriginal people, including the connections to ancestors to the past, present and the future.

Ancestors refer to a belief that a family and community’s ancestors are interconnected with the spiritual connections and country and watch over, guide and protect family and communities in the physical and spiritual world.

e.g:

• Aboriginal and TSI people’s spirituality is grounded in the belief that their ancestors watch over them for the entirely of their life. There is a strong belief that ancestors will offer guidance when needed and answer quesitons in unique ways when least expected. this creates a sense of pupose and wellbeing.

Determinants of wellbeing for Aboriginal and Torres strait islander peoples.

• Social determinant

• Historical Determinant

• Political Determinant

Social determinant is the circumstances in which people grow, live and the systems put in place to deal with illness.

e.g:

• Socioeconomic status

• the impact of poverty

• unempoyment

• Racial discrimination

Historical determinant

Historical determinant is the ongoing influences of evetns, policies, and truama on groups of people.

e.g:

• Colonisation and its legacy

• the impact of past government policies (stolen generation)

Political determinant

political determinant are political policies that shape the process of distributing resources and power to individuals and communities, and create or reinforce social and health inequalities.

e.g:

• unresolved land issues

• control of local resources

• the rights of self-determination and soveriegnty (individuals and comunities making their own choices and managins their own lives in culturally informed ways.

8B

Mental wellbeing changes overtime depending on what an individual is experiencing in their livess. This leads to indivdiduals being placed at different points on the mental wellbeing continuum over their lifetime.

Mental wellbeing continuum is a tool used to track fluctuating mental wellbeing, ranging from high levels of wellbeing to low levels of wellbeing.

Mental wellbeing is a dynamic (constantly changing) state, an individual’s placement on the continuum is not fixed and can shift over time.

Furtheremore, high levels of mental wellbeing are characterised by optimal functionig in everyday life. As someone moves down the continuum to lower levels of mental wellbeing their everyday functioning is disrupted.

The points of the mental wellbeing continuum

• High levels of mental wellbeing

characteristics - A perosn with high levels of mental wellbeing is:

• Able to function independently within their everyday life

• Able to cope with eveyday demand without showing an exessive level of distress and dysfunction

• Still may experience stress, sadness, and anger whoever have high levels of mental wellbeing due to their ability to cope with these experiences, regulate emotions, and express them appropriately.

  example:

• Mars is a healthy teenager who balances school a job and sporting commitments. Although she feels stressed when she has a lot of SAC Mars has a strong study timetable and support system and is able to cope with these stressors effectively.

Middle of the continuum - Neither extremely high nor low levels of mental wellbeing.

an individual with moderate levels of mental wellbeing:

• is not functioning at an optimal level

• experiences a temporary or moderate impact on mental wellbeing

• experiences amplified emotions and high levelos of stress

• has difficulty concentrating

• is more liely to experience irrational thought pattenrs.

  example: Mars is approaching year 13 exams and find herself unable to sleep and cyring often because of the intense stress. However, she seeks suppport form the school counsellor and once her exams are over she does back to her noral cheerful self.

Low levels of mental wellbeing

an individual with extremely lw levels fo mental wellbeing:

• shows high levels of distress

• is unable to indepentdently complete taks andmeet the demand of theri environment

• is impacted for an extended period of time (more than two eeks in in line with adivce form mental health professionals)

• may bre diagnosed by a mental health professional and may be tread though psychotherpay or medicaitons.

• example: when Mars finishe university she experiences a number of significant life strsssors and evelops significatn anxiety. She often has panic atacks an irrational thouhta leading her to cancel lans with friends an family. Apsychlogist diagnoses ehr with an anxiety disorder and spports her with therapy and medicaiton.

Factors influencing mental wellbeing

• internal factors

• external facotrs

These factors interact to influence a person’s mental wellbeing in two ways:

1. They can contribute to the developmetn or progression of lwo levels of mental wellbeing

2. They can protect an individual form development or progression of low levels of wellbeing, instead maintaining high levels of mental wellbeing.

Internal factors

Internal factors are factors from within the individual.

• Stress

• thought patterns

• genetic predisposition

How can this maintain high levels of mental wellbeing?

A person has naturally optimistic thought pattens, they may be more likely to view difficult situations positively and thus protecttheir mental wellbeing.

How can this lead to low levels of mental wellbeing?

If a personhas a genetic predisposition (family history) to a mental health disorder, they may be more likely t develop on ethan someone wo does not have the same genetic predisposition, leading to a greater lieklihood of having low levels of mental wellbeing.

External factors

External factors are factors that arise from an individual’s environmnet.

• loss of significatn relationship

• level of education

• experience difficulty within certain environemnet such as school

• access to support services, medical

How can this maintain high levels of mental wellbeing?

A person who has adequate access to support systems, like friends, family, or professional support, will have greater access to help when needed. This will help them maintain high levels of mental wellbeing, even in difficult circumstances.

How can this lead to low levels of mental wellbeing?

The loss of a significant relationship can negatively impact mental wellbeing if not adequately addressed, which involves low levels of mental wellbeing.

Distinguishing between stress, anxiety, and phobia

To illustrate the varied lived experience of different points on the mental wellbeing continuum • stress • anxiety • specific phobia.

These psychological constructs have many similarities, and as such, it can be difficult to distinguish between them. However,

Stress

Stress is a phsycological and physciological experience that occurs when an individual encounters something of significance that demands their attention and/or effort to cope.

• stress is a normal part of life, and is not necessarily a sign of low levels of mental wellbeing.

• distress occurs, however, when an individual does not feel as though they have adequate resources to cope with a stressor. In these cases, it can lower an individual’s level of mental wellbeing.

• Stress is usually in response to a known cause, which differentiates it from anxiety

Anxiety

Both stress and anxiety are on the moderate to high part of the mental wellbeing continuum. They are similar because:

-people will experience both stress and anxiety from time to time, and it is an expected part of daily life.

-they usually don’t interrupt daily functioning and are not always a sign of low mental wellbeing.

-some stress and anxiety can be adaptive for functioning as they can motivate people to take action, such as preparing for a SAC instead of avoiding it.

However, when anxiety is excessive, persistent over a long period of time, and disrupts aspects of daily functioning, an individual may experience lower levels of mental wellbeing.

Anxiety is a psychological and physiological response that involves feelings of worry and apprehension about a perceived threat.

→It can involve cautiousness regarding a potential threat, danger, or other negative events.

• While stress can involve both positive (eustress) and negative (distress) feelings, anxiety typically only involves negative feelings (distress).

• Anxiety is broader than stress and may be due to an unknown stimulus.

• Anxiety is usually future-oriented, meaning that it involves worrying about events that may happen in the future.

Specific phobial

assciated with low mental wellbeing.

People who have a specific phobia are often aware that their level of fear and anxiety is disproportionate to the phobic stimulus, but are unable to control these feelings. This is due to the fact that the sympathetic nervous system is dominant when an individual is exposed to their phobic stimulus, which can result in physiological stress responses including:

• Increased heart rate

• rapid breathing

• increased perspiration

• dilated pupils.

specific phobia is a type of anxiety disorder that is categorised by excessive and disproportionate fear when encountering or anticipating the encounter of a perticular stimulus.

Specific phobias are associated with:

• an individual going to great lengths to avoid their phobic stimulus

• significant disruption to an individual’s daily functioning either at work, home, in their social life, or with family (American Psychiatric Association, 2013)

• Low levels of mental wellbeing when encountering or attempting to avoid the phobic stimulus

9A

specific phobia and it’s contributing factors

• Biopsychosocial approach

Biopsychosocial approeach is a holistic, interdisciplinary framework for understanding the human experience in terms of the influence of biological, pscychological and social factors.

Biological factors

Biological contributing factors, which relate to the physiology of an individual’s brain and body, may lead to the development of specific phobia.

Biological factors ar einternal, genetics and/or physiologically based factors.

e two biological factors that contribute to the development and maintenance of specific phobia:

• abnormalities in neurotransmitter function (GABA dysfunction)

• the role of long-term potentiation.c

GABA (Gamma-amino butyric acid)

GABA is the main inhibitory neurotransmitter in the human nervous system.

. It regulates postsynaptic activation in neural pathways, preventing overexcitation and uncontrolled firing. This is important in regulating the flight-or-fight-or-freeze response and anxiety, as GABA acts to slow or halt the excitatory neural impulse responsible for these reactions.

Neurotransmitter is a chemical molcule that has an effect on one or two post-synaptic neuron.

Inhibitory is when the neurotransmitter decreases the likelihood of postsynaptic neuron firing an action potential.

GABA dysfunction

GABA dysfunction involves GABA not binding properly to receptor sites

GABA dysfunction is the insufficient neural transmission or reception of GABA in the body.

This can be due to a low level or production of GABA, or an insufficient reception or transmission of GABA across the synapse. GABA dysfunction can contribute to the development of phobia because:

• GABA dysfunction may cause someone’s flight-or-fight-or-freeze or anxiety response to be activated more easily than someone with adequate GABA levels. This means that, for some people, the stress response is more easily triggered by certain stimuli.

• recurrent stress responses to specific stimuli can lead to the development of a phobia

long-term potentiation

long-term potentiation is the long-lasting and experience dependent strengthening of the synaptic connections that regularly coactivated.

This contributes to the development of phobias by strengthening the association between neural signals involved in perceiving a stimulus and neural signals involved in activating the fear response. Through their repeated coactivation, the signals involved in perceiving a phobic stimulus more readily trigger the activation of the neural signals responsible for the fear response.

Psychological factors (the CAT goes BAa)

psychological factors are internal factors relating to an individual’s mental processes including their cognition, affect, thoughts, beliefs and attitudes.

three psychological factors that contribute to the development and maintenance of specific phobia:

• precipitation by classical conditioning

• perpetuation by operant conditioning

• the role of cognitive biases, including memory bias and catastrophic thinking.

Classical conditioning

percipitation by Classical condition

Classical conditioning is a process of learning through the involuntary association between a neutral stimulus and an unconditioned stimulus that results ina conditioned response.

Percipitation factors are factors that increase the susceptibility to and contribute to occurance of developing a specific phobia.

In terms of classical conditioning, what becomes a phobic stimulus would initially be the neutral stimulus (NS). Through repeated association with an unconditioned stimulus (UCS) that naturally induces fear, the NS becomes the conditioned stimulus (CS) or phobic stimulus, producing the conditioned response (CR) or phobic response. Consequently, classical conditioning is one way in which a phobic response can be acquired

It has also been suggested by researchers and psychologists that classical conditioning can precipitate a specific phobia without repeated pairings of the neutral stimulus and unconditioned stimulus. If the experience is highly traumatic, an individual can be conditioned to experience a fear response after one pairing of the neutral stimulus and unconditioned stimulus.

operant conditioning.

perpetuating factors

operant conditioning is a three-phase learning that involve an antecedant, behaviour and a consequence, whereby the consequence of abehaviour determines the likelihood that it will reoccur again.

perpetuating factors are factors that inhibit a person’s ability to recover from a specifc phobia.

The role of operant conditioning in phobia

The role of operant conditioning in phobias can be thought about largely in terms of the consequence stage because:

• an individual with a phobia will generally avoid contact with their phobic stimulus at all costs.

• by avoiding confrontation with the phobic stimulus, a person is negatively reinforced through this avoidance in not having to deal with their fear response.

• over time, this reinforcement strengthens or maintains the phobic response, making avoidance behaviours more likely to be repeated and preventing recovery through this cycle.

Perpetuation of specific phobia by classical conditioning

Antecedent -Phobic stimulus

Behaviour -Individual avoids phobic stimulus Consequence -Individual avoids fear response Negative reinforcement Behaviour is negatively reinforced due to the avoidance of an aversive stimulus (fear response)

Cgonitive bias

Cognitive bias is a predisposition to think about and process information in a certain way.

Cognitive biases contribute to phobias because some people consider certain stimuli as particularly harmful, dangerous or scary

Memory bias

Memory bias is a type of cognitive bias caused by inaccurate and exaggerated memory.

As phobias are often caused by traumatic events, people may remember the trauma as extremely significant or harmful, and this impacts their present cognitions about related stimuli. For example, people with arachnophobia (fear of spiders) may recall the size of a spider they encountered as much bigger than it was in reality

Catastrophic thinking

Catastrophic thinking is a type of cognitive thinking in which a stimulus or event is predicted to be far worse than it already is.

A person will often imagine the worst-case scenario possible when imagining an interaction with their phobic stimulus. This contributes to phobia, making stimuli seem worthy of extreme fear and anxiety

Sociial factors

There are two social contributing factors to phobia that you will learn about in this lesson:

• specific environmental triggers

• stigma around seeking treatment.

Social factors are external factors relating to an indiviual’s interaction with other and their external environment, including their relationships and community involvement.

Specific environmental triggers

Specific environmental triggers refer to a stimulu in a person’s environement that evoke extreme stress response leading to the development of a phobia.

There are a few different types of environmental triggers, including:

Direct confrontation: Jimmy was bitten by a snake as a young child and it was a highly distressing and upsetting event. Now, as a teenager, Jimmy has an extreme fear of snakes.

Observation: Franklin saw his best friend get bitten by a snake and it was highly distressing and upsetting for Franklin to see his friend in pain. Now, Franklin has an extreme fear of snakes.

Learning/indirect confrontation: On school camp, Eve learnt that snakes are dangerous snakes and learnt about a range of venomous snakes and the eects of being bitten by a snake. Now, Eve has an extreme fear of snakes.

• direct confrontation with a traumatic stimulus or event, e.g. being bitten by a snake.

• observing another person having a direct confrontation with a traumatic stimulus or event, e.g. watching someone be threatened with a weapon.

• learning about a potentially dangerous or traumatic stimulus or event indirectly, e.g. by watching a movie about threatening motorcycle gangs or reading about the danger of snakes.

Stigma from seeking treatment

stigma is the feeling of shame or disgrace experienced by an individual for a characteristics that differenciate them from others.

9B

Evidence-based intervention for specific phobia

Biological interventions for phobias are treatments which address the physiological aspects of phobias.

• Biological intervention

  →GABA agonist (Benzodizypine )

  →Breathing retraining

• Benzodiazypine

• Agonists

Benzodiazypine is a medical treatment that depresses central nervous sytem activity and is often used as a short-acting anti-anxiety medicaiton.

Agonists is a type of drug that imitates a neurotransmitter and works to initate a neural response (exitatory or inhibitory) when it binds to a specific receptor site of a neuron.

How benzodiazepines work as GABA agonists

1. Benzodiazepines bind to a GABA receptor site on a postsynaptic neuron.

2. The benzodiazepines increase the e ectiveness of GABA when it later binds to the same receptor sites and mimics its effects.

3. GABA is able to then have its inhibitory e ect, reducing the likelihood that the neuron will fire. This acts temporarily to reduce neural communication, in turn reducing anxiety

Breathing retratining

Breathing retraining is a method used to teach reathing control techniques that may reduce physiological arousal.

The process of breathing retraining

step 1: A psychologist or doctor will teach a person with a specific phobia how to consciously control their breathing. This will include:

• slow and deep inhalations, followed by slow and controlled exhalations

• counting slowly when breathing in, and when breathing out

• breathing slowly in through the nose, and focusing on breathing out slowly from the diaphragm.

step 2:

The learner applies the breathing techniques learnt in step 1 when in the presence of a phobic stimulus. For example, by counting aloud or in their head, or imagining the therapist saying the instructions to them when in the presence of the phobic stimulus. This restores the amount of oxygen in the body to an optimal level to help the parasympathetic nervous system become dominant, in turn decreasing the dominance of the sympathetic nervous system and reducing anxiety.

psychotherapeutic treatments

Psychotherapeutic treatments are treatments that address dsyfunctional emotions, thoughts and ehaviours through therapeutic communications.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy is a form of psychotherapy that encourages individuals to substitude dysfunctional cognition adn behaviour with adaptive ones

CBT involves a cognitive and a behavioural component.

• The cognitive component involves: – identifying negative thoughts and feelings (cognitions) about the issue.

  – replacing these negative thoughts and feelings with more positive ones.

• The behavioural component involves:

  – identifying negative behaviours relating to the issue.

  – developing and maintaining more positive behaviours relating to the issue

Cognitions and behaviours that may contribute to and perpetuate specific phobia

Cognitions

• Memory bias

• Catastrophic thinking

• A belief that the phobia can never be overcome

• A belief that the phobia can only get worse • Embarrassment

• Extreme fear

Behaviours

• Avoidance behaviours in which a person avoids their phobic stimulus and anything related to it at all costs

• Not seeking help

• Avoiding social activities that may expose a person to their phobia

Systematic desensitisation

Systematic desensitisation is a therapeutic technique that is used ot overcome phobia that involves a patient being exposed incrementally to increasingly anxiety-inducing stimuli, combined with the use of relaxation technique.

The process of systematic desensitisation

Step 1: The learning of relaxation techniques. A therapist might teach a patient a technique they can apply to reduce the physiological arousal and anxiety involved in the fear response. (One technique commonly used is breathing control, such as that outlined in breathing retraining.)

2. The development of a fear hierarchy. This involves creating a list of anxietyinducing experiences relating to the patient’s phobia, listed in order of easiest to confront, to the most difficult to confront.(For a person with a phobia of bugs, a fear hierarchy may look like: 1. Reading about bugs. 2. Drawing a picture of bugs. 3. Looking at cartoon bugs. 4. Looking at photos of bugs in a book. 5. Looking at videos of bugs online. 6. Being in the same house as a bug. 7. Being in the same room as a bug. 8. Standing directly in front of a bug. 9. Directly touching a bug).

3. The gradual step-by-step exposure. The gradual step-by-step exposure to each item of the fear hierarchy, beginning with the least anxietyinducing stimulus, paired with practice of the learnt relaxation techniques with each new exposure. (Each exposure to a step in the fear hierarchy is done in a controlled manner, with the use of relaxation techniques at each step. The patient does not move on to the next item in their fear hierarchy until the fear response is eliminated at each level.)

4. The continuation of this systematic exposure. The continuation of this exposure to items on the fear hierarchy until the most fear-inducing stimulus can be faced without producing the phobic response. (This process is often done with a therapist. At the end of this stage, a patient can confront their most fear-inducing stimulus without a fear response.)

Psychoedocation

involves teaching families and supporters of individuals with emtnal health disorder how to better understand, deal with and treat theri disorders.

There are two important components of psychoeducation that are taught to families and supporters:

• challenging unrealistic or anxious thoughts of the individual, and

• not encouraging avoidance behaviours.

Challenging unrealistic or anxious thoughts:

a person with a phobia often has unrealistic and anxious thoughts about their phobic stimulus. This can present in the form of extreme anxiety, catastrophic thinking, and memory biases. Family and supporters are encouraged to actively challenge these thoughts in order to help a person with a specific phobia to understand that some cognitive components of their fears are potentially unfounded and irrational. This should be done in a supportive, non-judgemental fashion. Like in CBT, this can help the person with a phobia begin to recognise their dysfunctional thoughts.

Not encouraging avoidance behaviours:

Phobias cannot be solved through avoidance behaviours. While avoidance coping strategies might be useful for relieving less severe forms of stress, they do not provide long-term solutions for phobias. This is because phobias involve a deeply ingrained fear response that cannot be eliminated entirely with temporary fixes. As such, families and supporters are taught that they should not encourage avoidance behaviours, as they do not solve and only perpetuate the phobic anxiety.