WK 2 - Factors that influence assessment and intervention

What gets in the way of applying the criteria?

• Religion, politics, age

• People present with symptoms corresponding to multiple mental health condition

• There is substantial heterogeneity within a single diagnostic criteria - people can have the same disorder but the presentation can be very different

• There are multiple pathways to the same condition

Co-morbidity

symptoms are prevalent in multiple disorders for a patient but it does not mean the individual has all of these disorders

Differential diagnosis

• Different things that would make each of these conditions more or less likely:

  • Example of ADHD and PTSD

• ADHD -> traits need to be present during the developmental period eg before age 12

• PTSD -> symptoms need to follow experiencing, witnessing or hearing about details of a traumatic event

Sometimes things can look very similar and this is where

clinical judgement comes in

GAD and major depressive disorder are the two disorders that have

the lowest clinical agreement on diagnosis despite being the most common disorders

systematic review and meta-analysis (Jacob et al., 2021) found individuals with a depressive disorder were approximately

12 times more likely to also meet the criteria for an anxiety disorder than those without depression

This comorbidity is associated with worse clinical outcomes:

• Higher symptom severity

• Higher functional impairment

• Lower quality of life

• Lower treatment response

A lot of research will only allow them to participate if they only have one disorder and do not present symptoms of another disorder so…

there is less research and treatment for people who present symptoms across multiple disorders

Usually assess using biopsychosocial understanding

• Biological factors interact with sociocultural influences and individual characteristics

• Reinforced in their everyday life

Without biopsychosocial understanding we target the risk of

not getting to the root of the problem if not getting at why they continue to experience the problem

Biological causes

• no physical test to diagnose

• genetics, hormones etc.

• increase susceptibility

Psychological causes

• temprement, personality, cognitive style, core beliefs

Social determinants

Conditions in the environment where individuals live, work etc. and these have a big influence on wellbeing

Socioeconomic status is one of the most established…

predictors due to unstable living environments and financial instability

What can we achieve as psychologists?

• Psychologists can provide influence to have a shift occur without being directly the reason that it occurs

Therapy factors

• Converse to risk factors with client population, there are also protective factors:

  • Building resilience and strong self-concept

Behavioural activation

This is a general thereaputic strategy and used in a lot of circumstances

People have to have a level of stability to be able to receive treatment from a psychologist so

they have to be on a certain level on the heirarchy of needs

Stages of change:

precontemplation, contemplation, preparation, action, maintenance, termination (the behaviour becomes a permanent part of their life so no relapsing)

Which stage of change does therapy occur at?

contemplation stage, easier for psychologist at action stage

Building discrepancy and rolling with resistance - clients need to recognise they need to…

change themselves - you cant instruct them and impose change upon them, you create an environment which allows change to occur

How can psychologists help with change?

can increase conflience in clients ability to change. If we are able to shift into preparations stage then we focus on goal setting

What can we do when people aren’t ready

• People are ethically allowed to decide they no longer want to continue with therapy even when you can see improvement

• You cant chase them down but can aim to stay in contact a little bit