mental wellbeing

levels of functioning

an individual’s ability to complete day-to-day tasks in an independent and effective manner.

resilience

the ability to successfully cope with, and adapt to, adversity and restore positive functioning.

emotional wellbeing

the ability for an individual to appropriately control and express their own emotions in an adaptive way, as well as understand the emotions of others.

social wellbeing

the ability for an individual to form bonds with others and maintain positive relationships.

SEWB model definition

SEWB Model: situates mental wellbeing with a broader, holistic framework that recognised the importance of culture and history as factors that influence wellbeing and reflects the understandings and specific needs of Aboriginal and Torres Strait Islander peoples.

o   It is multidimensional – meaning that it is made up of different components

o   It is holistic – which reflects an approach to wellbeing that considers the whole person, including their mental, physical, spiritual and social needs

7 domains of SEWB

1. connection to body:

-          Physical health

-          Nutrition and healthy lifestyle

-          “Body is a vessel” à connects to spirit

2. connection to mind and emotions:

-          Psychological state

-          To sit and be at peace with thoughts

3. connection to family and kinship:

-          Much grander concept

-          Collectivist approach

-          Not just nuclear family, but connection though respect and endearment, reward and war.

4. connection to community:

-          Could be geography, heritage, generalised

-          Each just as valid and important

5. connection to culture:

-          Language and lore à based on ancient principles or respect and understanding

-          Song and dance

6. connection to Country:

-          Land and environment e.g., beach, dirt, gardens, etc.

7. connection to spirituality and ancestors:

-          Set of beliefs and principles that people follow

-          All as valid as each other

wellbeing

a state in which an individual is mentally, physically and socially healthy and secure

mental wellbeing

an individuals’ current state of mind, including their ability to think, process information, and regulate emotions.

mental wellbeing continuum

involves the progression of levels of mental health. This ranges from an individual being mentally healthy, to having a mental health problem, and finally, to having a mental health disorder.

-        Our mental wellbeing is not static, rather it constantly fluctuates over time. This leads to individuals being placed on different points on the mental health continuum over their lifetime.

A tool used to track the progression and fluctuation of mental wellbeing. It includes a range from high levels of mental wellbeing to low levels of mental wellbeing. Every individual is placed at different points on this continuum at certain times

high levels of mental wellbeing definition + characteristics (HAADMA)

High levels of mental wellbeing – the current state of a person’s psychological wellbeing and functioning who is functioning at a satisfactory level

The characteristics of a mentally healthy person are:

·       High levels of functioning

·       Able to cope with stress

·       Able to meet the demands of everyday life and be productive

·       Displays resilience

·       Maintains positive relationships with others

·       Able to regulate emotions and express them appropriately

moderate (ddd) levels of mental wellbeing definition + characteristics (DENT)

involve a degree of disturbance or dysfunction within an individual which reduces their ability to function at an optimal level. (less profound than low levels of mw and is temporary)

characteristics

1. Difficulty concentrating and experiencing irrational thought patterns

2. Experiencing amplified emotions and high levels of stress

3. Not functioning at an optimal level

4. Temporary impact on mental wellbeing

low levels of mental wellbeing definition + characteristics (BUS)

cause severe and profound disturbances to an individual’s ability to function.

characteristics

1. Being unable to independently complete tasks

2. Unable to meet the demands of their environment.

3. Showing high levels of distress

internal factors

are influences that originate inside or within a person.

• they have a profound impact on an individual’s particular placement on the mental wellbeing continuum at different stages of their life.

• these can come from biological or psychological factors:

biological factors

involve physiologically determined influences, often not under our control, such as;

• the genes we inherit

• gender

• balances or imbalances in specific neurotransmitters,

• hormonal activities

psychological factors

involve all those influences associated with mental processes such as;

• our thoughts and ways of thinking

• beliefs and attitudes

• our skills in interacting with others

• perceptions of ourselves, others and our external environment

• how we learn, make decisions, solve problems, understand

• experience emotions and respond to stress

external factors

are influences that originate outside a person. these are directly linked to an individuals environment.

• these, too, are in a constant state of change as our environment changes.

• these can impact where an individual places on the mental health continuum, both positively and negatively:

·       Difficulties in certain environments (such as work or school)

·       Exposure to stressors

·       Loss of significant relationship

·       Level of education

stress

A state of physiological or psychological tension triggered by a stimulus that exceeds the ability to cope. Can include both eustress and distress.

anxiety

A state of heightened physiological arousal that is associated with feelings of worry or uneasiness that something is wrong or something unpleasant is about to happen. Distress.

phobia

a subset of anxiety disorders. In this regard, people with diagnosed phobia have amplified anxiety responses. Specific phobia is a further subset of phobias

specific phobia

excessive, distressing, and persistent fear or anxiety in response to a specific object or situation. It is intense, irrational and disproportionate/unreasonable.

key differences between stress, anxiety, and specific phobia

biological contributing factors

factors which might lead to the development of a phobia because of a physiological factor in an individual’s brain or body

1. GABA dysfunction

2. long term potentiation

GABA

the main inhibitory neurotransmitter in the nervous system (tells the neurons to stop firing)

GABA dysfunction

the insufficient neural transmission of GABA due to low level or production of GABA, or an insufficient reception or transmission of it across the synapse.

-       Regulates postsynaptic activation in the neural pathways, preventing over-excitation and uncontrolled firing

-       GABA acts to slow or halt the excitatory neural transmission responsible for these reactions

-       Important in regulating the flight-fight-freeze response and anxiety

• This can cause someone’s fight-flight-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 in response to certain stimuli. Recurrent stress responses to specific stimuli can lead to the development of phobia.

long term potentiation + process

a form of neural plasticity that causes a strengthening of neural connections that are repeatedly used (electrically stimulated).

1. Strengthened neural connections between neurons (where it is believed memories are stored)

2. Increased dendritic branching (increasing connections between neurons)

3. Increased levels of neurotransmitters and speed of processing of neural information (between neurons).

LTP and phobias

-       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 neural signals responsible for the fear response.

-       When an individual experiences fear, the amygdala will mediate emotionality and intensity of the fear, and the hippocampus will consolidate the event.

-       The more terrifying the event, the more vivid the memory due to the level of activity in the amygdala.  The amygdala adds emotional content to memory.

The more times the fear pathway in the brain is activated via exposure to the phobic stimulus, the more the neural pathway is strengthened.

psychological contributing factors

thoughts and mental processes that lead to the development of specific phobia

1. classical conditioning

2. operant conditioning

3. cognitive biases

precipitating risk factor

something that increases the susceptibility to mental illness and contributes to the occurrence of developing a mental health disorder. (Classical Conditioning)

classical conditioning - precipitating (how an association is learn)

Precipitating Factor

•       NS ----> no automatic response

•       UCS -----> UCR

•       CS -----> CR

perpetuating risk factor

something that inhibits a person’s ability to recover from a mental health disorder. (Operant Conditioning)

operant conditioning - perpetuating (why a phobic response continues)

A three-phase (antecedent, behaviour, consequence) model of learning where behaviours are modified by their consequences.

negative reinforcement

where a behavior is strengthened by the removal of an unpleasant stimuli

cognitive biases

a predisposition to think about and process information in a certain way. This can bias or cause errors in people’s judgements and thoughts. These contribute to phobias because some people consider certain stimuli as particularly harmful, dangerous or scary.

1. memory bias

2. catastrophic thinking

1) memory bias

a kind of cognitive bias caused by inaccurate or 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.

-          May include reconstruction - past experiences / memories are distorted to fit in with updated / current beliefs about the event or experience.

2) catastrophic thinking

kind of cognitive bias in which a stimulus or event is predicted to be far worse than it is.

-          A person will often imagine/ over-emphasise 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.

-          As a result, the person grossly underestimates their coping capacity.

social contributing factors

factors which involve some sort of interaction with other people or the environment.

1. specific environmental triggers

2. stigma around seeking treatment

specific environmental triggers and types (3)

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

Types:

• Direct confrontation with traumatic stimulus or event

• Observing another person having a direct confrontation with a traumatic stimulus or event

• Learning about a potentially dangerous or traumatic stimulus or event indirectly

stigma

the negative perceptions, attitudes, and beliefs that individuals or groups hold towards others based on a particular attribute or characteristic, often leading to prejudice and discrimination

stigma around seeking treatment

the sense of shame a person might feel about getting professional help for their phobia.

-          They might feel as though their phobia is too embarrassing or insignificant to seek professional help, or as though they are unusual and isolated from society in some way for doing so.

-          This is particularly prevalent for individuals with specific phobias of everyday items such as balloons, pens etc. as sharing their fear / concern can lead to ridicule and demeaning comments from trusted individuals.

- As phobias are based on at least somewhat irrational fears, seeking help can be difficult

evidence based interventions

are those that have been found effective based on valid and reliable research studies.  

• Using evidence-based interventions maximises the chance of benefit and minimises the risk of harm.

biological interventions

treatments which involve acting on the physiological elements of phobias

1. benzodiazepine agents

2. breathing retaining

agonist vs antagonist

Agonist: a molecule that mimics the effect of a neurotransmitter.

Antagonist: a molecule that opposes the effect of a neurotransmitter.

benzodiazepines + process

a type of short acting, anti-anxiety medication that act in response to control the over-excitation of neural pathways that are characteristic in a phobic fear response.

-          Drugs that mimic neurotransmitter by binding to and activating the receptor site of a neuron are called agonists.

-          Benzodiazepines are agonists because when they bind to a GABA receptor site, they increase the efficiency of the inhibitory effects of GABA.

-          By inducing inhibitory responses, the rapid excitatory communication between neurons in the fear response is reduced, relieving the anxiety it causes.

-          The ability of agonists to bind to a receptor site of a neurotransmitter depends on the mechanisms of the lock-and-key process. (Here the agonist acts as the ‘key’, with the same molecular structure as a neurotransmitter, and works to bind to the same ‘lock’ or receptor site as a neurotransmitter would)

Process

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

2. The benzodiazepines increase the effectiveness of GABA when it later binds to the same receptor sites

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

breathing retaining + steps

a method used to teach someone with a specific phobia how to control their breathing when in the presence of their phobic stimulus.

-          When they encounter their phobic stimulus, they often experience fast, shallow breathing. This can lead to hyperventilation, the engagement of other sympathetic nervous system responses, and thus, increased anxiety.

•       Breathing retraining helps to reduce and control their physiological response to their phobic stimulus and therefore alleviate the symptoms of anxiety.

•       Slow regular breathing lowers arousal levels and promotes relaxation and inhibits the fight-flight response

Steps:

1. Slow and deep inhalations, followed by slow and controlled exhalations

2. Counting slowly when breathing in, and on breathing out

3. Breathing slowly in through the nose and focusing on breathing out slowly from the diaphragm.

4. Participant may count aloud or in their head

psychological interventions

address the cognitive and mental processes which contribute to phobias

1. cognitive behaviour therapy (CBT)

2. systematic desensitisation

cognitive therapy vs behavioural therapy

Cognitive therapy – thinking therapy, aims to address the problems in cognition that contribute to negative emotions and behaviours

Behavioural therapy – application of classical, operant and observational learning to address behavioural aspects of a disorder

cognitive behavioural therapy (CBT)

A method used to help someone replace their unhealthy thoughts (cognitions) and behaviours with more healthy ones.

-       Once a person understands the interrelationship between unhealthy behaviours and cognitions, a therapist will work with them to develop strategies to overcome them.

This involves identifying both thoughts and behaviours that are healthier, which could potentially replace the unhealthy ones.

system desensitisation

A therapy technique used to overcome phobia involving a patient being exposed incrementally to increasingly anxiety-inducing stimuli, combined with the use of relaxation techniques.

• Gradual exposure to the phobic stimulus with the aim of replacing the phobic response with a relaxation response

system desensitisation process (RHPM)

1. Learn relaxation techniques (such as breathing retraining)

2. Development of a fear hierarchy, ranking anxiety inducing experiences related to the patient’s phobia from easiest to confront, to most difficult to confront

3. Graduated pairing of items in hierarchy with relaxation working upwards through hierarchy. A gradual step-by step exposure to each item on the hierarchy, beginning with the least anxiety inducing stimulus, paired with practise of the learned relaxation techniques

4. Continue until person is able to master the most anxiety producing situation in the hierarchy. Continuation of this systematic exposure until the most fear inducing stimulus can be faced without producing the phobic response.

social interventions

act to address the social and interactional causes of phobias

1. psychoeducation for families and supporters

psychoeducation for families and supporters

Phobias that are developed via environmental triggers or maintained via stigma can be managed through psychoeducation.

• this involves teaching families and supporters about the ways to manage and deal with a person’s phobia. It also involves providing a more general education about the nature of phobia to increase families’ and supporters’ understanding of the mental health disorder

1. challenging unrealistic or anxious thoughts

2. not encouraging avoidant behaviours

challenging unrealistic or anxious thoughts

• a person with a phobia often has unrealistic and anxious thoughts about their phobic stimulus.

• Family and supporters are encouraged to actively challenge these thoughts in order to help a person with a phobia to understand the fears 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 unhealthy thoughts.

not encouraging avoidant behaviours

• Phobias cannot be solved through avoidant behaviours. -

• These coping strategies may be helpful for lessening stress; however, they don’t provide long term solutions. This is because phobias involve a deeply ingrained fear response that cannot be eliminated with temporary fixes.

• Families and supporters are taught that they should not encourage avoidant behaviours, as they do not solve the phobia, they only perpetuate it.

protective factors

influences that enable an individual to promote and maintain high levels of mental wellbeing. They work by:

-       Reducing the risk of low levels of mental wellbeing or develop a mental disorder

-       Increasing the likelihood of high levels of mental wellbeing

biological protective factors

influence that stem from an individual’s brain and / or body that can maintain or promote mental wellbeing

1. adequate nutrition and hydration

2. adequate sleep

adequate nutrition and hydration

when the type and amount of food and drink that individual consumes meet their physical needs

• Balanced diet provides energy promoting growth and development and is important for optimal brain function

• A healthy lifestyle lets people feel better, fitter, and more able to cope with challenges

• It is recommended 2-3 litres of water a day

• Do not rely on drugs, alcohol or cigarettes to cope with mental health problems

sleep

a regular and naturally occurring altered state of consciousness that involves a loss of awareness and disengagement with internal and external stimuli.

adequate sleep

• Poor sleep/chronic sleep deprivation contributes to negative thinking, anxiety & emotional vulnerability.

• Resilience improves when an individual has enough sleep, because they are able to deal with adversity and challenges better.

• Adequate sleep is vital as a restorative process to prepare the body for the rigours of day-to-day life.

While you sleep your brain:

-       Makes decisions

-       Creates and consolidates memories

-       Makes creative connections

-       Clears out toxins

-       Learns and remembers how to perform physical tasks

psychological protective factors

influences that relate to mental processes that can maintain and promote mental wellbeing.

1. cognitive behavioural strategies

2. mindfulness meditation

cognitive behavioural strategies

• CBT uses psychological techniques to help maintain or improve mental health

• Focus on the interaction between thoughts, feelings and behaviours.

• CBT includes mindfulness-based therapies – teaching people to observe and change their connection to maladaptive thoughts and emotions.

• Requires them to deliberately focus their attention on the present experience in a non-judgemental manner through meditation and other mindfulness practices.

• Be taught stress management strategies like relaxation and meditation as well as coping strategies for everyday hassles and life events to promote resilience (overcome difficulties rather than avoid them). Resilience is the ability to demonstrate positive adjustments to negative life events

mindfulness meditation

the practice of meditation in which an individual focuses on their present experience to promote feelings of calm and peace.

• Paying specific attention to the present moment, including current feelings, thoughts, and surroundings.

• Observe their present experience with kindness and without judgement

Mindfulness meditation can be used to:

-       Improve emotional reactivity

-       Reduce the likelihood of rumination

-       Reduce stress

-    Improve memory

social protective factors

to influences that exist in an individual’s social environment that can maintain and promote mental wellbeing.

1. social support

social support

he resources other people provide, such as the message that one is loved, cared for and connected to other people. It is important that support is authentic and energising.

-       Social support can come from family members, friends, co-workers and neighbours

-   Strong social support with the opportunity for emotional disclosure decreases a person’s vulnerability to stress and increase their ability to cope.

-      Social support reduces loneliness and isolation which reduces the likelihood of developing maladaptive behaviours

types of social support

1. Emotional support - understanding and encouragement

2. Tangible support - food, shelter, money

3. Informational support - sharing knowledge or direction from those who have the knowledge

4. Appraisal support - help with coping options

culture determinants

Determinants of wellbeing: factors that influence wellbeing on individual and community levels. E.g. physical environment, economic factors or culture.

Culture: typically refers to the characteristics and knowledge of a particular group, and may encompass language, social habits, music, religion, food and more.

cultural continuality

the passing down and active practice of cultural knowledge, traditions, and values from generation to generation.

self-determination

the rights of all peoples to pursue freely their economic, social, and cultural development without outside interference (for example, without the government of a country making it illegal to perform certain cultural practices).