VCE Psychology Unit 4 Aos 2

What does mental wellbeing involve?

* Our state of mind
* Our enjoyment of life
* Our ability to cope with the stresses of everyday life
* Developing to our potential

Common characteristics of a mentally healthy person

* High levels of functioning
* Social and emotional wellbeing
* Resilience to life stressors

Functioning

Refers to how well an individual independently performs in their environment

What does functioning correspond to?

How well a person is meeting the challenges of living across a range of areas such as…

* Daily living skills
* Interpersonal relationships
* Emotions
* Cognitive skills
* School and work settings
* Recreational activities

Adaptive behaviour

Involves actions that enable a person to carry out their usual everyday tasks

Maladaptive (or dysfunctional) behaviour

Interferes with a person’s ability to carry out their usual activities in an effective way

Resilience

The ability to cope with and adapt well to life stressors and restore positive functioning

The seven SEWB domains

* Body
* Mind and emotions
* Family and kinship
* Community
* Culture
* Country
* Spirituality and ancestors

Connection to body

Physical health - feeling strong and healthy and able to physically participate as fully as possible in life

Connection to mind and emotions

Mental health - ability to manage thoughts and feelings

*  The ability to process, perceive and value the land and community

Connection to family and kinship

Connections to family and kinship systems are central to the functioning of Aboriginal and Torres Strait Islander societies

Connection to community

Community can take many forms. A connection to community provides opportunities for individuals and families to connect with each other, support each other and work together

Connection to culture

Connection to a culture provides a sense of continuity with the past and helps underpin a strong identity

* The past, present and future ways in which First Nations peoples have coexisted with the land, animals and each other (also embodies a larger spiritual element)

Connection to Country

Connection to Country helps underpin identity and a sense of belonging

Connection to spirituality and ancestors

Spirituality provides a sense of purpose and meaning

SEWB determinants

* Social
* Historical
* Political determinants

WHO definition of mental health

Mental health is a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community

Mental health problem

Problems that cause emotional, cognitive and behavioural difficulties that affect relationships and functioning in everyday life

Mental disorder

Mental health state that involves a combination of thoughts, feelings and/or behaviours which are usually associated with significant personal distress and impair the ability to function effectively in everyday life

What 3 things do mental disorders often lead a person to experience?

* Distress
* Dysfunction
* Deviance

Distress (mental disorder)

Unpleasant or upsetting emotions such as sadness, anxiety or feeling overwhelmed

Dysfunction (mental disorder)

The condition negatively impacts the person’s ability to complete daily activities and cope with everyday life

Deviance (mental disorder)

Thoughts and behaviours that are inconsistent with the person’s culture or society, including actions such as lashing out at others at socially withdrawing

Internal factors

Originate inside or within a person

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* Biological factors
* Psychological factors

External factors

Originate outside a person

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* Sociocultural factors

Biopsychosocial framework

An approach to describing how biological, psychological and social/cultural factors combine and interact to influence a person’s physical and mental health

* Reflects a holistic view of health

Risk factors

Increase the likelihood of a person either suffering from a mental disorder or experiencing a relapse

4P Factor Model

Describes four types of influences that can contribute to the development and progression of mental health disorders

Predisposing risk factors

Increase susceptibility to a specific mental disorder

Precipitating risk factors

Increase susceptibility to, and contribute to, the occurrence of a specific mental disorder

Perpetuating risk factors

Maintain the occurrence of a specific mental disorder and inhibit recovery

Protective factors

Reduce or prevent the occurrence or reoccurrence of a mental disorder

Biological risk factors

A range of factors that relate to the physiological functioning of the body

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Include…

* Genetic vulnerability
* Poor response to medication
* Poor sleep
* Substance use

Genetic vulnerability

Also referred to as genetic predisposition, genetic vulnerability is an increased likelihood that a person will develop a particular illness/disorder due to the DNA that they carry

Poor response to medication

Means having little to no reduction in the number or severity of symptoms despite taking medication as prescribed

Substance abuse

Refers to the harmful use of, or dependence on, psychoactive substances including alcohol or illicit drugs

Psychological risk factors

A range of factors that relate to the functioning of the brain and mind, including cognitive and affective processes such as thought patterns and memory

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Include…

* Personality
* Thoughts
* Feelings
* Behaviours

Rumination

Refers to obsessive thinking and worrying about the negative aspects of a past, present or future situation

Impaired reasoning and memory

Where a person’s own subjective reality results on difficulty with thinking logically, and accurately processing and recalling information

Self-efficacy

Relates to a person’s confidence that they can complete life tasks and meet their goals

Social risk factors

A range of factors that relate to a person’s social environment influence the development of mental disorders

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Include…

* Disorganised attachment
* Loss of a significant relationship
* Stigma as a barrier for accessing treatment

Attachment (social risk factor)

Refers to the emotional bond which form between an infant and another person (usually primary caregiver)

Disorganised attachment

Occurs when the infant or young child does not receive consistent care or emotional support from a primary caregiver early in life

Stigma (social risk factor)

A mark of shame, disgrace or disapproval typically associated with a particular characteristic or attribute that sets a person apart

Cumulative risk

Refers to the combined risks or factors that may interact with each other to cause a mental disorder

Additive model

As the number of risk factors increases, there is a corresponding increase in the likelihood of developing a mental disorder

Stress

Stress is a state of mental or emotional and physiological tension resulting from factors that are perceived to challenge or threaten our ability to cope

* A psychobiological response produced by internal and external stressors

Anxiety

An emotion akin to worrying and uneasiness that something is wrong or something bad is going to happen and is usually accompanied by physiological signs

Anxiety disorder

A group of disorders characterised by chronic feelings of anxiety, distress, nervousness, apprehension fear about the future, with a negative effect. It interferes with someone’s daily life and stops them doing from what they want to do

Phobia

An anxiety disorder characterised by a marked and persistent, intense, irrational fear or anxiety about a specific object, activity or situation

Phobic stimulus

The specific object or situation producing the fear associated with a phobia

* Causes acute physiological arousal

Panic attack

Sympathetic arousal

* Intense anxiety, dizziness, short of breath, tight chest, disorientation, feeling of no control

Anticipatory anxiety

A form of anxiety that can occur if a person with a specific phobia thinks about encountering their phobic stimulus in the future

How to answer question: Identifying and applying internal and external factors that influence mental wellbeing

* State the category the factor belongs to (internal or external) and then list the chosen examples
* Clearly provide examples from the scenario that back up the example (can use quotation marks if desired)
* Make a link from the example to the impact on mental wellbeing

Requirements for a diagnosis of specific phobia, symptoms must…

* Be present for more than 6 months
* Disrupt the person’s life, especially work and social relationships
* Cause them serious distress

Types of specific phobia

* Animal
* Situation
* Blood-injection-injury
* Natural environmental
* Other

Biological contributing factors (specific phobia)

Internal physiologically based or determined factors

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Include…

* Gamma-amino butyric acid (GABA) dysfunction
* Role of the stress response
* Impact of long-term potentiation

Gamma-amino butyric acid (GABA)

Is the primary inhibitory neurotransmitter in the central nervous system

* Makes the postsynaptic neuron less likely to fire
* Produces a calming effect, reduces feelings of anxiety, stress and fear

Glutamate

Is the primary excitatory neurotransmitter in the central nervous system

* 2nd most common neurotransmitter in the brain
* Makes postsynaptic neurons more likely to pass on the neural impulse

Dysfunctional GABA system

A failure to produce, release or receive the correct amount of gamma-amino butyric acid

* More vulnerable to anxiety or specific phobia

Long-term potentiation

The relatively permanent strengthening of synaptic connections as a result of repeated activation of the neural pathway

Process of long-term potentiation (phobia)

The more the connection is activated when the phobic stimulus is encountered → the more the connection is strengthened → the more the relevant pathway is strengthened → increased efficiency in transferring fear information along the pathway → decreased likelihood learning will be forgotten

Psychological contributing factors (specific phobia)

Refers to our thoughts, beliefs and perception about ourselves, our experiences and our environment

Two theoretical approaches to explaining specific phobia

* The Behavioural Model
* The Cognitive Model

The Behavioural Model

Phobias are learned through experience and may be acquired, maintained or modified by environmental consequences, such as reinforcement and punishment

* Emphasises the role of learning and experience
* Learned (precipitated) through classical conditioning
* Maintained (perpetuated) through operant conditioning

Precipitation of specific phobia through classical conditioning

A stimulus with no particular significance becomes, by association, a sign of impending threat or danger

* Fear conditioning can occur after only a single pairing if the UCS is sufficiently intense or traumatic

Perpetuation of specific phobia through operant conditioning

Avoidance of the phobic stimulus acts as a negative reinforcer, as the removal of anxiety (negative stimulus) strengthens/increases the likelihood of the avoidance behaviour being repeated

The Cognitive Model

Emphasises the role of memory bias and other distorted ways of thinking on how we behave

Key assumption

People with phobias have a cognitive bias

Cognitive bias

A systematic error in thinking that affects the decisions and judgments that people make

Memory bias

Distorting influence of present knowledge, beliefs and feelings on the recollection of previous experiences

* Memories often reconstructed to be worse than the actual event

Catastrophic thinking

A thinking style which involves overestimating, exaggerating or magnifying an object, activity or situation and predicting the worst possible outcome

* Involves rumination about the perceived threat

Social contributing factors (specific phobia)

Social and cultural factors can contribute to the type and incidence of specific phobia

* Can occur through direct exposure to a distressing or traumatic event

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Include…

* A specific environmental trigger
* Stigma around seeking treatment

Specific environmental trigger

Direct, negative and traumatic experience involving the phobic stimulus

* Precipitating factor

Avoidance behaviour

Intentionally behaving in ways that prevent or minimise contact with the phobic stimulus and avoiding situations in which the phobic stimulus might appear 

* Perpetuating factor

Social stigma

Refers to the negative attitudes and beliefs held in the wider community that lead people to fear, exclude, avoid or unfairly discriminate against people with a mental health problem or disorder

Self-stigma

Occurs when an individual accepts the negative views and reactions of others, internalises them, and applies them to themselves

Impacts of stigma

* Low self-esteem
* Low self-efficacy
* Can inhibit people from seeing a mental health professional for assessment and diagnosis
* Less likely to accept help
* More likely to go untreated for years

Evidence-based interventions

Treatments that have been found to be effective on the basis of valid and reliable research studies

What do evidence-based interventions do

* Maximise the chance of benefit
* Minimise the risk of harm
* Deliver treatment at an acceptable cost

Biological interventions

Target physiological mechanisms believed to be contributing to a specific phobia or its symptoms

* Benzodiazepines → Can minimise the onset/severity of symptoms
* Breathing retraining → Can help manage symptoms

Benzodiazepines

A class of sedatives or depressants which are a type of agonist drug that work on the central nervous system to make the post synaptic neuron less likely to fire

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Examples…

* Valiam
* Xanax
* Rohypnol
* Serepax

How do benzodiazepines work?

They are GABA agonists - mimic the activity of GABA by inhibiting post synaptic neural activity

* When a benzodiazepine binds to a GABA receptor site, it increases the inhibitory effects of GABA
* Makes the post-synaptic neuron less likely to fire
* Slows down CNS acitivity
* Reduces feelings of anxiety

Agonists

Mimic or enhance the action of a neurotransmitter

Antagonists

Inhibit the activity of a neurotransmitter

Short-acting

Means the benzodiazepine remains in the bloodstream and is cleared from the body in a short period of time

Example…

* Temazepam reach a peak after 2-3 hours and ceases to be effective after 6-8 hours

Long-acting

The benzodiazepine may accumulate in the bloodstream or take a longer period of time to leave the body

Example…

* Diazepam effects peak after 30-90 minutes and the drug remains in the bloodstream for up to three days

Amount of GABA in people with specific phobia

A study showed that anxiety disorder sufferers have 22% less GABA than healthy individuals

Benzodiazepines benefits

* Highly effective in reducing anxiety
* Few side-effects in the short term

Benzodiazepines limitations

* They treat the symptoms and not the cause of anxiety
* Medication alone is usually not sufficient

Consequences of long term use…

* Reduction in alertness
* Reduction in concentration and reaction time
* Addiction

Hyperventilation

Taking rapid, small shallow breaths

* Can result in oxygen and carbon dioxide imbalances in the blood
* Carbon dioxide levels can become low

Effects of hyperventilation

* Dizziness
* Palpitations
* Tingling in the fingers or body
* Pressure or tightness in the chest

Breathing retraining

An anxiety-management technique that involves teaching correct breathing habits to people with specific phobias

Psychological interventions

Aim to ‘unlearn’ the response to a stimulus

* Cognitive behavioural therapy (CBT)
* Systematic desensitisation

Cognitive behavioural therapy (CBT)

An intervention comprising of a range of cognitive and behavioural therapies and learning principles to help people identify, challenge and change unhelpful thought processes, feelings and behaviours to ones that are more helpful

Includes…

* Cognitive therapy
* Behavioural therapy

What CBT assumes

The way a person thinks about an object or situation influences the way they feel about it, and thus the way they behave in response to it

CBT duration

Usually requires weekly sessions of 30-60 minutes over 12-20 weeks

Cognitive therapy

Thinking therapy, aims to address the problems in cognition that contribute to negative emotions and behaviours

* Identify anxiety related thoughts and cognitive biases
* Look at evidence that supports/rejects these biases
* Switch from unhelpful, irrational thoughts to evidence-based, rational thoughts

Behavioural therapy

Application of classical, operant and observational learning to address maladaptive behavioural aspects of a disorder

* Aims to retrain the person so that good behaviours become automatic

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Examples…

* Relaxation techniques
* Breathing retraining
* Promoting exercise
* Encouraging rewarding, pleasant activities

Systematic desensitisation

Involves progressively introducing a person to their phobic stimulus while using relaxation techniques until their fear is replaced by a relation response