Psychological Problems Notes

Psychological Problems

Mental Health

Key Objectives

• Describe the main characteristics of mental health.
• Explain cultural variations in beliefs about mental health problems.
• Describe how mental health is linked to the increased challenges of modern living.
• Describe how society is challenging the stigma related to mental health problems.

Characteristics of Mental Health

• Inability to cope with everyday life can prevent people from functioning adequately.
• Distress causing an inability to function properly (e.g., work, relationships) can be viewed as a mental health problem.
• Ideal mental health consists of:
  • A positive attitude towards oneself.
  • Personal growth and development (self-actualization).
  • Feelings of independence (autonomy).
  • Resisting stress.
  • An accurate perception of reality.
  • Being able to cope with life and the changing environment (environmental mastery).
• Absence of these factors often leads to mental health problems.

Cultural Variations in Beliefs About Mental Health Problems

• Social norms are unwritten rules that people are expected to abide by, including:
  • Appropriate public behavior.
  • Control of aggression.
  • Politeness.
  • Control of culturally and socially offensive language.
• Social norms change between cultures and over time.
• Mental illness perceptions vary across cultures and historical periods.
  • Example: Homosexuality was once considered a mental illness.
• Some cultures may view hearing voices as divine or spiritual communication.
• Governments have been known to label political opponents as mentally ill.
• Behaviors considered abnormal in some cultures may not be in others (e.g., public nudity).
• Ideal mental health includes positive engagement with society and coping effectively with challenges.

Increased Challenges of Modern Living

• Modern society has led to geographical isolation from family and emotional support networks, increasing loneliness.
• The increase in people living alone has led to a rise in disorders such as depression and anxiety.
• Increased use of technology and the internet has been suggested as a cause for higher levels of mental health problems, although there is little evidence to support this view.
• Increased pressure at work and school has also been blamed for the rise of disorders such as depression and anxiety.
• Modern society increases loneliness and feelings of emotional isolation.

Increased Recognition of the Nature of Mental Health Problems

• Greater emphasis on normalizing mental health issues in recent years.
• Employers are encouraged to consider the wellbeing of their employees and support them through recovery.
• Recognition of men's mental health problems and high suicide rates has led to organizations focusing on this group (e.g., CALM).
• Charities (e.g., Time To Change) have been formed to reduce the stigma attached to mental health problems.
• Many high-profile celebrities and politicians have spoken openly about their mental health problems to reduce stigma.

Effects of Mental Health Problems on Individuals and Society

Key Objectives

• Describe how poor mental health can affect individuals (e.g., damage to relationships).
• Describe how poor mental health can affect wider society, such as crime rates and the economy.

Individual Effects

• Mental health issues can cause problems for people on an individual basis
• Living with a person with significant mental health problems can put a strain on relationships.
  • Partners may experience feelings of guilt and shame, and blame themselves.
  • Romantic relationships, social life, and physical intimacy might change.
  • Couples might not socialize as often or engage in social activities.
• A survey by Mind (2013) found that 63% of people with mental health problems who told their partner about their condition said that their partners were understanding.
• Mental health issues can:
  • Impact day-to-day living, such as personal hygiene and self-care.
  • Lead to loss of interest in socializing and engaging in enjoyable activities.
  • Have a wider impact on physical wellbeing by reducing the function of the immune system and leading to a greater susceptibility to infection.

Social Effects

• Sufferers require care and treatment, leading to a greater need for social care (social workers and mental health professionals).
• Lack of social care or shortages in trained staff impacts the treatment offered to patients.
• More funding for social care would increase patient care but put a greater strain on the economy.
• Some mental illnesses can lead to sufferers breaking the law, leading to increased crime rates.
  • Drug addiction can result in people stealing to sustain their addiction.
  • Alcohol addiction can increase acts of aggression in some individuals.
• People with mental health issues are rarely violent and are much more likely to be a danger to themselves than to members of the public.
• Work absence due to mental health issues increases after diagnosis, resulting in a negative impact on businesses and the economy.
• There is less stigma today surrounding mental illness, but many people might be concerned about divulging their illness to their employer.
• Mental health issues negatively impact health services and the economy.
• Mental health problems affect both individuals and society in negative ways.

Characteristics of Clinical Depression

Key Objectives

• Explain the differences between bipolar and unipolar depression, and sadness
• Describe the characteristics of unipolar depression
• Describe how unipolar depression is diagnosed using the ICD criteria.

Clinical Depression

• Depression is one of the mood (or affective) disorders.
• Mood disorders involve a prolonged and major disturbance of mood and emotions.
• Depression and sadness differ in duration. Depression lasts longer than sadness.
• Two main types of depression: unipolar and bipolar.
• Types differ in symptoms and can be distinguished from sadness by duration and mood/behavior changes.
• Unipolar depression: clinical depression occurs on its own.
• Bipolar disorder: mania occurs with depression.
• Mania: sense of euphoria or elation.
  • People with mania have a great deal of energy.
  • They lack a sense of purpose and survive on very little sleep.
• People with bipolar depression alternate between mania and depressive episodes.
• Depression can be categorized as either bipolar or unipolar.

Classification and Diagnosis of Unipolar Depression

• A person suffering from depression experiences a general slowing down and loss of energy.
• Depression can begin at any time of life but is rarely seen in pre-adolescent children.
• The average age of onset is in the late twenties, but the age of onset has decreased over the last fifty years, during which time depression's prevalence has increased.
• Depression is more prevalent in women than men, although this could be because men are less likely to seek help.
• The International Classification of Diseases (ICD) identifies three main behaviors that must be present for a diagnosis of unipolar depression:
  • Persistent sadness/low mood
  • Loss of interest/pleasure
  • Fatigue/low energy
• In addition, the ICD identifies a number of symptoms that often accompany the key behaviors, including:
  • Disturbed sleep
  • Poor concentration
  • Low self-confidence
  • Poor or increased appetite
  • Suicidal thoughts or acts
  • Agitation
  • Guilt/self-blame
• The ICD criteria identify a number of symptoms that must be present for a diagnosis of depression to be made.

Interventions

Key Objectives

• Describe both biological and psychological explanations of depression
• Explain the use of biological therapies in the treatment of depression
• Explain the use of psychological therapies in the treatment of depression.

Biological Explanations of Depression - The Influence of Nature, Imbalance of Neurotransmitters

• Biological explanations of depression indicate that depression is caused by internal factors (the influence of nature rather than nurture), including brain chemicals and genes.
• People suffering from clinical depression have lower levels of the neurotransmitter serotonin.
• Most modern anti-depressant medication helps to alleviate symptoms by regulating the levels of serotonin in the brain.
• A strength of the biological explanation of depression is its emphasis on the role of neurotransmitters and brain chemistry.
• Imbalances in neurotransmitters such as serotonin are associated with depression, which has led to the development of effective drug treatments, such as selective serotonin reuptake inhibitors (SSRIs). The target imbalances and help to treat symptoms in many individuals.
• However, cause and effect is difficult to establish. It could be that depression results in lower levels serotonin, rather than lower levels leading to depression.
• The biological explanation also simplifies the complex nature of depression by focusing on biological factors and neglecting the influence of other explanations.
• Biological causes overlook other vitally important reasons for the depression.

Psychological Explanations of Depression - The Influence of Nurture, Negative Schemes and Attributions

• Aaron Beck (1967) believed that depression was the result of a negative outlook.
• Depressed people acquire a schema - a blueprint by which they view the world. Depressed people develop a pessimistic view of the world (schema).
• Attributional style is another explanation.
• People with depression will often attribute negative events to sources that are internal (their fault), stable (their circumstances won't change, even with effort) and global (their depression is the result of some personal defect or personality characteristic).
• Seligman (1967) believed that depression is the result of learned helplessness.
• When people continually fail, or bad things happen to them, they begin to believe that this is the way it will always be, no matter what they try to do to change it. They learn to be helpless.
• Depression can be explained as both biological and psychological.

Interventions and Therapies

• Interventions and therapies for depression are often seen as reductionist. They reduce the causes of depression down to, for example, brain chemicals, and improve mental health by treating the symptoms.
• Other interventions, such as CBT, are seen as holistic - they treat the symptoms but also tackle the causes of depression - e.g. poverty, home life and lack of meaning in life.
• The most common treatment is antidepressant medication.
• There are two main types of antidepressants: tricyclic antidepressants and SSRI antidepressants.
• Tricyclic antidepressants block the transporter mechanism that absorbs both serotonin and another neurotransmitter called noradrenaline.
• SSRI (selective serotonin re-uptake inhibitors) work in a similar way to tricyclic antidepressants but mainly block serotonin only.
• The best-known SSRI antidepressant is Prozac (fluoxetine).
• A number of psychotherapies are used to help alleviate depression.
• Psychotherapy is a term used for a number of different treatments for mental illness that involve talking with a specially trained therapist.
• One of the most popular types of psychotherapy is cognitive behavioral therapy (CBT) which is holistic.
• CBT is based on the premise that the way we think about things impacts our psychological wellbeing.
• CBT emphasizes the role of maladaptive thoughts and beliefs as the main cause of depression. When people think negatively about themselves and their lives they become depressed.
• Wiles (2013) compared the effectiveness of CBT and antidepressant medication (sertraline) in the treatment of depression. Participants (469 adults diagnosed with depression aged 18-75) were randomly assigned to one of three treatment groups: CBT, antidepressants or a combination of both.
• All groups showed significant improvements in depressive symptoms at 12 months, showing that a holistic approach to treatment should be considered. Patients who did not respond to medication alone did benefit from the addition of CBT.
• Depression can be treated with medication, or by psychotherapy, such as CBT.

Addiction

Key Objectives

• Define addiction
• Explain the difference between addiction/dependence and substance misuse/abuse
• Describe the criteria for diagnosing addiction.

Addiction or Dependence

• Addiction or dependence refers to a behavior that leads to dependency.
• Example: an addiction to alcohol results in a dependency where individuals feel that they are unable to survive without it.
• Addictions also lead to other changes, including changes in behavior (psychological changes) and in levels of brain chemicals.
• Addiction differs from substance misuse or abuse in that the substance is taken to excess but does not necessarily lead to addiction.
• Example: a person might drink large amounts of alcohol but never feel that they couldn't live without it.

Classification and Diagnosis of Addiction

• The International Classification of Diseases (ICD) describes addiction as "A cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a group of substances takes on a much higher priority for a given individual than other behaviors that once had greater value".
• A diagnosis of dependence syndrome is made if three or more symptoms have appeared together for at least one month, or have occurred together repeatedly within a twelve-month period.
• These symptoms include, but are not limited to:
  • A strong desire or sense of compulsion to take the substance despite harmful consequences
  • Impaired capacity to control substance-taking behavior
  • Pre-occupation with substance use and the giving up of activities once deemed important.
• Many psychologists suggest that addiction need not be centered around a substance, but can also include an experience which becomes addictive.

Walter's Argument

• Walters (1999) argues that addiction can be defined as "the persistent and repetitious enactment of a behavior pattern".
• This suggestion leads to a broadening of the definition to include behaviors such as shopping and gambling.
• This behavior pattern includes:
  • Progression (increase in severity)
  • Pre-occupation with the activity
  • Perceived loss of control
  • Persistence despite negative long-term consequences.

Griffith's Argument

• Griffiths (1999) argues that addiction can be extended to other activities, including watching TV, playing computer games and using the internet. Such behaviors are potentially addictive.
• According to Griffiths, these behaviors share the same core components as addiction:
  • Salience: The activity becomes the most important one in the person's life.
  • Mood Modification: The activity produces an arousing 'buzz' or 'high'.
  • Tolerance: Increasing amounts of activity are needed to achieve the same effects.
  • Withdrawal Symptoms: Discontinuation or sudden reduction of the activity produces unpleasant feelings and physical effects.
  • Conflict: Conflict between the addict and the people around them, such as family and friends, or with other activities and interests.
  • Relapse: Reverting to earlier patterns of addiction soon after giving up.
• Addiction includes dependence.
• Symptoms of addiction include compulsions, loss of control and pre-occupation.

Interventions

Key Objectives

• Describe biological theories of addiction, including heritability
• Describe Kaij's twin study of alcohol abuse
• Describe psychological theories of addiction
• Explain one biological intervention and one psychological intervention for addiction.

Biological Theories of Addiction

• Biological explanations of addiction concentrate on areas that can be viewed on the nature side of the nature-nurture debate.
• Family and twin studies indicate that genes contribute to the development of addictive behavior.
• Heritability (the extent to which traits are inherited) estimates range from between 50\% and 60\% in both men and women.
• Kaij (1960) studied the rates of alcohol abuse in identical and fraternal twins in Sweden.
• He found that the concordance rate (the presence of the same trait in both twins) for identical twins was 54\% and that for fraternal twins it was only 28\%. Kaij concluded that there are genetic and hereditary factors involved in alcohol addiction.
• This means that children with parents who are alcohol dependent have a much greater chance of developing dependence disorders.
• This study suggests that genes play a big part in addiction. However the concordance rates for the identical twins being 54\% suggests the influence of other factors. As they are identical we would expect the other twin to also be an alcoholic as they share 100% of their genes.
• So although 54\% was higher than 28\% for the non-identical twins, it still shows evidence for the role of both biological factors and environmental factors.
• Research indicates a link between the D2 dopamine receptor (DRD2) and severe alcoholism. More specifically, two-thirds of deceased alcoholics had the A1 variant of the DRD2 gene.

Psychological Theories of Addiction

• Social learning theory (SLT) proposes that learning occurs through observation and communication. It explains addiction in terms of how and why addictive behavior is caused through social interaction.
• DeBlasio and Benda (1993) found the influence of peers to be a primary factor in the uptake of alcohol and drugs in adolescents.
• Young people who smoke are more likely to associate with other young people who smoke, indicating that they are attempting to conform to the norms of the reference group, or to peers whom they admire.
• Addiction can be explained in terms of biology (e.g., genes) and psychology (e.g., peer pressure).

Addictions and Therapies

• Aversion Therapy
  • Aversion therapy works by conditioning the individual into experiencing an unpleasant reaction when engaging in the unwanted activity.
  • When an unpleasant stimuli is paired with the unwanted behaviour, the behaviour becomes associated with the unpleasant feeling.
  • Drugs can be used that, when combined with an addictive substance (e.g., alcohol), result in a feeling of nausea. The individual then associates the activity (drinking alcohol) with feeling sick.
  • People can be taught to use negative visualization or to focus on unpleasant thoughts when their mind wanders towards the undesirable activity.
• Self-management Programs
  • People often benefit from self-help groups where they can gain support from other people who are struggling with addiction.
  • The most well-known of these is the 12-step program used by Alcoholics Anonymous.
  • The 12-step program of personal recovery involves a number of milestones on the journey to breaking the addiction.
  • Steps begin with an acceptance of the addiction. Steps are taken with the help of a sponsor - an experienced member who can offer individual support.
  • The 12-step program has proved useful for other addictions, including drugs and gambling.
• As mentioned on page 115, while some therapies and interventions can be thought of as reductionist (talking about one aspect of addiction and mental health), others are more holistic and can be combined with several treatments for improved outcomes.
• Treatment for addiction can involve biological and psychological interventions.
• Aversion therapy appears to work well short term but not so well long term. This could suggest using more than one therapy at a time such as support from CBT or the self-help groups, alongside the aversion therapy, to remain addiction free.
• This approach to therapy is more of an holistic one rather than just focusing on one treatment, such as aversion therapy, which is reductionist and only targeting reducing the urge for the behaviour.
• Not everyone responds positively to each treatment, which could be demotivating for the person and they could abandon the treatment plan they are on.