Untitled Flashcards Set

Health Psychology

Health is a “complete state of physical,mental,and social well-being and not merely the absence of disease or infirmity” (World Health Organisation,1948)

Health psychology is the understanding of psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill

Health psychologists do research, work with communities and government to implement interventions and policy, educate groups of people, work with individuals to improve health

Psychological interventions can reduce the amount of money spent on health care by 20%

Biopsychosocial Model

Health (or lack of) is related to 3 broad areas:

Bio (biological) genetics

Psycho (psychological) behaviors, personality, motivation, cognitive processes, lifestyle

Social (social) availability of health care, social influences on behaviours and beliefs

For example:

1. Genetic vulnerability

2. Addictive personality, party lifestyle, high stress

3. Live where alcohol is cheap & legal, friends like to drink, taxis available, drinking is valued in media

the biopsychosocial model of health

biological - physical health, disability, genetic vulnerabilities, drug effects, temperament

social - peers, family circumstances, family relationships, school, trauma

psychological - self-esteem,family relationships,trauma,social skills, IQ, coping skills

Causes of Death in Australia

health clearly not just a matter of biological factors

leading causes of death are preventable

Social Health Disparity

Biological factors cannot explain such a gap, psychological, and social factors are very influential.

Health Model

• Psychologists have developed and scientifically tested a number of theories to explain why peopl are healthy or unhealthy

1. Health belief model - a) Protection motivation theory

2. Optimistic bias

3. Theory of reasoned action

4. Theory of planned behaviour

1. Health Belief Model

How can we explain differences in healthy and unhealthy behaviours? for example…smoking!

• Perceived means there are many individual differences!

• Mediating variables include age,sex,SES,motivation

• Researchers using this theory have been able to predict whether people will go to dentist, do self breast cancer screenings

Protection: Motivation Theory of Health: incorporates self-efficacy into this model, belief in ability to have control over self

Health belief model

Perceived Susceptibility - I smoke two packs of cigarettes a day. I could develop lung cancer.

Perceived Severity - Many people die of lung cancer and other smoking-related illnesses.

Benefits and Barriers - If i quit smoking, I will significantly reduce my chances of getting lung cancer, But smoking is relaxing.

Cues To Action - Advertisements everywhere show the perils of smoking; none of my family and friends smoke.

SMOKING USE OR DISUSE

1. Optimistic Bias

• Perceived susceptibility to negative outcomes is not accurate

• We don’t like to think about negative outcomes happening to ourselves, prefer to be optimistic

• Accidents,diseases, etc more likely to happen to others than ourselves

• Shown in both adolescents and adults related to health risk behaviour, though adolescents’ bias is stronger.

1. Theory of Reasoned Action

• Socio-cognitive theory

• Intentions are a strong predictor of whether someone will do something

— Not perfect of course - there are many things we intend to do but never do

— But we rarely do something without intending to

• This theory tries to understand intentions

Attitude Toward Act or Behavior

Subjective Norm → Behavioral Intention → Behavior

Theory of Reasoned Action

The individual’s beliefs that the behaviour leads to certain outcomes and certain evaluations of these outcomes

→ Attitude towards the behaviour

→ Intention → Behaviour : Relative importance of attitudinal and normative considerations

← Subjective norms → The person’s beliefs that the specific individuals or groups think he/she should or should not perform the behaviour and his/her motivation to comply with the specific referents

1. Theory of Planned Behaviour

• includes components of the theory of reasoned action

• Attitudes

• Subjective norms

• This theory adds:

• Self-efficacy: belief in ability to have control over self (rather than chance, blaming others, etc.)

• Used to explain sunscreen use, hand-washing; also to predict intentions to eat healthy, exercise, self-cancer screenings

Prevention & Intervention

Public health pyramid

Tertiary: Provide interventions for those affected

Secondary: (Programs targeted at families in need to alleviate identified problems and prevent escalation)

Primary (Universal): (Programs targeted at entire population in order to provide support and education before problems occur)

• certain high-risk populations are targeted, aim to again prevent problems

• E.g., programs for young people

• broadly provided campaigns, reach large segments of population to prevent problems from ever developing

• E.g., ads on tv,billboards

• : help change health of population who have already developed a problem

• E.g., psychoeducational

Unhealthy Behaviours

Health-Compromising Behaviours

• Poor diet, quantity and quality

• Too little or no exercise

• Lack of sleep

• Smoking

• Excessive drinking

• Risky sex

Obesity: Contributing Factors

Definition: Excessive accumulation of body fat (in excess of 30% in women and 20% in men)

• regarded as a global epidemic by the World Health Organization

Overweight/obese Australians (Australia’s Health, 2012)

• Children 5-17 years:

• 16.2% of boys are overweight; 9.3% obese

• 18.2% girls are overweight; 5.6% obese

• Australia: second highest rate of childhood obesity in the world

• 42.4% of adult men are overweight; 25.5% obese

• 31% of adult women are overweight; 23.6 obese

Consequences of Obesity

Health Problems: diabetes,heart disease,sleep apnea,some cancers,gallstones

Increased Mortality Rate: A BMI of 30 increases the risk of mortality of 30%

Psychological problems: low self-esteem,depression,suicidal ideation

Discrimination: stigma,suffer from stereotypes of lazy,little self control

Social consequences: jobs,income,education

Treatment

• Public health campaigns

• Diet: fewer calories and more healthy: if temporary,usually gain weight gain

• Drugs: often not effective and have adverse health effects

• Surgery: gastroplasty,stomach stapling,gastric bypass

— Reduces size of stomach; allow less food absorbed

— Complications from surgery can occur

• Psychoeducation: counselors help customize programs

Smoking

• MOST preventable causes of illness disability, death

• 2003: 15,000 Australians died

• 1 cigarette = smoker loses 12 minutes of life

• Male smokers lose 13 years of life,females 14.5

• Cost to Australian society: $31.5 billion each year (health care, fires, reduced productivity,pain, & suffering)

Smoking: Contributing Factors

• Hearitability: about 60%

— Genetic susceptibility to drug addiction

— Fast metabolisers of nicotine are less likely to experience smoking as aversive

• Environmental

— Modeled by family members

— Social pressure from friends

— Identity: “tough”, risk-taking

• Continued smoking

— Physiological addiction: neurotransmitters

— Maintain identity

Treatment for Smoking

• Ad campaigns, school programs

• Taxes

• Medical: nicotine replacement,other drugs

• Behavioural therapy

Alcohol Abuse

• Alcoholism: when an individual is physiologically dependent on alcohol

• Problem drinkers: not associated have work,family, and health related complications associated with alcohol consumption

• 3rd leading cause of death in Australia

• Risky drinking has risen to 13.4% in last 10 years

• Rates higher for males and young adults

• 35% of 15-17 year olds binge drink (5+ drinks in 2 hours)

Alcohol Abuse: Contributing Factors

• Heritability: about 30%

• Genetic susceptibility to drug addiction

• Social-cognitive factors

• Self-medication, mental ‘escape’ from stressors

• Modeling from parents or significant others

• Personality: e.g. people with high levels of negative affects

Consequences

• Liver damage

— (e.g., cirrhosis)

• Increased risk of some cancers

• Hypertension, stroke

— (e.g., mouth)

• Fetal Alcohol Syndrome

• Poor judgement and decision making

— (increase in risk-taking and accidents

• Loss of family and social relationships

• Elevated risk of affective and anxiety disorders

Treatment for Alcohol Abuse

• Spontaneous remission: just stop, only 19%

• Rehabilitation and detoxification: formal care

• Aversion therapy: drug makes a person ill with drinking

• Cogntive-Behavioural Therapy

— Stress management techniques

— Support groups (e.g., Alcoholics Anonymous)

Barriers to Health Promotion

1. Individual Barriers to Health Promotion

• Lack of knowledge is rarely an explanation; people do know the risks

• Short-term rewards of health compromising behaviours (e.g.,smoking relieves anxiety)

• Negative effecs of health compromising behaviours are often not immediate

• Unrealistic optimism

• Gender: men less likely to engage in health promoting behaviour

• Self-presentation (or impression management) - concern about how others perceive self,attempt to control impressions

1. Family Barriers to Health Promotion

• Poor health habits often in childhood

• Parents model pooe health habits

• Parents reinforce poor health habits: Operant conditioning

Use junk food,tv,video games as rewards

1. Health System Barriers to Health Promotion

• Treatment over prevention: doctors focus on illness and not health

• Lack of health insurance

• Relationship between doctor and patient

• Communication between doctor and patient

1. Community,Cultural, & Ethnic Barriers to Health Promotion

• Norms of the community: encouraging heealthy or unhealthy habits (e.g.,smoking is allowed at a pub; employer offers gym membership deal)

• Disparities in health between Indigenous and Non-Indigenous Australians

— Higher rates for nearly every health stat

• Rural and remote living (access to health services)

Stress

Stress

• psychobiological process - response to danger or threat

• adjustment to events and situations - balance between perceived resources and demands

• What gives you stress? Assignments,shifts,bills,relationship demands

• How do you recognise stress,psychological symptoms,physical symptoms,behavioural symptoms

General Adaptation Syndrome

Theory for understanding psychobiological stress

1. Alarm: Release of adrenaline and other hormones (fight or flight response) prepare to meet challenge

2. Resistance: Respiration and heart rate return to normal,glucose levels and some stress-related hormones remain high

3. Exhaustion: After prolonged stress the body’s defenses break down, increased vulnerability to infection/disease

Transactional Process

• Richard Lazarus: theory for understanding stress

• Stress is a transaction between the individual and environment

Primary Appraisal: Person decides if the situation is benign,stressful,or irrelevant - and if stressful,what to do about it

Secondary Appraisal: Person evaluates options and decides how to respond

Three types of stress: 1.harm or loss 2.threat 3.challenge

Emotional forecasting: Anticipate the feelings associated with situations, impact of those emotions

Major Stressors

• Long-lasting (e.g., unemployment) or top of the list of stressors (e.g.,death of a family member)

• Associated with depression,sleep problems,fatigue,panic attacks,increased mortality

• Even work related stress contributes to depression and anxiety

• Catastrophes (e.g.,natural disasters)

• Daily hassles: everyday irritations (traffic,fighting with partner,paying bills,dealing with sick child)

Personality, Stress,& Health

• Personality can influence stress and health through motives,cognitive appraisal of situations, and coping strategies employed

• Type A personality: a personality style characterised by impatience,ambition,competitiveness,hostility - more likely to have heart disease

• Pessimistic people get sick more than optimistic

Gender,Stress, & Health

• Males under stress tend to get angry

• Females are more likely to help and use social support mechanisms

• Hormonal explanations for differences,oxytocin amplifiers physical responses in males but reduce it in females

• No differences in childhood, appear in adolescence

Stress and Anxiety

Stress and anxiety are emotional responses, but stress is typically caused by an external trigger. The trigger can be short-term, such as work deadline or a fight with a loved one or long-term,such as being unable to work,discrimination,or chronic illness. People under stress experience mental and physical symptoms, such as irritability,anger,fatigue,muscle pain,digestive troubles, and difficulty sleeping.

Anxiety, on the other hand, is defined by persistent,excessive worries that don’t go away even in the absence of a stressor. Anxiety leads to a nearly identical set of symptoms as stress: insomnia, difficulty concentrating, fatigue,muscle tension,and irritability.

Both mild stress and mild anxiety respond well to a similar coping mechanisms. Physical activity, a nutritious and varied diet, and good sleep hygiene are a good starting point, but there are other coping mechanisms available, such as:

• Identify what's causing stress and take action.

• Build strong, positive relationships: Connect with supportive friends and family members when you're having a difficult time.

• Get regular exercise, eat nourishing food and participate in activities you enjoy.

• Stay focused on the positive and avoid negative energy.

• Avoid drugs and alcohol.

• Rest your mind: Sleep, do yoga, meditate and perform relaxation exercises that can help restore energy.

• Get help from a psychologist when you're overwhelmed.

Coping with Stress

Top 5 stressors for Australians (APS. 2017)

1. finances

2. family concerns

3. health

4. maintaining a healthy lifestyle

5. health concerns of close others

Coping

• Coping is the way in which people deal with stressful situations

• Problem-focused: Person attempts to change the situation

• Emotion focused: Person attempts to change thoughts or emotional consequences of the stressor

Social Support

• The presence of others in whom one can confide and from whom one can expect help and concern

• Family members,friends,community members (e.g., religious leaders)

• A high level of social support is protective against the effects of stress by

1. Buffering people against the effects of stress (also known as the buffering hypothesis)

2. Making people less susceptible to experience stress in the first place

Enhancing Social Support

• Social support is not only helpful after stressors appear, it can also help avert problems in the first place

• Although men tend to have larger social networks than women, women seem to use theirs more effectively for support

• Many elderly individuals live in isolated conditions and have few people on whom to rely on

Organising One’s World Better

Time management

• Set Goals: these goals should be obtainable and should include long term and short term goals

• To Do Lists: indicate priorities,keeping goals in mind. Try to do these list late on the preceding day

• Schedule: allocate time periods to each item in the list

Improved personal control:

Giving workers some degree of control over aspects of their jobs

Exercising: Links to Stress & Health

• Exercise has both immediate and longer term effects in reducing stress

• Exercise and fitness help prevent people from developing stress related illnesses

Other Ways to Manage Stress

• Meditation, Hypnosis

• Counselling

• Relaxation: reduce physical arousal

• Systematic Desensitisation: classical conditioning proceudre that reverses this learning by pairing the feared object with a pleasant or neutral event.

Psychological Disorders

Distinguishing Disorders from Problems,Difficulties, & Distressing Emotions:

• Severity

• Persistence

• Level of impairment in everyday functioning

Classification of Disorders:

In late 19th century Kraepelin produced the first comprehensive classification system, published in 1883, classifying ‘mental illnesses’ in a similar way to physical illnesses, in terms of

• symptoms

• syndromes – clusters/patterns of symptoms

• assumption that each syndrome had a specific organic cause

• and would follow a particular course

Thus began the ‘medical model’ (Psychology was beginning at this time)

Nowadays

• Diagnostic and Statistical Manual of Mental Disorders 5th Ed., 2013, American Psychiatric Association(DSM-IV, 1994; DSM-IV-TR, 2000)

• International Classification Of Diseases (ICD 10, 2nd ed., 2004; ICD 11 due by 2017), World Health Organization ICD codes are included in DSM-5

DSM 5 - Diagnostic System

• Classifies psychological disorders

• Provides diagnostic criteria

• Descriptive system, not based on any one theoretical approach

• Essentially a categorical rather than dimensional system or a continuum

  • Severity ratings provide a dimensional aspect

  • Is essentially a set of concepts based on observations

  • Open to argument regarding which concepts should be included and/or how concepts should be modified

  • Ideas about disorder vary across time and place e.g., homosexuality was in DSM as a disorder until 1973

  • For each DSM or ICD edition, system is reviewed by series of expert panels and modified

  • Sometimes fierce debate about what should be included in DSM as a disorder

• For each DSM or ICD edition, system is reviewed by series of expert panels and modified

• Sometimes fierce debate about what should be included in DSM as a disorder

Glossary

Prevalence: The total number of cases of disease existing in a population

Co-Morbidity: A term used when a person’s problems or presenting symptoms meet the criteria for more than one diagnosis ie the person has multiple problems or multiple diagnoses.

Incidence: The number of newly diagnosed cases of a disease in a given time

Mortality: Death, a mortality rate is the number of deaths due to a disease divided by the total population

Morbidity: Another term for illness, Prevalence is a measure often used to determine the level of morbidity in a population.

According to the DSM-5

A mental disorder is a syndrome

• Characterised by clinically significant disturbance in cognition, emotion regulation or behaviour

• That reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning

• Usually associated with significant distress or impairment (disability) in social, occupational or other important activities

Not a mental disorder

• An expectable, culturally approved response to a stressor or loss (eg bereavement)

• Socially deviant behaviour (political or religious or sexual)

• Conflicts between individual and society

Unless deviance or conflict results from a dysfunction in the individual as defined on previous slide

Diagnosis of mental disorder not equivalent to need for treatment.

Select DSM-5 Diagnostic Categories

• Schizophrenia spectrum/psychotic disorders

• Depressive disorders

• Bipolar disorders

• Anxiety Disorders

• Obsessive-compulsive disorders

• Trauma- and Stressor related disorders

• Dissassociative disorders

• Feeding and Eating disorders

Eating Disorder

• Anorexia Nervosa

  • Self-starvation & significantly below normal weight, with disturbance in perception of the body

• Bulimia Nervosa

  • Recurrent episodes of binge eating & inappropriate compensatory behaviour (e.g. self-induced-vomiting; excessive exercise)

Anorexia Nervosa: DSM 5

• A. Restriction of energy intake relative to requirements, leading to significantly low body weight for age, sex, developmental trajectory and physical health. Weight less than minimally normal or expected for children or adolescents.

• B. Intense fear of gaining weight, or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a low weight

• C. Disturbance in way one’s body weight or shape is experienced, undue influence of weight or shape on self-evaluation, or persistent lack of recognition of seriousness of current low body weight

• Can have serious medical complications

• Sleep-Wake disorders

• Gender Dysphoria

• Substance-related and Addictive disorders

—

Substance-Related and Addictive Disorders

• Substance Use Disorder is new to DSM-5 merged abuse and dependence

• 3 main types of substance-related disorder

  • Substance use disorder (e.g. alcohol use disorder)

  • Substance intoxication (e.g. alcohol intoxication)

  • Substance withdrawal (e.g. alcohol withdrawal)

    • For some substances only 2 of the 3 types of disorder apply

    DSM-5 lists 10 classes of drugs

    • Alcohol

    • Caffeine

    • Cannabis

    • Hallucinogens

    • Inhalants

    • Opioids

    • Sedatives, hypnotics & anxiolytics

    • Stimulants

    • Tobacco

    • Other (or unknown) substances

  Substance use disorders

  • Essentially, problematic pattern of continued use of a substance that negatively affects psychological and social (& sometimes physical) functioning,with the person having diffculty regulating the level of use.

  • levels of severity

  • Alcohol use disorder the most common

• Plus one non-substance disorder: Gambling disorder

  • Activation of brain reward systems (instead of through adaptive behaviour).

• Personality Disorders

Anxiety Disorders

DSM-5 diagnostic categories (selected)

1. Specific phobia

• Persistent,marked fear or anxiety about an object or situation e.g., fear of heights,animals,receiving an injection,seeing blood

• The object/situation almost always evoke fear/anxiety

• Out of proportion to actual danger

• Phobia involves both fear and avoidance

• Typically lasting for 6 months or more

• Clinically significant distress or impairment in functioning

1. Social anxiety disorder/Social phobia

• Marked fear or anxiety about social situation/s where individual is exposed to possible scrutiny by others

• The social situation almost always evokes fear/anxiety

• Person fears being negatively evaluated

• Out of proportion to actual threat

• Typically lasting for 6 months or more

• Clinically significant distress or impairment in functioning

1. Generalised anxiety disorder

• Persistent high levels of anxiety or worry about a number of events or activities

• Worry about how much they worry

• Person finds it difficult to control the worry

• Accompanied by physical or cognitive symptoms, e.g.

• Restlessness/feeling on edge

• Fatigue; difficulty concentrating

• Irritability

• Muscle tension

• Sleep disturbance

• Symptoms cause significant distress or impairment in functioning

1. Panic disorder

• Recurrent unexpected panic attacks

• A panic attack is an abrupt surge of intense fear/discomfort

• Accompanied by physical symptoms, e.g. heart palpitations, diziness, difficulty breathing, nausea

• Extremely distressing

• Person may feel they will die as a result of the attack

• Ongoing worry (for at least a month) about having more panic attacks

• May change behaviour because of this

1. Agoraphobia

• Marked fear of, anxiety about, two of

• Using public transport

• Being in open spaces

• Being in enclosed spaces

• Being in a crowd

• Being outside of the home alone

• Fear stems from thoughts of having a panic attack (or other embarassing symptom) in without means to escape or to get help

• Out of proportions to actual threat or danger

• Agoraphobic situations actively avoided

• Clinically significant distress or impairment

DSM-5 diagnostic categories (selected)

Obsessive-compulsive disorders (OCD)

• OCD: presence of obsessions,compulsions or both

• Obsessions

• Persistent, uncontrollable intrusions of unwanted thoughts,urges or images - associated with anxiety or distress

• e.g. Contamination by germs

• Efforts to ignore, supress or neutralise the thoughts

• Compulsions

• Urges to engage in repetitive ritual behaviours

• Person feels driven

• e.g. Hand washing, cleaning,arranging,counting

• Aimed at preventing or reducing anxiety or a dreaded event

• Symptoms are time-consuming, or cause significant distress of impairment in functioning

Post-Traumatic Stress Disorder (PTSD)

• Exposure to a traumatic event

• Psychological disturbance (>1 month) attributed to trauma

• May not emerge immediately after stressor

• Intrusion (re-experiencing) symptoms

• e.g. reliving trauma through nightmares or flashbacks

• Avoidance: Efforts to avoid memories / reminders etc

• Changes in mood or cognitions associated with trauma

• e.g. Negative beliefs about self or world

• Persistent fear,anger, guilt or emotional numbing

• Elevated arousal

• e.g. hypervigilance; sleep disturbance

→ Depressive disorders

→ Disassociative disorders

→ Bipolar disorders

→ Schizophrenia spectrum / psychotic disorders

→ Personality disorders

Survival function of anxiety

• Anxiety stems from a neuropsychological system whose functions are

• Detection of signals of danger

• Preparation for coping with threat

• Associated with simultaneous excitation and inhibition of the fight or flight response

• Perceptions of threat shaped by family and community context & by personality factors

• Anxiety disorders can be seen as a dysregulation of this survival system

• Varied expressions (in the absence of a real threat)

• Increased alertness - hypervigilance

—

• Increased apprehension and worry

• Physiological symptoms, e.g. Increased heart rate; sweaty palms, upset stomach

The Arousal Performance

                             **PTSD -the event – Criterion A**

• Exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways:

  • Directly experiencing the traumatic event(s).

  • Witnessing, in person, the event(s) as (While) it occurred to others

  • Learning that the traumatic event(s) occurred to a close family member or close friend. Actual or threatened death must have been violent or accidental

  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g. as first responders collecting human remains, police officers repeatedly exposed to details of child abuse

  • Does not apply to exposure through electronic media, TV, movies, unless work related

Anorexia Nervosa  Self-starvation and significantly below normal weight with disturbance in perception and body.Bulimia Nervosa Recurrent episodes of binge eating and inappropriate compensatory behaviour (e.g. self-induced vomiting; excessive exercise). • Can have serious medical complications

Anorexia

Bulimia

Eating/weight: Extreme diet; below normal weight

Binge eating; normal weight

View of disorder: Denial of Anorexia; Proud of their diet

Aware of the Problem; secretive/ashamed of bulimia

Feelings of control: Comforted by rigid self-control | Distressed by lack of control.

Mood Disorders

Mood Disorders (in DSM-IV and psychological literature) refers to a group of disorders which includes:

Major depressive disorder

Five or more symptoms during two-week period, representing a change from previous functioning. Must include 1 or 2:

1. Depressed mood most of the day, nearly every day

2. Diminished interest/pleasure in all, or almost all, activities

3. Significant weight loss or gain or change in appetite

4. Insomnia or hypersomnia nearly every day

5. Observed psychomotor agitation or retardation

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt

8. Decreased ability to think or concentrate or indecisivness

9. Recurrent thoughts of death (not just fear of dying), suicidal ideation, intent or plans

• Clinically significant distress or impairment in functioning

• Not due to physiological effects of a substance or another medical condition

Depression : Contributing (Causative) Factors

• Genetic vulnerability

• Changes in neurochemistry (serotonin & norepinephrine)

• Adverse childhood experience

• Severe stress in adulthood

• Loss

• Pessimistic outlook

• Distress about relationships &/or isolation

• Perceived failure to meet own standards

• Chronic or disabling medical conditions

— Persistent feelings of sadness and despair and a loss of interest in previous source of pleasure

Bipolar disorder (formerly manic-depressive disorder)

The experience of one or more manic episodes as well as, in most cases, period of depression

• Bipolar I disorder

  • At least one manic episode (see next slide)

  • (usually but not necessarily also experience one or more depressive episodes)

• Bipolar II disorder

  • At least one hypomanic episode (but no manic episode)

  • At least one major depressive episode

  Manic Episode

  • Period of abnormally and persistently elevated, expansive, or irritable mood, and increased activity or energy, lasting => 1 week (any duration if hospitalization is necessary).

  • Three (or more) symptoms (4 if the mood is only irritable):

  • Increased

  • Self-esteem or grandiosity

  • Talkativeness or pressure to keep talking

  • Goal directed activity or psychomotor agitation

  • Decreased

  • Flight of ideas or subjective experience that thoughts are racing

  • Distractibility (i.e. attention easily drawn to unimportant/irrelevant external stimuli)

  • Decreased

  • Need for sleep (e.g. feels rested after only three hours of sleep)

  • Flight of ideas or subjective experience that thoughts are racing

  • Excessive involvement in activities with high potential for painful consequences (e.g. unrestrained buying sprees, sexual indiscretions, foolish business investments)

  • Distractibility (i.e. attention easily drawn to unimportant/irrelevant external stimuli)

  • Excessive involvement in activities with high potential for painful consequences (e.g. unrestrained buying sprees, sexual indiscretions, foolish business investments)

  • Severe enough to cause marked impairment in functioning, or hospitalization, or there are psychotic features

  • Not due to physiological effects of a substance, or to another medical condition

Causes

Contributing factors

• Genetic vulnerability/predisposition

• Changes in neurochemisrty

• High life stress

• Environmental factors

DSM-5 does not list a group called mood disorders and instead considers depressive and bipolar disorders as seperate groups

Schizophrenia

• Positive symptoms

• Behavioural excesses or peculiarities

• Hallucinations,delusions,disorganised speech

• Delusions – a disorder of thought or belief. False beliefs/thoughts that are maintained even though they clearly are out of touch with reality

• False beliefs which are held in a very fixed way, not amenable to argument, typically personal - not shared by other members of the person’s family or cultural group; often the person is quite preoccupied with these beliefs:

  • The radio has messages only for me

  • My private thoughts are being broadcast to other people

  • Thoughts are being injected into my mind against my will

  • Delusions of grandeur (I am the king/queen/prime minister)

  • Delusions of persecution –

Hallucinations .. Can occur in all 5 senses but auditory is most common

• Sensory perceptions in absence of, or distortion of, external stimulus

• Olfactory = experience smells in the absence of stimuli

• Gustatory = tasting things in the absence of stimuli

• Visual = seeing things that are not there

• Auditory = Hearing voices

• Tactile = Experiencing touch in the absense of stimuli

Etiology of Schizophrenia

• Genetic vulnerability/predisposition

• Neurochemical factors

  • Dopamine and serotonin

• Structural abnormalities of the brain

  • Prefrontal (+ve?) and temporal (-ve?) lobes

• The neurodevelopmental hypothesis

  • Disruptions in maturational processes of the brain pre or perinatally

• 'Expressed emotion’

  • As a predictor of relapse or course of disorder

• Precipitating stress

• There is a range of psychotic disorders – varying in severity, duration and breadth of symptoms

• A diagnosis of schizophrenia requires the presence of active psychotic symptoms for a month and some level of symptomatology for at least 6 months

  • i.e. schizophrenia is on the more severe part of the spectrum

Negative symptoms

• Behavioural deficits

• Flattened emotions, social withdrawal, impaired attention, and poverty

• Avolition - apathy, lack of motivation/capacity to initiate

• Deteorioration of adaptive behaviour, quality of the person’s work and social and personal care

Personality Disorders

• Chronic and severe disturbances that inhibit an individual’s capacity to love and to work

• Prevalence is estimated at 2-3% in the general population

• Symptoms are likely to persist but they can be minimised with treatments.

• Severe challenges to interpersonal relationships

• Borderline Personality Disorder: marked by unstable interpersonal relationship, mood swings, manipulativeness and self-harm

• Antisocial Personality Disorder: marked by irresponsible and socially disruptive behaviour

Borderline Personality Disorder

Borderline personality disorder is marked by extremely unstable interpersonal relationships, dramatic mood swings, an unstable sense of identity, intense fears of separation and abandonment, manipulativeness and impulsive behaviour. Also characteristic of this disorder is self-mutilating behaviour, such as wrist-slashing, carving words on the arm or burning the skin with cigarettes. Borderline personality disorder affects approximately 1.4 to 5.9 percent of the Australian population (see Australian DBT Institute, 2022).

However, previous research suggests the percentage of people presenting to hospital with borderline personality disorder has been as high as 43 percent for inpatient services and up to 23 percent for outpatient services, showcasing the need for more research in this area (Jackson & Burgess, 2000; Australian DBT Institute, 2022). Patients with borderline personality disorder tend not only to be highly distressed but to act on it: close to 10 percent of patients with the disorder die by suicide, and between 10 and 30 percent of people who die by suicide carry the diagnosis (Linehan, 2000).

Narcisstic Personality Disorder

Narcissistic Personality Disorder (NPD) is a mental health condition characterized by an inflated sense of self-importance, a constant need for admiration and attention, and a lack of empathy for others. Individuals with NPD often have a grandiose self-image and believe they are special, unique, or superior to others.

They may exaggerate their achievements and talents, and they are preoccupied with fantasies of unlimited success, power, beauty, or ideal love.

Narcissistic Personality Disorder

People with narcissistic personality disorder have severe trouble in relationships because of a tendency to use people, to be hypersensitive to criticism, to feel entitled to special privileges and to become enraged when others do not respond to them in ways they find satisfying or appropriate to their status.

Individuals with this disorder show little empathy for other people.

Narcissistic Personality Disorder

Some common signs and symptoms of Narcissistic Personality Disorder include:

1. Grandiosity: Having an exaggerated sense of self-importance and superiority.

2. Excessive need for admiration: Craving constant attention, praise, and recognition from others.

3. Lack of empathy: Difficulty understanding or recognizing the feelings and needs of others.

4. Sense of entitlement: Expecting special treatment and feeling entitled to privileges.

5. Exploitative behavior: Taking advantage of others to achieve their own goals.

6. Envious of others or believing others are envious of them.

7. Arrogance and haughty behavior: Displaying an attitude of superiority and looking down upon others.

Narcissism

Narcissistic personality disorder affects approximately 1% of the population.  However, narcissism can be viewed more broadly as a multifaceted personality trait existing on a continuum and therefore occurring to varying degrees in the general population.

This presentation is designed to extend your understanding of the narcissistic personality.

Neurodevelopmental Disorders

Disorders involving deviations from normal development

• Includes Intellectual Impairment (Intelligence), Communication Disorders, Autism Spectrum Disorder, Attention-deficit Hyperactivity Disorder, Specific Learning Disorder, Motor Disorders And Other Neurodevelopmental Disorders

• Neurodevelopmental Disorders typically are diagnosed during infancy, childhood or adolescence. However, there has been an increase in diagnoses of ADHD in adults.

Attention Deficit Hyperactivity Disorder

Inattention

• Difficulty keeping their mind on a task, or get bored of a task easily

• Jumping to a new task without completing the previous one

• Easily distracted, unable to follow instructions carefully

• Loses things/steps required to complete the task

• Making careless mistakes

Impulsiveness

• Speaking regardless of the consequences

• Talking excessively, interrupting or intruding on others

• Difficulties waiting for their turn (displaying emotions without restraint)

Hyperactivity

• Constantly moving and roaming

• Fidgeting, tapping hands or feet, squirming in a seat

• Adults’ presentation may differ in relation to physical hyperactivity and may have less pronounced symptomatology (external)

Autism Spectrum Disorder (ASD)

Autism Prevalence

• Other symptoms included in the DSM 5 include: repetitive or restrictive behaviors (repetitive speech or movements), resistance to change and highly specialized and limited interests

• Preoccupation with certain foods or unusual objects such as light bulbs

• Differences in social interactions

• Cognitive abilities can range from severely challenged to gifted in particular areas

Social Psychology

introduction and social influence

The focus of social psychology

• focus on the social environment and its influence on behaviour,thinking and emotio

• link to issues of social and practical significance

• (e.g., Nazism, the psychology of health, intergroup relations,racism and prejudice, etc.)

• individual processes

• e.g., social cognition, self regulation

• interpersonal processes

• e.g., relationships,communication

• intergoup processes

• e.g., stereotyping, prejudice

Social Influence: Three types

• Obedience

— Unquestioningly following orders

— Milgram’s famous study → Psychology’s most famous experiment

• Ps: 40 males (20-50 y.o.) from various socioeconomic backgrounds

• signed up for a study of “learning and memory”

• “teacher” vs “learner”

• “learner” strapped into an electric chair with electrode strapped to wrist, with a paste “to avoid blisters and burns”

• “electric shock generator”: instrument panel with 30 lever switches from 15 to 450 volts, labelled “slight shock” to “XXX”

The procedure

• paired-associate learning task

• the learned pressed a switch to respond

• if incorrect, teacher administered a shock, begining at 15V and moving up

• if teacher hesitated, experiment said:

• “please continue”

• “the experiment requires that you continue”

• “you have no choice, you must go on”

• all this despite “learner” complaining, screaming, pounding on the wall, falling silent

the truth of the matter

• “learner” was a paid actor

• no electric shocks actually given

• real purpose was to see how far ordinary men would go in causing pain to another person simply because they were told to by an authority figure

• 110 experts (incl. 39 psychiatrists) predicted only 10% would exceed 180V and no-one would obey until the end

• but 65% actually did

• international replication

underlying mechanisms/mechanisms underlying obedience

• trasnferral of responsibility to authority figure or person/group giving orders

• submission to power of person/group giving orders

• can be power of “authority”but also rewards, coercion, etc.

Compliance

• responding to a DIRECT request

• compliance techniques abound

• ingratiation (Smith, Pruitt, & Carnevale, 1982)

• problem when too obvious (Gordon,1996)

• reciprocity principle (Regan, 1971)

• more likely to comply if someone does you a favour first

Factors influencing obedience

• immediacy (distance between teacher and learner)

• proximity of authority figure (distance between teacher and experimenter)

• group pressure

• disobedient vs. obedient peers

• legitimacy of authority figure

• Bushman (1984,1988) - perceived legitimacy based on appearance (i.e., clothing) of “authority figure

Is obedience such a bad thing?

• much is made of Milgram’s demonstration of the negative consequences of blind obedience…

• …but society would break down if people didn’t obey orders or rules

• -emergency services

• directions from boss at work

• organisational policies and procedures

Compliance

• responding to a DIRECT request

• compliance techniques abound

• Ingratiation (Smith,Pruitt, & Carnevale, 1982)

• problem when too obvious (Gordon,1996)

• reciprocity principle (Regan, 1971)

• more likely to comply if someone does you a favour first

“Multiple requests” techniques

• foot-in-the-door

• e.g., soap study (Freedman & Fraser,1996); Polish street (Dolinski, 2000)

• door-in-the-face

• e.g. Youth offenders (Cialdini et al., 1975)

• Low-ball

• -E.g. experiment starting times (Cialdini,Cacioppo,Bassett, & Miller, 1978)

Conformity

• classic experiment: Solomon Asch (1951,1952,1956)

• matching line lengths

• ps were shown one line and asked which of three others matched it in length

• stimulus was unambiguous

• 1 real participant

• several confederates all gave the same wrong answer

the results

• 25% remained independent throughout

• 50% conformed to (wrong) majority on at least 1/3 of the trials

• 5% conformed on all trials

• average conformity rate = 33%

Why?

• ps reported feeling uncertainty and self-doubt, then self-consciousness, fear of disapproval, and loneliness

• a real fear - 16 real Ps openly ridiculed 1 erroneous confederate in a reverse version of the experiment (Asch,1955)

• reasons for conforming:

1. majority knew what they saw was different from the group but they felt they may be wrong

2. others knew they were right but didn’t want to stand out

3. a few actually thought they saw the lines as the group did

4. independents either were entirely confidentt or guided by a belief in doing task correctly

Factors influencing conformity: individual factors

• low self-esteem

• high need for social support

• low IQ

• low perceived status within group

• gender (depending on nature of task)

Factors influencing conformity: situational factors

• group size - depends on judgement being made

• recent searches suggests people like to be in the “minority” where tastes are concerned, but in the “majority” where opinions are concerned (Spears,Ellemers, & Doosje, 2009)

• — shared opinions reflect strength of social support, whereas shared tastes reflect distinctiveness

• where there is an objectively correct answer, group size isn’t as important

• group unanimity

• a single disaster can reduce conformity from 33% to 5.5%

• — even when majoriy and dissenter are BOTH wrong

Compliance techniques

• norm of reciprocity - (dealing with others)

• door-in the face technique - persuasion starting with a large request

• foot-in-the-door technique- persuasion starting with a small request

• lowballing - a persuasion for a small commitment that is increased later

Stereotypes and Prejudice - Social Psychology

Stereotypes

• Stereotypes are the perceptions, beliefs, and expectations a person has about members of a group.

• The assumption that all members of that group the same characteristics (negative or positive) leads to false assumptions in areas of gender, ethnicity, age, etc

• stereotypes are deeply ingrained and often automatic and unconscious

• stereotypes often lead to prejudice (positive or negative). An individual belonging to a group (Baumesiter & Bushman) thinking (cognitive) leads to admiration, prejudice and social discrimination (behaviour).

Prejudice

Theories of prejudice

Motivational Theories: Prejudice helps some people maintain their sense of security and meet their needs. Members of other groups are less social than members of their own group (Adorno, 1950; Brewer, 2010).

Cognitive Theories: Using schemas and cognitive “shortcuts” to process information faster about our social world (Lewis et al., 2012)

Learning Theories: Prejudice is learnt, mostly from parents and guardians, fear of strangers and people who are different. Stereotypes in media certain ethnic group are connected with particular roles and characteristics (Degner & Ventura,2010).

Attitude components

• cognitive

• mental representation of the attitude object and its various attributes

• knowledge or belief regarding what the object “is” (could involve a “moral”judgement)

• affective (feelings,evaluations)

• positive vs. negative

• ambivalent (e.g., exercise)

• disposition to have behavioural intentions

• approach vs. avoidance

Attitude characteristics

• strength

• durability, resistance, and impact of an attitude

• importance

• personal relevance

• accessibility

• ease with which attitude comes to mind

• recency and frequency of activation

Resistance to change

• attitudes tend to resist alteration

• confirmation bias:

• biased attention towards, selection of, and memory for attitude-consistent information

• biased attention AWAY from anything which disconfirms or is inconsistent with our attitudes

• leads to biased assimilation of evidence

Example

• Lord, Ross & Lepper (1979)

• ****Pro- and anti-death penalty students recruited for a study

• ****Both groups instructed to read two (fake) studies on the deterrent effect (or non-effect) on crime of the death penalty

• ****Each side judged the attitude-consistent study to be more empirically sound and convincing

• ****Each side’s attitudes diverged further (i.e., the sample became more polarised) after the study

• This kind of thing happens in everyday life – you probably do it yourself! – Try think of an example

Attitude-behaviour

• one reason why attitudes matter: they predict behaviour

• however, correlations between attitudes and behaviour are often weak

• e.g., health and fitness, environmental behaviour, cheating

Why?

• situational demands or practical constraints

• automatic behaviours or strong habits

• weighing up costs and benefits - may be too costly or not rewarding enough to behave in an attitude-consistent manner

When do attitudes predict behaviour?

• when attitudes are stronger, more accessible, more important, more consistent

• when attitudes are assessed without social influence or self-presentation pressure

• when more specific attitudes are assessed

• e.g., attitudes towards recycling vs. towards the environment

• when aggregrate behaviours are predicted

• attitudes predict behaviour patterns better than single acts

Social Psychology

Agression and violence

• Behaviour (verbal or physical) intended to hurt someone

• Hostile

• Sometimes anger-based

• Protecting or restoring self-esteem and status

• Lashing out when hurt or upset

• Instrumental

• Means to an end

So what causes aggression?

Aggression is likely to be the outcome of a complex process that involves multiple factors

• Psychodynamic view:

  • Emphasises the innate/instinctual aspect of aggression

  • Triggers include anger, frustration, shame

• Evolutionary view:

  • All animals display the capacity to harm or kill other members of their species

  • Aggression: strategy evoked when survival or reproductive success is threatened

• Biological factors

— Aggression is controlled by the brain – Can be evoked by electrical stimulation of the hypothalamus and the amygdala – Lesions of the amygdala produce a tame animal •Aggression is modulated by hormones (testosterone and serotonin) •Genetics: Animal studies reveal that an aggressive temperament can be inherited.

• Individual differences

• Situational cues

• Norms and values

Biological factos

• Hormonal

• Testosterone levels related to restlessness, irritability, low frustration tolerance, delinquency

• Higher levels among (unprovoked) violent criminals…and men!

• Causal link?

• Age

• Higher rates in adolescence and young adulthood

• Genetics

• Aggressive behaviour is heritable like other traits

Alcohol

• Linked to 40% of violent crimes, >50% of sexual assault crimes

• Associated with aggression in lab studies

• More intense shock administration – increased by social pressure (Taylor & Sears, 1988)

• Complex mechanism

• Reduced cortical control; more activity in “primitive” brain areas

• Disinhibition, reduced self-awareness, less impulse control

• Reduced thinking about consequences – more “reactive” behaviour in the moment

• ¨Even thinking about alcohol can increase aggressive thoughts and behaviours*(Subra, Muller, Begue, Bushman, & Delmas, 2010)​*

• Exposure to photos of bottles of alcohol (compared with photos of bottles of juice or water) led to faster decisions about whether a letter-string was a word or a non-word if the word was aggressive (e.g., kill)

• Subliminal exposure to alcohol-related words (compared with neutral words) increased actual aggression towards experimenter (in the form of giving more negative evaluations of the experimenter)

“Frustration-aggression” hypothesis

• Aggression as response to blocked goal attainment

• Focus on environmental trigger vs dispositional drive

• Problems with this hypothesis

— Aggression also produced in response to pain or fear

— Frustration does not always lead to aggression

— Frustration primarily leads to aggression when it is attributed as international - elicits anger

Learning aggression

Instrumental learning

• Rewarded by others

• Instrumentally effective

Modelling/imitation

• Bobo doll (Bandura, Ross & Ross, 1963

• Corporal punishment: Strauss et al. (1977) found a linear relationship between being spanked as a child and aggressive behaviour over following two years

Violence and TV

• Enormous exposure of children to TV violence

• More TV watching correlates with higher aggressiveness

• Watching more violent material correlates with greater aggressiveness

• More violent TV watching at 8 predicts higher violent crime conviction rate at 30

• Cause or effect?

• Aggressiveness might underlie a preference for violent TV or a third factor might underlie both

Environmental Factors

• Crowding

• More violence with denser population

• Temperature

• Heat is linekd to violence as “environmental irritant”

• More violence on hotter days, seasons,years, cities,regions

• Less honking by air-conditioned drivers

Self-esteem and aggression

• Low self-esteem not related to agression

• Narcissists and individuals with high (but unstable) self-esteem likely to react aggressively when positive self-view is threatened

• Threatened egotism (Baumeister, Smart, & Boden, 1996)

Culture and violence

• “Culture of honour” in the American South

• South settled by Scots-Irish herders, with little early law enforcement

• Led to ready use of violence in response to perceived insults and threats against property

• Honour and reputation valued very highly

• Southerners especially likely to endorse violent retaliation to insults, including those staged in the lab

General aggression model

• Individual variables (personality,genetics,attitudes,etc.) interact with situational variables (e.g., provocation, aggressive cues, alcohol or drug consumption, etc.) to produce aggression

• Effort at reducing aggression,therefore, must be aimed at multiple levels

• Individual (e.g., anger management skills)

• Interpersonal (e.g., conflict resolution skills)

• Societal (e.g., policies, education)