Mental Health

Mental Health Prevalence

• One in five Australians aged 16-85 have experienced a mental health concern.
• The impact of significant events, like pandemics, can take 1-2 years to manifest in mental health outcomes.
• Mental health issues are the second leading cause of death in Australia.
• Governments are responsible for funding mental health services.
• The demand for mental health services outpaces the supply.
• The cost of supporting mental health needs is high, particularly for individuals with complex issues.
• Multiple factors contribute to the development of mental health issues.

Decolonization

• Australia needs to decolonize its mental health systems.
• This includes empowering and supporting more Indigenous psychologists.

Social and Emotional Wellbeing

• A model that represents how we process and grow as humans
• Emphasizes building strengths and capabilities in adolescents for a productive and fulfilling life.
• Addresses a wide range of issues including racism and trauma.

Reflexivity

• Encourages self-reflection and awareness of one's own perspectives and biases
• Promotes understanding of how our internal experiences shape our interactions with others.

Decolonizing

• A process of challenging and dismantling systems of oppression and inequality
• Promotes the recognition and valuing of diverse knowledge systems
• Aims to create more equitable power dynamics in society.

Cultural Awareness

• Involves understanding the cultural norms and practices of different groups
• Encourages respectful and appropriate interactions across cultures
• Provides guidance on appropriate behavior and communication styles.

Cultural Safety

• A commitment to creating an environment where individuals feel respected and valued despite their cultural background
• Requires ongoing reflection and learning to ensure practices are free from racism.

How to Ensure Cultural Safety

• Acknowledge the lasting impact of colonization on present-day realities
• Be aware of individual biases and assumptions
• Recognize the importance of self-determination in decision-making processes

Building a Safe Working Environment

• Create a workplace where the rights and dignity of all individuals are honored and upheld
• Promote inclusion and respect for all members of the workforce

The Concept of Mental Health

• The mental health model often focuses on individual functioning within a given environment
• This perspective can neglect the role of systemic and social factors in mental well-being.

Mental Health Statistics

• Over 40% of people experience a mental health disorder at some point in their lives.
• 20% of people have experienced a mental health disorder in the past year.

Definition of Abnormal Psychology

• Abnormal psychology studies unusual behavior and mental illness.
• Psychopathology focuses on the scientific study of mental illness, including classification, diagnosis, causation, and treatment.

Defining Mental Health Conditions

• It's challenging to definitively distinguish between mental health and illness, similar to the concept of health and illness.
• Mental illness involves identifying and classifying abnormalities.
• Treatments for mental illness require rigorous testing, including placebo groups, to ensure effectiveness.

Criteria for Identifying Abnormal Behavior

• Three Ds of Abnormality:
  • Deviance: Behavior deviates from expected norms.
  • Distress: The individual or their family experiences distress.
  • Dysfunction: The individual's ability to function in their life and society is impaired.

Abnormality: Normal vs. Abnormal

Causes of Mental Health Conditions: Bio-Psycho-Social Model

• Psychological Factors:

  • Emotions
  • Attitudes
  • Learning
  • Beliefs
  • Stress

• Social Factors:

  • Family dynamics
  • Peer relationships
  • Cultural influences
  • Socioeconomic factors

• Biological Factors:

  • Physiological processes
  • Medications
  • Neurochemistry
  • Genetics

Mental Health Professionals and Their Roles

• Psychiatrist:

  • Fully qualified medical doctor with specialized training in mental health.
  • Can prescribe medication.

• Clinical Psychologist:

  • Holds a doctorate in psychology with specialized training in assessment, treatment formulation, and more.
  • Takes a bio-psycho-social approach to treatment.
  • Cannot prescribe medication.

• Registered Psychologist:

  • Treats less serious mental health issues.
  • Generally requires less specialized training.

• Social Worker:

  • Works in direct services or clinical fields, often related to mental health.

• Counsellor:

  • Assists individuals in understanding themselves and making life changes.
  • Does not require specific qualifications.

Key Points to Remember

• Only the title "Psychologist" is legally protected.
• Defining abnormal behavior is a complex and often subjective process.
• The bio-psycho-social model emphasizes the interplay of multiple factors in mental health.

Mental Health Models

• Cognitive-Behavioral Model
  • Based on thoughts, feelings, and behaviors
  • Maladjustment: Negative core beliefs (Aaron Beck)
    • Interpretations of experiences
    • Consistent with earlier experiences
    • Stems from early life experiences
  • Treatment
    • Psychoeducation
    • Understanding automatic thoughts
    • Cognitive restructuring (challenging negative thoughts and themes)
    • Behavioral experiments
    • Exposure
  • CBT is a common therapy method

DSM: Diagnostic and Statistical Manual

• Defines Psychology
• Serves as a guideline, not a definitive rule
• DSM-5-TR (2022)
  • Reflects the medical/biological model
  • No assumptions, clear explicit criteria

### Humanistic Model

• Emerged as a response to the psychoanalytic model
• Focuses on psychological health
  • Self-actualized (Maslow)
  • Fully functioning (Rogers)
• Maladjustment: Thwarted self-actualization
• Treatment: Empathetic approach
• Critiques/Limitations: Therapy components, but not sufficient on their own.

Behavioral Model

• Rooted in psychoanalysis, difficult to falsify
• Classical conditioning (Pavlov)
  • Unconditioned Stimulus (US)- Unconditioned Response (UR) & Conditioned Stimulus (CS)- Conditioned Response (CR)
• Operant conditioning (Skinner)
  • Reinforcement and Punishment
  • Learning through action
• Suggests that excitement, punishment, and abnormal behavior are learned
• Critiques/Limitations: Overemphasis on behavioral aspects and emotional elements
• Treatment: Many applications, including exposure therapy

Biological/Medical model:

• Dominant in Psychiatry
• Key assumptions of mental disorders:
  • Diagnosable like physical illness
  • Explained by biological disease process
  • Treated with medication or ECT
• Criticisms/limitations:
  • Need to avoid extreme reductionism
  • Overgeneralizing from animal research
  • Assuming causation based on treatment efficacy

Psychological Model

• Psychoanalytic
  • Dominant in the first half of the 20th century
  • Personality (as described by Freud):
    • Id: Pleasure principle, instinctual drive
    • Ego: Reality principle
    • Superego: Moral principle
  • Constant conflict between Id and Superego
  • Maladjustment: Excessive use of defense mechanisms requires treatment.

Panic Attacks

• Not a diagnosis, but relevant to anxiety disorders.
• Approximately one-third of people have experienced a panic attack.
• Typically peak within 10 minutes.
• Characterized by a sudden onset of intense dread and overwhelming feelings.
• Can be expected (cued) or unexpected (uncued/spontaneous).

Panic Disorder

• Defined by recurrent, unexpected panic attacks.
• May also involve anxiety or worry about future panic attacks.
• Often leads to significant changes in life behavior.
• Associated with panic-related behavior: avoidance and escape.
• Catastrophic thoughts are also common with panic disorder.

Panic Attacks vs Panic Disorder

• Fear of fear and the anticipation of a panic attack are common.
• Many people seek treatment only after several years of struggling.
• People can misinterpret bodily reactions, for example, mistaking the effects of caffeine for anxiety.

Treatment for Panic and Anxiety

• Psychoeducation about panic attacks and anxiety.
• Exposure therapy to help individuals confront and manage their fears.
• Interceptive exposure to help individuals tolerate bodily sensations associated with anxiety.

Yerkes-Dodson Law

• Proposes that optimal performance occurs with an optimal level of arousal.
• Performance decreases as anxiety levels become too high.

Normal Anxiety

• From an evolutionary perspective, anxiety is necessary for survival.
• Individuals differ in their predisposition to anxiety due to genetics and learned behaviors.

Abnormal/Pathological Anxiety

• Shares many similarities with normal anxiety.
• Distinguished by:
  • Inappropriate occurrence.
  • Excessive intensity.
  • Overestimation of threat.

DSM Classifications for Anxiety Disorders

• Obsessive-compulsive disorder (OCD).
• Social anxiety disorder.
• Specific phobias.
• Post-traumatic stress disorder (PTSD).

DSM IV Changes in Anxiety Disorder Classifications

• Shift from grouping anxiety disorders based on the presence of multiple symptoms to a more unified approach.
• The DSM IV no longer groups anxiety disorders into a single category.

Anxiety: Activated fear

• Characterized by an activated fear response to a perceived threat.
• The experience of anxiety is consistent across individuals.
• Involves the activation of three interconnected systems:
  • Physical system: Mobilizes physical resources to cope with threats.
  • Cognitive system: Perception and interpretation of threats, attention shifts towards the threat, and hypervigilance occurs.
  • Behavioral system: Influences our responses to perceived threats.

Specific Phobias

• Marked or consistent fear reaction to a specific object or situation.
• Fear is proportional to the actual threat.
• Persistent, lasting 6 months or more.
• Subtypes: Animals, natural environment, blood-injection-injury, situational (e.g., flying).
• Possibly caused by classical conditioning (bad experience leading to phobia).
• More common in females (2:1).
• Prevalence: 7-9% of adults.

Generalized Anxiety Disorder (GAD)

• Excessive and uncontrollable worry about a wide range of events.
• Associated with 3Ts:
  • Restlessness, fatigue, concentration difficulties.
  • Muscle tension, sleep disturbances.
  • Constant stream of consciousness.
• Worries can be about professional, financial, world events, minor matters, or personal health/safety.
• Worry intensity is disproportionate to the actual likelihood of the event.
• Limited control over worry.
• Worry is often catastrophic.
• Lifetime prevalence: 6.1%.
• Higher prevalence in females.

Obsessive-Compulsive Disorder (OCD)

• Repeated intrusive irrational thoughts or impulses causing severe anxiety or distress.
• Attempts are made to ignore, suppress, or neutralize the obsessions.
• 4 Dimensions:
  • Contamination
  • Doubt/harm
  • Symmetry or order
  • Forbidden/taboo
• Compulsions: repetitive actions/thoughts to neutralize anxiety.
  • Washing/cleaning
  • Checking
  • Repeating
  • Ordering/arranging
  • Mental compulsions
• Obsessions and compulsions can occur individually, but the combination is most common.

Treatment

• Cognitive Behavioral Therapy (CBT) is a common treatment option.
• Exposure is an essential ingredient in CBT.

Psychoeducation

• Personalized approach to identify specific triggers.
• Explanation of anxiety in general, including avoidance behavior.
• Relaxation techniques are taught.
• Cognitive restructuring and thought challenging are used.

Major Depressive Disorder and Persistent Depressive Disorder

• Depressive disorders are characterized by extreme mood disturbances.
• Typically episodic, with an average of four episodes throughout a lifetime.
• Unipolar: Individuals experience episodes on only one side of the mood spectrum (depression).
• Bipolar: Individuals experience extremes in both directions (depression and mania/hypomania).

Sadness vs. Clinical Depression

• Clinical depression: Frequency, intensity, and duration of sadness are disproportionate to a person's life situations.
• Accurate diagnosis is crucial to avoid misdiagnosis and underdiagnosis.

Major Depressive Disorder

• Major depressive episode: Defined by the presence of at least five symptoms for a two-week period.
  • Symptom categories:
    • Emotional: Depressed mood, loss of interest or pleasure.
    • Cognitive: Feelings of worthlessness, guilt, and difficulty concentrating.
    • Somatic: Changes in appetite, sleep, and energy levels.
    • Motivational: Loss of energy and decreased activity.

Prevalence of Major Depressive Disorder

• Affects 5-25% of the population, with rates varying based on age and gender.
• In Australia, it is the leading cause of non-fatal disability.
• Onset often occurs after puberty, with peak prevalence in the 20s but can also happen later in life.

Persistent Depressive Disorder

• Characterized by a depressed mood for most days for at least two years.
• Individuals have never been without these feelings for more than two months.
• Exclusion criteria: No manic/hypomanic episodes, not better explained by another psychotic disorder, and not caused by substance use or other medical condition.
• Significantly impacts daily functioning.

Prevalence of Persistent Depressive Disorder

• Affects 1-2% of the population.
• Typically emerges in childhood or early adulthood.
• Often follows a chronic course.

Treatment and Theories

Biological Causation Theories

• Genetic vulnerability: A predisposition to depression is inherited.
• Neurochemistry: Imbalances in neurotransmitters like serotonin and dopamine may play a role.
• Neuroendocrine system: Abnormal function of the stress response system (e.g., the hypothalamic-pituitary-adrenal axis) might contribute to depression.
• Vulnerability stress models: A combination of biological vulnerability and stressful life experiences can lead to depression.

Treatments:

• Drugs:

  • SSRIs (Selective Serotonin Reuptake Inhibitors): Common medications like Prozac, Zoloft, and Paxil block the reabsorption of serotonin, increasing its concentration in the brain.

• ECT (Electroconvulsive Therapy):

  • Involves administering brief electrical currents to the brain.
  • Despite potential side effects, it has been highly effective in treating severe depression.

• Relapse: A common issue with biological treatments, necessitating ongoing maintenance strategies.

Psychological Theories:

• Diathesis stress models: A combination of predisposing psychological factors and stressful life events can trigger depression.
• Schema theory (Beck, 1976): Negative cognitive schemas, ingrained patterns of thinking, contribute to depressive symptoms.
• Ruminative response styles (Nolen-Hoeksema, 1991): Dwelling on negative thoughts and experiences, leading to increased depressive symptoms.

Vicious Cycle of Depression:

• Feel depressed:
  • Loss of interest and pleasure in previously enjoyed activities.
  • Persistent negative thoughts about oneself, the world, and the future.
• Reduced activity and social life:
  • Withdrawal from social interactions and limited engagement in activities, leading to further isolation and decline in mood.

Cognitive Behavioral Therapy (CBT):

• Psycho-education: Understanding the nature of depression, its symptoms, and potential treatment options.
• Behavioral activation: Identifying and engaging in activities that bring joy and meaning, increasing positive experiences.
• Cognitive restructuring: Challenging and altering negative thought patterns, identifying distorted thinking, and replacing them with more realistic interpretations.
  • Gathering evidence to disconfirm negative beliefs and support more balanced perspectives.
• Behavioral activation:
  • Setting goals and values.
  • Increasing and reinforcing positive events, promoting engagement in enjoyable activities.

Anorexia Nervosa

• Characterized by restriction of energy intake, leading to low body weight.
• Individuals with AN also experience intense fear of gaining weight and have a distorted perception of their body shape.
• Two subtypes exist: Restricting and Binge-eating/Purging.
• Restricting subtype involves individuals not engaging in binge eating/purging in the last 3 months.
• Binge-eating subtype involves individuals engaging in binge eating/purging at least once a week in the last 3 months.
• AN is associated with psychological problems like depressed mood, irritability, anger, social withdrawal, and poor concentration.
• Physical problems include anemia, low body temperature, hair loss, osteoporosis, metabolic disturbances, and heart failure.
• AN affects approximately 0.5-1% of women.
• 90% of individuals with AN are women.
• Onset typically occurs in mid to late adolescence, as individuals become more aware of social pressures related to body image.
• AN has a chronic course with slow recovery.
• Frequent and severe challenges occur throughout the lifespan, with 20% remaining chronically ill.
• Interestingly, 50% of individuals with AN go on to develop bulimia nervosa.
• AN has the highest mortality rate of all psychiatric disorders.

Bulimia Nervosa

• Recurrent episodes of binge eating followed by inappropriate compensatory behaviors (e.g., purging, excessive exercise).
• These episodes occur at least once every 3 weeks and are not exclusive to the period of AN.
• Individuals with BN have a distorted body image.
• Bulimia nervosa affects approximately 1-3% of females.
• 90% of individuals with BN are female.
• Onset typically occurs in adolescence to early adulthood.
• Although chronic, bulimia nervosa has a better long-term prognosis than AN.

Binge Eating Disorder

• Recurrent episodes of binge eating that occur at least once a week for 3 months.
• Individuals with BED do not engage in inappropriate compensatory behaviors.
• BED is not exclusive to individuals with obesity or AN.
• Females are more likely to be affected by BED.

Biological Theories

• Heritability plays a role in both AN and BN. Other psychological issues are also frequently observed within families of individuals with these eating disorders.

Psychological Theories

• Many psychological theories explain both AN and BN.
• Individuals with AN and BN often base their self-worth on their body size.
• They experience intense fear of gaining weight.
• They strive to attain unrealistic levels of thinness.

Psycho-social Causes

• Parental criticism, lower parental support, and negative comments on behavior are associated with eating disorders.
• Eating disorders can spread socially, highlighting the impact of socio-cultural factors (e.g., media influence).

Treatments

• Medical management:

  • "Refeeding" is a key aspect of treatment, often involving a dietician.
  • Levels of care vary, with inpatient or outpatient depending on the severity of the eating disorder.

• Psychological interventions:

  • Cognitive-Behavioral Techniques (CBT-E) is a four-stage treatment approach for adults with eating disorders.
  • Maudsley Family Based Therapy (FBT) is a family-oriented approach for treating children and adolescents.