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Questions and Answers
What proportion of Australians aged 16-85 have experienced a mental health concern?
How long can it take to experience the fallout of a significant event on mental health?
What is the second largest cause of death in Australia as mentioned in the mental health context?
What aspect of mental health systems in Australia is emphasized regarding Indigenous communities?
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Why is the demand for mental health services challenging in Australia?
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What is the primary goal of social and emotional wellbeing in adolescents?
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Which of the following best describes cultural safety?
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How can individuals contribute to building a safe working environment for Aboriginal people?
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What does reflexivity encourage individuals to do?
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What is an important aspect of ensuring cultural safety in healthcare?
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What are the three Ds of abnormality used to classify mental health conditions?
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Which professional is specifically a fully qualified medical doctor with specialist training in psychiatry?
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In the context of mental health, which of the following is NOT typically considered a biological factor?
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What is a key limitation in defining mental health conditions?
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Which type of professional typically helps individuals gain understanding and make changes in their lives but does not require specific qualifications?
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What is the main goal of cognitive restructuring in the Cognitive-Behavior Model?
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Which model emphasizes the role of early life experiences in the formation of negative core beliefs?
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What criticism is commonly directed towards the Biological/Medical model?
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According to the Humanistic Model, what is seen as a sign of maladjustment?
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Which treatment strategy is associated with the Behavioral Model?
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What is a key component of the DSM-5-TR regarding mental disorders?
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Which concept describes the conflictual relationship between the Id, Ego, and Superego in Psychoanalytic theory?
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What aspect is often considered a limitation of the Cognitive-Behavioral Model?
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What distinguishes panic disorder from a panic attack?
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Which of the following accurately describes the Yerkes-Dodson Law?
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What is a common behavior associated with panic-related responses?
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How is abnormal/pathological anxiety characterized?
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What role does the cognitive system play in the experience of anxiety?
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What is a defining characteristic of specific phobias?
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Which subtype of specific phobia involves a fear of situations such as flying?
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What are the associated symptoms of Generalized Anxiety Disorder (GAD)?
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What is the lifetime prevalence of Generalized Anxiety Disorder (GAD)?
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What is a common behavior associated with Obsessive-Compulsive Disorder (OCD)?
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Which of the following best describes compulsions in OCD?
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What type of treatment is considered essential for addressing anxiety disorders?
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Which of the following is NOT a symptom of Generalized Anxiety Disorder (GAD)?
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What differentiates major depressive disorder from persistent depressive disorder?
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Which is a treatment method that involves sending electrical currents to the brain?
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How many symptoms must be present to qualify for a major depressive episode?
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Which symptom category is NOT included in the classification of symptoms for major depressive disorder?
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Which concept relates biological factors and stress to the onset of depression?
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What is a common outcome of untreated major depression?
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Which psychological theory focuses on the importance of challenging negative beliefs in treating depression?
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What is the peak age range for the onset of major depressive disorder?
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What is a significant symptom of Anorexia Nervosa?
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Which subtype of Anorexia Nervosa engages in binge eating behaviors?
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What percentage of women are affected by Bulimia Nervosa?
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What distinguishes Binge Eating Disorder from Bulimia Nervosa?
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What is a psychological factor commonly associated with Anorexia Nervosa?
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Which group of individuals has the highest prevalence of Anorexia Nervosa?
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What is one of the primary biological treatment methods for eating disorders?
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What is a key difference in the outcome of Bulimia Nervosa compared to Anorexia Nervosa?
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Study Notes
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
Category | Normal | Abnormal |
---|---|---|
Behavior | Deviance | Maladaptive behavior |
Experience | Personal distress | - |
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.
-
Symptom categories:
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.
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