Mental Health

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Questions and Answers

What proportion of Australians aged 16-85 have experienced a mental health concern?

1 in 7

1 in 5 (correct)

1 in 15

1 in 10

How long can it take to experience the fallout of a significant event on mental health?

5 years

Immediately

3-6 months

1-2 years (correct)

What is the second largest cause of death in Australia as mentioned in the mental health context?

Cardiovascular diseases

Accidents

Mental health issues (correct)

Cancer

What aspect of mental health systems in Australia is emphasized regarding Indigenous communities?

Decolonizing mental health systems Signup and view all the answers

Why is the demand for mental health services challenging in Australia?

Demand is outpacing supply Signup and view all the answers

What is the primary goal of social and emotional wellbeing in adolescents?

To create a productive and full life Signup and view all the answers

Which of the following best describes cultural safety?

An understanding of personal biases and assumptions Signup and view all the answers

How can individuals contribute to building a safe working environment for Aboriginal people?

By supporting the rights and dignity of all individuals Signup and view all the answers

What does reflexivity encourage individuals to do?

Evaluate their self-perception and reactions Signup and view all the answers

What is an important aspect of ensuring cultural safety in healthcare?

Acknowledging historical colonization's impact Signup and view all the answers

What are the three Ds of abnormality used to classify mental health conditions?

Deviance, Distress, Dysfunctional Signup and view all the answers

Which professional is specifically a fully qualified medical doctor with specialist training in psychiatry?

Psychiatrist Signup and view all the answers

In the context of mental health, which of the following is NOT typically considered a biological factor?

Family dynamics Signup and view all the answers

What is a key limitation in defining mental health conditions?

Difficulty in classification Signup and view all the answers

Which type of professional typically helps individuals gain understanding and make changes in their lives but does not require specific qualifications?

Counselor Signup and view all the answers

What is the main goal of cognitive restructuring in the Cognitive-Behavior Model?

Challenge negative thoughts and themes Signup and view all the answers

Which model emphasizes the role of early life experiences in the formation of negative core beliefs?

Cognitive-Behavioral Model Signup and view all the answers

What criticism is commonly directed towards the Biological/Medical model?

Extreme reductionism in mental health explanations Signup and view all the answers

According to the Humanistic Model, what is seen as a sign of maladjustment?

Self-actualization thwarted Signup and view all the answers

Which treatment strategy is associated with the Behavioral Model?

Exposure therapy Signup and view all the answers

What is a key component of the DSM-5-TR regarding mental disorders?

Clear explicit criteria for diagnosis Signup and view all the answers

Which concept describes the conflictual relationship between the Id, Ego, and Superego in Psychoanalytic theory?

Conflict of instincts Signup and view all the answers

What aspect is often considered a limitation of the Cognitive-Behavioral Model?

Reductionistic approach to complex issues Signup and view all the answers

What distinguishes panic disorder from a panic attack?

Panic disorder involves recurring, unexpected panic attacks. Signup and view all the answers

Which of the following accurately describes the Yerkes-Dodson Law?

Optimal arousal leads to peak performance. Signup and view all the answers

What is a common behavior associated with panic-related responses?

Avoidance of situations associated with panic attacks. Signup and view all the answers

How is abnormal/pathological anxiety characterized?

By excessive fears and misinterpretation of threats. Signup and view all the answers

What role does the cognitive system play in the experience of anxiety?

It shifts attention towards the perceived threat. Signup and view all the answers

What is a defining characteristic of specific phobias?

Fear reaction to the presence or anticipation of specific objects or situations Signup and view all the answers

Which subtype of specific phobia involves a fear of situations such as flying?

Situational Signup and view all the answers

What are the associated symptoms of Generalized Anxiety Disorder (GAD)?

Muscle tension, sleep disturbance, and restlessness Signup and view all the answers

What is the lifetime prevalence of Generalized Anxiety Disorder (GAD)?

6.1% Signup and view all the answers

What is a common behavior associated with Obsessive-Compulsive Disorder (OCD)?

Repeated intrusive thoughts leading to anxiety Signup and view all the answers

Which of the following best describes compulsions in OCD?

Repetitive actions or thoughts to neutralize anxiety Signup and view all the answers

What type of treatment is considered essential for addressing anxiety disorders?

Exposure therapy as a primary method Signup and view all the answers

Which of the following is NOT a symptom of Generalized Anxiety Disorder (GAD)?

Intrusive thoughts Signup and view all the answers

What differentiates major depressive disorder from persistent depressive disorder?

Duration of depressive mood Signup and view all the answers

Which is a treatment method that involves sending electrical currents to the brain?

Electroconvulsive Therapy Signup and view all the answers

How many symptoms must be present to qualify for a major depressive episode?

5 symptoms Signup and view all the answers

Which symptom category is NOT included in the classification of symptoms for major depressive disorder?

Behavioral Signup and view all the answers

Which concept relates biological factors and stress to the onset of depression?

Vulnerability stress model Signup and view all the answers

What is a common outcome of untreated major depression?

Relapse into depressive episodes Signup and view all the answers

Which psychological theory focuses on the importance of challenging negative beliefs in treating depression?

Cognitive Behavioral Therapy Signup and view all the answers

What is the peak age range for the onset of major depressive disorder?

Late teens to early twenties Signup and view all the answers

What is a significant symptom of Anorexia Nervosa?

Disturbance in body shape perception Signup and view all the answers

Which subtype of Anorexia Nervosa engages in binge eating behaviors?

Binge-eating subtype Signup and view all the answers

What percentage of women are affected by Bulimia Nervosa?

90% Signup and view all the answers

What distinguishes Binge Eating Disorder from Bulimia Nervosa?

Involvement of inappropriate compensatory behaviors Signup and view all the answers

What is a psychological factor commonly associated with Anorexia Nervosa?

Intense fear of gaining weight Signup and view all the answers

Which group of individuals has the highest prevalence of Anorexia Nervosa?

Adolescents and young adults Signup and view all the answers

What is one of the primary biological treatment methods for eating disorders?

Medical management and refeeding Signup and view all the answers

What is a key difference in the outcome of Bulimia Nervosa compared to Anorexia Nervosa?

Long-term recovery rates Signup and view all the answers

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.

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	-

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.

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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