Clinical Psychology Full Presentations PDF

Lecture 1-2: Foundations of clinical psychology Clinical and Health Psychology Anna Gabińska, Ph.D. Organization of the course  syllabus  google classroom  Consultations  Clinical Psychology Club https://www.facebook.com/groups/985575542550542/ Lecture overview  Found...

Lecture 1-2: Foundations of clinical psychology Clinical and Health Psychology Anna Gabińska, Ph.D. Organization of the course  syllabus  google classroom  Consultations  Clinical Psychology Club https://www.facebook.com/groups/985575542550542/ Lecture overview  Foundations of clinical psychology  historical overview (literature)  ways of defining, area of interest, tasks  relations of clinical psychology with other disciplines (literature)  empirical basis of psychological practice  the scientist-practitioner model  What is Clinical Psychology? The field of clinical psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Lightner Witmer (1907) defined clinical psychology as „the study of individuals, by observation or experimentation, with the intention of promoting change”  What is Clinical Psychology?  Clinicians combine knowledge from research on human responses and mental processes with assessment in order to understand and treat the individual.  Clinical psychology is a subfield of psychology that examines the study and treatment of human behavior and mental processes. The focus in on examining human behavior, personality characteristics, and psychopathology.  What is Clinical Psychology?  Clinical psychology focuses on the cognitive, emotional, social, behavioral and biological contributors to human functioning across the life span, in varying cultures, and at all socioeconomic levels.  Increasing interdisciplinary and collaborative nature to the science.  Clinicians differ from other psychologists in their approach to human beings.  Intro to clinical psychology  There are different theoretical orientations used in clinical psychology  Different approaches have different ideas about what causes psychological disorders to develop.  Most psychological disorders are caused by multiple factors - Bio-psycho-social model  Treatment is shaped by one’s understanding of the causes of the problem  Eclectic approaches combine ideas from the different approaches within psychology The place of clinical psychology among other mental health domains Clinical Psychology vs. Psychiatry Clinical Psychologists… Psychiatrists….  Learn to think as  Are physicians researchers  Learn facts and use  To evaluate findings this knowledge to  To defend their views understand and treat by citing data patients  View the nature of  Focus on biological client’s problems in a aspects of client’s multivariate way problem Overlap of Clinical Psychology and Psychiatry Both…  Diagnose  Treat using therapy (although training in psychotherapy is more heavily emphasized for clinical psychologists) Distinguishing Clinical Psychology from Related Professions Counseling Psychology  Most similar to clinical psychology  Training about the same  Counseling psychologists tend to deal with problems of adjustment in healthy individuals  Historically counseling psychologists worked within university counseling centers  In last few decades, they have expanded their work setting to include private practice Distinguishing Clinical Psychology from Related Professions Psychotherapy, coaching  In contrast to clinical psychology, both are unregulated titles (anyone can offer services suing them)  Different training – for psychotherapy and coaching there are no educational requirements, only licensing.  Only Clinical psychologist can conduct psychological assessment.  Provide psychologogical help in a form of psychotherapy or personality development to people with mental health/well-being problems Distinguishing Clinical Psychology from Related Professions Social Work  M.S.W. (2 years of post B.A. training) emphasizing clinical work  Typically focus on working with the poor and disenfranchised segments of the population  Work in settings dealing with many aspects of a patient’s life and care such as social security, housing, food stamps, Medicare, arrangements for nursing homes, and foster care placement  Emphasis on therapy, but not diagnostic training or emphasis on research Clinical Psychology Specialisations  Adult disorders  Diagnosis  Psychotherapy  Rehabilitation  Substance abuse  Child and adolescents  Health psychology  Neuropsychology  Geropsychology  Community Psychology  Forensic Psychology  Psychoanalysis What do Clinical Psychologists do? Conduct Research on human Make Psychological behavior and mental Assessments processes Use therapy to treat mental Teach as Faculty problems & disorders Work in Provide consultation administration Develop/engage in/direct Develop/engage in/direct health promotion programs prevention programs Significance of research ▪ Psychology hasn’t always been acknowledged as a purely scientific discipline. ▪ Especially its clinical branch has been frequently referred to as a kind of art. ▪ Although recently psychology has become increasingly associated with cognitive sciences and scientific methods of research became prevalent, not all psychologist appreciate its scientific part, adopting a more humanistic approach. ▪ Thus it is still considered by many as a ‘soft’ science. ▪ Conflict between researchers and practicing clinicians. Why to consider the notion of psuedoscience in the context of psychology? ▪ As psychology has been applied to various occupations and fields, many of psychological concepts and theories have been not properly used and abused not only by professionals outside the field, but also among psychologists themselves. ▪ As a result the field is full of assessment methods and interventions that deserve a status of pseudoscientific. ▪ Thus it is frequently hard to differentiate psychological methods from pseudo-psychological ones and so-called pop psychology, especially if one is a layman. Significance of research  Psychological disorders are real problems that affect real people.  Research into the causes and treatment of psychological disorders is critically important.  need to distinguish science from pseudoscience.  Many popular books and websites claim that adult children of alcoholics have a distinct personality profile (low self-esteem, feelings of powerlessness, difficulties with intimacy.) -> research showed that adult children of alcoholics are no more likely to have these problems than anybody else (Lilienfeld et al., 2010).  What can we say about ones personality based on a person’s handwriting? Nothing! ◼ Handwriting analysis or graphology is sometimes claimed to be a psychological assessment technique. ◼ However, actually it is not. There is no evidence for its validity (Eysenck & Gudjonsson, 1986; Greasley, 2000). Significance of research  The use of psychiatric medication has increased dramatically relative to the provision of psychological interventions.  building evidence for insurance companies and policy makers that particular psychological interventions are effective.  Cathartic technique in psychological practice (Trzebińska & Gabińska, 2015)  Catharsis – releasing emotions, venting anger  Many mental health professionals consider it as a core technique to achieve positive therapeutic change.  But growing evidence that intensified expression of negative emotions may be harmful because, paradoxically, it causes an intensification of these feelings (Lohr, Olatunji, Baumeister, & Bushman, 2007).  Limitations of cathartic technique ▪ People having personality dispositions to experience negative emotional states (Kennedy- Moore & Watson, 2001) ▪ Expressing anger (Bushman, 2002) ▪ Bereavement (Bonanno, Keltner, Holen, & Horowitz, 1995; Bonanno & Keltner, 1997) ▪ Debriefing which takes place immediately after the traumatic event (Devilly, Gist, & Cotton, 2006; McNally, Bryant, & Ehlers, 2003): ▪ for victims of sudden violence (Rose, Brewin, Andrews, & Kirk, 1999) ▪ victims of burns and car crashes (Mayou, Ehlers, & Hobbs, 2000) Interested?  Read more here:  Trzebińska & Gabińska (2015) Correcting emotions in psycotherapy in Roczniki Psychologiczne https://www.researchgate.net/publication/299465157_ Correcting_emotions_in_psychotherapy  The Scientist-Practioner Model  Call for clinical psychologists to be scientists goes back to the earliest days of the field. ◦ Witmer (1907) argued that the pure and applied sciences advance as one – what retards or fosters progress in one, retards or fosters progress in the other.  The Boulder Conference (1949) ◦ Formulated the “Boulder Model”  Scientist-Practitioner Model Main reasons for “joint” training as scientists and practitioners So students could develop interests in both research and practice, despite the fact that most would concentrate on one or the other in their careers. Underlying assumptions:  Specialization in either research or practice was seen as likely to contribute to narrowness of thinking and rigidity of action.  Direct involvement in clinical work by researchers would foster their knowledge of important clinical issues so they would be more likely to study them. Why are clinical psychologists required to engage in research to earn their degrees?  Clinical psychologists need to be trained to critically evaluate published research on assessment methods and treatment options to determine which have been validated.  Research training will help clinicians objectively evaluate their own treatment methods.  A strong research background will aid clinicians who work with community mental health centers in assessing the effectiveness of the agency’s programs.  Clinical psychologists who work as faculty members at a university need to supervise and mentor students in research programs. What are Evidence-Based Practices?  Interventions that show consistent scientific evidence of being related to preferred client outcomes.  are an alternative to authority-based practice (Gambrill, 2005). Appeals to: “If Freud said it, it must be true.” A famous person “Eighty percent of social workers Popularity use…I’m going to use it too.” Tradition “That’s the way we have always done it.” Consensus “We all believe that ____” Retrieved from: https://twitter.com/lizditz/status/578947080087060481 EBP = Evidence Based Practice → practice based on empirical research EBM = Evidence Based Medicine → medicine based on empirical research EBPP = Evidence-Based Practice in Psychology → psychological practice based on empirical research EBA = Evidence Based Assessment → diagnosis based on empirical research APA Policy Statement adopted in August 2005  “Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”  To provide a rational basis for deciding which treatments to fund (e.g. which medications to prescribe). The EBP Model – Best Available Best Research Evidence available research evidence  Adopt a scientific view of clinical psychology  Knowledge of clinical research design and methods  Strategies for accessing best available research  Ability to evaluate relevant evidence Multiple Types of Research Evidence  Clinical observation  Qualitative research  Systematic case studies  Single-case experimental designs  Public health and ethnographic research  Process-outcome studies  Effectiveness research in naturalistic settings  RCTs and their logical equivalents  Meta-analysis Lecture 3:The concept of health and disease in clinical psychology. Clinical and Health Psychology Anna Gabińska, Ph.D. Lecture overview  The concept of health and disease in clinical psychology.  the notion of psychological health  different criteria in assessing mental health and disorders (ie. statistical, socio-cultural, theoretical)  the notion of diagnosis and classification of psychological problems Specificity of psychological norm  Norm – ideal or real pattern of characteristics (i.e. behavior, personality or development)  Primacy of negativity – norm as a lack of pathology  Terms “psychological norm” and „health” used interchangeably  Statistical model  Normal or healthy = mediocre, average, or present in most people  Refers to the normal distribution of certain features - normal is what is in the area of central tendency (the area defined by the acceptable standard deviations)  Pathological phenomena due to the prevalence may be considered as norm  And people deviating positively?  Socio-cultural model  Normal is something that is recognized as common, typical for a particular culture – behavior consistent with commons and conventions  Normal individual – typical for a particular group or culture.  Related to the cultural heritage, values and social roles  An indicator of optimal functioning - the ability to meet own important needs in a manner consistent with social norms Socio-cultural model  Abnormal individual – a person who does not meet the common social-cultural, ethical and legal norms of a society in culture (abnormal in a sense that he/she violates the social order and jeopardizes the functioning of society and personal development)  Disorder (social maladjustment) is a violation of socio-cultural norms (also ethical, legal etc.)  entails social sanctions  The most relativized model, charged with evaluation  In periods of social change, breakthroughs and sudden shifts in the systems of values the phenomena considered abnormal intensify Theoretical model  Norm is determined by reference to theoretical models  Norm comes from scientific claims, reasonable concepts or empirically proven relationship  Models within the paradigms: psychoanalytic, cognitive-behavioral, humanistic, systemic  Theoretical norm became a standard, to which the individual data are referred How to define abnormality? The four Ds. or three Ds  Distress  Deviance  Dysfunction  (Dangerousness)  Meeting only one criteria ismany times symptomatic of a mental disorder.  The criteria of mental disorders are indeed value-related. Concepts of normality and abnormality Rosenhan and Seligman suggested that there are seven criteria that could be used to decide whether a person or a behavior is normal or not. 1.Suffering – does the person experience distress or discomfort? 2. Maladaptation – does the person engage in behaviors that make life difficult for him or her rather than being helpful? 3. Violation of moral or ideal standards – does the person habitually break the accepted ethical and moral standards of the culture? Concepts of normality and abnormality 4. Irrationality – is the person incomprehensible or unable to communicate in a reasonable manner? 5. Unpredictability – does the person act in ways that are unexpected by himself, herself or other people? 6. Vividness and Unconventionality – does the person experience things that are different from most people? 7. Observer discomfort – is this person acting in a way that is difficult to watch or that makes other people embarrassed?  How to define abnormality?  Qualitative criteria:  Abnormal functioning is of different quality than healthy  Quantitative criteria:  Abnormal is something that significantly differs from the average, defined for a given feature  Criteria of coexisting combinations of traits:  Abnormality when few symptoms exist together  Psychopathological symptom ▪ Disruption, disorder of the smallest manifestations of mental life ▪ Examples: anxiety, hallucination, depressed mood, lack of initiative ▪ A sign of abnormality in one of the mental functions: ▪ cognitive ▪ emotional ▪ impulses ▪ motivational ▪ volitional ▪ integrating mental activities  Psychopathological syndrome ▪ A pattern of symptoms indicative of some disease ▪ Several symptoms coming from different psychological functions occurring together ▪ A set of symptoms and signs that are usually due to a single cause (or set of related causes) and together indicate a particular physical or mental disease or disorder. Also called symptom complex. ▪ Example: manic syndrome Mood changes Sudden changes in energy and activity Speech disruptions Impaired judgment Changes in thought patterns  Mental disorder ◼ A pattern of symptoms with characteristic beginning, course and final, conditioned with specific disease factor ◼ A set of symptoms which follow a characteristic pattern and develop in a specific way. It’s process it goes through different phases. ◼ Example: bipolar disorder  Models of classifications ▪ Categorical approach – there are separate classes, clusters of disorders of high consistency, different from other classes ▪ Dimensional approach – health and disorder differ only in the severity or intensity ▪ Prototypical approach ▪ Prototype – the most representative; disease entity, that has the typical qualities; the reference point ▪ In the current classifications  Classifications of mental disordes ▪ ICD-11 (International Classification of Diseases and Related Health Problems, 2019) ▪ DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 2022); (DSM-5: 2013) ▪ CCMD-3 (The Chinese Classification of Mental Disorders ( 中国精神疾病分类方案与诊断标准) ▪ Some of the wordings of the diagnosis are different: ▪ borderline personality disorder in the DSM, ▪ emotionally unstable personality disorder (borderline type) in the ICD, ▪ impulsive personality disorder in the CCMD.  The DSM-5-TR definition of mental disorder (APA, 2022, p.14):  „a syndrome characterized by clinically significant disturbance  in an individual’s cognition, emotion regulation, or behavior  that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.  Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.  An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above”. (p.14) The complete state model of mental health and illness (Keyes & Lopez, 2007) High subjective well-being Struggling Flourishing Incomplete Complete Mental Illness Mental Health High Low psychopathology psychopathology Floundering Languishing Complete Incomplete Mental Illness Mental Health Low subjective well-being Lecture 4:Between clinical assessment and clinical diagnosis Clinical and Health Psychology Anna Gabińska, Ph.D. Lecture overview  Between clinical assessment and clinical diagnosis.  different assessment tools used by clinical psychologists (literature)  the role of intelligence, personality and behavioral assessment in clinical psychology (literature)  clinical judgment  Clinical Diagnosis: classifications of mental disordes ▪ ICD-11 (International Classification of Diseases and Related Health Problems, 2019) ▪ DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 2022) ▪ CCMD-3 (The Chinese Classification of Mental Disorders ( 中国精神疾病分类方案与诊断标准)  Between clinical assessment and clinical diagnosis  If someone is depressed, we may, in a particular case, diagnose for instance with the full DSM-IV nosology of: - Major Depressive Disorder, Recurrent, Severe Without Psychotic Features, With Melancholic Features, With Full Interepisode Recovery, Superimposed on Dysthymic Disorder.  But what does it tell us?  A psychiatrists might say, “OK. It’s major depression, let’s try an antidepressant medication.”  (Fair enough. After all, if someone breaks his leg the treatment doesn’t hinge on why he broke his leg.)  But a psychologist has to ask why. “Yes, but why is he depressed?” And in answer to this question the DSM diagnosis tells us nothing.  Aim of the clinical psychological assessment  Understanding the person’s problem: 1. Description of a problem (what is it specifically?) 2. Analysis of the causes of a problem (how it started?) 3. Analysis of psychopathological mechanism (how it is maintained?)  Underlying assumption: Symptoms manifest and indicate the pathological process.  Psychological assessment is most useful in the understanding and evaluation of personality and problems of living.  What is clinical psychological assessment? a broader psychological assessment to more accurately diagnose a person's psychological condition. Based on information from multiple sources: psychological tests personal interview, family interview observation job history records reports and records from other physicians, therapists, and counselors. „Getting to know the whole story” - a person’s inner and outer life, past and present life situations, psychological state and behaviors. Why to assess? in cooperation with a psychiatrist to make a psychiatric diagnosis to understand psychological difficulties and problems reported by a person and determine the likely causes and the best ways to deal with these issues to assess the weaknesses and strengths of functioning Based on assessments, psychologists develop and apply effective therapeutic treatment plans and interventions. Psychological assessment  process that involves the integration of information from multiple sources, such as psychological tests, observation, interviews, analysis of personal history, description of current symptoms and problems by either self or others, and collateral information.  comprehensive psychological evaluation consisting of selection, administration, evaluation, interpretation of various assessment instruments and integration of results into a coherent report (in case of clinical assessment often including guidelines for treatment planning)  How do I know which psychological tools to use? The type of tools used in the clinical psychological assessment depends on the purpose of the diagnosis. Sometimes the purpose is clear from the beginning A psychiatrist asks for help in differentiation between two specific disorders; The child is sent to the psychologist with suspected ADHD, A client wants to know his IQ, etc.  How do I know which psychological tools to use? In determining the purpose of the diagnosis, a personal interview with the patient/client is necessary. Even when the purpose of assessment is clear from the beginning, the interview is necessary to determine possible contraindications to the use of specific psychological tools (problems with eyesight, hearing, hand motility, language barrier, cultural barrier, etc.) Different assessment tools used by clinical psychologists Methods, techniques, tests:  nomothetic idiographic  standardized „free”  quantitative qualitative  objective projective  psychometric interpretative  PERSONALITY INVENTORY INTERVIEW  INTELIGENCE TEST PROJECTIVE TEST BEHAVIORAL ASSESSMENT Different assessment tools used by clinical psychologists  Interviews  Structured interviews for different DSM disorders  The intake-admission interview  The case-history interview  The mental status examination interview  Observation (structured vs. Unstructured)  Questionnaires:  The broad screening measures (SCL-90-R)  Symptoms checklists (BDI)  Personality Inventories (MMPI, NEO-PI-R)  Projective tests (TAT or RISB)  Sample Task Performance Techniques  Intelligence testing (WAIS-IV. Stanford-Binet-5th Edition)  Behavioral assessment (functional analysis)  Clinical Judgement -> Diagnostic inference Aim: to create an accurate description of the client/patient. Development of an optimum level of rapport → increases the likelihood of client’s optimum level of performance. Impact of various situational variables (transient conditions, assessment context). Clinician's objectivity may be biased by: - first impression (primacy effect) - self-fulfilling prophecies, confirmatory bias – especially in a hypothesis-testing situation. - clinician’s professional and personal experience (personal and cultural bias).  Clinical Judgement -> Diagnostic inference Accurate person perception is positively associated with: - intelligence - good emotional adjustment - similarity in race and cultural backgrounds Accuracy of clinical judgments also heavily relies on: - the level of knowledge and experience of the diagnostician - the kind of sources used to create client’s description - acknowledging the role of chance -> that our predictions will be less than 100% accurate - Not only relying on intuition, but also actuarial prediction  Clinical and mechanical (actuarial, statistical) diagnosis (Meehl, 1954) Clinical judgment refers to the typical procedure long used by clinical and applied psychologists and physicians, in which the judge puts the data together using informal, subjective methods => Rule-of-the-thumb (Meehl, 1956,p. 264) Psychologists, who base their work on clinical prediction, believe that their experience gives them a „clinical insight”, which allows them to make better predictions than those derived from research. Clinical and mechanical diagnosis Clinicians differ in how they do this: the very nature of the process tends to preclude precise specification (Grove et al., 2000), but all value the use of personal interviews. Meehl suggested that such diagnosis should be replaced by mechanical diagnosis, so that there are: ⚫ explicit, well-defined rules ⚫ leading to reproducible results ⚫ regardless of the circumstances of diagnosis  Problems with diagnosis of mental disorders in children and adolescents (metanalysis by Merten et. al., 2017) Significant differences are observed between clinical and epidemiological data in mental disorders -> overdiagnosis especially in case of ADHD A number of studies suggest that misdiagnosis does occur -> diagnosticians are prone to making mistakes in the decision-making process. Research by Bruchmüller and colleagues (2012) suggest that diagnosticians make more false-positive than false-negative diagnoses, which can be seen as proof of overdiagnosis of ADHD. 16.7% of psychotherapists diagnosed ADHD although diagnostic criteria were not fulfilled. Only 7% gave no diagnosis, although the case vignette fulfilled diagnostic criteria for ADHD. Lecture 5: Main models of human functioning and approaches used in clinical psychology. Part 1 Clinical and Health Psychology Anna Gabińska, Ph.D. Lecture overview Main models of human functioning and approaches used in clinical psychology.  one-dimension model and multipath models  diathesis-stress model  psychodynamic approach  humanistic Patogenic approach  One-dimension models of mental disorders:  explain disorders in terms of a single cause  predominantly linear explanation  considered to be overly simplistic.  Multipath models of mental disorders:  explain disorders in more holistic and interactive terms.  system of different reciprocal influences (biological, psychological, social and sociocultural) interact in complex ways to yield the major etiological and maintaining processes responsible for mental disorders.  i.e. Biopsychosocial model  The interaction of genes and environment (Barlow & Durand, 2015)  Genetic factors contribute to all disorders (but explain less than 50%) -> there must be an environmental trigger for a disorder to occur.  Diathesis-stress model – one inherits a predisposition for a certain behavior or trait (diathesis), which can be activated in a particular conditions of stress. Diathesis or Vulnerability, is genetically determined and makes a person prone to develop a disorder Stress is environmental The bigger the vulnerability, the smaller the life stress required to produce the disorder.  Psychodynamic model  Sigmund Freud was the first to challenge the view that mental disorders were caused by physical illness. Instead, he proposed that psychological factors were responsible.  The essence of the psychodynamic approach is to explain behavior in terms of its dynamics, i.e. the forces that drives it. 1. Personality structure 2. Level of awareness 3. Psychosexual stages 4. Defense mechanisms Personality structure  Adult personality is structured into three parts - id, ego and superego - that develop at different stages in our lives.  According to Freud, the key to a healthy personality is a balance between the id, the ego and the superego.  People differ in terms of the extent to which their personality is dominated by the id, ego or superego. For example, a person with a personality dominated by id will tend to be pleasure seeking and antisocial, lacking concern for others. Personality structure -Id  The impulsive and unconscious part of our personality, present at birth (instinctual).  gaining pleasure;  immediate satisfaction at any cost  no regard for social norms  Guided by pleasure principle  Id seeks gratification of instinct in action (eating) or fantasy (visualizing food). Personality structure - Ego  The conscious, and rational part of the mind, acting in the external world.  Develops around the age of two years, but changes with time.  It’s aim is to work out realistic ways of balancing the demands of the id in a socially acceptable way:  gratification delay is possible  Able to separate wish from fantasy, tolerates tension, able to compromise. Personality structure - Superego  Forms at around the age of four years, is a learned aspect of self.  Includes ego ideal and conscience (individual’s morality).  Seeks to perfect and civilize our behavior.  Learned through identification with one’s parents and others.  Black – white judgments – no ability to compromise. Levels of awareness  Freud’s most enduring insight was his recognition that unconscious forces can influence behavior.  Conscious – a logical mind  Unconscious – ruled by pleasure-principle  Psychic energy is used to find acceptable ways to express unconscious ideas and wishes or to keep them repressed Freud’s model of personality structure Psychosexual stages  Freud used the term ‘sexual’ to mean sensual or physical. At each stage, a person’s life force is attached to an organ of the body.  Focuses on the development of the instincts, therefore rooted in biology  He theorized that the ways in which children deal with immature sexual urges during different stages of psychosexual development shape personality.  Freud predicted that experiences during these key stages would result in distinct adult personality types. Such effects are due either to frustration or overindulgence during any psychosexual stage – both of which lead to a fixation on the stage and characteristic kinds of behavior. PHRASE Healthy resolution of Frustration or harsh Overindulgence Ages/ erotic focus the stage treatment ORAL 0-1 years Ability to form Oral aggressive Oral receptive (mouth) relationships with character is character Eating, sucking, biting others and accept characterised by is optimistic, gullible, their aggressiveness, overdependent on affection; enjoyment domination, others, trusting, and of food and drink. pessimism, envy, and full of admiration for suspicion. others. ANAL 1–3 years The ability to deal Anal retentive Anal expulsive (anus) with character is neat, character Expelling or retaining authority and to have stingy, precise, is generous, messy, feces a balance between orderly and obstinate. disorganised, being orderly and careless, and defiant. being disorganised. PHALLIC 3–6 years The superego is based Phallic character is reckless, self-assured and (genitals) on an internalisation a harsh, punitive superego, and may have masturbating of the views of the problems with sex and sexual identity. same-sex parent, Freud suggested that a fixation at this stage Latency 6-12 years leading to the may lead to homosexuality. (none, sexually development of a repressed) expanding conscience and mature social contacts moral development. GENITAL 12-20 years, Genital character is the ideal. Well-adjusted, mature adult who is able (genitals) to love and be loved, work hard and contribute to society. Defense mechanisms  The ego attempts to keep conflicts and their discomfort from reaching consciousness by employing a variety of defense mechanisms that distort reality, usually at an unconscious level.  Help the individual cope with anxiety and prevent the Ego from being overwhelmed.  Have adaptive value if they are mature and do not become a style of life to avoid facing reality.  MECHANISMS OF DEFENSE that help the Ego deal with the anxiety  Overusing defense mechanisms, results in SYMPTOMS formation - disguised expression of repressed emotions and impulses Defense mechanisms  Displacement (transfer of impulses from one person or object to another).  Projection (undesirable thoughts are attributed to someone else).  Denial (refusing to accept reality)  Sublimation (negative emotions are transformed to positive, socially acceptable behaviors or emotions)  Suppression (pushing uncomfortable thoughts into the preconscious so they can be accessed later). Humanistic model  Emphasis on people as friendly, cooperative and constructive;  Humanity is basically good, forward-moving, and trustworthy  focus on drive to self-actualization the drive to better self: we have the ability to become what we want and to fulfill our capacities people are motivated by the actualizing tendency to enhance the self.  Reality: the product of our unique experiences and perceptions of the world; subjective universe is more important than the events themselves. Rogers’s Humanistic Theory Development of abnormal behavior occurs when society imposes conditions of worth on people so that their self-concept and actualizing tendency become incongruent. Such incongruence produces behavior disorders. Unconditional positive regard: Value and respect a person, separate from one’s actions Abnormal behavior results from disharmony between a person’s potential and self- concept. Figure 12.9 Rogers’s view of personality structure Abraham Maslow  Actualizing tendency: People are motivated to satisfy not only biological needs, but also the self.  Self-actualization: Inherent tendency to strive toward realization of one’s full potential Maslow’s hierarchy of needs Lecture 6: Main models of human functioning and approaches used in clinical psychology. Part 2 Clinical and Health Psychology Anna Gabińska, Ph.D. Lecture overview Main models of human functioning and approaches used in clinical psychology.  behavioral  cognitive approach  Behavioral model  All behavior is learned.  The reason you tend to be aggressive or loving or good at exams or suffer from a mental disorder can all be explained in terms of the experiences you have had as opposed to any inherited dispositions.  Like psychodynamic theorists, behavioral theorists believe that our actions are determined largely by our experiences in life.  People are born as a ‘blank slate’.  Behavior is all that should concern psychologists – there is no need to search for the mind or analyze thoughts and feelings.  Personality is as a collection of response tendencies that are tied to various stimulus situations  Behavioral model  Focus on symptoms not causes  Normality equaled with the possession of an adequately large repertoire of learned responses  A major cause for abnormal behavior is a learned maladaptive responses  acquisition of emotional responses,e.g. anxiety  No distinction between symptoms and behavior disorder  “Mentalillness”/“Mental disorder” are not meaningful  Classical conditioning  Learning by temporal association  When two events repeatedly occur close together in time, they become fused in a person’s mind; before long, the person responds in the same way to both events. If a man experiences chest pains which result in anxiety while shopping in a department store, he may develop a fear of department stores and begin to avoid them because he associates them with anxiety.  Classical Conditioning Step 1: Unconditioned stimulus (UCS) > Unconditioned response (UCR) Conditioned Stimulus (CS) No response Step 2: Pairing UCS and CS > Conditioned Response (CR) + Step 3: Conditioned Stimulus (CS) > Conditioned Response (CR)  Classical Conditioning Step 1: Unconditioned stimulus (UCS) > Unconditioned response (UCR) Conditioned Stimulus (CS) No response Step 2: Pairing UCS and CS > Conditioned Response (CR) + Step 3: Conditioned Stimulus (CS) > Conditioned Response (CR)  Operant Conditioning Humans learn to behave in certain ways as a result of receiving rewards whenever they do so. Positive reinforcement- increasing a behavior by providing a positive reinforcer when the behavior occurs. Negative reinforcement- increasing a behavior by removing a negative reinforcer when the behavior occurs. Punishment- decreasing a behavior by providing a negative consequence when the behavior occurs.  Operant conditioning  Extinction (omission training)- decreasing a behavior by removing a positive reinforcer when the behavior occurs.  If a young woman begins to lose weight and her friends and family praise her for doing so, she may continue to lose weight, even if it means starving herself.  Her restricted eating behavior will continue because she now associates a reduction in her diet with the praise and acceptance of others. Observational learning: Social Learning Theory by A. Bandura  Acquisition of new behaviors does not only rely on personal experiences.  Responses are learned indirectly by observing and repeating behavior of others, there is no direct reinforcement.  Individuals observe role models (people with whom they identify) and learn about the consequences of behavior through indirect reinforcement. These consequences are represented as expectancies of future outcomes and stored as internal mental representations.  Cognitive model  Based in information processing viewpoint.  Cognition involves the mental processes of perceiving, recognizing, judging and reasoning.  Schemas: a set of underlying assumptions rooted in experiences, values and perceived capabilities (beliefs, attributions, expectancies)  Irrational and maladaptive assumptions and thoughts  Cognitive disortions  Cognitive model - Ellis  Ellis believed that everyone’s thoughts were rational at times and irrational at other times.  When we think rationally, we behave rationally and we feel happy, competent and efficient.  When we think irrationally we can develop negative or disturbed habits in our thinking which can lead to psychological disturbance (i.e. depression, anxiety)  dysfunctional thought patterns  pathology results when persons adopt illogic in response to life situations A – activating event B – belief C – consequences (emotional) What are Automatic Thoughts? What was going through your mind?  Happen spontaneously in response to situation  Occur in shorthand: words or images  Do not arise from reasoning  No logical sequence  Hard to turn off  May be hard to articulate Negative Stressful Automatic Thoughts Situation Emotions  Core Beliefs  Core beliefs underlie and produce automatic thoughts.  These assumptions influence information processing and organize understanding about ourselves, others, and the future.  These core beliefs remain dormant until activated by stress or negative life events.  Categories of core beliefs (helpless, worthless, unlovable) Core Beliefs Automatic Thoughts Examples of Core Beliefs  Helpless core beliefs  I am inadequate,  I am powerless,  I am vulnerable  I am a failure  Unlovable core beliefs  I will be rejected or abandoned,  I am ugly,  I am different,  Worthless core beliefs  I am worthless,  I am hurtful,  I don’t deserve to live  Cognitive Conceptualization Physiology Current Automatic Thoughts Situation About self, world Feelings And others Behavior Childhood Compensatory And Early Underlying Core Beliefs Strategies Life Events  Cognitive Distortions  Some tend to make consistent errors in their thinking.  Often, there is a systematic negative bias in the cognitive processing of patients suffering from psychiatric disorders  Selective abstraction - conceptualizing based on a detail  Overgeneralization - creating a rule based on only one (or few) incidents  Incorrect assessment of danger versus safety - sensing risk as dangerously high  Dichotomous (polarized) thinking - Interpreting in terms of extremes  All-or-nothing thinking - all good or all bad  Emotional reasoning - feelings are facts  Magnification  Minimization Lecture 7: Characteristic features of psychological help and psychological interventions used in clinical psychology. Clinical and Health Psychology Anna Gabińska, Ph.D. Lecture overview helping relationship - its elements and determinants (stages of change, ethics) common factors of psychotherapy associated with positive outcome the role of clinical assessment in providing effective psychological help Who is helping?  friends  family members  role model  priest  couch  fortune-teller  psychiatrist  psychologist Psychological helping relationship - its elements and determinants 1. Taking into account social and cultural criteria in the assessment of mental health/disorders  Concepts: norm, moral misconduct, maladaptive functioning vs. mental disorder vs. mental "illness". 2. Recognizing psychological disturbances for the purposes of receiving specialized help 3. Understanding human behavior instead of judging it morally.  Concepts: empathy, unconditional acceptance, "being on the client's side", psychopathological symptom, its function and psychological mechanism. Psychological helping relationship - its elements and determinants 4. Treating difficulties as a problem to be solved and a starting point for a beneficial life change.  Concepts: post-traumatic growth, personal development, personality and social resources, mental strength, social support. 5. Restraint towards atypical behaviors, deviating from common patterns of functioning.  Concepts: individual autonomy, client's good and rights, therapeutic contract. 6. Following the code of ethics and following the rules of mental hygiene.  https://www.apa.org/ethics/code Ethical Essentials  Confidentiality and informed consent  Multiple roles  Client harm: sexual abuse of therapy clients  Competence Additional ethical issues Criteria for receiving psychological help  Subjective experience of the problem  Psychological nature of the problem  The right motivation  No contraindications to receive psychological help  Subjective experience of the problem (Fish, Weakland i Segal, 1982) 4 criteria must be meet: 1. The client must express concern about his own or others' behavior, feelings or thoughts. 2. The client's behavior, thoughts or feelings must be described as: disturbed (unusual, inappropriate, abnormal) or not safe (causing suffering) or harmful (potentially or directly) to the client or others who display them. 3. The client must admit that he made an intentional effort to change or inhibit a given behavior, thoughts or feelings, but it did not bring the expected effect. 4. As a result of the lack of positive results of own efforts aimed at overcoming the undesirable behavior, the client asks for help.  Psychological nature of the problem  The problem concerns the client or people directly related to him (not, for example, the president or prime minister, but client’s brother or partner).  The client has some influence on the problem (e.g. his difficulty in managing home budget but not the tax system in Poland)  The problem lies in the competences of a psychologist (giving support in finding yourself in a new life situation but not cancer treatment) The right motivation  Internal or external motivation  Why did the person decide to come?  Why the person is coming right now?  How severe the problem is?  Severity in terms of: how annoying/worrisome/troublesome it is?  Who is affected by the problem? Contraindications to receive psychological help  "Suicidal" thoughts and /or tendencies  Possibility of neurological disorders  Disturbances of consciousness  Strong psychopathological symptoms  Physical exhaustion/cachexia  Low level of intellectual functioning Stages of Change Prochaska, Norcross, & DiClemente  Precontemplation (Denial)  “What problem? I’m not thinking about it.”  Contemplation (Ambivalence)  “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.”  Preparation / Determination (Admission)  “I have a problem.”  Action (Taking steps / Making changes)  “I have a problem and I’m ready to do something about it.”  Maintenance (Continuing what works)  “I’m stabilized and doing well. How can I support my ongoing recovery?”  Relapse / Recycle (Trying again)  “I’m stabilized but have relapsed. How can I get back into active recovery?”  What works in therapy? In one of a number of major reviews, Wampold identifies the following factors that affect outcomes:  General effects - common factors that underlie all psychotherapies: 70 per cent  Specific effects – that is particular aspects linked to a specific model: 8 per cent.  Unexplained variability – most likely linked to client differences: 22 per cent.  In other words, the model practised counts for only 8% towards positive outcome in therapy. Wampold BE. (2001). The great psychotherapy debate. New Jersey: Lawrence Erlbaum So what works in psychotherapy? “The relationship is the most significant in- therapy factor as related to positive outcomes.” Paul, S and Haugh S (2008) The Relationship not the Therapy? In S Haugh and S Paul, The Therapeutic Relationship: Perspectives and Themes Ross-on-Wye: PCCS Books. Common factors of psychotherapy associated with positive outcome Common factors: shared, fundamental elements of therapy (rather than specific techniques) are “active ingredients”  therapeutic relationship/alliance,  instillation of hope,  attention  corrective experience,  opportunity for catharsis,  practicing new behaviors  Common factors of psychotherapy associated with positive outcome Three-stage sequential model of common factors: support, learning, action factors (in that sequence)  Support factors: a strong therapist-client relationship, therapist warmth and acceptance, trust  Learning factors: changing expectations about oneself, changes in thought patterns, corrective emotional experiences, new insights  Action factors: taking risks, facing fears, practicing and mastering new behaviors, working through problems Therapeutic Factors in Group Therapy  Instillation of hope  Universality  Imparting information  Altruism  Corrective recapitulation of the primary family group  Development of socializing techniques  Imitative behavior  Interpersonal learning  Group cohesiveness  Catharsis  Existential factors  Clients pathway If a patient opts-in to the Information session Psychological Therapies Is this service for me? Service they’ll be invited to a first meeting with an individual clinician Yes No There is a range of Assessment Discharge therapies available that can meet Treatment different people’s Individual Group needs If one decides that the Discharge and/or service isn’t the right one, referral on to another therapeutic center should service direct the person somewhere else where ones needs can be meet. Lecture 8-9: Types of psychological help available in solving various psychological and health problems. Clinical and Health Psychology Anna Gabińska, Ph.D.  Variety of professional activities of clinical psychologist due to the purpose of help (psychoeducation, prevention, promotion, counselling, crisis intervention, psychotherapy)  psychotherapy theories and approaches (readings). Types of psychological help  Prevention  Promotion  Psychoeducation  Counseling  Psychotherapy  Crisis intervention Different types of psychological help in health care system Health promotion Prevention Treatment Aftertreatment procedures (relapse`s prevention)  Promotion Aim: improve overall wellbeing; encourage and increase protective mental health factors and healthy behaviors that help prevent the onset of various disorders;  ie. creating living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles.  Recipients: various groups: may be delivered where people live, work, learn, and thrive. Specific features: school and workplace mental health programs, early childhood interventions, social support and community engagement, women empowerment, anti-discrimination programs Prevention Aim: prevent problems (disturbances, dysfunctions, disorders) before they occur.  prevention – conscious action aimed to keep something from happening. Recipients: depending of the type of prevention it can be addressed to the whole population, those at risk of developing problems/disorders or those, who already suffer from mental disorders. Specific features: requires not only knowledge from clinical psychology but also social psychology (social influence, groups, stereotypes etc.). Makes use of psychoeducation, skills training and raising awareness. Prevention efforts vary also based on the level of intensity and development phase they target.  Psychoeducation Aim: providing knowledge, skills and experience in order to improve coping with difficulties, emotions and relationships. Recipients: mainly healthy individuals or targeted clinical population. Specific features: used in health promotion, prevention and treatment of patients with mental disorders.  Psychoeducation  Programs for targeted clinical populations  improves knowledge about mental illness/coping with stress/healthy behaviors/parental skills  behavioral tailoring improves medication adherence as prescribed  relapse prevention reduces rates of symptom relapses and rehospitalizations  cognitive-behavioral coping skills training reduces the severity and distress of persistent symptoms  Social skills training (SST) for psychotic patients – with an aim of acquisition and utilization of social skills.  Improves social functioning  Reduces relapse rates and hospitalization  Assertiveness training – not necessary for clinical populations, for all who have trouble expressing their opinions. Counseling or psychotherapy? Clinical psychologists and counseling psychologists both treat wide variety of mental and emotional problems.  Counseling psychologists typically focus on individuals whose symptoms are less severe, such as those coping with everyday stresses and adjusting to life’s rollercoaster ride.  Clinical psychologists often treat patients with more serious symptoms and disorders.  In both the same techniques may be used, but in each psychologist should have different assumptions about abilities of the client/patient.  Counseling Aim: facilitating reflection about oneself and one’s problems in order to take the responsibility for one’s lives and effectively manage one’s development Recipients: healthy individuals in times of developmental crises and experiencing troubles with adjustment. Specific features: the most common form of psychological help, diagnostic consultation, "short-term psychotherapy.” Life/professional coaching - training systems developed in order to support people and organizations in achieve their goals.  Psychotherapy Aim: treatment of mental disorders, recognized as specific syndromes. Recipients: individuals with symptoms of mental disorders. Specific features: primary (eg. in the case of neurotic syndromes) or complementary (eg. in the case of psychosis) method of treatment for mental disorders. Insight therapies (talk therapies) and behavioral therapies (changing overt behavior) Therapeutic approaches are related to the main theoretical perspectives and beliefs about root of behavior. Different kinds of psychotherapy  https://www.psychologytoday.com/intl/types-of- therapy  https://www.div12.org/psychological-treatments/  Crisis intervention Aim: supporting people so that they regain the ability to independently solve the crisis. Recipients: healthy individuals experiencing severe or profound crisis. Specific features: in times of high emotional tension, fear, sense of loss of control and helplessness, and when disorganized behavior and somatic symptoms appear. Debriefing - intervention (partly psychoeducation) oriented to minimize the risk of PTSD as a result of experienced trauma. Understanding the needs of the other person as a basis for effective help  factors affecting the current needs of the people: gender, personality, temperament stages of life, life situation, cultural background.  matching the type of support provided to the properties of the individual and the situation he/she is in.  the relationship between the desired support and the support delivered. Formats of Psychotherapy  The most common is Individual therapy Psychotherapy Type % of Clinical Psychologists Who Practice It Individual 98 Couples/Marital 48 Family 34 Group 20 Family (and Couples) Therapy Aim: ultimate: treatment of mental disorders, dealing with wide variety of psychological problems direct: nurturing change and development in families and couples, who undergo crisis by improving the communication and solving family problems. Recipients: families of individuals suffering from mental disorders or experiencing psychological problems; couples in crisis. Specific features: effective intervention requires a change of interaction(s) between family members. Mental disorders understood as playing a particular function for the whole family system (identified patient). Family Therapy: The System as the Problem  When the family therapy movement initially arose in the mid-1900s, it was considered revolutionary  Psychological symptoms as a byproduct of dysfunctional families  One individual may exhibit symptoms, but the problem belongs to the entire system  Circular causality—events influence each other reciprocally  As opposed to linear causality, which is endorsed by individual therapists  Focus on functionalism of symptoms  Within family, symptoms may be adaptive Family Therapy: The System as the Problem  Focus on functionalism of symptoms  Within family, symptoms may be adaptive  Family Life Cycle: developmental theory for families, including seven stages  Leaving home  Joining of families through marriage or union  Families with young children  Families with adolescents  Launching children and moving on in midlife  Families in late middle age  Families nearing the end of life Group Therapy Aim: several clients meet regularly with one or more therapists to resolve problems of (inter)personal nature.  Based on the notion that: 1. learning that others also share their problems leaves people feeling less alone and ashamed; 2. others may provide useful feedback (if its quality is controlled by the therapist); 3. we can model certain behaviors in groups more easily; 4. group constitutes a good place for practicing new behaviors and acquiring social skills.  A variant of group therapy is a self-help group.  Self-help groups usually are not led by professional therapists - they are simply groups of people who share a common problem and meet to give and receive support Group Therapy: an Interpersonal Emphasis  Most forms of group therapy strongly emphasize interpersonal interaction  Take advantage of the fact that the group therapy experience itself is based on interacting with other people  Irvin Yalom is a leader in this interpersonal approach to group therapy  Clients’ problems stem from flawed interpersonal relationship skills  If they can practice and improve on this with fellow group members, they can generalize lessons learned Therapeutic Factors in Group Therapy  Instillation of hope  Universality  Imparting information  Altruism  Development of socializing techniques  Imitative behavior  Interpersonal learning  Group cohesiveness  Catharsis  Existential factors Therapeutic Factors in Group Therapy  Universality  Clients realize that others share the same struggles (i.e., “We’re all in the same boat”)  Especially powerful in homogeneous groups  Group Cohesiveness  Feelings of interconnectedness among group members  Trust, acceptance, belongingness  Analogous to therapeutic alliance in individual therapy Therapeutic Factors in Group Therapy  Interpersonal Learning  The same interpersonal tendencies that contributed to the client’s problems will appear in the group context  Group members form relationships with each other and work to improve them, and those improvements will help with outside relationships eventually  The group becomes a social microcosm for each client  Clients enact their own relationship pathology (without knowing it) in the group itself  Focus on the here-and-now  Discourage discussion of lives outside of therapy  Encourage discussion of relationships between group members in the current moment  Clients talk directly with each other about the way they behave toward each other Group membership  Typically 5-10 clients - 7 to 8 members in a group is ideal.  Open-enrollment groups—individuals leave or join at any time  Closed-enrollment groups—members start and finish together  Most individuals can be included, unless they can’t interact meaningfully with others and reflect upon that interaction  Psychosis,acute crisis, frequent absences are problematic Effectiveness of Group Therapy  Not studied as extensively as individual therapy  Existing studies strongly suggest that group therapy is beneficial  About equal to individual therapy in most studies; slightly inferior in a few studies  Cohesiveness in group is a major contributor to successful outcome  Can be less expensive than individual therapy also  What Types of Psychotherapy Do Clinical Psychologists Practice?  Eclectic/integrative therapy was most popular orientation until 2010  Cognitive is now #1  Psychodynamic therapy has declined since 1960s Orientation 1960 1973 1981 1986 1995 2003 2010 Eclectic/Integrative 36 55 31 29 27 29 22 Cognitive — 2 6 13 24 28 31 Psychodynamic/Psychoanalytic 35 16 30 21 18 15 18 Behavioral 8 10 14 16 13 10 15 Humanistic/Rogerian/Existential/Gestalt 6 7 7 12 4 2 2 Patient/Client variables: Who benefits the most?  YAVIS  Young, attractive, verbal, intelligent, successful  But…depends on type of intervention, the nature of the problem, etc.  Level of distress  Motivation  Openness  Gender  Ethnicity  SES Therapy utilization rates The 20 mental disorders treated most frequently by licensed psychologists in the U.S. in 2017 (Stamm, Lin & Christidis, 2018 as cited in Rossiter, 2022) Lecture 10: Foundations of health psychology Clinical and Health Psychology Anna Gabińska, Ph.D. Lecture overview Foundations of health psychology  historical overview (literature)  ways of defining, area of interest, tasks  relations with clinical psychology and other related disciplines  the concept of health – models and approaches used in health psychology.  pathogenic and salutogenic approach  the concept of resilience resources and deficits Health Psychology definitions ▪ ‘… the aggregate of the specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction; and the improvement of the health care system and health policy formation. (Matarazzo, 1980, 1982, 2001) ▪ Health psychology is the study of psychological processes that influence health, illness and health care.  Health psychology  Based on biopsychosocial model “Health psychology examines how biological, social and psychological factors influence health and illness. Health psychologists use psychological science to promote health, prevent illness and improve health care systems.” - APA, 2014  Key concepts  Health:health is the influence of both our physiology (diet/exercise) and psychology (stress/social support).  Lifestyle: the patterns of our everyday decisions which characterize our behavior.  Stress: personal response to events that threaten to disrupt our daily behaviors. What do Health Psychologists do? promote healthier lifestyles, for try to improve the healthcare system, example help people to lose weight or by for example advising doctors about stop smoking better ways to communicate with their patients. use psychological interventions to provide information and advice help self-management of illness and to different organizations coping with pain or illness involved in public health investigate health and illness encourage patients to improve behaviors. A range of models and their health encouraging frameworks are used to explain and behaviors such as exercise, predict behavior and develop healthy diet, oral hygiene, health interventions aimed at changing checks/self-examination and health beliefs, increasing internal attending preventative medical control or self belief screenings Health  Presence or absence of disease  Complete physical, mental, social well-being  Ability to maintain normal roles  Developmental and behavioral potential is realized to fullest extent possible  Striving toward optimal functioning Psychology and Health  Dual Pathway Model: Two broad ways in which psychological processes may influence physical health Psychological Direct Path Physical Processes Health Behaviour Models of Health  Clinical model  Role performance model  Adaptive model  Eudemonistic model  Agent-host-environment model  Health-illness continuum Clinical Model (pathogenesis)  Provides narrowest interpretation of health  People viewed as physiologic systems  Health identified by absence of disease or injury  State of not being “sick”  Opposite of health = disease or injury  The pathogenesis of a disease is the mechanism that causes the disease.  Pathogenesis can also describe the origin and development of the disease, and whether it is acute, chronic or reccurent.  Emphasis on relieving the ‘pain’ Role Performance Model  Able to fulfill societal roles  Viewed as healthy even if clinically ill, if still able to fulfill roles  Sickness = inability to perform one’s role Adaptive Model  Creative process  Disease = a failure in adaptation or maladaptation  Extreme good health = flexible adaptation to the environment  Focus is stability, with ability to grow and change  Eudemonistic Model  Comprehensive view of health  Actualization or realization of a person’s potential  Illness = condition that prevents self-actualization  Human potential through goal-directed behavior, competent self-care  Satisfying relationship with others  Maintaining structural integrity and harmony with social and physical environments  Health = expansion of consciousness Agent-Host-Environment Model  Each factor constantly interacts with the others  When in balance, health is maintained  When not in balance, disease occurs Health-Illness Continuum  Measures person’s perceived level of wellness  Health and illness/disease opposite ends of a health continuum  Move back and forth within this continuum day by day  How people perceive themselves and how others see them affects placement on the continuum Salutogenesis  A.Antonovsky: Why did some manage to avoid illness and do well even when subjected to extreme stressors?  Salutogenesis is an alternative medicine concept that focuses on factors that support human health and well-being rather than on factors that cause disease.  Definition by WHO: “Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.”  Pathogenic and salutogenic approach AREA OF PATOGENIC APPROACH DIFFERENCES SALUTOGENIC APPROACH homeostasis as a natural state of ASSUMPTION heterostasis, constant tendency to human organism increase entropy as a fundamental characteristic of human organism DEFINITION OF continuum stretching between the dychotomy: either health or disease HEALTH poles of absolute total health and disease ATTITUDE considered as to be constantly considered as definitely pathogenic, present in human life, emphasizing TOWARDS trying to eliminate them STRESSORS their beneficial role, trying to learn living with them. RESEARCH seeking disease-specific risk factors DOMAIN seeking general factors that contribute to health HYPOTHESIS omitting cases that do not match the VERIFICATION focus on cases deviating from the assumptions common expectations  Salutogenic approach 1. Stressors are considered to be constantly present in human life stressor – stimulus for which there is no ready adaptive response 2. Continuum health - disorder. D H S T R E S S O Rs Health as a process of searching for a balance between environmental requirements and the individual resources. Why does anyone, despite the constant presence of stressors, moves towards the pole health?  Resilience  Psychic resistance despite of stressors, adversity and challenges  Also is referred to as the ability of individuals to "rebound from the bottom" or return to the mental health and relatively good functioning after experiencing highly stressful event  Main research area of developmental psychopathology  Related concepts: emotional intelligence, self- regulation, self-organization, salutogenesis  Determined by dynamic protective factors  Not a personality trait, rather a process  There may be resilience resources or deficits.  General Protective Factors  Stable relationship to primary person  Emotionally supportive educational climate  Role models for constructive coping  Social support outside the family  Responsibilities in the family  Temperamental characteristics (eg, sociability)  Cognitive competences (eg,.average intelligence)  Self-efficacy, positive self-concept  Active, not just reactive coping behavior  Meaningfulness and structure in one‘s development  Realistic future planning  Sense of humor The complete state model of mental health and illness (Keyes & Lopez, 2007) High subjective well-being Struggling Flourishing Incomplete Complete Mental Illness Mental Health High Low psychopathology psychopathology Floundering Languishing Complete Incomplete Mental Illness Mental Health Low subjective well-being Positive Psychology Lecture 11: Health and disease in the psychological stress paradigm. Clinical and Health Psychology Anna Gabińska, Ph.D.  Lecture overview Health and disease in the psychological stress paradigm. different ways of defining stress (as a stimuli, state or a relationship) main theoretical models of stress sources of stress Stress  Stress is “any circumstances that threaten or are perceived to threaten one’s well-being and thereby tax one’s coping abilities.” Stress is your mind and body’s response or reaction to a real or imagined threat, event or change.  Stressor – stimulus for which there is no ready adaptive response The threat, event or change are commonly called stressors. Stressors can be internal (thoughts, beliefs, attitudes) or external (loss, tragedy, change).  Hobfoll stress model  Stress - response to an environment in which there is: a) a threat of loss of resources b) an actual loss of resources c) no increase in resources after they’ve been invested.  Resources  objects, conditions, personal characteristics and sources of energy that are essential for survival (directly or indirectly)  valued and recognized as valid by a group of people (the social aspect)  their acquisition and protection as the basic motivation of action Think about it…  CONTROL = STRESS  Stress = Control  Control = Stress Stress  Stressors are always present so stress is a common, everyday event. Major and minor problems may be stressful. Even daily hassles can also negatively influence our well-being. All stressful events cumulate – can have an additive impact. Eustress: positive experiences that promote well-being Distress: those experiences that cause some type of harm Stress – the role of appraisal  Stress is experienced individually, subjectively. Different people might feel different degree of stress from the same event. It is because we appraise events in different manner. Primary appraisal - initial evaluation of the relevance, level of threat, and degree of stress the event causes. You check if the event is 1) irrelevant to you, (2) relevant, but not threatening, or (3) stressful. Secondary appraisal – if the event is viewed as stressful, we make an evaluation of our ability to cope: coping resources and options for dealing with the stress. (Based on Lazarus & Folkman, 1994) Stress – context of experience  Stress embedded in the environment – environmental stress (ie. excessive noise, traffic, pollution, crowding). Ambient stress – refers to chronic negative conditions embedded in the environment.  Our culture influences the experience of stress as it is a context of our appraisal od events. Disparities in the stressors experienced by specific cultural groups. Racial discrimination negatively affects the mental health and well-being for targets of racism. For immigrants, acculturation, or changing to adapt to a new culture, is a major source of stress related to reduced well-being. Stress – common causes  There are three basic categories: Acute stressors – “threatening events that have a relatively short duration and a clear endpoint.” 2. Chronic stressors – “threatening events that have a relatively long duration and no readily apparent time limit.” Anticipatory stressors – “upcoming or future events that are perceived to be threatening.” Can affect us psychologically and physically just as strongly as actual stressors do. Stress – common causes  Frustration – “occurs in any situation in which the pursuit of some goal is thwarted.” Failures and losses are two common kinds.  Internal conflict – “occurs when two or more incompatible motivations or behavioral impulses compete for expression.” Approach – approach – must make a choice between two attractive goals. Avoidance – avoidance – must make a choice between two unattractive goals. Approach – avoidance – must choose whether or not to pursue ONE goal, which has both pros and cons. Stress – common causes  Role conflicts - being an athlete, a kid, trying to be a mature adult  Imbalance – too much work, not enough play and vice versa  Life changes – new job, moving, marriage, divorce  Self talk- negative thought patterns “I can’t do it”  Expectations – from ourselves and/or others, which are too high or too low  Poor quality relationships with family or friends  Time pressures (due dates)  Lack of meaning or purpose especially in those who think they have no goals Response to stress: complex and multidimensional  1. Emotional responses  2. Physiological responses  3. Behavioral responses Emotional response to stress  Commonly we expect negative emotional responses: annoyance, anger, and rage apprehension, anxiety, and fear dejection, sadness, and grief  Can also prompt positive emotional responses such as gratitude or renewed love for friends and family  Strong emotions may impede or enhance our ability to cope with stress, depending on our level of arousal and the task complexity. The “inverted-U hypothesis” predicts that: For low complexity tasks, the best is a high level of arousal. For medium complexity tasks, a medium level of arousal works the best. For high complexity tasks, a low level of arousal is best. Physiological response to stress  The fight-or-flight response is “a physiological reaction to threat that mobilizes an organism for attacking (fight) or fleeing (flight) an enemy.”  The fight-flight response is not well suited for coping with modern threats.  Occurs in the autonomic nervous system (ANS), which “is made up of the nerves that connect to the heart, blood vessels, smooth muscles, and glands.”. ANS is broken into two divisions: Sympathetic division mobilizes energy during emergencies, engages the fight-or-flight response. Parasympathetic division conserves energy, has calming effect on body. Physiological response to stress  Hans Seyle’s general adaptation syndrome is a “model of the body’s stress response, consisting of three stages.” 1. Alarm reaction – initial response to threat, fight-or-flight response engages. 2. Resistance – if threat continues, physiological changes stabilize, coping begins. 3.Exhaustion – if the threat continues too long, the body’s resources are depleted, leading to physical exhaustion and illness.  Stress can suppress certain aspects of the immune response.  Stress can interfere with neurogenesis, the formation of new neurons, in the brain Behavioral response to stress  usually we refer to coping, or “active efforts to master, reduce, or tolerate the demands created by stress.”  Coping responses may be: Healthy (e.g., actively trying to solve a problem by asking for help or generating solutions) Unhealthy (e.g., ignoring problem, indulging in alcohol, excessive eating)  Coping strategies help determine whether stress has any positive or negative effects on a person. Lecture 12: Health and disease in the psychological stress paradigm. Part 2 Clinical and Health Psychology Anna Gabińska, Ph.D.  Lecture overview Health and disease in the psychological stress paradigm. different ways of defining stress (as a stimuli, state or a relationship) main theoretical models of stress sources of stress coping with stress the role of social support in coping with stress (literature)  Coping with stress  Coping: anything people do to adjust to the challenges and demands of stress; any adjustments made to reduce the negative impact of stress  Coping: efforts to master, reduce, or tolerate the demands created by stress.  Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of a person (Folkman & Lazarus, 1984, p. 141)  Coping: process by which people try to manage the perceived discrepancy between the demands and resources they appraise in a stressful situation.  Coping? Hobfoll stress model  Stress - response to an environment in which there is: a) a threat of loss of resources b) an actual loss of resources c) no increase in resources after they’ve been invested.  Resources  objects, conditions, personal characteristics and sources of energy that are essential for survival (directly or indirectly)  valued and recognized as valid by a group of people (the social aspect)  their acquisition and protection as the basic motivation of action Coping with stress  We are motivated to do things to reduce our stress, because it is uncomfortable and leads to many negative effects.  In the literature one can find at least 100 coping taxonomies and 400 lower-order categories of coping techniques.  Problem-Focused and Emotion-Focused Coping by Lazarus and Folkman (1984)  Coping Dimensions Derived Theoretically by Carver et al.(1989)  Task-Oriented, Emotion-Oriented, and Avoidance-Oriented Coping by Parker and Endler (1992) Coping by Lazarus and Folkman (1984)) 1. Problem-focused coping:responses aimed at managing or altering the problem causing the distress. Efforts to act on the source of stress to change the person, the environment, or the relationship between the two: -- Planned problem solving -- Confrontation 2. Emotion-focused coping : are directed toward regulating emotional states. -- Denial/avoidance -- Seeking meaning -- Distraction or minimization -- Self-blame -- Expressing/sharing feelings -- Wishful thinking 3. In 1996 Lazarus admitted that distinction between problem- vs. emotion-focused coping led to an oversimplification. 4. Most ways of coping can serve both functions and thus could fit into both categories. For example, making a plan not only guides problem solving but also calms emotion. Coping Dimensions Derived Theoretically by Carver et al.(1989) 13 dimensions of coping were identified:  5 interpreted as sub-dimensions of problem-focused coping: active coping, planning, suppression of competing activities, restraint coping, seeking social support for instrumental reasons  5 sub-dimensions of emotion focused coping: seeking social support for emotional reasons, positive reinterpretation and growth, acceptance, denial, turning to religion  3 classified as “less useful” strategies: focus on and venting of emotions, behavioral disengagement, mental disengagement  COPE inventory Coping by Parker and Endler (1992)  Task-Oriented, Emotion-Oriented and Avoidance- Oriented Coping  Problem focused coping strategies are associated with a task-orientation, which refers to strategies used to solve a problem, reconceptualize it (cognitively), or minimize its effects.  Emotion-focused ones reflect a person-orientation, which refers to to strategies that may include emotional responses, self-preoccupation, and fantasizing reactions.  3rd basic dimension– avoidance-oriented coping  Coping Inventory for Stressful Situations (CISS) satisfactory psychometric properties and a stable factor structure confirmed across different cultures Coping by Parker and Endler (1992) Avoidance-oriented coping, involves both task-oriented and person-oriented strategies.  A person may avoid a stressful situation by engaging in substitute activities (distraction–e.g., watching TV) or seeking out other people (social diversion).  Task-oriented avoidance is conceptualized as distraction. In task-oriented coping, the person is confronting the stressful task. In distraction coping, the person is substituting an alternative task of his or her choosing.  Person-oriented avoidance takes the form of social diversion. Social diversion is “person-oriented in that the individual tries to “lose himself or herself ” by being with other persons rather than confronting the stressful situational task.  Responses to Stress Model Connor-Smith et al.(2000) A developmental and contextual theoretical framework of responses to stress in childhood and adolescence. expands on other models by considering voluntary and involuntary responses to stress. It includes five factors. The Responses to Stress Questionnaire ~RSQ  Responses to Stress Model Connor-Smith et al.(2000) Voluntary Strategies 1. Primary Control Coping - Attempts to directly modify stressful problem or emotion (problem solving, emotional expression and emotional regulation) 2. Secondary Control Coping – Attempts to adapt via cognition (cognitive restructuring, positive thinking) 3. Disengagement Coping - Attempts to redirect attention away from the stressor or emotional reaction (denial, wishful thinking) Involuntary Strategies 4. Involuntary Engagement – Directed toward the stressor or their emotional reactions (arousal, rumination, impulsive action) 5. Involuntary Disengagement – Directed away from the stressor or their emotional reactions (emotional numbing, escape) Responses to Stress Model  Emphasizes developmental changes in nature of stress, internal/external constraints limiting coping processes, and a complex interplay between voluntary and involuntary responses to stress.  Involuntary responses reflect individual differences in temperament, over-learned and automatic responses  Assumes an increase in secondary control coping and emotion-focused coping and decreases in disengagement with maturity Constructive Coping  Constructive coping - “refers to efforts to deal with stressful events that are judged to be relatively healthful."  Constructive coping involves: Confronting problems directly Effort Realistic appraisals of stress and coping resources Learning to recognize and manage disruptive emotional reactions to stress Learning to exert some control over potentially harmful or destructive habitual behaviors.  There are three main categories of constructive coping strategies: 1. Appraisal-focused 2. Problem-focused 3. Emotion-focused Appraisal-focused coping: Thoughts, beliefs and Perceptions Some cognitive Our perception of stress is distortions something we can control. All or Nothing Thinking Changing the way we think Overgeneralization about it will effect how we Jumping to Conclusions feel about it. Should Statements Stress mindset: Frame stress Personalization as a challenge rather than a threat. We can avoid some stressors  If traffic stresses you out, take the bus  If you get anxious about your carpet being stained, install tile flooring.  If you worry to be late for class in the morning, wake up 15 minutes earlier. Many stressors can be avoided  When you think about stress as something that can effect your health, it may encourage you to take drastic measures.  More and more people recognize the pressure and hectic lifestyles that we lead have consequences.  Many are questioning whether “having it all” is worth the effort  Many top executives have said “enough” and have chosen to leave high paying jobs for a simpler life.  Could you simplify your life? Lecture 13: Health promotion and disease prevention. Part 1 Clinical and Health Psychology Anna Gabińska, Ph.D.  Lecture overview Health promotion and disease prevention. health and lifestyle (literature, next lecture) determinants of people’s health-related behaviors (literature, next lecture) preventive and risk factors (literature, next lecture) three levels of preventions promoting health in diverse populations methods for promoting health and preventing disease Different types of psychological help in health care system Health promotion Prevention Treatment Aftertreatment procedures (relapse`s prevention)  Health promotion is behavior motivated by the desire to increase well-being and actualize human health potential  Disease prevention or health protection is behavior motivated by a desire to actively avoid illness, detect it early or maintain functioning with the constraints of illness  Promotion Aim: improve overall wellbeing; encourage and increase protective mental health factors and healthy behaviors that help prevent the onset of various disorders;  ie. creating living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles.  Recipients: various groups: may be delivered where people live, work, learn, and thrive.  Usually targeted to the general public or a whole population. Interventions aim to enhance individuals’ ability to achieve developmentally appropriate tasks/competence, positive self- esteem, well-being, ability to cope with adversity. Specific features: school and workplace mental health programs, early childhood interventions, social support and community engagement, women empowerment, anti- discrimination programs Prevention Aim: prevent problems (disturbances, dysfunctions, disorders) before they occur.  prevention – conscious action aimed to keep something from happening. Recipients: depending of the type of prevention it can be addressed to the whole population, those at risk of developing problems/disorders or those, who already suffer from mental disorders. Specific features: requires not only knowledge from clinical psychology but also social psychology (social influence, groups, stereotypes etc.). Makes use of psychoeducation, skills training and raising awareness. Prevention efforts vary also based on the level of intensity and development phase they target. Mental health literacy Kutcher & Wei (2014)  understanding how to obtain and maintain positive mental health  understanding mental disorders and their treatments  enhancing help-seeking efficacy (knowing when and where to seek help and developing competencies designed to improve one’s mental health care and self- management capabilities)  decreasing stigma related to mental disorders; Corrigan & Watson (2002):  „Public stigma is the reaction that the general population has to people with mental illness.  Self-stigma is the prejudice which people with mental illness turn against themselves.  Both may be understood in terms of three components: stereotypes, prejudice, and discrimination.” Box 16-2 Healthy People 2020 Framework Prevention  Primary – counteracting harmful circumstances before they have had a chance to produce illness.  Secondary – early identification of mental health problems and prompt treatment of problems at an early stage so that mental disorders do not develop.  Tertiary – reduction of the duration of the negative effects of mental disorders after their occurrence. Primary intervention  prevent the onset or future incidence of a specific problem.  Intent: reduction or elimination of causative risk factors  Examples: immunization, physical activity to reduce risk of cardiovascular disease, you can educate people to practice some of the preventive behaviors Secondary intervention  early diagnosis and prompt coping with a specific problem to prevent more severe problems developing.  detect a disease early and prevent it from getting worse, so it reduces the impact of the disease.  Intent: early identification through screening and treatment  Example: A person gets a mammogram to detect breast cancer, you can educate people to deal with the problem as its symptoms begin to be just visible. Tertiary intervention  Improvement of the quality of life and reduction of the burden after the problem has developed; in other words we reduce or minimize the consequences of a disease once it has developed.  Elimi