PSY1204: Introduction to Clinical Psychology Lecture 1 PDF

PSY1204: Introduction to Dr David Francis Clinical Hunt Psychology What is clinical psychology?  Focuses on diagnosis and treatment of mental, emotional, and behavioural disorders....

PSY1204: Introduction to Dr David Francis Clinical Hunt Psychology What is clinical psychology?  Focuses on diagnosis and treatment of mental, emotional, and behavioural disorders. Integration of research with therapeutic A branch of psychology techniques. Carrying out the assessment, diagnosis, and treatment of various conditions. that…  Overview of main psychological disorders (Mental Health Problems) and Neurological Disorders – and “comorbidities”. In this course…. Possible causes Biological, psychological and social perspectives. Introduction therapies E.g. Cognitive Behaviour Therapy and Psychodynamic. What has been the path to this point? What are some of the pressing issues? Biological (Somatagenesis) Genetic risk – autism…bipolar…psychosis. Brain anomalies. Due to genetic codes for development? Eg fronto-limbic? Amygdala? Due to illness? Injury? Psychological reaction (psychogenesis) “View one takes” (cognitive distortion). Developmental factors…attachment, early. history, general stresses, major stress (PTSD). Social factors Multiple indices of deprivation. Social and societal determinants. What about societal/existential factors?  Activity (10 minutes) Can you turn to your neighbour and discuss the following question: What is the one thing that you are curious to learn about in this module? History of (clinical) psychology  “Pre-history” (Western = 20,000 BC) Theoretical approach Animism Natural world consist of demons/spirits. Different behaviour – Early period explained as possession or possibly punishment. Treatment Exorcism e.g. chants. Trepanning e.g. hole in skull (now: “Craniometry”). Ostracism. Greek & Roman period Approach: Somatogenesis e.g. Hippocrates (Physician) Emotional distress is NOT a punishment but has natural, biological causes (e.g. flu). Categories of distress formed from observation: Mania. Melancholia. Phrenitis (brain fever). “deviance” in thinking/behaviour assumed to be due to a brain/body pathology, some ideas plausible, others bizarre. Brain is seat of consciousness Balance of Body fluids (humours e.g. bile (black/yellow)/blood/phlegm) affect mental state. Movement of uterus causing “hysteria” in https://www.youtube.com/watch?v=9tx1zlbtHAw women. Sanguine (Blood) – optimistic Phlegmatic (Phlegm) - Reasonable/calm Treatment Choleric (Y Bile/liver) - easily angered/passionate Aim for tranquillity, sobriety, abstinence. Melancholic (B Bile Spleen) – quiet/sad/serious  Greek & Roman period Somatogenic Illness due to NATURE not punishment from gods (Hippocrates). And natural processes for recovery. Prognosis following from careful history taking and note taking of symptoms. “the uterus does not issue forth like a wild animal [around the body disrupting functions]…it is drawn together because of stricture caused by inflammation” Galen. Do not let [concerns of Some consideration given of psychological aspects to emotional distress and treatment tomorrow] disturb you… (Psychogenesis). you shall meet them with People are not concerned by things but by the the same weapons of reason view they take of them. as you defeated those of today Marcus Aurelius, Meditations (Stoic tradition) “Dark ages” & Medieval era From end of Greco-Roman period to Medieval, little development in understanding the causes or of treatments for mental health challenges. Scientific methods not developed. Causes for events seen as having spiritual dimension. Main Approach: Belief in demonology. Different behaviour interpreted as possession. Treatment Prayers, touching with relics, laying of hands.  Medieval period In context of Social upheaval (plagues/wars/famines). Lack of scientific understanding and superstition. Punishment from god led to scapegoating, especially those with no voice/power. Example: Witchcraft Some possibly had psychosis, e.g. believed had flown with devils. Others “transgressed moral codes” (fear over female sexuality/power/control). Most probably scapegoats for any misfortune. Estimates of 100,000 women executed in Europe in the period.  Renaissance & Elizabethan period In general society, some consideration of how events cause emotional distress. Shakespeare’s plays: Macbeth, hallucinations (the ghost of murdered Banquo). Triggered by guilt over regicide/killing of Banquo. Lady Macbeth, obsessive rituals triggered by guilt. Hamlet, psychotic depression occasioned by loss of father. Threat from his father’s murderers (or a “guise” so can be left alone).  Towards enlightenment: Humanitarianism and social revolution John Locke (1632 -1704) in the UK proposed that “the self” was developed by experience and “reasoning” argument for mental health problems. – “madmen put wrong ideas together, and so make wrong propositions but argue reason right from them…” Quaker movement in the UK. – Started retreats for the vulnerable for rest and some mild work. Pinel (1745-1826) in France – In line with egalitarian ideals of the French Revolution, proposed a Social Theory of Vulnerability. » Those with mental health challenges were normal people who should be approached with compassion, as their reasoning was affected by severe personal and social problems. » Added that institutionalising people “denying light and air” exacerbated their problems.  “until 1770 the public were allowed into the asylum to view (and provoke) the patients. Industrial revolution The scale of these visits were breathtaking: every week more than 2,000 visitors were free to wander through the wards, and mix Asylums became “theatre” for the rich with the patients, whose nurses and keepers (e.g. Bedlam (Bethlem and Maudsley)) would parade them and get them 17th-18c. to "perform".” Nell Leyshon Unscientific treatments proposed. https://www.theguardian.com/culture/2010 Mental health challenges is excess of /sep/04/nell-leyshon-on-bethlem-bedlam blood, therefore: Bloodletting. Other “treatments”. Fright. Forced vomiting. Cold baths. Spinning chairs.  Into the Victorian era Social exclusion rather than humane interventions continued … (but not always)…. J.S. Mill (Utilitarianism) in 1859 warned of the danger to vulnerable people of being “…in peril of a commission de lunatico, and of having their property taken away from them and given to their relatives”. Compounded by the Eugenic movement: “Discredited theory ranked human groups with…white Europeans at the top and people dwelling in their conquered colonies at the bottom” SJ Gould. People with intellectual/physical disabilities or were mentally unwell were seen as “not fit” to fit in and, again, scapegoated. Into the 20th century “Eugenics” became the pseudo- science behind the rise of fascism in western countries. 1930-45 Used to rob people of their human rights, possessions, and ultimately, in Nazi Germany, their lived. 1920-1976, making of segregated “colonies” and forced sterilisation of people with learning disabilities e.g. some US states and Sweden. Advances in understanding mental health A biological Approach (Kraepelin, 1856-1926) Proposed chemical imbalance (e.g. in metabolism) as causal of mental health challenges. Established systems of classification according to medical knowledge and not social prejudice (e.g. dementia praecox, later schizophrenia). Considered symptom patterns, course, and prognosis through a longitudinal lens. An example of advances in identification and treatment Syphilis is caused by germs (bacteria), is transmitted, and can damage areas of brain (“Neuro-syphilis”), leading to delusions, depression/mania. If treated early, does not lead to brain injury and mental health symptoms. Advances in understanding mental health Psychological Approach Jean-Martin Charcot (1825-1893) Studied hysteria (physical symptoms without clear medical cause). Psychological trauma can manifest as physical symptoms (e.g., paralysis, loss of hearing). Established the mind-body connection in mental disorders and used hypnosis to explore psychological factors. Josef Breuer (1842-1925) Anna O.: Patient with hysteria, showing physical symptoms linked to past trauma. Discussion of trauma (catharsis) relieved symptoms, highlighting the importance of repressed memories. Laid the foundation for Freud’s development of psychoanalysis by linking emotional expression with symptom relief. Foundations of Psychoanalysis Charcot’s work on trauma and physical symptoms + Breuer’s talking cure = Psychoanalysis. Focus on unconscious processes and the therapeutic value of talking about repressed trauma.  Advances in understanding mental health Socio-behavioural approaches Watson (1920s) described inducing a phobia in a child by pairing an innocuous stimulus with a frightening event. Little Albert Experiment: Watson conditioned a fear response in a young boy ("Little Albert") by repeatedly pairing a neutral stimulus (a white rat) with a loud, frightening noise. Outcome: After repeated pairings, Albert developed a fear of the rat, even in the absence of the noise. This fear generalised to other similar objects, such as furry animals or objects. Contribution: This experiment demonstrated how classical conditioning can be used to induce emotional responses, laying the groundwork for behaviourism and our understanding of learned behaviours and phobias. If fears/phobias can be learnt they can be unlearnt, e.g in Post Traumatic Stress Disorder after WWII http://www.youtube.com/watch?v=Xt0ucxOrPQE Towards current era Following the end of World War II, acceptance of human rights and need for social justice The United Nations Declaration on Human Rights. Redevelopment of civil rights movements (e.g. in USA). Bio-psycho-social accounts (e.g. by World Health Organisation (WHO). Diagnostic criteria and treatments reflecting factors that are: Bio-Medical Psychological Social Role for eco-biopsychosocial approaches…  Activity (10 mins) Can you turn to your neighbour and discuss the following question: What role do you think that nature might play in clinical psychology?  Modern approaches to clinical psychology Integrative Therapies Combines elements from multiple therapeutic models (e.g., CBT + Mindfulness). CBT-E for eating disorders Focuses on personalised, client-centred treatment plans. Technology-Driven Interventions Telehealth: Expanding access through online therapy. Digital Tools: Mental health apps, VR for PTSD, AI- assisted interventions. AI: Emerging use in diagnostics and patient monitoring.  Modern approaches to clinical psychology Trauma-Informed Care Recognises the role of trauma in mental health. Somatic Experiencing: Focus on how trauma impacts the body. Third-Wave Therapies Acceptance and Commitment Therapy: Acceptance + value-based living. Dialectical Behaviour Therapy: Emotion regulation, mindfulness, and distress tolerance. Neuroscience and Biological Integration Brain Imaging: Using neurobiology to inform treatments. Collaboration with psychiatrists on pharmacotherapy.  The role of a clinical psychologist today Collaborative and Interdisciplinary Work: Team-based care: Working with psychiatrists, social workers, etc. Integrated in primary care settings: Addressing mental health within general healthcare (CMHF, ICBs, covered in Lecture 9). Specialisation in Emerging Fields Neurodiversity & Autism: Assessment and intervention for neurodevelopmental conditions. Health Psychology: Addressing psychological impact of chronic illness (e.g., cancer, diabetes).  The role of a clinical psychologist today Focus on Preventative Mental Health Public mental health initiatives in schools, workplaces, communities Early intervention to prevent long- term issues. Social determinants of mental health. Cultural Competence & Social Justice Culturally adapted therapies for diverse populations Advocating for social change and mental health access. Self-Care & Professional Development Self-care and reflective practice to avoid burnout. Continuous learning and professional growth.  Summary Today we have… Introduced the module. We have discussed the role of clinical psychology and psychologists. The historic development in this field. Where we are now and into the future.  Optional further reading Geraets, C. N., Van der Stouwe, E. C., Pot-Kolder, R., & Veling, W. (2021). Advances in immersive virtual reality interventions for mental disorders: A new reality?. Current opinion in psychology, 41, 40-45. Schefft, C., Heinitz, C., Guhn, A., Brakemeier, E. L., Sterzer, P., & Köhler, S. (2023). Efficacy and acceptability of third-wave psychotherapies in the treatment of depression: a network meta-analysis of controlled trials. Frontiers in Psychiatry, 14, 1189970.