PSYC1002 Lecture 4 2024 Canvas.pptx

PSYC1002: Mental Health Conditions Lesson 4 Models of Mental Illness Classification & Diagnosis Dr Elizabeth Seeley-Wait (Slides based on Dr Rebekah Laidsaar-Powell and Dr Sarah Ratcliffe‘s work) Acknowledgement of Country I would like to acknowledge the land on which we learn, study and share to...

PSYC1002: Mental Health Conditions Lesson 4 Models of Mental Illness Classification & Diagnosis Dr Elizabeth Seeley-Wait (Slides based on Dr Rebekah Laidsaar-Powell and Dr Sarah Ratcliffe‘s work) Acknowledgement of Country I would like to acknowledge the land on which we learn, study and share today, the land of the Gadigal people. We pay our respects to Elders past and present and to any First Nations students with us today. As we learn about mental health conditions, let us keep in mind that there is so much we can learn about well-being from the original custodians of this land including keeping connection to family and Country. Today’s Lesson Biological/Medical Model Psychoanalytic Humanistic Psychological Models Behavioural Cognitive-Behavioural The Diagnostic and Classification and Statistical Manual of Diagnosis Mental Disorders (DSM) Recommended reading: Chapter 15 ‘Psychological Disorders’ (pages 554-602) in Passer M. W. & Smith R. E. (2015). Psychology: the science of Biological / Medical Models Biological / Medical Model Overview History: see the textbook chapter Dominant model in psychiatry, the underlying model of DSM-5 Key assumptions of mental disorders: can be diagnosed similar to physical illness can be explained in terms of a biological disease process Mental disorders treated by targeting biological deficiencies: Medication (e.g. antidepressants) Electroconvulsive Therapy (ECT) Biological / Medical Model Criticisms and Limitations Need to avoid extreme reductionism Complexity of psychological phenomenon are impossible to explain at the neural/molecular level Over extrapolation from animal research Presuming causation from treatment efficacy (E.g: SSRI / panadol) Medical Model may not be applicable to psychological illness Clear boundary between physical health & illness BUT- Continuum between psychological health and disorder Clear boundaries between different physical illnesses BUT- Comorbidity among psychological disorders Psychological Models Psychoanalytic Humanistic Behavioural Cognitive Behavioural Psychoanalytic Theory of psychoanalysis was the most dominant in the 1st half of the 20th Century Freud (1856-1939): described personality as: Id (pleasure principle; instinctual drives; wants/desires; inner child) Ego (reality principle; satisfy Id but realistic means & problem solves) Superego (moral principle; moral self) Id & superego = constant conflict Ego tries to work out and problem solve how to meet both needs Psychoanalytic Maladjustment= Unresolved conflicts -> Anxiety -> Excessive use of defence mechanisms -> symptoms/suffering Example: Dislike dad (Oedipus Complex) Id= wants to get rid of dad Superego= getting rid of/hurting/killing is wrong Ego= Develops defence mechanisms (repression, projection, denial, reaction formation, displacement etc) The idea is we all have these defence mechanisms to help us from knowing what is happening in the unconscious Same process explains normal and abnormal behaviour/emotions Psychoanalytic Treatment Building insight into unconscious processes Develop awareness of the unresolved conflicts Develop awareness of the defence mechanisms Significance Revolutionised the concept of mental illness Made no clear dividing line between abnormal and normal Had a strong influence in the early stages of the DSM Critiques/ Limitations Lacks evidence Not open to empirical evaluation Unfalsifiable (e.g. Oedipus Complex) Humanistic Model 1960’s & 1970’s – reaction to the negativity of the psychoanalytic model Begin with psychological health Self-actualised (Maslow) Fully functioning human (Rogers) “When I look at the world, I am pessimistic. When I look at people, I am optimistic” Self-actualisation = experience life to the full, living in the here and now, trust your own feelings, independent, appreciate the wonders of life, aware of society’s rules but don’t accept without question, sensitive to the need to others, spontaneous Humanistic Model Maladjustment Self actualisation has been thwarted Environment imposes conditions of worth Own experience, emotions, needs are blocked Example: Creative talent Treatment Empathy, unconditional positive regard Critiques/Limitations These form elements of therapy- but NOT sufficient Example of patient with severe anxiety Difficult to research When is self actualisation is achieved? Behavioural Model Reaction to Psychoanalysis being unfalsifiable Behaviour is observable & measurable Classical Conditioning (Pavlov) US-UR CS-CR Operant Conditioning (Skinner) Reinforcement and punishment Suggests explanations for both normal and abnormal behaviour Adjustment/maladjustment from your learned history Treatment: many applications e.g. exposure Behavioural Model Critiques / limitations Overemphasis on behavioural aspects, excluding cognitive and emotional elements Observational/Vicarious learning/modeling; Bandura (1974) Showed learning without own experience Reintroduced the importance of cognitions Mental representation Example: Child with anxious parent Cognitive-Behavioural Model Current dominant psychological model Thoughts-Feelings-Behaviour What we think  How we feel  What we do E.g. Walking along the street and I see a dog THINK FEEL DO THINK FEEL DO Same dog > perceptions, interpretation of threat, cognitions which influence feelings and behaviour Cognitive-Behavioural Model Maladjustment Negative Core Beliefs (Aaron Beck) Long held, core beliefs / understanding of world that a person holds  Influences interaction with and interpretation of the world Interpretations of experiences are consistent with our core beliefs Come from early life experiences Set blueprint for how you interact/interpret the world E.g. loving, responsive family >> I m safe, I am enough, I am loved unloving, neglectful family >> I am alone, I am not worthy Friend ignores you (ambiguous) Cognitive-Behavioural Model Cognitive distortions/biases - First noted by Beck in 1960s - Misinterpret situation based on faulty assumptions or beliefs - Different cognitive distortions - Selective attention - Catastrophising - Personalising - Recognising + challenging these distortions forms a central part of CBT Automatic negative thoughts Core beliefs, so quick may not notice them Quick to bias/influence Cognitive-Behavioural Model Treatment Psychoeducation = Understanding automatic thoughts = Noticing/ catching automatic thoughts Cognitive restructuring = Challenging content of negative automatic thoughts = LOTS of ways to do this (e.g. disputing) Behavioural experiments Exposure Psychological Models Psychoanalytic Cause: Repression of Unresolved Conflict Treatment: Insight Humanistic Cause: Thwarted Self Actualisation Treatment: Empathy, Unconditional Positive Regard; Self discove to achieve your full potential Behavioural Cause: Learned Associations (Stimuli Response) Treatment: Learn new associations Cognitive-Behavioural Cause: Negative Core Beliefs, Biased Thinking, Learned associations Treatment: Cognitive restructuring, exposure, behavioural Diversity matters! Professor Pat Dudgeon https://psychology.org.au/aps-ccn-conf/2022/programccn/speaker https://indigenouspsychology.com.au/ https://www.apa.org/pi/women/iampsyched/timeline Classification and Diagnosis Classification Systems Diagnostic and Statistical Manual of Mental Disorders (DSM) American Psychiatric Association 1st edition: 1952 Currently DSM 5 (2013) and DSM-5-TR (2022) Australia/ USA/ English speaking world International Classification of Diseases and Health Related Problems (ICD) World Health Organisation Mental Disorders added in 1948 Currently 11th edition Europe Comparable as they both describe symptom clusters, but not identical Pros and Cons of Classification + Diagnosis Pros Cons Improve communication between Labeling / stigma researchers / health professionals Improves research and treatment Over medicalising reasonable planning reactions to stressful situations May improve communication and Problems of validity, reliability, understanding of mental health in ambiguity the community Some people find diagnosis helpful (i.e ASD case example) Practical reasons – e.g. funding DSM Diagnostic and Statistical Manual (DSM) defines psychopathology Defines Symptoms/ Criteria/Differential Diagnosis Published by the American Psychiatric Association Reflects the biological/medical model of mental illness Most agreed upon definitions / current consensus Evolving : 5th edition published in 2013, Text Revision published 2022 Helpful but guideline only Notably: Generalised Anxiety Disorder first introduced in DSM-III-R (1987) Binge Eating Disorder first included in DSM-5 (2013) Asperger’s Disorder removed from DSM-5 (2013) Prolonged Grief Disorder included in DSM-5-TR (2022) DSM-5-TR Updated Language e.g. Intellectual disability -> intellectual developmental disorder Development of the DSM DSM-I (1952), DSM-II (1968) Strongly influenced by psychoanalytic theory E.g. DSM-I (1952) Depressive reaction: “the anxiety in this reaction is allayed, and hence partially relieved, by depression and self-deprecation. The reaction is precipitated by a current situation, frequently by some loss sustained by the patient, and is often associated with a feeling of guilt for past failures or deeds. The degree of the reaction in such cases is dependent upon the intensity of the patient’s ambivalent feeling toward his loss (love, possession) as well as upon the realistic circumstances of the loss” (DSM-I) DSM-1 (1952) & DSM-2 (1968) Problematic reliability Inter-rater reliability: Can we agree on the diagnosis? How much depression/ self deprecation is needed? How often? What if guilt is not present? What qualifies as a ‘loss’? Etc Problematic validity Is this really what “depression” is? Based on unproven theories about cause: Depression as a defense from unacceptable unconscious ambivalent feelings DSM-III and beyond…. Major developments in classification DSM-III (1980) DSM-III-R (1987) DSM-IV (1994) DSM-IV-TR (2000) DSM-5 (2013) DSM-5-TR (2022) Reflects the medical/biological model No theoretical assumptions about causation If causation is not known: Description of symptoms Patient report, direct observation, measurement No assumptions about unconscious processes Clear, explicit criteria and decision rules Improved reliability. What about validity? DSM-5 Major Depressive Disorder Major Depressive Disorder: A Single or Recurrent depressive episode Major Depressive Episode: 1. Depressed mood most of the day, nearly every day 2. Markedly diminished pleasure/interest in activities 3. Significant weight loss or gain 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day 6. Fatigue/loss of energy nearly every day 7. Feelings of worthlessness, excessive guilt nearly every day 8. Diminished ability to concentrate nearly every day 9. Recurrent thoughts of death, suicide, suicide attempts 5 or more is needed, (incl 1/ or 2/) in a 2-week period DSM-5 (2013) Research planning process began in 1999 Originally planned for publication in 2011 Acknowledged limitations of categorical system Encourages assessment of severity, not only presence of symptoms or disorders Depressed mood most of the day, nearly every day: 0 1 2 3 Markedly diminished pleasure/interest in activities: 0 1 2 3 Insomnia or hypersomnia nearly every day: 0 1 2 3 Critics: call for a bolder move towards a dimensional understanding of mental disorders. Using the DSM From the DSM-5: “Clinical training and experience are needed to use DSM for determining a diagnosis. The diagnostic criteria identify symptoms, behaviours, cognitive functions, personality traits, physical signs, syndrome combinations, and durations that require clinical expertise to differentiate from normal life variation and transient responses to stress. To facilitate a thorough examination of the range of symptoms present, DSM can serve clinicians as a guide to identify the most prominent symptoms that should be assessed when diagnosing a disorder. Although some mental disorders may have well-defined boundaries around symptom clusters, scientific evidence now places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors… Mental Health Conditions Lesson 2: Done