Applied Behavioural Science Notes PDF

Topic 2 – Biological Bases of Behaviour Learning Outcomes Upon completing this topic, you should be able to: Explain how twin studies are used to answer the question of "nature or nurture" Define teratogen, and identify several teratogens for dental health Discuss the influence of st...

Topic 2 – Biological Bases of Behaviour Learning Outcomes Upon completing this topic, you should be able to: Explain how twin studies are used to answer the question of "nature or nurture" Define teratogen, and identify several teratogens for dental health Discuss the influence of stress on overall health and human behaviour Biological influence of behaviour Genetic o Shape how we do things. Diet o Long term effects: underdevelopment. o Short term, food coma: reduce motivational levels. Twins Dizygotic (DZ) twins share the same amount of DNA as regular siblings (50%). Fraternal twins. Dizygotic twins do not look fully identical, different to monozygotic twins. Same as siblings but they got conceived at the same time. Two eggs are fertilised by two sperms to produce two genetically unique children. Developed in the same environment. Personality: 0.3 correlation; moderate correlation. Monozygotic twin (MZ): Identical twins One fertilised egg splits and develop two babies Personality: 0.5 correlation; high correlation Siblings are born at different times, different environmental factors. Assumption: Jorge and Carlos are fraternal twins or dizygotic twins, sharing 50% of DNA. Truth: Jorge and William are monozygotic twins. Carlos and Wilbur are monozygotic twins. Twins were mixed up and each twin grew up in different environments. o Lived rurally vs metropolitan. Who's more similar in personality? More based on genetic than environment. Who's more similar in behaviours? More based on environment than behaviour. Explanation: The data suggests that both genetics and environment play a role in both personality and intelligence, but genetics appear to have a stronger influence on intelligence than on personality. Personality: The correlation for monozygotic twins (MZ) is higher (0.50) than dizygotic twins (DZ) (0.30), suggesting a moderate genetic influence on personality. Intelligence: The correlation for monozygotic twins (MZ) is even higher (0.85) than for personality, suggesting a stronger genetic influence on intelligence. Heritability Heritability: The proportion of variance of an observed trait in the population that can be attributed to genetics. Conscientiousness = 44% Intelligence = 80% Risk taking = 55% for 14-year-old males, 0% (not sig) for females (N.B. result from one study only) Certain disorders: Schizophrenia = 80% Depression = 42% women (may be less for men) Bipolar disorder = 85% Anxiety = 45% Heritable patterns of tooth decay Caries phenotypes in the primary dentition were highly heritable, with genes accounting for 54-70% of variation in caries scores. If your parents have good teeth, you are more likely to have good teeth too. The heritability of caries scores in the permanent dentition was also substantial (35-55%, all p < 0.01). Heritable pattern of periodontitis The study of both reared-together twins and monozygous twins reared apart (110 in total) A significant (p < 0.05) genetic component was identified for gingivitis, probing depth, attachment loss and plaque. Heritability estimates indicated that between 38% to 82% of the population variance for these periodontal measures of disease may be attributed to genetic factors. Genetics and Interpersonal Relationships Behaviour is influenced by genetics (to a degree) Conscientiousness, motivation, etc. Oral health related factors are also surprisingly strongly influenced by genetics Caries Periodontitis Oral microbial species Genetic influences - may mean you have to work harder than others to avoid an increase in oral health related factors. Teratogenic influence Teratogen: Any environmental agent that causes damage during the prenatal period. It can cause damage to the foetus. Maternal diseases: Diabetes and HTN Chemicals Diet Irradiation Drugs Abnormal temperatures Impact dependent upon time, 3 stages: Germinal stage (week 1-2) – generally fatal, leads to prenatal miscarriage Embryonic stage (week 3-8) – structural abnormalities Foetal stage (week 9 onwards) – functional abnormalities Exposure to teratogen at different developmental stages has different affects. Shows what is developed during each stage and the influence of teratogen on different structure and function developed prenatally: Yellow: functional development Red: structural development Beyond 9 weeks - functional defects of the teeth Teeth development starts around week 6. 6-9 weeks is when major congenital anomalies (structural anomalies) related to teeth can occur. Beyond 9 weeks is when functional defects and minor congenital anomalies can occur. Teratogenic Influence: Teeth Teratogens can also alter enamel and teeth colour. Hormones Hormones are secreted by glands, and travel through the circulatory system to target distant organs to regulate physiology and behaviour. Biological factor that can directly influence one's behaviour. Hormones and behaviour Solid line: normally cycling women, not on OCP Dotted: OCP Results: Normally cycling women, has fluctuation in motivation. o Earnt more money. OCP women has less fluctuation in motivation. o Earnt less money than those with fluctuating motivation. Summary: Correlation between oestrogen levels and motivation / money earnt in normally cycling women. Sex Hormones and Oral Health Female sex hormones can amplify the relationship between plaque and gingivitis. Pregnancy gingivitis 40% of women will develop gingivitis during their pregnancy (caused by massive sex hormone changes). o Largely due to rise in progesterone. The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before gestational week 37) Female risk factors linked to: Puberty  Monthly menstrual cycles Pregnancy Menopause Foetal alcohol syndrome (FAS) Foetal alcohol spectrum disorder (FASD) Mother consumes large amounts of alcohol during pregnancy o =Prenatal exposure to alcohol Outcomes influenced by time and length of alcohol exposure Alcohol is a teratogen. Affects a range of prenatal development. The amount of alcohol and when the baby is exposed to alcohol can influence the baby and can vary in extent (depending on how much and when they were exposed) During week 6-16, the baby can develop both functional and structural abnormalities. FAS is the most severe form of FASD. FAS & FASD affects: Physical abnormalities General cognitive impairment Mental retardation Impaired motor coordination Attention Memory Language Behavioural presentation Irritability, seizures, hyperactivity, tremors Stress: Physiology, correlates, and consequences Organisation of the nervous system A. Central Nervous System (CNS) Brain and spinal cord B1. Somatic nervous system Efferent: carry messages from CNS to muscles etc in periphery of body Afferent: carry messages from sensory receptors (skin, muscles, joints) to joints Under conscious control B2. Autonomic nervous System Carry messages to heart, blood vessels, smooth muscles and glands Not under conscious control (‘automatic’) Stress response Two stress response pathways in the brain Fast ‘fight or flight’ pathway (via autonomic nervous system) o When under threat o Left pathway: hypothalamus to autonomic nervous system and to the adrenal medulla Slow ‘HPA axis’ pathway o Stresses that are not life threatening o Longer term stresses o Slower stress pathway  o Right pathway: hypothalamus to pituitary and to adrenal cortex. Secretes corticosteroid, stress hormone (e.g cortisol). o Cortisol triggers physiological response. o Can affect someone overall health over a long period of time. Cortisol (stress hormone) Small increases have positive effects Quick bursts of energy Heightened memory function Burst of increased immunity Lower sensitivity to pain Chronically high levels of cortisol (chronic stress) High blood pressure Hardening of the arteries Diabetes Immune system inhibition Muscle atrophy Osteoporosis Inverted U hypothesis Mild to moderate stress = better quality of performance High levels of stress = poorer quality of performance Stress and oral health Bruxism (grinding) Cancer sores Dry mouth (also a side effect of some antidepressants) Burning mouth syndrome  Lichen planus (white lines, sores, and ulcers in the oral cavity) Temporomandibular disorder (TMD) Gum disease (through a dampening of the immune system) Factors moderating stress impact Personality Optimism Conscientiousness (better health habits) Social support Improved immune functioning Improved physical health Mental health Beliefs Self-compassion Stress increased mortality only for those who believed that stress was bad for their health Autonomic (automatic) nervous system Sympathetic NS Mobilises body in emergencies Known as the fight or flight response o ↓ blood to digestion o ↓ blood to periphery o ↑ adrenalin for exertion o ↑ heart rate Parasympathetic NS Conserves resources ↓ heart rate ↓ blood pressure Revision Questions What is a teratogen? What role does genetics play in oral health? Are genetic factors more pronounced in the primary or permanent dentition? Why? Why are twin studies helpful for determining heritability estimates? Research shows that risk taking behaviour may be heritable for boys but not girls. Based on your basic understanding of heritability, provide a hypothesis for why this might be the case. Topic 3 – Classical conditioning and Operant conditioning Learning Outcomes Upon completing this topic, you should be able to: Explain the main features of classical conditioning Define different elements of operant conditioning, including reinforcement and punishment Discuss the implications of classical and operant conditioning on encouraging positive dental health behaviours and reducing dental phobia 4P Factor Model Predisposing Why them? Factors that render a person vulnerable to the presenting symptoms A factor that makes a person vulnerable to the behaviour or symptom Precipitating Why now? Triggers for the onset of presenting symptoms When the factors that are triggering the actual behaviour or symptom Perpetuating Why does it continue? Factors that are maintaining presenting symptoms, or barriers for recovery Factors maintaining the behaviour or symptoms Protective What can I rely on? Factors that reduce or prevent the occurrence/re-occurrence of presenting symptoms Can be before or after the symptom of behaviour Example: Diabetes Predisposing: Genetics Precipitating: High sugar consumption Perpetuating: Sedentary lifestyle Protective: Access to quality health care Theories of Learning Learning behaviours Learning is a long-term change in behaviour that is based on experience. Learning can be conscious or subconscious. Learning influences how people behave in clinic. Classical conditioning (also known as Pavlovian conditioning) Classical conditioning theory was serendipitous discovery by Ivan Pavlov. The dogs usually will start drooling when it sees food. In this experiment, the dogs had detected a pattern that allowed them to reliably predict the arrival of food. When the lab technician enters, the dogs knows that food is coming soon. Every time the lab technician entered; the dog would start drooling because it understands that food is coming soon. Unconditioned stimulus or Unconditioned response Happens naturally without any manipulation or learning. Example: Someone fears spiders. You show them a photo of a spider, they will feel some sort of sensation. Learning phase Neutral stimulus: stimulus is not associated with anything. Example: Bell. During the learning phase, we pair the unconditioned stimulus with the neutral stimulus. Presence of the food (unconditioned stimulus) and bell (neutral stimulus), which caused drooling (unconditioned response). Overtime, if you present the food and bell over and over again, the bell will become the conditioned stimulus. This means that you no longer need to pair it with the food for the drooling to occur, the unconditioned response. Little Albert Experiment Neutral Stimulus (NS): o This is a stimulus that, before conditioning, does not naturally bring about the response of interest. o In this case, the Neutral Stimulus was the white laboratory rat. o Initially, Little Albert had no fear of the rat, he was interested in the rat and wanted to play with it. Unconditioned Stimulus (US): o This is a stimulus that naturally and automatically triggers a response without any learning. o In the experiment, the unconditioned stimulus was the loud, frightening noise. o This noise was produced by Watson and Rayner striking a steel bar with a hammer behind Albert’s back. Unconditioned Response (UR): o This is the natural response that occurs when the Unconditioned Stimulus is presented. o It is unlearned and occurs without previous conditioning. o In this case, the Unconditioned Response was Albert’s fear response to the loud noise – crying and showing distress. Conditioning Process: o Watson and Rayner then began the conditioning process. o They presented the rat (NS) to Albert, and then, while he was interacting with the rat, they made a loud noise (US). o This was done repeatedly, pairing the sight of the rat with the frightening noise. o As a result, Albert started associating the rat with the fear he experienced due to the loud noise. Conditioned Stimulus (CS): o After several pairings, the previously Neutral Stimulus (the rat) becomes the conditioned stimulus, as it now elicits the fear response even without the presence of the loud noise. Conditioned Response (CR): o This is the learned response to the previously neutral stimulus, which is now the Conditioned Stimulus. In this case, the Conditioned Response was Albert’s fear of the rat. o Even without the loud noise, he became upset and showed signs of fear whenever he saw the rat. Classical Conditioning: Extinction It is possible to uncondition a fear response. According to classical conditioning, extinction occurs when the conditioned stimulus is no longer paired with the unconditioned stimulus. This is called the extinction phase. Classical Conditioning Summary Classical conditioning is learning by association. Two stimuli are linked together to produce a new learnt response. Unconditioned stimulus o The thing that triggers an automatic response. It’s not taught. o (e.g., smell of your favourite food). Unconditioned response o Naturally occurring response to the unconditioned stimulus. o (e.g., you salivate or feel hungry when you smell your favourite food). Neutral stimulus o Does not produce a response at this stage. o (e.g., the sound of a whistle). Conditioned stimulus o When the neutral stimulus elicits/evokes the conditioned response because of the association with the unconditioned stimulus/response. o (e.g., pairing the sound of a whistle with the smell of your favourite food. The whistle then goes from neutral to conditioned stimulus). Conditioned response o The learnt/acquired response to the conditioned stimulus that is often the same as or similar to the unconditioned response. o (e.g., salivating or feeling hungry when you hear the whistle, even if you don’t smell your favourite food). Extinction o Unlearning the pairing of the conditioned stimulus/response to the unconditioned stimuli. Generalisation o Generalise response to similar stimuli. Operant Conditioning Using reinforcement or punishment to increase or decrease a behaviour. o Such as implement a reward or punishment. Reinforcement: A consequence that will make you more likely to do the target behaviour again. o Positive reinforcement (providing something good). o Negative reinforcement (removing something bad). Punishment: A consequence that will make you less likely to do the target behaviour again. o Positive punishment (providing something bad). o Negative punishment (removing something good). Positive reinforcement/Punishment Involves the provision of a stimulus E.g., Verbal praise; a sticker; dessert E.g., Verbal abuse; detention; jail term Positive Reinforcement Definition: Positive reinforcement is a procedure where a positive stimulus (something desirable) is added as a result of a desired behaviour, increasing the likelihood of that behaviour occurring again.  Example: Receiving praise from a teacher for completing homework on time. The praise (positive stimulus) reinforces the behaviour of completing homework on time. Positive Punishment Definition: Positive punishment involves applying a negative stimulus (something unpleasant) as a consequence of an undesirable behaviour. Example: Spanking a child for misbehaving. The physical pain (negative stimulus) is intended to decrease the likelihood of misbehaviour. Negative Reinforcement/Punishment The removal of a stimulus E.g., Allowing a child a night off homework after they attain a good grade on an exam E.g., Taking away a child’s iPad when they are misbehaving Negative Reinforcement Definition: Negative reinforcement is a procedure where a negative stimulus (something unpleasant) is removed or avoided as a result of a desired behaviour, increasing the likelihood of that behaviour occurring again. Example: Taking a painkiller to alleviate headache pain. The removal of pain (negative stimulus) reinforces the behaviour of taking the painkiller. Negative Punishment Definition: Negative punishment involves removing a positive stimulus (something desirable) as a consequence of an undesirable behaviour. Example: Taking away a child's phone privileges for breaking a rule. The removal of phone privileges (positive stimulus) is intended to decrease the likelihood of the child breaking the rule in the future. Operant conditioning: Maximising change For rewards to work, they must be personally meaningful Timing is important. When we immediately reward a behaviour, people (and animals) learn it more quickly  o Consequences can be tightly linked to the target behaviour (but not always appropriate) o Charging someone else with the rewards and punishments (if necessary) can help to minimise cheating Intrinsic rewards maximise the chance that behaviour change endures o Remind yourself of the intrinsic benefits of your behaviour change Be realistic. Set appropriate goals. Limitations of operant conditioning Availability of rewards o Possible for a fixed amount of time, but ongoing rewards could be expensive and/or tiering Behavioural gains may be context dependent (Bouton, 2014) Operant conditioning requires cognitive skills and motivation (not always available) Revision: Classical and operant conditioning In psychology, what do we mean when we talk about ‘learning’? What is classical conditioning? What did John Watson’s experiments with Little Albert demonstrate? A parent takes away their child’s iPad when they have misbehaved o Is this reinforcement or a punishment? o Is it positive or negative? How might you use operant conditioning, or classical conditioning as part of your health behaviour change assignment? Topic 4 – Social Learning Learning Outcomes Upon completing this topic, you should be able to: Explain the key features of Bandura's social learning theory Discuss potential primary, secondary and tertiary social influences for an individual's oral health Apply the learning theories discusses thus far to conducting a functional analysis for your behavioural-change assignment Functional analysis A behavioural assessment technique used to identify the function or purpose of a problem behaviour. It helps to understand why a behaviour occurs, what triggers it, and what consequences it has. T his information is essential for developing effective behavioural interventions that address the underlying causes of the problem behaviour. Application of the laws of operant conditioning to establish the relationships between stimuli and responses A reward increases the likelihood the behaviour will reoccur. A punishment decreases the likelihood the behaviour will reoccur. Important element to think about when doing functional analysis is to consider what happens before and after desired behaviours. Antecedent: o Usually, we refer to the situation or context or emotional state of the individual. Behaviour: o Behaviour that you're engaging in due to the antecedent. Consequence: o Consequences after you have engaged in the behaviour. o Antecedent behaviour consequences. Typically used to explain how problem behaviours are maintained through ‘antecedents’ and ‘consequences’ Assess the antecedent and consequence related to the behaviour to design a behavioural intervention. o To decrease a behaviour, you can decrease the antecedent that is likely to cause this behaviour. o To increase a behaviour, you can increase the antecedents/triggers that is associated with this behaviour. ▪ Increase/strengthen antecedents (e.g., reminder on phone, availability of floss, reminders from friends/family) ▪ Improve consequences (e.g., meaningful rewards) Reward or punishments ▪ Changes to the environment Example: You are more likely to remember to go running if your shoes are placed near the door. Operant conditioning part is looking at the consequences, what happen we have engaged in the behaviour. o To decrease a behaviour that is associated with something positive, then you want to engage in another behaviour is similar positive consequence OR diminish the positive effects of the behaviour that you want to reduce.  o To increase the behaviour and the consequence is negative, you want to reduce the negative nature of the consequence or increase the positive nature of the consequence that is associated with the desired behaviour. We can then intervene through o Avoiding antecedents (or planning for them) o Introducing replacement behaviours o Modifying consequences (e.g., if I don’t snack on chocolate, I can buy myself a magazine) Tools to support behaviour change Manipulating the consequences related to the behaviour to increase the likelihood of increasing a behaviour happening: Operant conditioning o Rewards and punishments Functional analysis Enlisting social support o E.g., telling your family about your plan, then you won’t want to let them down o Working with another, or a group The power of thoughts o Utilising helpful thoughts to motivate you o Investing less in unhelpful thoughts Learning through the social context Biological factors influence behaviour o Genetics o Physiology o Hormones o Influence of stress Behavioural learning influences behaviour o Classical conditioning o Operant conditioning Learning through social influence o Family o Peer group o Culture Social learning theory (Bandura, 1963) Theory that people learn from one another, via observation, imitation, and modelling. o This process requires a degree of cognitive skill. o Observation: Taking in what's in your environment. Observing what and how people in your environment are doing things. o Imitation: Is copying the behaviour of what you have observed. o Modelling: Is the person that is being imitated The process which they pass one behaviour to another individual Encompasses cognitive skills such as attention, memory and motivation o Sometimes called social cognitive theory. Social learning theory explains behaviour in terms of continuous reciprocal interaction between cognitive, behavioural, and environmental influences. Bobo Doll Experiment  Observational Learning: o The experiment showed that children can learn behaviours by observing others, without direct reinforcement. o Children who watched an adult model act aggressively toward the Bobo doll were more likely to imitate those aggressive actions themselves. Role of Reinforcement and Punishment: o Bandura found that children who observed the adult model being rewarded for aggression were more likely to imitate the behaviour than those who saw the model punished, suggesting that consequences can influence learning and imitation. Influence of Media and Environment: o The findings suggested that children are likely to imitate behaviours they observe in their environment, including those in media. o This has implications for how violence or other behaviours depicted in media might influence young viewers. Gender Differences: o The study showed that boys were more likely to imitate physical aggression than girls, highlighting possible gender differences in social learning. Limitations of Bobo Doll Experiment: Controlled laboratory setting Short term observation – limited insight on long term effects Generalisability – other age groups Reciprocity Bandura argues the reciprocity differentiates social learning from behaviourism. Social learning involves a two-way influence between individual factors and the environment. Behaviourism suggests behaviour is shaped solely by the environment. This is incorrect. People learn behaviours from others, but they also play an active role in the process: attention, memory, motivation, etc. Factors influencing imitation of behaviours Must have ability to perform behaviour Attractive, high status of model o Higher social status - more desirable, attractive ; positive factors; it is more likely for an individual to imitate the behaviour Level of identification with model o The more one identifies with the model, the more they are likely going to imitate the behaviour. Vicarious reinforcement o Mirror neurons enable us to experience a version of the experience of others o Example: you see someone yawn, you want to yawn too. Social Learning of Fear Comparison of Mechanisms: o Social fear learning and classical fear conditioning activate similar neural mechanisms. Study Design: o Direct Conditioning: o Some participants experienced fear conditioning firsthand (blue square paired with a mild electric shock). o Observational Learning: o Others observed someone else undergoing fear conditioning (seeing their reaction to the shock associated with the blue square).  Neural Activation: o Both groups showed activation in fear-related brain areas, including the amygdala (fear conditioning) and hippocampus (memory), indicating learned fear toward the blue square. Outcome: o Both directly conditioned and observational groups associated the blue square with a negative experience. Benefits of Social Learning: o Social learning of fear is safer than direct conditioning since it avoids firsthand exposure to aversive events. Complexity of Social Learning: o Research suggests that social fear learning activates a broader network of neurons than classical conditioning, possibly due to the additional cognitive processes involved (e.g., interpreting and empathizing with the observed individual's response). Learnt Fear Social Transmission of Fear: o Debiec & Sullivan (2014) found that newborn rats learned fear responses by detecting their mothers’ scent, rather than through direct exposure to fear conditioning. Implications for Humans: o Researchers suggest a similar mechanism in humans, where babies might sense fear through subtle cues from their mothers, such as changes in voice, facial expressions, movements, or scent. Study Details: o Female rats were conditioned to fear the smell of peppermint, which was then indirectly communicated to their newborns. Parental Influence on Fear: o Both conscious social learning and subconscious parental signals can contribute to learned fears, such as dental anxiety, in offspring. No Direct Observation Needed: o The newborn rats did not directly witness their mothers’ fear conditioning process. Determinants of Dental Health Attitudes and Behaviors Healthcare Attitudes: Defined as the development of dental health attitudes and behaviors over a lifetime. Primary Socialization Immediate Family Influence: Young children learn dental habits (e.g., brushing technique, frequency) primarily through family members. Example: A 15-month-old imitates her mother’s toothbrushing actions, learning how to care for her teeth (Freeman, 1999). Secondary Socialization Broader Social Influences: As children enter school, peers and educators play a role in shaping health behaviors. Conflicting Messages: Mixed signals, such as school rewards with sweets versus parental restriction on confectionery, can create conflicting dental health attitudes. Example: A mother concerned about school’s use of sweets as rewards, contradicting her home rules (Freeman, 1999). Tertiary Socialization Adult Social Influences: Includes broader social norms, health education, and social pressures affecting dental habits.  Example: A smoker trying to quit starts eating sweets as a substitute, leading to dental decay, illustrating social norms and adult health pressures influencing behaviour changes (Freeman, 1999). Okada Study Parental Modelling and Oral Health: o Children's oral health behaviours are often learned through imitation of parental actions, as described by social learning theory. Parental Influence: o Parental modelling is a strong influence on children’s behaviours, such as tooth brushing, yet its impact on variables related to oral diseases is rarely studied. Findings: o Direct Influence: Parents’ oral health behaviours directly impacted the number of decayed teeth in children. o Indirect Influence: Parental behaviours also affected gingival health indirectly through children’s oral health habits. o Emphasis on Parental Self-Care: The study highlights the importance of parental oral health care for influencing children’s dental health. Limitations: Socioeconomic status (SES) was not included in the model, and cultural factors specific to Japan may have influenced results. Topic 4 – Anxiety Disorder Learning Outcomes Upon completing this topic, you should be able to: Explain the key features of anxiety disorders Identify factors that contribute to the aetiology of anxiety disorders Discuss the links between anxiety and poor oral health, and potential underlying factors that contribute to this relationship Why do I need to know about special groups? Your job involves Establishing a helping relationship between the OHT and the patient Intent to create a facilitative, caring and healing environment in which the patient, dentist, and team members can learn, grow, change, and heal Relationship based on respect for the patient’s autonomy Patient-centred model of care This drive towards health and wholeness provides an environment and level of care that is very rewarding for the patients and for the oral health professionals that have built their practices around this model Your patients are heterogeneous o Different issues are relevant to different people Understanding specific issues that patients face enables you to: o Enhance treatment plans o Fine tune your interactional style to suit the patient o Have a clearer understanding of what the patient’s oral health goals might be o Including the skills to feel confident to ask them Develop empathy Psychopathology Disorders of the mind – thoughts and behaviours that are maladaptive and interfere with at least one aspect of a person’s life Multiple causes of abnormal psychology, including: o Psychological factors o Cognitive-behavioural factors, o Biological factors o Socio-economic & cultural factors Epidemiology 43.7% Australians aged 16-85 years ((8.6 million people) had experienced a mental disorder at some time in their life 21.4% (4.2 million people) had a 12-month mental disorder Anxiety was the most common group of 12-month mental disorders (16.8% or 3.3 million people) 39.6% of people aged 16-24 years had a 12-month mental disorder What is mental health? Mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, and is able to contribute to his or her community. What is mental illness? “A clinically diagnosable disorder that significantly interferes with an individual’s cognitive, emotional or social abilities.” How are mental health conditions diagnosed? Use of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (aka the DSM-5). Diagnosed by mental health professionals, such as a psychologist or a psychiatrist Purpose of classification Giving a label can be validating for some individuals Effective communication between clinicians and healthcare workers Knowing the diagnosis helps to understand why the condition developed (also known as the aetiology) The diagnosis helps to direct treatment Treatments Usually by a general practitioner (GP) initially Referral to a psychologist or psychiatrist Other mental health professionals (e.g., alcohol and other drug counsellors, psychiatric nurses) Medication Group therapy Other complementary treatments Combination of treatments Anxiety disorders Fear & Anxiety Fear describes feelings that occur when a source of harm is immediate or imminent. Anxiety describes feelings that occur when source of harm or threat is uncertain or distant in space or time (anticipatory). Anxiety disorders Anxiety: a normal human emotion, and can have adaptive functions Anxiety Disorders: a group of mental disorders characterised by fear and anxiety o Interferes with someone's functioning Anxiety vs anxiety disorder - IMPORTANT SLIDE Differentiated by: Intensity o Everyday: mild o Anxiety disorder: more significant effect, distressing for the individual Functional impairment – social, occupational, leisure Significant distress Extended duration – anxiety, fear or nervousness does not subside Anxiety disorders in the DSM5 Separation anxiety disorder Selective mutism Specific phobias (including blood/injection phobias) Social anxiety disorders Panic disorder Agoraphobia Generalised anxiety disorder (GAD) Substance/medication-induced anxiety disorder OCD and PTSD has been taken out and placed into it's own categories. Types of anxiety: Summary Generalised anxiety disorder (GAD) o Excessive worry that is not focused on any one object or situation. Anxiety is not specific. o Anxious about a range of things for a minimum of 6 months Specific phobias o Intense fear/anxiety is triggered by a specific stimulus or situation o Behavioural avoidance - avoid fear object Panic disorder o Anxious about having a panic attack Recurrent unexpected panic attacks, and persistent worrying about having panic attacks, and/or the implications of the attacks Panic attacks: o Intense fear or apprehension, accompanied by physical signs such as rapid breathing, elevated heart rate, nausea, and dizziness o Not a panic disorder unless they are worried about having another panic attack Agoraphobia o Fearful and anxious when they perceive escape is difficult or help might not be available (e.g., using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, being outside of the home alone in other situations) Social Anxiety Disorders o Marked fear, anxiety and/or avoidance of social interactions and situations where one is perceived to be scrutinized, the focus of attention, or be judged negatively by others o Fear of being judge These conditions used to be considered anxiety disorders, but due to their complexities, are now considered stand-alone categories. Nevertheless, they have elements of anxiety Posttraumatic stress disorder (PTSD) o A severe disorder characterised by intense fear, anxiety and helplessness after a traumatic event. Obsessive-compulsive disorder (OCD) o Repetitive obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to perform specific acts or rituals) Australian Epidemiology of Anxiety Disorders Occur twice as frequently in females than males (2:1 ratio) – Why? Biological Factors: Hormonal fluctuations (e.g., estrogen and progesterone) may increase anxiety risk in females. Genetic Vulnerability: Genetic markers linked to anxiety might be more prevalent or impactful in women. Psychological Factors: Women are more likely to internalize emotions and engage in rumination, contributing to anxiety. Social and Cultural Expectations: Gender roles and pressures to balance work and family may heighten stress and anxiety in women. Trauma and Life Events: Higher rates of trauma experiences (e.g., domestic violence, sexual assault) in women can lead to increased anxiety. Help-Seeking Behavior: Women are more likely to seek help for mental health issues, leading to higher reported rates of anxiety compared to men, who may underreport symptoms. Epidemiology of anxiety  Lifetime prevalence of any anxiety disorder is about 28.8% (includes PTSD & OCD) Generic Aetiology Risk factors for anxiety Genetics (heritability estimate range 30-50%) Being widowed, separated or divorced Being unemployed or not in the labour force Low education Ongoing stressful events Physical health problems Substance use Personality factors Panic disorder About 30-40% of the population have had at least one panic attack in their life This doesn’t mean they meet criteria for panic disorder Panic disorder involves reoccurring panic attacks together with o Anxiety about panic attacks o Worrying about the consequences of a panic attack o Avoidance behaviour Panic attacks An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur. The abrupt surge can occur from a calm state or an anxious state: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, lightheaded, or faint 9. Chills or heat sensations 10. Paraesthesias (numbness or tingling sensations) 11. Derealisation (feelings of unreality) or depersonalisation 12. Fear of losing control or going crazy 13. Fear of dying What triggers a panic attack? First panic attacks have many causes, but often the trigger is some physical shift in the body It might be a change in blood pressure or blood sugar levels, something hormonal, or the effects of drugs or alcohol, that increases one’s heart rate, breathing rate How to be supportive during a panic attack There is an overlap in symptoms of panic attack and heart attack. Please take possible heart attacks seriously and inform emergency services! Often, though, the differentiation is obvious Panic attacks are driven by misinterpretation and catastrophization of bodily symptoms Staying calm is very helpful, but validate the person’s distress is equally important Facilitating relaxation via slow, steady breathing Dental anxiety Dental anxiety versus dental phobia Dental anxiety High dental fear prevalence estimate – 7.8% and 18% (Armfield, 2010) Anxious feelings before or during dental appointment Some avoidance is possible Dental phobia Diagnosable mental disorder Prevalence estimate: 0.9 – 5.4% (Armfield, 2010) Fear is excessive or unreasonable Marked avoidance or appointments tolerated with extreme discomfort Causes of dental anxiety/phobia Negative past experiences Fear of pain and/or specific fear of injections Feelings of losing control Embarrassment Needle phobia Recent meta-analysis (McLenon & Rogers, 2019) Children exhibited the greatest fear of needles The prevalence of needle phobia decreases with age Women have greater needle fear than men, across all countries studied Approximately 1 in 6 healthcare workers in long-term- care facilities and 1 in 13 healthcare workers in hospitals avoided influenza vaccination because of the fear of needles Association between dental anxiety & general anxiety Weak positive correlation of around r =.3 between dental anxiety and general anxiety Therefore, while there is an association, those who are dentally anxious are not necessarily anxious in daily life, and visa-versa Anxiety and oral health  Oral health problems associated with anxiety disorders include: o canker sores o dry mouth o lichen planus (a common disease affecting the skin and mucous membranes) o burning mouth syndrome, and o temporomandibular joint disorders Patients with anxiety disorders may disregard their oral health altogether and are at an increased risk for cavities, periodontal (gum) disease and bruxism (teeth grinding) Anxiety Medication and Oral health 57 psychotropic medications: o 23 antidepressants, 22 antipsychotic or anticonvulsant drugs 12 anxiolytic and sedative medications 34 different oral side effects were identified, including o Xerostomia (dry mouth) (91%) o Increased salivation (49%) o Tardive dyskinesia (involuntary movements of the tongue, lips, face) (49%) o Dysguesia (distortion of sense of taste) (46%) o Dysphagia (impairment of communication) (37%), and o Oral stomatitis (inflammation of mouth and lips) (25%)