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Warwick in London Summer School Mental Health and Resilience

Warwick in London Summer School Mental Health and Resilience. Dr. Gemma Gray g.gray@warwick.ac.uk. Learning objectives. Understand what abnormal psychology is and how abnormal behaviour  is defined Understand different theories of abnormal behaviour and mental health

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Warwick in London Summer School Mental Health and Resilience

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  1. Warwick in LondonSummer SchoolMental Health and Resilience Dr. Gemma Gray g.gray@warwick.ac.uk

  2. Learning objectives • Understand what abnormal psychology is and how abnormal behaviour is defined • Understand different theories of abnormal behaviour and mental health • Understand what resilience is • Think about how resilience to mental health problems can be developed

  3. What is mental health?

  4. What is mental health? “Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” WHO, 2014

  5. What is abnormality?   • Normality and abnormality exist on a continuum (Millon, 2004) • Statistic definition: Behaviours that occur very rarely in the normal population Abnormal Abnormal? Anxiety Abnormal? IQ

  6. What is abnormality?   • Jahoda (1958) Deviation from ideal mental health

  7. What is abnormality?   Distressing to self or others Dysfunctional for person or society Deviant: violates social norms Judgment of Abnormality Dangerous to self or others

  8. Theories of mental health • Medical/biological Theory: Abnormal behavior develops through an underlying physical cause • Psychodynamic Theory: Abnormal behavior develops as a consequence of unconscious drives and defense mechanisms • Behavioural Theory: Abnormal behaviour develops as a consequence of learning through associations between negative stimulus and response • Cognitive Theory: Abnormal behaviour develops as a consequence of errors of thinking and attribution

  9. Theories of mental health • Behavioural Theory: Abnormal behaviour develops as a consequence of learning through associations between negative stimulus and response • Cognitive Theory: Abnormal behaviour develops as a consequence of errors of thinking and attribution

  10. Behavioural theory • Classical Conditioning: Pavlov (1905) and Watson and Rayner (1950) Classical conditioning – Involuntary, stimulus -> response • Operant conditioning: Skinner (1937) positive and negative reinforcement – Voluntary, response -> stimulus

  11. Positive reinforcement Sympathy from parent US Teacher shouts UR Upset Behaviour more likely to happen again Negative Reinforcement Avoid school Avoidance Learning US Teacher shouts CS Going to school UR Upset Upset “I don’t want to go to school” Positive Punishment Parents shout Behaviour less likely to happen again CS Going to school UR Upset Negative Punishment Toys taken away Classical Conditioning Operant Conditioning

  12. Behavioural Theory • Social learning theory: Learning through observation and imitation of others, e.g. Bandura (1963) Bobo doll experiment: • Vicarious Reinforcement • Modeling

  13. Application • Phobias: Watson and Raynor (1920) Little Albert: conditioned phobia of rats • Depression:  Deprivation of positive reinforcement (Lewinsohn, 1974) • Conduct disorder: Parenting programmes based on social learning principles

  14. Cognitive theories Negative Beliefs about the world “Everything is terrible” • Beck (1977) • Surface cognition: Automatic beliefs about ourselves or situation • Cognitive schemas: Unconscious beliefs, attitudes and assumptions Negative Beliefs about self “I am a terrible person” Negative Beliefs about the future “My life will always be terrible” The Cognitive Triad of Depression

  15. Cognitive theories • Beck (1977): Cognitive distortions – negative automatic thoughts

  16. Cognitive theories • Seligman (1977) Learned helplessness and depression

  17. Cognitive theories • Abramson, Seligman, and Teasdale (1978) Attribution Theory • Failing an exam

  18. Cognitive theories • Abramson, Seligman, and Teasdale (1978) Attribution Theory • Passing an exam

  19. Cognitive theories • Depressive explanatory style

  20. Cognitive Theory Activating Event Cognitive Behavioural Therapy (CBT) • Focus on tacking maladaptive thinking to change in behavior and emotion • Cognitive restructuring: challenges negative automatic thoughts • Behavioural therapy: actively changing behaviour Belief Consequences Ellis (1962) ABC Model

  21. Cognitive Behavioural Therapy (CBT) Negative Event (A) Negative Event (A) Irrational Belief (B) Rational Belief (B) Unhealthy Negative Emotion (C) Healthy Emotion (C)

  22. Cognitive Behavioural Therapy (CBT) My boss shouted at me My boss shouted at me “She thinks I’m useless” “She was having a bad day” Emotion: No depression Behaviour: engage in discussion with boss Emotion: Depression Behaviour: Withdrawal

  23. What do you think?

  24. Prevalence of mental health problems • McManus et al (2016) Adult Psychiatric Morbidity in England survey • Prevalence of mental health problems in general population  in 2014 • 1 in 6 adults report having symptoms of common mental health disorder in any given week, 1 in 5 women and 1 in 8 men  • 13% experienced a mental health problem worldwide in 2017

  25. What are Common Mental Health problems? • Depression: 3.3% • PTSD: 4.4% • Generalised Anxiety Disorder: 5.9% • Mixed Anxiety and Depression: 7.8% Source: www.mind.co.uk

  26. Mental Health in childhood • Green (2004) Mental health of young people in Great Britain survey: prevalence of mental health disorders in children • 1 in 10 suffer from a mental health problem: •  5 – 10 year olds - more common in boys (10%) than girls (5%) , •  11-16 year olds 13% of boys and 10% girls has a mental health problem • Anxiety and depression (4%) Conduct disorder (6%) Hyperkinetic disorder (2%) Other less common disorders (1%) • Child and Adolescent Mental Health Services referrals up by nearly 50% over past three years (NSPCC, 2019)

  27. Long-term effects of childhood mental health • Goodman (2011) UK Longitudinal study of 17,634 children: association between childhood psychological problems and the ability to work and earn as adults. • Mental health problems harder to treat in adulthood: i.e. conduct disorder

  28. Summary • Mental health problems are very common in the general population • Within Abnormal Psychology there are different approaches used to understand and treat mental health problems • Why are some people more resilient to mental health problems?

  29. Vulnerability – Stress Model Vulnerability Genetic Biological Psychological Environmental Stressors • Environmental • Economic • Occupational • Interpersonal Psychological Disorder

  30. Resilience • Ability to ‘bounce back’ from adversity • Normal development under adverse circumstances (Fonagy et al 2001)  • Relative resistance to psychosocial risk experiences (Rutter 1999) 

  31. Background • Werner (1971) Longitudinal study of the children of Kauai, Hawaii: 1/3 of high risk children were 'resilient'  • Garmezy (1973): Project Competence • Maladaptive: low competence, high adversity  • Competent: high competence, low adversity • Resilient: high competence, high adversity • Rutter (1979) Isle of Wight study - children of parents with mental illness

  32. Resilience Models • State or trait?? • Garmezy (1985, 1987) Three main models:  Protective/ vulnerability model Challenge Model Compensatory Model

  33. Protective Factors: Environment • Garmezy (1985, 1991)  • Family Cohesion:  • Rutter (1978) having at least one good parent-child relationship substantial reduces risks of mental health problem • Extra support systems: other adults, schools, church

  34. Protective Factors: Personality • What traits are related to resilience? • Relationship between traits and resilience: Campbell- Sills (2006), Nakaya et al (2006) Annalakshmi (2007) • Low neuroticism and Psychoticism • High extraversion and conscientiousness

  35. Protective factors: Personality • Positive emotion: Fredrickson (1998, 2001) Positive emotion and coping in the wake of September 11 • Emotional Intelligence: Self-awareness, emotional expression, self control and management central to resilience (Armstrong et al., 2011) • Hardiness trait: Kombasa et al (1982) hardy people tend to view stressful situations as less threatening – Commitment, Challenge and Control

  36. Protective factors: Personality • Self-efficacy: Believe in one’s abilities (Bandura, 1977) • Self-Esteem: Subjective opinion of self worth • Dumont and Provost (1999) self esteem and self efficacy related to students reaction to daily hassles

  37. Coping styles • Folkman and Lazarus (1998) • Emotion focused coping:focus on reducing the emotional response to the stressor, i.e. avoidance, engaging in comforting behaviours • Task focused coping: focus on solving the problem, i.e. thinking of new strategies • Campbell-Sills et al. (2006) Emotional vs. Task-Oriented coping

  38. Resilience and education • Academic Resilience: Achieving good educational outcomes • Growth Mindset:Dweck (1988) fixed vs. growth mindset • Growth mindset associated with resilience, and better academic outcomes (Zeng et al, 2016; Blackwell, 2007) • Students taught to have more of a growth mindset did better in school (Aronson, 2002)

  39. How can we build resilience?

  40. What is mental health? “Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” WHO, 2014

  41. The resilient person Other resources • Connectedness • Family • Friends • Community Thoughts Self-Efficacy • Self-knowledge • Rational beliefs • Mindfulness Behaviours • Task-focussed coping • Goal setting • Ask for help Feelings Positive emotions • Self-Esteem Purposeful

  42. Summary • Resilience research has found that there are multiple protective factors that act in response to life adversity • As well as treating mental health problems, psychologists also develop mental health promotion programmes in order to increase resilience against them • Lerner et al. (2005) Five 'C's: Confidence, Competence, Connection, Character, Caring/compassion 

  43. Further reading • Gazzinga, M.S (2018) Psychological Science,  W. W. Norton & Company • Chapter 11. Health and Wellbeing • Chapter 14. Psychological Disorders • Chapter 15.Treatment of Psychological Disorders

  44. Further resources www.mind.co.uk www.time-to-change.org.uk

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