MENTAL HEALTH

1. MENTAL HEALTH A LOOK AT SOME SPECIFIC CONDITIONS

2. Anxiety Disorder: Phobia Aaaaaarrrrggghhhh PEACHES!

3. The BiopsychosocialFramework Contributing Sympathetic arousal GABA Management Benzodiazepines – anti depressants Contributing Environmental trigger Parental modelling Transmission of threat info Management Non fear modelling Accurate info Contributing Cognitive model Behavioural model Psychodynamic model Management CBT Systematic desensitisation flooding

4. Anxiety disorders • Anxiety – physiological arousal, feelings of apprehension, unease, worry that something bad is about to happen • Anxiety disorder – chronic feelings of anxiety, distress, nervousness, apprehension • Level of anxiety is so severe that it interferes with everyday life • Many different types of anxiety disorders

5. What is a phobia • Everyone is afraid of things, mostly these things are not classed as phobias • Phobias are INTENSE and IRRATIONAL • Characterised by an unreasonable fear directed towards a particular object, situation or event • Phobias effect the lives of sufferers • Specific phobia specific situation object or event • The ‘thing’ they are afraid of is referred to as the phobic stimulus

6. DSM phobia categories • Animals • Situations • Blood / injections • Natural environments • Other (choking, dying, illness, falling etc)

7. How many phobias? • Traditional phobia names use a Greek prefix • Most specific phobias are not listed in the DSM as there are literally too many to list • Simply classified as ‘specific phobias’ • ICD -10 uses the term ‘specific’ interchangeably with ‘isolated’ • Some phobias are less specific eg. Agoraphobia • These are referred to as ‘complex phobias’

8. Anglophobia- Fear of England or English culture

9. Tyrannophobia- Fear of tyrants

10. Specific phobia • Exposure to the phobic stimulus causes an anxiety response • Panic attack – intense anxiety, dizziness, short of breath, tight chest, disorientation, feeling of no control • SYMPATHETIC AROUSAL! • Know that the fear is irrational • Feel compelled to avoid the phobic stimulus • Anticipatory anxiety can also occur if they think about encountering the phobic stimulus

11. Biological factors • Some evidence for genetic inheritance – predisposition, not a guarantee of a disorder • Sympathetic arousal closely related to stress response, and thus also to phobic response • Problem is that stress response is being elicited with no real threat to the organism

12. The role of Gamma-amino-butyric acid…….GABA • Not enough Yogabagaba makes me anxious!

13. GABA • Gamma-amino butyric acid is the primary inhibitory neurotransmitter in the CNS. • Inhibits postsynaptic neurons – stops them passing on the neural impulse • Helps fine tune brain activity, keeps neural transmission from getting out of control • Without GABA neural activation could spread like fire throughout the brain causing seizures

14. glutimate • 2nd most common neurotransmitter in the brain • Excitatory neurotransmitter • Makes postsynaptic neurons more likely to pass on the neural impulse • Gets the post synaptic neuron excited so it requires less stimulation to make it fire • Also plays a role in learning and memory, strengthening synaptic connections

15. GABA Stop the message! GLUTIMATE Get the message going!

16. GABA and anxiety • Lack of the neurotransmitter GABA might lead to over stimulation, and thus heightened anxiety • Benzodiazepines – a class of drugs that ‘calm down’ neural activity. Valiam, Xzanax, Rohypnol, Serepax etc. • All drugs are either Agonists– mimic the activity of a neurotransmitter • Or Antagonists – inhibit the activity of a neurotransmitter

17. Benzodiasepines - agonists • Mimic the activity of GABA in inhibiting post synaptic neural activity • Effective in the management of anxiety disorders • So anxiety disorders might be the result of a dysfunctional GABA system, not making enough neurotransmitter • One study showed that anxiety disorder sufferers have 22% less GABA than healthy individuals • Conversely studies show that antagonists can increase anxiety

18. GABA supplements? • GABA like substances found in many foods, supplements also available from health food retailers • Unlike drugs that are specifically manufactured for the purpose, there is no evidence that supplements can penetrate the blood brain barrier • The blood brain barrier is a kind of filtration system that only allows certain substances into the brain

19. Papaphobia- Fear of the Pope

20. Behavioural model • Phobias are learned • Learned through classical conditioning or observational learning • Maintained through operant conditioning

21. Behavioural model – Watson and little albert

22. Arachnophobia • UCS– spider in sandpit • UCR– fear • NS– spiders • CS– spiders • CR – fear • Avoidance of spiders or spider related places, images etc is negatively reinforcing, avoiding the bad stimulus. • This strengthens further avoidance behaviours

23. Cognitive model • Focus is on thinking • How do people process information • How do they think about the phobic stimulus • Key assumption – people with phobias have a cognitive bias – a tendency to think in a way that involves errors and bad judgement and decision making

24. Cognitive model – attentional bias • Seek out and notice threatening stimuli over normal stimuli • Eg. Arachnophobias might notice a spider web in the corner while everyone else is looking at the painting on the wall • Tend to be hyper vigilant – always looing out for the phobic stimulus

25. Cognitive model – memory bias • Remember the bad things more readily • Eg. Only remember being dumped by a big wave, not the hundreds of small waves that were enjoyable to jump over • Memories reconstructed to be worse than the actual event

26. Cognitive model – interpretive bias • Neutral situations or stimuli interpreted as threatening • Eg. Fluff on the carpet is a spider, a dog running over happily is going to attack

27. Cognitive model – catastrophic thinking • Negative thinking in which things are percieved in the ‘worst possible’ light • What can go wrong will go wrong, and in a big way • Often underestimate their ability to cope with the situation

28. Socio-cultural factors –specific environmental triggers • Traumatic event involving the phobic stimulus • Fear learned through classical conditioning • Fear persists through operant conditioning • Research shows that the more severe the trauma the more likely it is that a phobia will develop • If the trauma is severe enough only one experience is necessary (unlike normal CC where repeated pairings are needed) • Not a complete explanation, some people do not develop phobias despite severe trauma

29. Socio-cultural factors – parental modelling • Child who observes an extreme fear reaction from a parent may imitate the same reaction • Modelling bravery can help children cope with fears

30. Socio-cultural factors – transmission of threat information • Delivery of information from others about potential threat • Children might develop a phobia if constantly warned about the dangers of going outside alone • Research suggests that fears develop largely due to negative information about a specific event, object or situation being communicated often enough

31. Lutraphobia- Fear of otters

32. Cognitive behavioural therapy • Cognitive therapy – thinking therapy, aims to address the problems in cognition that contribute to negative emotions and behaviours • Behavioural therapy – application of classical, operant and observational learning to address behavioural aspects of a disorder • Aim to retrain the person so that good behaviours become automatic • Key assumption – the way that people think influences the way that they feel. Thus changing the thinking can be helpful

33. Cognitive behavioural therapy • CBT is focused in the present • Recognition that past events shaped now • However focus of CBT is changing the current trend in thinking and behaving • Client taught to identify unhelpful thoughts and to shift thinking to more balanced helpful thoughts • Makes the client responsible for their thoughts rather than being a victim of them

34. CBT and phobias • Tries to develop a new understanding of the phobic stimulus • Identify anxiety related thoughts and cognitive biases • Look at evidence that supports/rejects these biases • Switch from unhelpful irrational thoughts to evidence based rational thoughts

35. CBT behavioural component • Behavioural component aims to address maladaptive behaviours that are a part of the condition • Behavioural experiments – go on a plane and notice that it did not crash! • steps in behavioural component • Make a prediction • Review the evidence for and against • Devise an experiment to test this • Note the results • Draw conclusions

36. CBT – behavioural component Attempts to replace fear response with relaxation patient taught relaxation techniques gradually introduced to fear inducing stimulus while practicing relaxation. Systematic desensitisation Fear hierarchy

37. CBT – behavioural component Expose the patient to their fear straight away They will panic at first Soon realise that nothing bad has happened Flooding

38. Things to do • Learning activities 6.16