Psychology of Health and Wellbeing

Question 1

What are psychological health problems?

Answer 1

Emotions, perceptions, judgements, thoughts, physiological sensations, urges, motivations and behaviours that cause distress (to self and or others) & impact daily living

Lie outside ‘normal’ range of functioning

Recurring pattern of human experience

Question 2

How are psychological health problems linked to being ‘abnormal’?

Answer 2

1 in 5 people live with a psychological disorder
Most ‘abnormal’ processes exists on continua with ‘normal processes
Most people ‘qualify’ for diagnosis at some point in their lives
Psychological health disorders aren’t statistically or qualitatively abnormal
Naming it ‘abnormal psychology’ - Aligns with biomedical view of these experiences
Conceptualisation ignores strong evidence from other perspectives
Term is stigmatising

Question 3

What is a psychological health diagnosis?

Answer 3

A label given to someone suffering a certain set of symptoms

Question 4

What are the positive effects of receiving a diagnosis?

Answer 4

Make sense of what PPT feeling
Reduce self-blame
Can access services
Can find support

Question 5

What are the negative effects of receiving a diagnosis?

Answer 5

Stigma
Sense of difference
Defeat
Can feel trapped
Turns ‘people with problems’ to patients with illnesses - defined by a label and loss of meaning/individuality

Question 6

What are the common lay and clinical narratives linked to psychological health problems?

Answer 6

Stigma, secrecy, shame, blame, isolation
Illness, condition
Potential recovery

Question 7

How do perspectives in other study areas differ from the clinical perspective?

Answer 7

Other branches of psychology:

Cognitive, Differential, Social, Behavioural
Other disciplines - Less stigmatized

Sociology, social policy, public health, anthropology

Question 8

What is diagnostic classification?

Answer 8

Based on recurring & reliable patterns of these human experiences
Categorises and classifies them into discrete entities called ‘diagnosis’ of ‘disorder’
Nothing inherently wrong and highly useful practically

Question 9

What are the aims of classification systems?

Answer 9

Reliability → To ensure confidence that talk about and study of these experiences are about the same phenomena

Underlying assumption → Having such a system/systems furthers understanding mechanism, cause, which leads to effective treatment

Question 10

What are the different classification systems?

Answer 10

Diagnostic and Statistical Manual of Mental Disorders (DSM5)
International classification of diseases - 11th edition

Question 11

How is the DSM developed?

Answer 11

Taskforces
Develop lists of disorders and criteria (symptoms) required for diagnosis

Question 12

What are symptoms of major depressive disorder?

Answer 12

Experience 5+ symptoms during the 2-week period
At least one symptom should be depressed mood or loss of interest/pleasure
Depressed mood most of the day, almost everyday
Markedly diminished interest/pleasure in all/ almost all activities most of the day, nearly every day
Thought has slowed & physical movement decreased
Fatigue or low energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think, concentrate and or indecisiveness
Recurrent thoughts of death & suicidal ideation without specific plan or have a specific plan/suicide attempt
Symptoms must cause clinically significant distress, impairment
Symptoms must not result from substance abuse, another medical condition

Question 13

What are the scientific, practical and ethical critiques of the DSM?

Answer 13

Understanding of biological causes in psychiatric disorders isn’t happening - Don’t know if diagnoses are actually discrete ‘things’
No confirmation tests like medicine
Ultra-common comorbidity
Ultra-common diagnostic differences among clinicians
Insel (2013
Lack of validity as no objective laboratory measure to diagnose
Minor changes to criteria make big differences in diagnostic rates (e.g. ADHD, ASD, Childhood Bipolar disorder)
Diagnoses have proliferated over time, arbitrary deletions too
Financial links between DSM-V task force members and pharmaceutical companies
DSM book is a income stream for American Psychiatric Association

Question 14

What the issue of medicalisation of normality in the DSM-V?

Answer 14

That clinicians were making normal characteristics included into mental disorders - ‘medicalising’ the world

Question 15

What is an alternative to psychological diagnosis via the DSM or ICD? What is its definition?

Answer 15

Psychological formulation - The process of co-constructing a hypothesis or “best guess” about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them

Person-specific theories
Can be alternative to diagnostic categories and or/complement them
Emphasise collaboration, meaning, understanding
Highlights factors amenable to intervention

Question 16

What are the 5 Ps of Formulation?

Answer 16

Conceptualised way to look at clients and their problems

1. Presenting the problem, 2. Predisposing factors, 3. Precipitating factors, 4. Perpetuating factors and 5. Protective factors

Question 17

What do psychological formulations integrate?

Answer 17

Integrate ideas from different theories and perspectives to conclude the presentation of the problem

Question 18

What is theory specific formulation?

Answer 18

Harder to integrate various elements
Can be more precises
Due to research base can be linked more strongly to specific evidence-based practice
Can be limited by diagnosis, blind-spots in theory
Can be used to straddle diagnoses

Question 19

How can psychological formulation be used for intervention?

Answer 19

Built collaboratively over time with person
Not imposed, instead explained, practised, encouraged
Put meaning, understanding into problems, cycles
Highlight places to intervene in therapy but also with surrounding others and other support agencies

Question 20

What are the benefits of psychological formulation?

Answer 20

Clarifying hypotheses and questions

Providing an overall picture or map

noticing what is missing, prioritizing issues and problems

selecting and planning interventions

minimizing bias by making choices and decisions explicit

framing medical interventions

predicting responses to interventions
thinking about lack of
progress, ensuring that a cultural perspective in incorporated, helping the service user to feel understood and contained

strengthening the therapeutic
alliance.

Question 21

What are the disadvantages of psychological formulations?

Answer 21

Some similar limitations to diagnosis
Individualizing, pathologizing, excluding social contexts

Question 22

What are the overlapping influences in psychological wellbeing?

Answer 22

Macro influences, interpersonal influences, intrapersonal influences

Question 23

What are macro-level influences?

Answer 23

Justice Failures:

Poverty
Social exclusion
Discrimination
Multiply discriminated identities

Question 24

Explain how poverty risks psychological health problems but psychological health problems also risk poverty

Answer 24

Negative perceptions of people in poverty
Stereotypes abound are harmful
Stigma can be internalised - lead to mental health problems
Childhood poverty particularly damaging
Intergenerational transmission of poverty

Question 25

What study was done on the impact of discrimination and marginalisation on psychological disorders?

Answer 25

Review of 12 studies 2007-2013 , primarily cross-sectional - 55,000+ PPT
Discrimination associated with many diagnosed disorders (depression, anxiety, PTSD, eating disorders)
Analyses controlled poverty, gender, ethnicity etc.
Multiple discrimination
Systematic review - 40 studies
‘Resilience’ versus ‘cumulative risk’
Depression, anxiety most common outcome but others studied
Strong evidence for cumulative risk and weak evidence for resilience
Methodological flaws outlined, but even in stronger studies, racism and heterosexism particularly associated particularly with outcomes

Question 26

What are large scale factors influencing psychological health? How are they considered on an individual basis?

Answer 26

Large scale factors, have important psychological health consequences
Poverty, unemployment, inequality
Racism, Sexism, Heterosexism
Psychologists working with individuals doesn’t address this
Need policy, influence, advocacy, campaigning work

Question 27

What are intrapersonal influences?

Answer 27

Psychological processes:

Personal historical factors
Cognitive factors
Behavioural factors

Question 28

What did a systematic review of how using personal history can help indicate psychological disorders find?

Answer 28

44 articles published between 2001 and 2011
145,507 PPT
Clear associations between early life adversity and all psychological disorders, in development, persistence and severity

Question 29

What are examples of the psychological processes that can cause psychological disorders?

Answer 29

Unprocessed memory intrusions (cognitive processes)
Formation of negative expectancies and self-beliefs (cognitive processes)
Disruption of developmental pathways
Disruption of social bonds

Question 30

How do cognitive processes influence psychological wellbeing?

Answer 30

Information processing distortions in many cognitive domains all along the ‘information processing chain’

Selective attention –> Memory –> Interpretation –> Cognitive products –> Inhibition

Selective attention to threat stimuli in anxiety
Selective memory of negative self-related information in depression
Overly general memory in depression
Absence of selective memory in anxiety disorders
Selective interpretations/judgments
Intrusive repetitive thinking: worry, rumination
Difficulties with inhibitory control

Question 31

What is a cognitive model that shows how cognitive disorders inform cognitive models of emotional disorders?

Answer 31

(look at notes for diagram)

Internal and/or external triggers –> Perceived threat –> Anxiety

Anxiety leads to physiological, cognitive symptoms –> Catastrophic misinterpretation –> Safety behaviours

Question 32

How do we investigate whether something is cause or correlation?

Answer 32

Cross-sectional studies
Studies of recovered patients
Longitudinal studies
Third variables (e.g. stress reactivity, poverty, abuse)

Question 33

What behavioural processes that negatively influence psychological wellbeing?

Answer 33

Classical: Avoidance, escape create habituation; prevents extinction
‘Safety’ behaviours: Mixed evidence
Recent rethinking of avoidance: ‘It depends’

Question 34

What are interpersonal influences in behavioural processes?

Answer 34

Attachment
Family dynamics/parenting
Peer groups
‘Authority’/leadership figures (e.g. teachers, bosses)
Social support/ connectedness
Sources of alienation (e.g. Discrimination, bullying)

Question 35

What is attachment and the different types?

Answer 35

Ainsworth - Strange Situation
- Secure attachment
- Insecure attachment
Avoidant
Ambivalent
Disorganised

Question 36

Explain the ideas of secure and insecure attachment and why and how insecure attachment is considered such a risk for psychological health problems.

Answer 36

Secure attachment - Infant is comforted by the presence of their caregiver

Insecure attachment - Act very similar with stranger and care giver

Strong evidence the insecure attachment is a general risk factors for poor psychological health
Some specific relations (depression, anxiety, personality disorders)
Personality disorders
Anxious attachment → emotional dysregulation
Avoidant attachment → Avoidant, inhibited personality
Insecure attachment unlikely to be a sufficient cause
Requires interplay with other factors

Question 37

What changed from earlier ideas of parental influences on child psychological health to more current ideas of ‘negative family emotional climate’?

Answer 37

Controversial older literature about family dynamics → High expressed emotion (towards individual) and ‘double bind’ (two conflicting messages, with one neglecting the other) as risk factors for later psychosis

But ‘refrigerator’ mother also blamed - Autism caused by lack of mothers warmth
More recently family risk conceptualised as ‘Negative Family Emotional Climate’

Question 38

What is meant by negative family emotional climate?

Answer 38

Different factors accumulate to create a negative family emotional climate (cumulative risk factors approach)

E.g. Little warmth or positivity - much criticism + high negative emotional expression + poorly managed parental emotion + psychological controlling behaviours

Question 39

What is the general structure of the cumulative risk factors approach?

Answer 39

Well-established links with depression, anxiety

Direct links but also indirect via suppressed emotion

Factors of instability, adverse life events, family structure & SES, parenting practices, parental verbal conflict, mood problems + disturbed, anti-social, parental behaviour

Question 40

What is the impact of peers on psychological health?

Answer 40

Overt bullying clearly linked to later psychological health problems, also frequent teasing
Teasing and bullying = More likely to children of lower SES
Friends offer supp

Question 41

Explain how social support can protect against development of psychological health problems

Answer 41

Buffering hypothesis:

Process of:

Stressor –> Appraisal –> Response –> Expression in symptoms or behaviour

social support may prevent negative appraisal and may facilitate reappraisal, maladaptive response inhibition and/or inspire adaptive responses

Offsetting Mechanism:

Social support contributes to positive psychological health and can help offset perceived stigma of psychological health diagnosis which can impact positive psychological health

Question 42

What is early life stress and what is it’s impact on development and psychiatric disorders later in life?

Answer 42

Early life stress - Experiencing sexual abuse, physical abuse, emotional abuse, physical neglect and emotional neglect

Carr et al. (2013) - ELS triggers, aggravates, maintains, and increases the recurrence of psychiatric disorders

The symptoms of those who experienced ELS can be subdivided into internalizing symptoms, such as anxiety, depression, inhibition, somatic complaints, physiological arousal, fear, avoidance, and re-experiencing, and externalizing symptoms, such as aggression, delinquency, prostitution, exaggerated increased levels of activity, and problems related to sexual behavior

Question 43

How is discrimination linked to psychological health?

Answer 43

Vargas et al. (2020)

Multiply discriminated groups exhibit higher risk for some mental health problems, particularly depression symptoms.

However, methodological problems abound in this literature (e.g., correspondence between study sample and types of discrimination assessed), which limits our ability to draw clear conclusions about multiple discrimination

Question 44

How have psychology’s goals evolved since the 1930s? What were some key steps involved? What were some key ideas involved?

Answer 44

Prior to WW2:
‘Curing psychological illness’
‘Making everyone’s life more productive and fulfilling’
Identifying and nurturing ‘Giftedness’ in all its forms

After WW2:

Changed to focus on healing and repairing damage within a disease model of human functioning (positive psychology - also building up positive qualities)

Founding of the NHS
Founding of the US National Institute for Mental Health

Question 45

What are positive psychology interventions?

Answer 45

Theoretically-grounded and empirically validated instructions, activities, and recommendations designed to enhance well-being

Assigning:
Expressing gratitude expression, listing things grateful for
Doing acts of kindness
Thinking positively about the future
Savouring ‘the moment’
Smiling
Mindfulness exercises
Meditations (e.g. Loving kindness meditation)

Question 46

What study was done to show the effectiveness of positive psychology interventions?

Answer 46

Bolier et al. (2013) 39 studies - evaluation 6139 PPT
Mostly healthy populations but some aimed at depression or anxiety problems
Small to moderate effects for wellbeing and depression (large range d = 0 - 2.4)
Small effects at 3- to 6-month follow up
Larger effects for individual delivery, face to face, healthcare settings, longer intervention duration
Smaller effects in better-quality interventions

Question 47

What is meant by ‘flourishing’ in positive psychology?

Answer 47

Seligman - Flourishing is the result of paying careful attention to building and maintaining the five aspects of the PERMA model.

The PERMA model is a model Seligman developed to explain what contributes to a sense of flourishing. The five factors in this model are:

Positive emotions, engagement, relationships, meaning and accomplishments

Question 48

What are the pathways for flourshing?

Answer 48

Longitudinal, cross-sectional, experimental research all indicate that each area (family, work, education, religious community) contributes satisfaction, wellbeing, quality of life, good health, life meaning

Question 49

What are the limitations of flourishing?

Answer 49

Very broad construct
Measurement problems
Contradictions (e.g. meaning and purpose within adversity?)
Lack of critical thinking
Implicit value judgments

Question 50

What are the five advantages of ‘balanced’ positive psychology?

Answer 50

Positive psychology critiques oversimplified
Subjective - ‘valued’ experiences and emotions
Individual - ‘perseverance, optimism, courage’
Social - Civility, altruism, pro-sociality
Recognise that life with no ‘bad times’ is superficial
Recognise that out of ‘bad’ can come ‘good’ & vice versa
Five conceptual aspects ‘balance’ positive psychology

Question 51

To what degrees do ‘flourishing’, ‘self-compassion’, and ‘psychological flexibility’ express attaining those balances?

Answer 51

Avoid extremes
Develop complementary among ‘areas’
Temper construct definitions
Require contextual sensitivity
Acknowledge both: conscious, unconscious phenomena

Question 52

What is compassionate mind training?

Answer 52

Based on Paul Gilbert’s work
With highly shame-prone and self-critical people
Draws on evolutionary theory about ‘social mentalities’
Actively trains, cultivates soothing, kindly stance towards self
Draws on Buddhist conceptualization of compassion as:
Sensitivity to suffering + Motivation, courage to address relieving it

Threat system <-> Soothing System <-> Drive System

Question 53

Is compassion-based intervention effective in increasing self-compassion?

Answer 53

Compassion-based intervention effective in increasing self-compassion, reducing distress
Compassion: d = .52, 95% CIs [.32-.71], p < .001. (n = 1172)
Depression: d = .46, 95% CIs [.25-.66], p < .001. (n = 665)
Anxiety: d = .40, 95% CIs [.23-.57], p < .001. (n =1063)

Question 54

What is psychological flexibility?

Answer 54

Kashdan & Rottenberg (2010 )
Psychological flexibility spans a wide range of human abilities to …
Recognise and adapt to various situational demands
Shift mindsets or behavioural repertoires when these strategies compromise personal or social functioning
Maintain balance among important life domain
Be aware, open and committed to behaviours that are congruent with deeply held values

underpins clinical model of acceptance

Question 55

What is ACT (acceptance commitment theory)?

Answer 55

ACT is updated form of CBT
Emphasises accepting unpleasant, painful thoughts, feelings to let them go
Articulates personal values
Garners commitment to actions
Teaches ‘Open, aware, engaged’ responses

Underpinned by psychological flexibility

Question 56

What evidence was found for the success of psychological flexibility within ACT?

Answer 56

Hayes et al. (2006) - Substantial evidence that psychological flexibility with less distress and psychopathology (r = .42)

Lab studies saw psychological flexibility procedures produced large effects (Levin, 2012)

Gloster (2020) - Found meta analytic effects favour ACT

.57 for ACT and .16 for CBT

Question 57

Compare and contrast the components and goals of Compassionate Mind Training with those of Acceptance and Commitment Theory. Do you think one might be better than the other? If so, which and why?

Answer 57

CMT focuses on three systems of threat, soothing and drive - more restrictive than ACT which emphasises a shift in mindset if there is a compromise in social functioning

Question 58

Outline and describe the basic goals of the Power Threat Meaning Framework (PTM).

Answer 58

PTM brings together macro factors
Brought into useable explanatory framework
Proposed as alternative to diagnostic classification

‘What has happened to you?’ – (What role did Power play? Whose Power?)
‘How did it affect you?’ – (What kinds of Threats did this pose?)
What sense did you make of it?’ – (What Meaning(s) did/do these situations, experiences have for you?)
What did/do you have to do to survive?’ – (What kinds of Threat Response are you using?)
‘What are your strengths?’ – (What access to Power resources do you have? What Powers do you have yourself?)
‘What is your story?’ ⎯ (How does all this fit together?)

Question 59

Outline how Marko’s situation was interpreted within the PTM in the example case

Answer 59

Refugee - experienced war, genocide, beaten and physically neglect

Moved to UK - not working due to poor psychological health + strained relationship with wife and son

Marko presented with
Flat mood, lacked pleasure, frequently tearful, poor motivation
Easily started, frequent panic attacks, constantly tense, nightmares
Avoided anything associated with previous experiences
Numbed/blunted - no sense of future
Some suicidal thought but no plans or actions

Application to the power threat meaning network
How do we understand ‘where Marko is’ from the perspective of Power, Threat & Meaning?
‘What has happened to you?’ – (What role did Power play? Whose Power?)
‘How did it affect you?’ – (What kinds of Threats did/does this pose?)
‘What sense did/do you make of it?’ – (What Meaning(s) did/do these situations, experiences have for you?)
‘What did you have to do to survive?’ – (What kinds of Threat Response are you using?)

Question 60

How did power impact Marko’s life and what did it do to Marko?

Answer 60

State-sanctioned violence against his ethnic group
Forced removal from his home by militia
Daily abuse/dominance/imprisonment/threat
After liberation: forced refugee status
Becoming an ethnic minority in to-him-foreign UK
Neighbourhood harassment
Unemployment, social stigma and exclusion

Impact:

Virtually instantly: legally/’legitimately’ robbed of security, identity sources: work, community, wife, family, culture, fun, hobbies
Extreme threat response: hypervigilant, startled, nightmares, constantly highly aroused/anxious/angry/frustrated
Ongoing low-level social threat: not belonging, feeling unwelcome, afraid

Question 61

How was Marko understood/integrated? How was he helped?

Answer 61

His symptoms are responses to repeated trauma, systematic powerlessness, destruction of his way of life
Marginalisation UK made his life more difficult
Foreshortened future sense and numbing are rational (not ‘disordered’) ways of trying to dampen intense fear

Not receive PTM treatment
Used cog therapy/ exposure base to build understanding of trauma

Question 62

What is the classical trauma bind explanation that Marko experienced?

Answer 62

Traumatic event(s) –> Extreme threat appraisals –> fear activated –> Avoids cues, stimuli –> Memories, events narratives are unprocessed –> intrusions/flashbacks (FEEDS BACK INTO EXTREME THREAT APPRAISALS)

Question 63

Describe the steps Marko’s counsellor took with him, their purpose, and how Marko grew during the time they worked together

Answer 63

Marko early sessions
Found it hard to talk
More fearful & have more intrusions in the day after
Trusted consultant, felt could continue
As felt more comfortable , gradually revealed more of his story
Began by expressing anger at suffered injustices

Marko mid sessions
Came to understanding that numbing was his way of coping with his experiences
Hopelessness, feeling disconnected, not going outside his community
Costing connections with wife & child

Marko later sessions
Began to find courage to risk, experiment again
Talked to his wife more
Encouraged others in his community to talk
Recognised UK must become his home

Power threat meaning
Key was getting him a safe place to express rage at injustice done to him
Acknowledging feelings of marginalisation

Question 64

What conclusions can be made about Marko and the PTM?

Answer 64

The work done with Marko was consistent with PTM framework

Marko’s situation was ‘ripe’ for PTM – it outlined mechanisms ‘at work’ in his situation

Narrative-and meaning-making helped

Consultant was guided by PTM-type model of trauma that suggested mechanisms and ways to address them – acknowledge exposure, reduce avoidance of further threat, come to more adaptive narrative of meaning

Underlying mechanisms are linked to DSMV-defined disorder PTSD, but it’s the mechanisms that were important, not so much specific ‘disorder symptoms’

Question 65

Can we understand mechanism and process without categorising it as disorder?

Answer 65

Conceptualising mechanisms as beyond intrapsychic (social justice, agency, marginalisation) aids understanding, but intervention is optimally ultimately individual

Question 66

What can and can we not change in terms of situations and coping?

Answer 66

There are always both present ‘situation’ and our reactions to it

Situation is other people involved, social/physical circumstances

To change situation
Leave it, do something to alter course

Can’t always do these things
In particular we can’t make other people behave the way we want them to

We can always change our own reactions

Question 67

What is the ACT model?

Answer 67

Composed of six overlapping and interdependent processes

Called the ‘Hexaflex’ (Hexagonally shaped visual aid)

Each has flexibility and flexibility ‘sides’

Question 68

List the 6 inflexible processes articulated by the ACT ‘Hexaflex’

Answer 68

Inflexible:

• Experimental avoidance
• Dominance of past and future
• Lack of clarity and/or contact with values
• Lack of effective action
• Attachment to a self-story
• Cognitive function

Question 69

List the 6 flexible processes articulated by the ACT ‘Hexaflex’

Answer 69

Open: Willingness/acceptance + Cognitive defusion (looking at thoughts rather than from them)

Engaged: Contact with the present moment + Flexible perspectives about ‘stories’

Aware: Clarity about, contact with personal values + Committed actions towards values

Question 70

Define the 3 states of mind that are considered necessary to acquire psychological flexibility?

Answer 70

Awareness

Mindfulness meditation, raisin exercise
Daily diary tracking psychological flexibility
Paying attention whilst doing three tasks

Openness

Acknowledging and validating experiences
‘It is normal to be upset about this’
Noticing tendency to avoid, encouragement to lean in
Singing difficult thoughts/saying them in a funny voice
‘Leaves on a stream’ exercise
- Meditation on principle of cognitive defusion to cope with uncomfortable thoughts and feelings

Engagement

Two sides of a coin metaphor
‘Sweet-spot’ exercise
- Makr room for all the feelings that arise
‘Qualities of our heroes and heroines’ exercise
Generating actions
Making public commitments
SMART goal-setting

Question 71

What are the overall realities of ACT?

Answer 71

Ideas here likely exactly what’s needed
Getting people to accept , commit is tricky

People need to want to change, be willing to work at it
If they do and can, they will

Data on all exercise here very mixed

For some, they work great
Placebo effect is real

Don’t worry if they don’t find your own way to accept, commit

Question 72

Explain how the expression ‘There’s many a slip ‘tween the cup and the lip’ captures an ACT reality.

Answer 72

It implies that even when a good outcome or conclusion seems certain, things can still go wrong - E.g with ACT, practicing positively can’t always occur

Question 73

Why might the evidence base for the effectiveness of the suggested ACT exercises be so weak?

Answer 73

Difficult to measure direct outcome of the methods as they rely on self-guided mental effort to complete - ensure consistency between PPT?

Question 74

To what degrees do people ‘recover’ from psychological health disorders diagnoses?

Answer 74

Don’t really know
Clinical approach is primarily to relieve overt suffering
Research focus is on understanding risks of ‘disorder’
Few measures of ‘flourishing’ available
Need long-term follow ups - difficult, expensive
Implicit beliefs among clinicians that few do go on to do well

Question 75

Compare and contrast the psychological health ‘profile’ used in the recounted recovery study with psychological flexibility, self-compassion, and flourishing. Consider both the ‘quality’ of the actual health states high scorers would likely have and for what purposes the measures would likely be best used.

Answer 75

Rottenberg et al. (2018):

Archive data on US ‘population-representative’ sample

Given diagnosed depression - what proportion later had no symptoms + on multifaceted wellbeing profiles scored in highest 25% of people never diagnosed.

Profile = Rate on: life satisfaction, negative affect, positive affect, autonomy, environmental mastery, personal growth, positive relations with others, purpose in life and self-acceptance

Results
10% of those diagnosed with depression were, 10 years later, symptom free and functioning

25% better than those never diagnosed - not great recovery prospects but somewhat improved

Overall, diagnosed group scored half as well as non-diagnosed group

Anxiety disorder not nearly as good

Question 76

Why was the study described in lecture as ‘only the tip of the iceberg’?

Answer 76

Most people go through psychological troubles without diagnosis

Even most of these recover and thrive

Even the most serious disorders seem to moderate with age

Question 77

What are the eight variables consistently linked to good outcomes after ‘trouble’?

Answer 77

Cultural. community and family resources

Treatment variables

Social interactions and relationships

Personal goals and projects

Habits and self-regulation

Emotional and cognitive resources

Temperamental and genetic factors

Premorbid functioning

Question 78

Recount the recommended research steps to improve understanding of and ability to offer good prospects of recovery.

Answer 78

Measure good outcomes more thoroughly, accurately, often

Measure good function as potential protective factor too

Don’t focus simply on risk factors

Root out implicit attitude that full recovery doesn’t happen
Research how to help people live well