Quiz 3 Flashcards
(310 cards)
1
Q
What is clinical depression often confused with that may lead to an increase in diagnoses in recent times?
A
Intense sadness
2
Q
Why does intense sadness often get incorrectly diagnosed as a depressive disorder?
A
Because diagnosticians fail to take into account context i.e. if the person has just experienced something very sad
3
Q
What may account for the 36% increase in depression from Baxter (2014) systematic review?
A
- Increase in population over time - Some depression checklists may be measuring psych distress rather than clinical depression - greater public awareness of depression -> more frequent use of the term
4
Q
What might explain the stagnant rate of depression despite advances in treatments?
A
- equal increase in prescriptions and reporting of depression cancelling each other out (not yet suported) - treatment received by ppl who did not meet requirements for clinical depression ie. not targeted to those with the greatest need - survey methodologies and diagnostic criteria changed substantially between 1990-2015, limiting the extent to which comparisons can be made.
5
Q
What is the Better Access scheme?
A
- Designed to expand availability of psych treatment under Medicare - Patients could be referred to a clinical psych by a medical practitioner as part of a GP Mental Health Treatment Plan or referred by a psychiatrist or paediatrician - New billing items to subsidise costs
6
Q
How much did the Better Access scheme exceed budgeting expectations?
A
By 2011, the scheme was costing ‘more than three times its initial 4 year estimate of $538 million, or more than $10 million each week
7
Q
What were some concerns regarding Better Access?
A
Apart from the cost, there were concerns about: - Inequities in the distribution of services - the model of care - the quality of the treatment provided - the adequacy of the evaluation commissioned by the government
8
Q
Why was it impossible to carry out a controlled trial on the effectiveness of Better Access scheme?
A
Because the Better Access scheme was rolled out nationally in advance of any evaluation
9
Q
According to Jorm (2018), how have mental health services, psych distress levels, suicide rates changed since Better Access?
A
Mental health sevices - drastically increased and then started to plateau Psych distress levels - relatively unchanged Suicide rates - increased
10
Q
How likely is it that other gradual changes in Australia, such as increased risk factor exposure or willingness to report symptoms, are masking any improvements in mental health?
A
Unlikely - because the increase in services under Better Access was so rapid
11
Q
What explanations does Jorm (2018) provide for lack of impact of Better Access on mental health levels?
A
- Dose not sufficient - most patients getting minimal treatment - Services not going to ppl with highest need - quality of treatment is low - underlying determinants of mental health problems in community - Better Access maybe partly a shift in funding source for services that were already being provided
12
Q
What is the conclusion of Jorm (2018) review on Better Access?
A
- No detectable benefit to the mental health of Australians - Need for development of more effective treatments and improved implementation of existing treatments in practice
13
Q
Mulder (2017): why are clinically proven treatments that benefit individual patients not working at a community level?
A
Maybe: - not being directed at those who will benefit - non-illnesses being overdiagnosed - more severe illnesses, where arguably treatment is more effective, left untreated - treatment of poor quality - treatments being applied too late - Would things be even worse without the increase in mental health treatments
14
Q
What suggestions does Mulder offer for improved mental health outcomes?
A
May need to do less, not more. eg. widespread use of long-term medications not convincingly associated with better long-term outcomes for mental disorders. Factors such as income inequality, discrimination, prejudice, unemployment and strongly materialistic and competitive values may contribute to increased mental distress
15
Q
Mulder (2017): What factors may be needed in addition to psych treatments?
A
Potential for prevention through risk factor modification particularly: - parenting behaviours, - school and workplace environments, - diet and lifestyle (Jorm et al., 2017)
16
Q
What is “selling sickness” or “disease mongering”?
A
Depression epidemic debate linked to executives in the pharmaceutical industry, who are said to benefit financially from increases in the number of people taking antidepressants
17
Q
What are the 3 main factors that influence the ‘depression epidemic’?
A
- Multinational drug companies - Medical practitioners - The public
18
Q
In what parts of the world can psychologists prescribe medication?
A
- 7 states of the US - Alberta, Canada - Guam - South Africa
19
Q
What does the AMA say about prescription rights laws?
A
- Prescription of med by other professionals = risky because do not meet accreditation standards set out on the National Prescribing Service (NPS) Competencies Required to Prescribe Medicines - no high-level evidence that independent non-medical prescribing is safe for patients or cost‑effective for the health system
20
Q
Why do psychologists feel concerned about prescription rights?
A
Lack of perceived knowledge, politics, ethics, and law.
21
Q
How is sadness from grief and depression delineated in the DSM-5?
A
Early editions: someone could NOT be diagnosed with Major Depressive Disorder if the symptoms occurred following bereavement, particularly within the first two months. However, critics argue that although low mood and sadness could be expected following a loss, possible that bereavement could be the trigger for clinical depression. As such, the DSM-5 (the current DSM) removed this criterion.
22
Q
What is thanatology?
A
The study of death, dying, grief and loss Thanatologists study, teach, research, and care for the psychological health of those responding to both death and non-death losses NOT palliative care (caring for terminally ill)
23
Q
What is disenfranchised grief?
A
Grief experienced after losses that cannot be openly acknowledged, publicly mourned, or socially supported eg. death from AIDS, loss of pet, death of extramarital partner, losing personality due to brain injury (non-death)
24
Q
What is complicated grief? (sometimes called prolonged grief)
A
When the experience of grief becomes debilitating and results in impairment in daily functioning
25
What is developmental, or maturational, grief?
Grief over life transitions. Often includes relinquishing activities and friends eg. leaving school, changing friends, empty nest, retirement and the loss of abilities through functional decline and degeneration
26
What is anticipatory grief?
Grief in anticipation of eventual loss, eg., whilst loved ones are progressively declining in health, upcoming redundancy or divorce.
27
Dr Lisa Burke: What are the four key characteristics of grief?
1. Pervasive - has wide-ranging effects on people on so many domains, 2. Dynamic - active process that involves emotions, thoughts and behaviours for people. 3. Even though it’s universal, it is an individual process - how one person experiences grief is different to next person. And the meaning that they attribute to that loss is different as well. 4. Grief is a process, not a passive moving through of prescribed stages. There's no time limit on grief. Grief is your individualised process, your active work that you do to cope with loss.
28
Dr Lisa Burke: What is the difference between acute griedf and chronic grief?
Acute Grief: painfully present, and usually in the time period directly after the loss Chronic Grief: those mourning reactions that don't subside over time.
29
Dr Lisa Bourke: What are the 4 types of disenfranchised grief?
1. Death is stigmatised, eg. suicide, HIV/AIDS, drink-driving. 2. Relationship is stigmatised eg. extramarital affair 3. Relationship not seen as significant, eg. loss of a pet, early pregnancy miscarriage. 4. Loss is not seen as a valid source of grief, eg. non-death losses- losing a loved one cognitively to dementia or traumatic brain injury, mental illness, substance abuse. Even though they're physically still here, we grieve for the loss of the person that we knew.
30
Which grief diagnosis appears in the DSM-5?
Persistent complicated bereavement disorder. Included in DSM-5 as a category requiring further study
31
What did early psychoanalytic approaches to understanding grief conceptualise mourning?
As a process of detaching from the lost person or object, which would then free the ego for new and healthy attachments. This notion of 'breaking bonds' permeated at the time, with many practitioners labelling the failure to break bonds and relinquish attachments "pathological grief".
32
When was Elisabeth Kubler-Ross's infamous book "On death and dying: What the dying have to teach doctors, nurses, clergy, and their own families." published? What was the intention / outcome?
1969 Intention: give the dying a voice by recounting interviews she conducted with patients who were dying, Outcome: responses she depicted (denial, anger, bargaining, depression, and acceptance) came to be described as a theory of the grieving process. This 'theory' continues to be mistakenly applied in the literature and practice.
33
What was Kubler-Ross' model originally based on?
Anticipatory grief - she worked with those with terminal diagnoses
34
What were the 5 stages of grief?
1) Shock and denial 2) Anger, resentment, guilt 3) Bargaining 4) Depression 5) Acceptance
35
What is the best use for Kubler-Ross model based on literature?
Best regarded as a description of the feelings and thoughts that people described as they themselves were dying.
36
What is one downfall about the Kubler-Ross model?
Portrays people as passive recipients of grief experience, ie they moved from phase 1 into phase 2, 3, 4 and 5. And then at the end of that, their grief is resolved. - Limited utility for ppl to feel like they have active control over grief and can manage grief. - Limited utility for professionals to support ppl when they're grieving.
37
Is grief now recognised as an active or passive process?
Active - no time limit on it. - not prescribed stages to move through sequentially, but rather, people are trying to cope with grief as best they can. It can be hard work - called 'grief work' There's a raft of feelings and cognitions and behaviours in any given moment and people are actively trying to make sense of their experiences. - acknowledging the grief that you experience whilst, at the same, trying to find a way to reinvest in your changed life
38
What % of people cope without professional support, using their own internal resources and support from family and friends, a spiritual or religious network, a work place etc?
90%
39
What grief are the 10% that do need professional help likely to be experiencing?
Complicated Grief
40
Dr Lisa Burke: What are the risk factors for experiencing complications with grief?
- Personality style - Attachment style - Relationship with deceased - If deceased was a child - If deaths were multiple or traumatic
41
How do thanatologists 'treat' patients?
Range of person-centred evidence-based interventions Respect the individual and their process. Don't impose any restrictions on their grieving or any set process that they need to engage in. Goals are to support the person in their individual grief experience.
42
What is the major change in treatment strategies for grief now versus 50 years ago?
Today, thanatologists actually encourage attachment with the lost person/item, whereas 50 years ago people were encouraged to stop thinking about it and move on with life
43
What is the difference btw loss-oriented and restorative based interventions?
Loss-oriented (emotion-focused)- help people find meaning in their loss. Attend to people's active symptoms of grief, the loss-oriented symptoms eg. missing someone so much that it hurts, crying, wanting to relive memories Restoration-oriented (process-focused) = finding ways to continue living in your different, changed life.
44
What type of interventions to children and young adults tend to respond well to?
Children really respond well to group therapy, particularly adolescents and young people respond really well to sharing grief and feeling like they are less isolated and alone
45
What types of therapy do thanatologists offer?
- CBT, - Schema therapy, - Narrative therapy. - Attachment-based work (bcos attachment is about saying hello and saying goodbye too). - art therapies eg. ppl in group therapy create a mandala together and dedicate it to their lost loved one, or object. - sand tray therapy. - play therapy with children.
46
What is reminiscence therapy?
When thanatologists encourage grief sufferers to bring memories eg. photo albums, items that belonged to their loved one. Reminisce together Very helpful technique, both for death-related grief, non-death-related grief as well, but also anticipatory grief. It can be very, very valuable for a couple or a family to sit together and reminisce together before the eventual death.
47
What is considered one of the most critical issues in grief?
Finding meaning / sense in the loss The reconstruction of meaning
48
What were the 3 steps involved in Freud's 'grief work'?
1) Freeing the bereaved from bondage to the deceased 2) Readjustment to new life circumstances without the deceased 3) Building of new relationships
49
What other aspects were incorporated in Freud's thinking?
Separation required the energetic process of acknowledging and expressing painful emotions such as guilt and anger. If bereaved failed to complete their grief work, the process would become complicated and increase the risk of mental and physical illness. ‘moving on’ as quickly as possible to return to a ‘normal’ level of functioning
50
Why are stage theories (like Kubler-Ross stages of grief) appealing? What are their downfalls?
Bring a sense of conceptual order to a complex process and offer the emotional promised land of ‘recovery’ and ‘closure’. Incapable of capturing the complexity, diversity and idiosyncratic quality of the grieving experience. Do not address the multiplicity of physical, psychological, social and spiritual needs experienced by bereaved people, their families and intimate networks.
51
Bonanno (2002): What are the 5 distinct trajectories that covered the outcome patterns of most participants
Five distinct trajectories: 1) common grief or recovery (11%) 2) stable low distress or resilience (46%) 3) depression followed by improvement (10%) - most prevalent in those who experienced relief following a period of considerable caregiver burden or who suffered oppressive relationships 4) chronic grief (16%) 5) chronic depression (8%)
52
What were some other findings from Bonanno's (2002) study on grief?
- Those experiencing highest levels of distress tended to exhibit high levels of personal dependency prior to the death of their spouse. - For those not depressed before the loss, dependency was an important predictor of grief reactions. - A lack of expectation or psychological preparation for the loss = increased distress. - The distinction between chronic grief and chronic depression, is of critical importance. - Relationship conflict was predictive of chronic depression but not chronic grief. - Chronic grievers reported greater processing of the loss and searching for meaning compared to chronically depressed
53
What are the two more comprehensive and influential grief models used today?
1) Dual-Process Model (cognitive perspective) 2) Task-Based Model
54
What are the 2 different orientations of the Dual-Process Model?
1) Loss orientation (emotion-focused) - the griever engages in emotion-focussed coping, exploring and expressing the range of emotional responses associated with the loss 2) Restoration orientation (problem-focused) - griever engages with problem-focussed coping and is required to focus on the many external adjustments required by the loss, including diversion from it and attention to ongoing life demands The model suggests that the focus of coping may differ from one moment to another, from one individual to another, and from one cultural group to another
55
What are the 4 tasks of the Task-Based Model (Worden, 2008)?
1) Accept the reality of the loss 2) Process the pain of grief 3) Adjust to a world without the deceased 4) Find an enduring connection with the deceased in the midst of embarking on a new life
56
Within the task-based model of grieving, Worden (2008) also identifies seven determining factors that are critical to appreciate in order to understand the client’s experience, what are they?
(1) who the person who died was (2) the nature of the attachment to the deceased; (3) how the person died; (4) historical antecedents; (5) personality variables; (6) social mediators; (7) concurrent stressors.
57
What % of the bereaved population experience the sense of presence of the deceased?
Over half, although true incidence is thought to be much higher, given a great reluctance among the bereaved to disclose its occurrence to clinicians for fear of ridicule or being thought of as ‘mad or stupid’.
58
What is the difference btw adaptive and maladaptive continuing bonds?
Whether the given expression reflects an attempt to maintain a more concrete tie that entails failure to relinquish the goal to regain physical proximity to the deceased. This can be compared to a more internalised, symbolically-based connection, which suggests a greater acceptance of the death.
59
What is one of the major contributors to complicated grief?
A failure to find spiritual or secular meaning in the loss
60
How can one find meaning in loss?
1. making sense of the loss 2. finding benefits from the loss
61
Roughly how many people experience intense or chronic grief?
10-15%
62
At what point does grief intensity reduce for most people?
After around 6 months
63
Under what conditions is prolonged grief disorder diagnosed (not included in the DSM)?
Symptoms must last for at least 6 months and cause significant impairment in social, occupational and other important areas of functioning
64
What are some symptoms of PGD?
Sleep disruption, Substance abuse, depression, Compromised immune function, Hypertension, Cardiac problems, Cancer, Suicide, and Work and social impairment. These effects have been observed for as long as four to nine years after the death
65
Are anti-depressants helpful for bereavement complication?
Although reduce depressive symptoms, not generally helpful
66
What happens when social grieving rules are internalised by the mourner?
Disenfranchised grief acquires an internal character
67
Disenfranchised grief occurs due to lack of social recognition of one of what 3 elements?
1) The relationship the mourner has with the deceased person (non-family, ex-partner, same-sex) 2) The type of loss itself (pets, celebs, people we haven't met, anticipatory grief, suicide, HIV/AIDS) 3) The characteristics of the mourner (young, old, intellectually disabled)
68
What are 3 common grief trajectories?
- Resilience (45-60% of grievers) - typically resolve by 6 months - short-lived disruptions to overall funtioning Recovery (15-25% of grievers) - moderate disruption to daily functioning - strong feelings of yearning and disruptions to everyday functioning which resolve approximately a year after the loss Complicated or Prolonged Grief (10-15%) - considerable, persistent and pervasive grief-related distress, such as strong, painful feelings of emptiness, avoidance, yearning and substantial disruptions to functioning
69
What were commonly cited coping strategies for people dealing with disappearance?
Acceptance Emotional support Venting emotions Mental disengagement
70
How do resilient mourners differ from prolonged mourners?
Resilient participants reported significantly: - Lower attachment anxiety and attachment avoidance; - Lower destructive detachment; - Greater emotional stability and healthy dependency; - Great ability to derive comfort from memories of their deceased spouse, yet a lower sense of a continuing bond; and, - Less loneliness and greater ability to disclose to others. Often younger, with more positive worldview No significant differences were found between participants classified as resilient and those classified as in recovery
71
What differences have been found between prolonged grievers and those in recovery?
Recovered participants reported significantly higher ability to feel comfort from memories and greater ability to disclose than prolonged grievers Recovered participants did not differ from prolonged grievers on emotional stability, attachment and continuing bonds.
72
What have been found to be predictors of grief severity and persistence?
Greater severity: - females, - those who lost a child, - lower education and - higher depressive symptoms Longitudinally, at a 6-year follow up, baseline grief severity was the only significant predictor of grief persistence.
73
What are the 2 broad goals of the positive ageing perspective?
1. Develop and implement strategies that promote successful ageing by changing modifiable factors linked to illness, optimising capabilities, increasing social interactions and enhancing engagement in life 2. Explore psychological constructs linked with ageing well
74
What are the 3 components of Rowe and Kahn's definition of successful ageing?
- Absence of disease/disability - High cognitive and physical functioning - Engagement with life
75
Roughly what percentage of older people fit Rowe and Kahn's definition of successful ageing?
12% - although most people meet at least one individual criteria
76
What do researchers believe is the most important aspect of positive ageing?
- Lack of disability/good physical function - 2nd is cognitive functioning
77
What % of people rate themselves as successfully ageing?
Most people rated themselves betwen 7-10 out of 10 Therefore discrepancy btw what older ppl think abouth themselves and what researchers think
78
What is one thing qualitative studies have found older people associate with positive ageing, that quantitative studies have missed?
Adaptability or resilience - maintaining a positive attitude despite having problems. More important than freedom from impairments Engagement
79
An active model in which brain plasticity maintain neural processes, thought to be enhanced through engagement with cognitively meaningful and stimulating activities
Cognitive Reserve
80
Global sense of control over life and the future. Linked with reduced anxiety, better problem solving, and is protective against the impact of hardship
Mastery
81
Linked with higher quality of life, less loneliness, less distress, better cognitive function
Self-efficacy
82
Three domains - cognitive, affective and reflective
Wisdom
83
Reflected in expert knowledge, reasoning and problem solving skills, and sound decision making
Cognitive Wisdom
84
Encompasses positive emotions, ability to regulate emotions and the experience of fewer negative emotions
Affective Wisdom
85
The ability to accept the views of others and overcome subjective perspectives
Reflective wisdom
86
The ability to maintain subjective wellbeing despite experiencing challenges
Resilience
87
Demonstrated links between religious involvement, adaptation to illness, greater resilience and improved health behaviours. Also, self-reflection and searching for existential meaning
Spirituality
88
Engaging on activities to maintain social roles, align with personal values, and are meaningful to the individual
Meaningful / purposeful engagement
89
Stirling (2016): what is the most common response to the concept of ageing in Western cultures?
Fear
90
Sitrling (2016): what did researchers actually find about peoples living experiences of ageing?
Beneficial clarity of values and enjoyable landscape of experiences and competencies
91
How does emotional regulation contribute to increased well-being in older age?
1. Better at predicting emotional arousal in situations and can therefore select situations better 2. Attention is more selective to positive info 3. Emotional arousal following choice making is moderated by cognitive control -\> decrease in negative emotions
92
What emotionally meaningful goals and activites are prioritised in older age?
1. Generative activities - passing on ones knowledge 2. Present oriented goals ie alleviating aversive symptoms 3. Reducing network size 4. Focusing on stimuli with emotional valence ie music In summary, regulation of emotion becomes stronger in older age
93
What are the 3 dimensions of gerotranscendence?
- Cosmic - experience of time is re-defined, life seen as a chain of events rather than isolated point in time - Dimension of Self - decreases in self-centredness - Social - superficial socialising reduced favour meaningful relationships High levels of gerotranscendence is reached naturally in about 20% of people
94
What is the greatest barrier preventing transcendence in later life?
Expectation that later life will involve a continuation of same values as mid-adult life as well as mistaking new joy in contemplation as 'depression' or 'slowing down'
95
What 3 factors are likely to promote well-being and capacity for coping in later life?
1. Social Roles 2. Members of a community able to draw strength and resilience from those close to death / impaired 3. Disability and adversity are part of natural range of experience in life
96
Briefly describe Keys Model of Psych Well-Being
Low chronic illness / high psych well-being = flourishing Low chronic illness / low psych well-being = languishing High chronic illness / low psych well-being = floundering High chronic illness / high psych well-being = adapting
97
Stirling (2016): what are other aspects of healthy ageing
Resilience Optimism Positive expectancy Self-efficacy
98
What has been identified as the most effective interventions for social isolation?
- Adopting community development approach; - Adapted to fit a specific local area; and, - Focused on productive engagement (e.g., creating opportunities for socialisation and forming new social networks).
99
What are the four common features of terrorism that have been identified?
- Involve acts of violence; - Intended to create/instill fear in people; - Driven by political/social motives; and, - Targeted towards those not involved combat (this includes civilians and unarmed/off-duty military personnel).
100
Is labelling an individual or group as a terrorist consistent with how terrorism is conceptualised?
No - definitions focus on terrorist acts, not on groups or individuals
101
What are 5 different types of terrorism?
Mass terror: acts of terrorism committed by political leaders targeted at the general population (e.g., Stalin) Random terror: committed by individuals or groups, targeted at civilians (e.g., 9/11; 2015 Paris shootings) Focused random terror: committed by individuals and groups, but targets at members of the opposition. Focused random terror uses many of the same methods as random terror (e.g., bombs), but does so in areas with large numbers of the opposition (e.g., Israeli-Palestine conflicts). Dynastic terror: assassinations carried out by individuals/groups targeting a ruling elite or state leader (e.g., the assassination of Benazir Bhutto). Lone wolf terror: individuals acting alone, targeting governments or civilians (e.g., 2017 Las Vegas shootings; 2014 Lindt Café siege)
102
What is Instead the most critical problem in research on terrorism?
Overreliance on secondary sources that provide information indirectly (i.e., newspaper articles) - subject to bias, under-reporting, and/or issues with accuracy.
103
Why does research rely on secondary sources?
Primary sources (terrorists) difficult to bring into study
104
Explain Terror Management Theory (TMT)
Humans experience conflict btw desire to live and mortality salience: awareness that death cannot be avoided and can happen at any time. This conflict results in a constant state of existential terror, which humans attempt to alleviate by espousing cultural or other symbolic beliefs to provide meaning and value to life (and its certain death) These beliefs can be easily threatened by reminders of the inevitability of death, resulting in an even stronger, but less effective, defence of the espoused views To avoid becoming paralyzed by this terror, people immerse themselves in cultural systems and worldviews that offer them literal immortality (e.g., the promise of an afterlife after one’s death) or symbolic immortality (e.g., being remembered by others after one’s death). Faith in one’s cultural worldview thus functions as a buffer against death-related anxiety.
105
How does TMT apply to terrorism?
Evoking death-related thoughts (mortality salience; MS) in individuals or groups can lead to stronger worldview defence and greater support for extremist violence May be doing so to reduce their existential terror/anxiety and give meaning to their lives
106
Give an example of TMT relating to terrorism
A sample of Iranian participants reported stronger support for suicide bombings targeting Americans when in a mortality salience condition (i.e., reminded of death) than in a control condition
107
What did Vergani et al. (2019) find re: TMT across 3 studies?
No significant effect on support for extremist violence for Australian university students. Therefore, little support for the hypothesis that MS results in increased support for violent extremism. Participants exposed to the MS manipulation reported increases in conservative religiosity (belief in divine power) but not extremist violence Study 3: increased support for policies that act to fight against violent extremism in Melbourne Jewish community More study needed to address inconsistencies in evidence surrounding TMT and the MS hypothesis, at least in regards to violence and extremism.
108
What were the 3 main findings of Das et al. (2009) study on TMT and news?
1) The murder of Van Gogh and news reports of terrorism overseas increased death-related thoughts, which in turn predicted prejudice towards Arabs, but only after Van Gogh's death. 2) News on a terrorist threat close-by increased death-related thoughts, which in turn predicted implicit prejudice towards Arabs, but only in those with low self-esteem 3) The effect of terrorism news on prejudice against Arabs was replicated for non-Muslims. Also, it increased prejudice against Europeans for Muslim participants "Terrorism news triggers an unconsciously activated fear of death, which then becomes the basis for judging outgroups"
109
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "strong emotional reactions such as disbelief, numbness, fear and confusion."
Phase 1 - Immediate Aftermath
110
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "active efforts to adapt to new environment, intrusive and hyperarousal symptoms present, somatic symptoms - headaches, dizziness, nausea, anger irritability and social withdrawal"
Phase 2 - 1 week – several months
111
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "Disappointment and resentment as it becomes evident that aid and restoration is unlikely to lead to complete return to pre-attack status."
Phase 3 - several months
112
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "Reconstruction phase typified by physical and emotional rebuilding, resumption of old roles, re-establishing social connections"
Phase 4 - months to years
113
What are the most common psychological disturbances arising from terrorism?
Anxiety Depression Substance Use PTSD
114
What are four main themes of generated terrorism-related anxiety?
- Anxiety relating to being physically harmed; - Political fear, which relates to anxiety about the social consequences that communal fear generates by targeting and demonising one element within society; - Fear of losing civil liberties; and, - A sense of insecurity brought about by a feeling of reduced safety
115
What helps adolescents with regard to anxiety around terrorism?
Talking about it
116
The risk of developing depression in response to terrorism is increased by the which risk factors?
female gender, low social support, experience of other stressors, co-morbidity with another psychological disorder (e.g., PTSD, panic)
117
In what situations is PTSD risk heightened?
- direct victims of the event (i.e., present during the attack or who lost a family member or close friend) - prevalence rates increasing to 30-40% - previous life stress or trauma, - being female, - younger age, - low SES, - ethnic minority status - history of psychiatric illness
118
Rudenstein and Calea (2015) recommend a three-phase approach to intervention in response to terrorism, what does it involve?
1. Normalisation of heightened fear and anxiety within the first few days of the terrorist event. No need for formal intervention - most symptoms resolve on their own. 2. Screening for high-risk individuals, accompanied by ongoing normalisation and information provision. Involves consideration of variables that increase risk of PTSD, ASD, anxiety, depression and problematic substance use. 3. Referral of symptomatic individuals who meet clinical indicators of disorder to professional services.
119
What is one of the leading theories of stress and trauma?
Conservation of Resources Theory Developed as a theory to explain stress reactions
120
What does the Conservation of Resources theory state?
Psychological stress reults from real or perceived loss of resources (material resources such as housing, transport, and/or psychosocial resources such as social support).
121
What 3 situations does stress transpire according to the Conservation of Resources?
1. When there has been an actual loss of resources, 2. Threat of lost resources, 3. A lack of gained resources where it was expected.
122
Does the COR theory believe that people are resilient?
Yes - COR purports that people are resilient to resource loss to the extent that they can acquire and maintain resources that will buffer the stress resulting from the loss. In the case of terrorism, terrorism both results in resource loss (e.g., death of family/friends, loss of housing/employment) and depletes the resources needed to cope with the loss (e.g., sense of safety).
123
What are some cognitive distortions that have been implicated in the development and maintenance of psychological issues arising from terrorism?
Catastrophising: expecting the worst to happen and expecting the consequence to be disastrous if it does occur (e.g., “If I fail this assignment, I’ll never finish my degree, never get into postgraduate studies and my life will be a failure”). Helplessness: a sense of being powerless that results after repeated failure or exposure to a traumatic event. Rumination: rumination is the process of repeatedly thinking about a problem or event. Although not a cognitive distortion in and of itself, greater rumination of distorted thoughts enhances them.
124
What percentage of refugees have experienced at least 1 traumatic event? What is the average number of traumatic events experienced by refugees?
90-95% 4
125
In Australia, what % of West Papuan and Iraqi refugees meet the clinical cut off score for PTSD on the Harvard Trauma Questionnaire?
29.5% 31%
126
What % of the world’s population are thought to be international migrants?
3% ie more than 200 million people
127
What are some of the clinical challenges when working with severely traumatised refugees, as described by Maier (2015)?
- Very severe trauma - Shattered assumptions about the trustworthiness of the world - Loss of self-sameness/identity - Feel deeply isolated, can't share experiences with anybody - Physical disabilities and complaints - Insecure residency permit status - Cultural and social uprooting - Survivor's/perpetrator's guilt - Moral injury
128
What is the name given to transgressions that lead to serious inner conflict because the experience is at odds with core ethical and moral beliefs?
Moral injury
129
What is one barrier for refugees seeking help?
Different cultural views
130
What is one of the challenges of engaging with refugees, especially in PTSD?
Mismatch between Western conceptualisations of the disorder and how it is presented and expressed in different cultures eg. Cambodian refugees may describe symptoms of night terrors and sleep paralysis, neither of which align with our diagnostic criteria, however, in Cambodian culture these symptoms are related to beliefs that PTSD reflects night hauntings by the spirits of people who have been killed in the homeland who torment survivors
131
What are 5 things you should focus on when providing CBT to traumatised refugees?
1. Extend the psycho-educational element of therapy 2. Explore their symptoms in their own words - makes them the expert of their experience + openness to accept their culture and views 3. Explore the impact of their trauma on their role functioning 4. Involve them in therapeutic goal-setting - likely to differ from what you think they're goals will be 5. Obtain supervision
132
Julie Kuck: what does immigration and it's healing require of psychologists?
Curiosity, trust and bravery
133
Julie Kuck: what are examples of universal themes?
Puppies and babies
134
Julie Kuck: what are the 3 brains that Julie refers to?
1. Heart - compassion - how to create in unique and indiv ways 2. Gut - survival - how to construct and craft 3. Mind - knowing - how to do the work (requires instruction, teaching, inventing and perception)
135
What is positive education
Umbrella term encompassing theory and research in relation to what makes life worth living Learn how to flourish in life -\> well-being based on strengths of individuals Mindset skills
136
What are some of the benefits of positive education?
- Promotes individual growth - Teaches students how to make themselves contented - Reduces depression - Happy students make high achievers - Makes teachers' lives easier - Increases student motivation
137
What is the Penn Resiliency Program (PRP)? What are some of the benefits?
Intended to increase students' ability to handle day-to-day stressors and common issues. Achieved by teaching students how to think realistically and flexibly about problems they encounter, as well as assertiveness, creative brainstorming, relaxation, decision-making. - Reduces helplessness - Reduces depression - Reduces anxiety - Reduces behavioural problems
138
What are 2 exercises used in the Strath Haven Positive Psych Curriculum?
1. three good things then write reflection answering three questions: "Why did this good thing happen?"; "What does this mean to me?"; "How can I increase the likelihood that further good things like this will happen?" 2. Using signature strengths in a new way. Students completed the VIA Signature Strengths test for children (www.authentichappiness.org) and learn to identify these in themselves and others.
139
Where has positive education arisen from in the 70s, 90s, and 2000s?
70s - self-esteem 90s - social skills programs 2000s - resilience programs Since then -\> anti-bullying initiatives, values programs and student wellbeing initiatives, including social and emotional learning programs
140
What is the point of using positive psychology interventions and coaching psychology in schools?
The coaching can enhance the training of the positive psychology intervention
141
What conclusion can be drawn from the APS article on positive education?
- Positive psychology and coaching psychology have much to offer schools. However, to increase sustainability, the successful integration and strategic application of both approaches is required - Customise programs for schools - Need for further research - Need for expert external consultants and educators to work collaboratively with schools to create and evaluate individualised programs
142
What are the five pillars that Seligman believed contribute to overall wellbeing? (PERMA)
Positive emotions Engagement Relationships Meaning Accomplishment - Important areas that people pursue for their own sake, - Can be defined and measured independently of one another. - Five PERMA domains fall on the positive side of the mental health spectrum. That is, well-being is not simply the lack of negative psychological states, but is the presence of positive psychological states.
143
What are some criticisms of positive psychology / education?
Methodologically suspect, Conceptually unclear, Faddish
144
Kristjansson (2012): How has positive psych evolved over the years?
1950s - 1070s - humanistic psychology - emphasis on positive self-fulfillment and self-education Positive psychologists fault humanistic psychology for its lack of scientific rigor, for ignoring wellness-enhancing social (as distinct from personal) variables, and for confusing description with prescription 1980s and 1990s - adaptability psychologies - coping, self-esteem, self-efficacy, self-determination theory, multiple intelligences, and emotional intelligence. Positive psychologists fault the adaptability psychologies for refusing to take seriously the moral factors that make life worth living for most people. eg. moral intelligence is missing from the list of multiple intelligences.
145
What are some conclusions of Kristjansson (2012) article on positive education?
Modifying postitive psychs happiness theory -\> purely objective account. Such a modification could eliminate some of the troublesome ambiguities at the heart of the theory and make it more amenable to practical application. Methods such as cognitive behavioral therapy and mindful meditation that had a long history before the advent of positive psychology tend to do best in effectiveness tests. The only educational intervention that is undeniably unique to the positive education program—the promotion of positive affect in the classroom via the broaden-and-build thesis—may lose some of its appeal if it turns out that fundamental statements in the thesis are of a conceptual rather than an empirical nature.
146
What are 2 reasons why positive psychologists haven't been able to address the 'positive institutions' pillar of happiness?
- They haven't had access to whole schools - Practically, it's easier to enforce change on an individual level, rather than large-scale political transformation
147
Why does Prof Haslam think concept creep has occurred?
In the last 50 years, Western society has grown more sensitive to harm and expanded their definition of what harm is
148
In terms of concept creep, what does horizontal and vertical expansion mean?
Horizontal expansion - qualitatively new phenomena Vertical expansion - quantitatively less extreme phenomena
149
What is a potential reason for this shift in conceptualisation re: concept creep?
The adaptability and malleability of humankind - ie. humans respond to social reality and influence this reality. As such, this shift can have implications on how individuals perceive and characterise themselves
150
How has abuse shifted horizontally/qualitatively? How has abuse shifted vertically/quantitatively?
- Abuse now includes emotional and psychological - Things that don't involve physical contact - Neglect - What constitutes emotional abuse is often diffuse and ambiguous - In terms of neglect, "What was not done, but should have been" is much less concrete than "What was done, but should not have been"
151
How has bullying shifted horizontally/qualitatively? How has bullying shifted vertically/quantitatively?
- Cyberbullying - Workplace bullying - Ignoring or excluding behaviours - Less extreme bullying - Less repetitive bullying eg: posting one picture online - New questionnaire wording: "these things may happen repeatedly" - Element of power often doesn't exist with cyberbullying, perp is often anonymous - Perceived bullying is now a thing, intentionality is often missing
152
How has prejudice shifted horizontally/qualitatively? How has prejudice shifted vertically/quantitatively?
- People need to deny the existence of racism, and oppose affirmative action policies to prove they're not racist - Symbolic racism - Aversive prejudice eg: having an unconscious antipathy for outgroup members based on fear, unease or discomfort - Microaggressions eg: faltering speech, trembling speech when discussing racial issues
153
How has trauma shifted horizontally? How has trauma shifted vertically?
- Trauma to psychological state, not the body - Childbirth, sexual harassment, infidelity, emotional loss, grief
154
How have mental disorders shifted horizontally? How have mental disorders shifted vertically?
- Bad habits, personal weaknesses, medical problems, and character flaws now considered mental disorders - Less versions of severe conditions eg: Aspergers - Normal worry, fear and sadness are creeping into mental disorders
155
How has addiction shifted horizontally? How has addiction shifted vertically?
- Behavioural and process addictions - Bad habits and repetitive pleasurable activities considered addictions
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Intense sadness
What is clinical depression often confused with that may lead to an increase in diagnoses in recent times?
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Because diagnosticians fail to take into account context i.e. if the person has just experienced something very sad
Why does intense sadness often get incorrectly diagnosed as a depressive disorder?
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- Increase in population over time - Some depression checklists may be measuring psych distress rather than clinical depression - greater public awareness of depression -\> more frequent use of the term
What may account for the 36% increase in depression from Baxter (2014) systematic review?
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- equal increase in prescriptions and reporting of depression cancelling each other out (not yet suported) - treatment received by ppl who did not meet requirements for clinical depression ie. not targeted to those with the greatest need - survey methodologies and diagnostic criteria changed substantially between 1990-2015, limiting the extent to which comparisons can be made.
What might explain the stagnant rate of depression despite advances in treatments?
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- Designed to expand availability of psych treatment under Medicare - Patients could be referred to a clinical psych by a medical practitioner as part of a GP Mental Health Treatment Plan or referred by a psychiatrist or paediatrician - New billing items to subsidise costs
What is the Better Access scheme?
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By 2011, the scheme was costing ‘more than three times its initial 4 year estimate of $538 million, or more than $10 million each week
How much did the Better Access scheme exceed budgeting expectations?
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Apart from the cost, there were concerns about: - Inequities in the distribution of services - the model of care - the quality of the treatment provided - the adequacy of the evaluation commissioned by the government
What were some concerns regarding Better Access?
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Because the Better Access scheme was rolled out nationally in advance of any evaluation
Why was it impossible to carry out a controlled trial on the effectiveness of Better Access scheme?
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Mental health sevices - drastically increased and then started to plateau Psych distress levels - relatively unchanged Suicide rates - increased
According to Jorm (2018), how have mental health services, psych distress levels, suicide rates changed since Better Access?
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Unlikely - because the increase in services under Better Access was so rapid
How likely is it that other gradual changes in Australia, such as increased risk factor exposure or willingness to report symptoms, are masking any improvements in mental health?
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- Dose not sufficient - most patients getting minimal treatment - Services not going to ppl with highest need - quality of treatment is low - underlying determinants of mental health problems in community - Better Access maybe partly a shift in funding source for services that were already being provided
What explanations does Jorm (2018) provide for lack of impact of Better Access on mental health levels?
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- No detectable benefit to the mental health of Australians - Need for development of more effective treatments and improved implementation of existing treatments in practice
What is the conclusion of Jorm (2018) review on Better Access?
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Maybe: - not being directed at those who will benefit - non-illnesses being overdiagnosed - more severe illnesses, where arguably treatment is more effective, left untreated - treatment of poor quality - treatments being applied too late - Would things be even worse without the increase in mental health treatments
Mulder (2017): why are clinically proven treatments that benefit individual patients not working at a community level?
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May need to do less, not more. eg. widespread use of long-term medications not convincingly associated with better long-term outcomes for mental disorders. Factors such as income inequality, discrimination, prejudice, unemployment and strongly materialistic and competitive values may contribute to increased mental distress
What suggestions does Mulder offer for improved mental health outcomes?
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Potential for prevention through risk factor modification particularly: - parenting behaviours, - school and workplace environments, - diet and lifestyle (Jorm et al., 2017)
Mulder (2017): What factors may be needed in addition to psych treatments?
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Depression epidemic debate linked to executives in the pharmaceutical industry, who are said to benefit financially from increases in the number of people taking antidepressants
What is "selling sickness" or "disease mongering"?
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- Multinational drug companies - Medical practitioners - The public
What are the 3 main factors that influence the 'depression epidemic'?
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- 7 states of the US - Alberta, Canada - Guam - South Africa
In what parts of the world can psychologists prescribe medication?
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- Prescription of med by other professionals = risky because do not meet accreditation standards set out on the National Prescribing Service (NPS) Competencies Required to Prescribe Medicines - no high-level evidence that independent non-medical prescribing is safe for patients or cost‑effective for the health system
What does the AMA say about prescription rights laws?
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Lack of perceived knowledge, politics, ethics, and law.
Why do psychologists feel concerned about prescription rights?
176
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Early editions: someone could NOT be diagnosed with Major Depressive Disorder if the symptoms occurred following bereavement, particularly within the first two months. However, critics argue that although low mood and sadness could be expected following a loss, possible that bereavement could be the trigger for clinical depression. As such, the DSM-5 (the current DSM) removed this criterion.
How is sadness from grief and depression delineated in the DSM-5?
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The study of death, dying, grief and loss Thanatologists study, teach, research, and care for the psychological health of those responding to both death and non-death losses NOT palliative care (caring for terminally ill)
What is thanatology?
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Grief experienced after losses that cannot be openly acknowledged, publicly mourned, or socially supported eg. death from AIDS, loss of pet, death of extramarital partner, losing personality due to brain injury (non-death)
What is disenfranchised grief?
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When the experience of grief becomes debilitating and results in impairment in daily functioning
What is complicated grief? (sometimes called prolonged grief)
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Grief over life transitions. Often includes relinquishing activities and friends eg. leaving school, changing friends, empty nest, retirement and the loss of abilities through functional decline and degeneration
What is developmental, or maturational, grief?
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Grief in anticipation of eventual loss, eg., whilst loved ones are progressively declining in health, upcoming redundancy or divorce.
What is anticipatory grief?
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1. Pervasive - has wide-ranging effects on people on so many domains, 2. Dynamic - active process that involves emotions, thoughts and behaviours for people. 3. Even though it’s universal, it is an individual process - how one person experiences grief is different to next person. And the meaning that they attribute to that loss is different as well. 4. Grief is a process, not a passive moving through of prescribed stages. There's no time limit on grief. Grief is your individualised process, your active work that you do to cope with loss.
Dr Lisa Burke: What are the four key characteristics of grief?
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Acute Grief: painfully present, and usually in the time period directly after the loss Chronic Grief: those mourning reactions that don't subside over time.
Dr Lisa Burke: What is the difference between acute griedf and chronic grief?
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1. Death is stigmatised, eg. suicide, HIV/AIDS, drink-driving. 2. Relationship is stigmatised eg. extramarital affair 3. Relationship not seen as significant, eg. loss of a pet, early pregnancy miscarriage. 4. Loss is not seen as a valid source of grief, eg. non-death losses- losing a loved one cognitively to dementia or traumatic brain injury, mental illness, substance abuse. Even though they're physically still here, we grieve for the loss of the person that we knew.
Dr Lisa Bourke: What are the 4 types of disenfranchised grief?
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Persistent complicated bereavement disorder. Included in DSM-5 as a category requiring further study
Which grief diagnosis appears in the DSM-5?
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As a process of detaching from the lost person or object, which would then free the ego for new and healthy attachments. This notion of 'breaking bonds' permeated at the time, with many practitioners labelling the failure to break bonds and relinquish attachments "pathological grief".
What did early psychoanalytic approaches to understanding grief conceptualise mourning?
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1969 Intention: give the dying a voice by recounting interviews she conducted with patients who were dying, Outcome: responses she depicted (denial, anger, bargaining, depression, and acceptance) came to be described as a theory of the grieving process. This 'theory' continues to be mistakenly applied in the literature and practice.
When was Elisabeth Kubler-Ross's infamous book "On death and dying: What the dying have to teach doctors, nurses, clergy, and their own families." published? What was the intention / outcome?
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Anticipatory grief - she worked with those with terminal diagnoses
What was Kubler-Ross' model originally based on?
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1) Shock and denial 2) Anger, resentment, guilt 3) Bargaining 4) Depression 5) Acceptance
What were the 5 stages of grief?
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Best regarded as a description of the feelings and thoughts that people described as they themselves were dying.
What is the best use for Kubler-Ross model based on literature?
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Portrays people as passive recipients of grief experience, ie they moved from phase 1 into phase 2, 3, 4 and 5. And then at the end of that, their grief is resolved. - Limited utility for ppl to feel like they have active control over grief and can manage grief. - Limited utility for professionals to support ppl when they're grieving.
What is one downfall about the Kubler-Ross model?
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Active - no time limit on it. - not prescribed stages to move through sequentially, but rather, people are trying to cope with grief as best they can. It can be hard work - called 'grief work' There's a raft of feelings and cognitions and behaviours in any given moment and people are actively trying to make sense of their experiences. - acknowledging the grief that you experience whilst, at the same, trying to find a way to reinvest in your changed life
Is grief now recognised as an active or passive process?
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90%
What % of people cope without professional support, using their own internal resources and support from family and friends, a spiritual or religious network, a work place etc?
194
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Complicated Grief
What grief are the 10% that do need professional help likely to be experiencing?
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- Personality style - Attachment style - Relationship with deceased - If deceased was a child - If deaths were multiple or traumatic
Dr Lisa Burke: What are the risk factors for experiencing complications with grief?
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Range of person-centred evidence-based interventions Respect the individual and their process. Don't impose any restrictions on their grieving or any set process that they need to engage in. Goals are to support the person in their individual grief experience.
How do thanatologists 'treat' patients?
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Today, thanatologists actually encourage attachment with the lost person/item, whereas 50 years ago people were encouraged to stop thinking about it and move on with life
What is the major change in treatment strategies for grief now versus 50 years ago?
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Loss-oriented (emotion-focused)- help people find meaning in their loss. Attend to people's active symptoms of grief, the loss-oriented symptoms eg. missing someone so much that it hurts, crying, wanting to relive memories Restoration-oriented (process-focused) = finding ways to continue living in your different, changed life.
What is the difference btw loss-oriented and restorative based interventions?
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Children really respond well to group therapy, particularly adolescents and young people respond really well to sharing grief and feeling like they are less isolated and alone
What type of interventions to children and young adults tend to respond well to?
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- CBT, - Schema therapy, - Narrative therapy. - Attachment-based work (bcos attachment is about saying hello and saying goodbye too). - art therapies eg. ppl in group therapy create a mandala together and dedicate it to their lost loved one, or object. - sand tray therapy. - play therapy with children.
What types of therapy do thanatologists offer?
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When thanatologists encourage grief sufferers to bring memories eg. photo albums, items that belonged to their loved one. Reminisce together Very helpful technique, both for death-related grief, non-death-related grief as well, but also anticipatory grief. It can be very, very valuable for a couple or a family to sit together and reminisce together before the eventual death.
What is reminiscence therapy?
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Finding meaning / sense in the loss The reconstruction of meaning
What is considered one of the most critical issues in grief?
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1) Freeing the bereaved from bondage to the deceased 2) Readjustment to new life circumstances without the deceased 3) Building of new relationships
What were the 3 steps involved in Freud's 'grief work'?
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Separation required the energetic process of acknowledging and expressing painful emotions such as guilt and anger. If bereaved failed to complete their grief work, the process would become complicated and increase the risk of mental and physical illness. ‘moving on’ as quickly as possible to return to a ‘normal’ level of functioning
What other aspects were incorporated in Freud's thinking?
205
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Bring a sense of conceptual order to a complex process and offer the emotional promised land of ‘recovery’ and ‘closure’. Incapable of capturing the complexity, diversity and idiosyncratic quality of the grieving experience. Do not address the multiplicity of physical, psychological, social and spiritual needs experienced by bereaved people, their families and intimate networks.
Why are stage theories (like Kubler-Ross stages of grief) appealing? What are their downfalls?
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Five distinct trajectories: 1) common grief or recovery (11%) 2) stable low distress or resilience (46%) 3) depression followed by improvement (10%) - most prevalent in those who experienced relief following a period of considerable caregiver burden or who suffered oppressive relationships 4) chronic grief (16%) 5) chronic depression (8%)
Bonanno (2002): What are the 5 distinct trajectories that covered the outcome patterns of most participants
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- Those experiencing highest levels of distress tended to exhibit high levels of personal dependency prior to the death of their spouse. - For those not depressed before the loss, dependency was an important predictor of grief reactions. - A lack of expectation or psychological preparation for the loss = increased distress. - The distinction between chronic grief and chronic depression, is of critical importance. - Relationship conflict was predictive of chronic depression but not chronic grief. - Chronic grievers reported greater processing of the loss and searching for meaning compared to chronically depressed
What were some other findings from Bonanno's (2002) study on grief?
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1) Dual-Process Model (cognitive perspective) 2) Task-Based Model
What are the two more comprehensive and influential grief models used today?
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1) Loss orientation (emotion-focused) - the griever engages in emotion-focussed coping, exploring and expressing the range of emotional responses associated with the loss 2) Restoration orientation (problem-focused) - griever engages with problem-focussed coping and is required to focus on the many external adjustments required by the loss, including diversion from it and attention to ongoing life demands The model suggests that the focus of coping may differ from one moment to another, from one individual to another, and from one cultural group to another
What are the 2 different orientations of the Dual-Process Model?
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1) Accept the reality of the loss 2) Process the pain of grief 3) Adjust to a world without the deceased 4) Find an enduring connection with the deceased in the midst of embarking on a new life
What are the 4 tasks of the Task-Based Model (Worden, 2008)?
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(1) who the person who died was (2) the nature of the attachment to the deceased; (3) how the person died; (4) historical antecedents; (5) personality variables; (6) social mediators; (7) concurrent stressors.
Within the task-based model of grieving, Worden (2008) also identifies seven determining factors that are critical to appreciate in order to understand the client’s experience, what are they?
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Over half, although true incidence is thought to be much higher, given a great reluctance among the bereaved to disclose its occurrence to clinicians for fear of ridicule or being thought of as ‘mad or stupid’.
What % of the bereaved population experience the sense of presence of the deceased?
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Whether the given expression reflects an attempt to maintain a more concrete tie that entails failure to relinquish the goal to regain physical proximity to the deceased. This can be compared to a more internalised, symbolically-based connection, which suggests a greater acceptance of the death.
What is the difference btw adaptive and maladaptive continuing bonds?
214
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A failure to find spiritual or secular meaning in the loss
What is one of the major contributors to complicated grief?
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1. making sense of the loss 2. finding benefits from the loss
How can one find meaning in loss?
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10-15%
Roughly how many people experience intense or chronic grief?
217
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After around 6 months
At what point does grief intensity reduce for most people?
218
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Symptoms must last for at least 6 months and cause significant impairment in social, occupational and other important areas of functioning
Under what conditions is prolonged grief disorder diagnosed (not included in the DSM)?
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Sleep disruption, Substance abuse, depression, Compromised immune function, Hypertension, Cardiac problems, Cancer, Suicide, and Work and social impairment. These effects have been observed for as long as four to nine years after the death
What are some symptoms of PGD?
220
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Although reduce depressive symptoms, not generally helpful
Are anti-depressants helpful for bereavement complication?
221
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Disenfranchised grief acquires an internal character
What happens when social grieving rules are internalised by the mourner?
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1) The relationship the mourner has with the deceased person (non-family, ex-partner, same-sex) 2) The type of loss itself (pets, celebs, people we haven't met, anticipatory grief, suicide, HIV/AIDS) 3) The characteristics of the mourner (young, old, intellectually disabled)
Disenfranchised grief occurs due to lack of social recognition of one of what 3 elements?
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- Resilience (45-60% of grievers) - typically resolve by 6 months - short-lived disruptions to overall funtioning Recovery (15-25% of grievers) - moderate disruption to daily functioning - strong feelings of yearning and disruptions to everyday functioning which resolve approximately a year after the loss Complicated or Prolonged Grief (10-15%) - considerable, persistent and pervasive grief-related distress, such as strong, painful feelings of emptiness, avoidance, yearning and substantial disruptions to functioning
What are 3 common grief trajectories?
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Acceptance Emotional support Venting emotions Mental disengagement
What were commonly cited coping strategies for people dealing with disappearance?
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Resilient participants reported significantly: - Lower attachment anxiety and attachment avoidance; - Lower destructive detachment; - Greater emotional stability and healthy dependency; - Great ability to derive comfort from memories of their deceased spouse, yet a lower sense of a continuing bond; and, - Less loneliness and greater ability to disclose to others. Often younger, with more positive worldview No significant differences were found between participants classified as resilient and those classified as in recovery
How do resilient mourners differ from prolonged mourners?
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Recovered participants reported significantly higher ability to feel comfort from memories and greater ability to disclose than prolonged grievers Recovered participants did not differ from prolonged grievers on emotional stability, attachment and continuing bonds.
What differences have been found between prolonged grievers and those in recovery?
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Greater severity: - females, - those who lost a child, - lower education and - higher depressive symptoms Longitudinally, at a 6-year follow up, baseline grief severity was the only significant predictor of grief persistence.
What have been found to be predictors of grief severity and persistence?
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1. Develop and implement strategies that promote successful ageing by changing modifiable factors linked to illness, optimising capabilities, increasing social interactions and enhancing engagement in life 2. Explore psychological constructs linked with ageing well
What are the 2 broad goals of the positive ageing perspective?
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- Absence of disease/disability - High cognitive and physical functioning - Engagement with life
What are the 3 components of Rowe and Kahn's definition of successful ageing?
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12% - although most people meet at least one individual criteria
Roughly what percentage of older people fit Rowe and Kahn's definition of successful ageing?
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- Lack of disability/good physical function - 2nd is cognitive functioning
What do researchers believe is the most important aspect of positive ageing?
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Most people rated themselves betwen 7-10 out of 10 Therefore discrepancy btw what older ppl think abouth themselves and what researchers think
What % of people rate themselves as successfully ageing?
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Adaptability or resilience - maintaining a positive attitude despite having problems. More important than freedom from impairments Engagement
What is one thing qualitative studies have found older people associate with positive ageing, that quantitative studies have missed?
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Cognitive Reserve
An active model in which brain plasticity maintain neural processes, thought to be enhanced through engagement with cognitively meaningful and stimulating activities
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Mastery
Global sense of control over life and the future. Linked with reduced anxiety, better problem solving, and is protective against the impact of hardship
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Self-efficacy
Linked with higher quality of life, less loneliness, less distress, better cognitive function
237
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Wisdom
Three domains - cognitive, affective and reflective
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Cognitive Wisdom
Reflected in expert knowledge, reasoning and problem solving skills, and sound decision making
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Affective Wisdom
Encompasses positive emotions, ability to regulate emotions and the experience of fewer negative emotions
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Reflective wisdom
The ability to accept the views of others and overcome subjective perspectives
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Resilience
The ability to maintain subjective wellbeing despite experiencing challenges
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Spirituality
Demonstrated links between religious involvement, adaptation to illness, greater resilience and improved health behaviours. Also, self-reflection and searching for existential meaning
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Meaningful / purposeful engagement
Engaging on activities to maintain social roles, align with personal values, and are meaningful to the individual
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Fear
Stirling (2016): what is the most common response to the concept of ageing in Western cultures?
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Beneficial clarity of values and enjoyable landscape of experiences and competencies
Sitrling (2016): what did researchers actually find about peoples living experiences of ageing?
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1. Better at predicting emotional arousal in situations and can therefore select situations better 2. Attention is more selective to positive info 3. Emotional arousal following choice making is moderated by cognitive control -\> decrease in negative emotions
How does emotional regulation contribute to increased well-being in older age?
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1. Generative activities - passing on ones knowledge 2. Present oriented goals ie alleviating aversive symptoms 3. Reducing network size 4. Focusing on stimuli with emotional valence ie music In summary, regulation of emotion becomes stronger in older age
What emotionally meaningful goals and activites are prioritised in older age?
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- Cosmic - experience of time is re-defined, life seen as a chain of events rather than isolated point in time - Dimension of Self - decreases in self-centredness - Social - superficial socialising reduced favour meaningful relationships High levels of gerotranscendence is reached naturally in about 20% of people
What are the 3 dimensions of gerotranscendence?
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Expectation that later life will involve a continuation of same values as mid-adult life as well as mistaking new joy in contemplation as 'depression' or 'slowing down'
What is the greatest barrier preventing transcendence in later life?
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1. Social Roles 2. Members of a community able to draw strength and resilience from those close to death / impaired 3. Disability and adversity are part of natural range of experience in life
What 3 factors are likely to promote well-being and capacity for coping in later life?
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Low chronic illness / high psych well-being = flourishing Low chronic illness / low psych well-being = languishing High chronic illness / low psych well-being = floundering High chronic illness / high psych well-being = adapting
Briefly describe Keys Model of Psych Well-Being
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Resilience Optimism Positive expectancy Self-efficacy
Stirling (2016): what are other aspects of healthy ageing
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- Adopting community development approach; - Adapted to fit a specific local area; and, - Focused on productive engagement (e.g., creating opportunities for socialisation and forming new social networks).
What has been identified as the most effective interventions for social isolation?
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- Involve acts of violence; - Intended to create/instill fear in people; - Driven by political/social motives; and, - Targeted towards those not involved combat (this includes civilians and unarmed/off-duty military personnel).
What are the four common features of terrorism that have been identified?
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No - definitions focus on terrorist acts, not on groups or individuals
Is labelling an individual or group as a terrorist consistent with how terrorism is conceptualised?
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Mass terror: acts of terrorism committed by political leaders targeted at the general population (e.g., Stalin) Random terror: committed by individuals or groups, targeted at civilians (e.g., 9/11; 2015 Paris shootings) Focused random terror: committed by individuals and groups, but targets at members of the opposition. Focused random terror uses many of the same methods as random terror (e.g., bombs), but does so in areas with large numbers of the opposition (e.g., Israeli-Palestine conflicts). Dynastic terror: assassinations carried out by individuals/groups targeting a ruling elite or state leader (e.g., the assassination of Benazir Bhutto). Lone wolf terror: individuals acting alone, targeting governments or civilians (e.g., 2017 Las Vegas shootings; 2014 Lindt Café siege)
What are 5 different types of terrorism?
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Overreliance on secondary sources that provide information indirectly (i.e., newspaper articles) - subject to bias, under-reporting, and/or issues with accuracy.
What is Instead the most critical problem in research on terrorism?
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Primary sources (terrorists) difficult to bring into study
Why does research rely on secondary sources?
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Humans experience conflict btw desire to live and mortality salience: awareness that death cannot be avoided and can happen at any time. This conflict results in a constant state of existential terror, which humans attempt to alleviate by espousing cultural or other symbolic beliefs to provide meaning and value to life (and its certain death) These beliefs can be easily threatened by reminders of the inevitability of death, resulting in an even stronger, but less effective, defence of the espoused views To avoid becoming paralyzed by this terror, people immerse themselves in cultural systems and worldviews that offer them literal immortality (e.g., the promise of an afterlife after one’s death) or symbolic immortality (e.g., being remembered by others after one’s death). Faith in one’s cultural worldview thus functions as a buffer against death-related anxiety.
Explain Terror Management Theory (TMT)
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Evoking death-related thoughts (mortality salience; MS) in individuals or groups can lead to stronger worldview defence and greater support for extremist violence May be doing so to reduce their existential terror/anxiety and give meaning to their lives
How does TMT apply to terrorism?
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A sample of Iranian participants reported stronger support for suicide bombings targeting Americans when in a mortality salience condition (i.e., reminded of death) than in a control condition
Give an example of TMT relating to terrorism
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No significant effect on support for extremist violence for Australian university students. Therefore, little support for the hypothesis that MS results in increased support for violent extremism. Participants exposed to the MS manipulation reported increases in conservative religiosity (belief in divine power) but not extremist violence Study 3: increased support for policies that act to fight against violent extremism in Melbourne Jewish community More study needed to address inconsistencies in evidence surrounding TMT and the MS hypothesis, at least in regards to violence and extremism.
What did Vergani et al. (2019) find re: TMT across 3 studies?
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1) The murder of Van Gogh and news reports of terrorism overseas increased death-related thoughts, which in turn predicted prejudice towards Arabs, but only after Van Gogh's death. 2) News on a terrorist threat close-by increased death-related thoughts, which in turn predicted implicit prejudice towards Arabs, but only in those with low self-esteem 3) The effect of terrorism news on prejudice against Arabs was replicated for non-Muslims. Also, it increased prejudice against Europeans for Muslim participants "Terrorism news triggers an unconsciously activated fear of death, which then becomes the basis for judging outgroups"
What were the 3 main findings of Das et al. (2009) study on TMT and news?
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Phase 1 - Immediate Aftermath
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "strong emotional reactions such as disbelief, numbness, fear and confusion."
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Phase 2 - 1 week – several months
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "active efforts to adapt to new environment, intrusive and hyperarousal symptoms present, somatic symptoms - headaches, dizziness, nausea, anger irritability and social withdrawal"
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Phase 3 - several months
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "Disappointment and resentment as it becomes evident that aid and restoration is unlikely to lead to complete return to pre-attack status."
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Phase 4 - months to years
In the 4 phase model of response to terrorism (Benedek, 2005), which phase of the terrorism response model is: "Reconstruction phase typified by physical and emotional rebuilding, resumption of old roles, re-establishing social connections"
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Anxiety Depression Substance Use PTSD
What are the most common psychological disturbances arising from terrorism?
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- Anxiety relating to being physically harmed; - Political fear, which relates to anxiety about the social consequences that communal fear generates by targeting and demonising one element within society; - Fear of losing civil liberties; and, - A sense of insecurity brought about by a feeling of reduced safety
What are four main themes of generated terrorism-related anxiety?
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Talking about it
What helps adolescents with regard to anxiety around terrorism?
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female gender, low social support, experience of other stressors, co-morbidity with another psychological disorder (e.g., PTSD, panic)
The risk of developing depression in response to terrorism is increased by the which risk factors?
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- direct victims of the event (i.e., present during the attack or who lost a family member or close friend) - prevalence rates increasing to 30-40% - previous life stress or trauma, - being female, - younger age, - low SES, - ethnic minority status - history of psychiatric illness
In what situations is PTSD risk heightened?
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1. Normalisation of heightened fear and anxiety within the first few days of the terrorist event. No need for formal intervention - most symptoms resolve on their own. 2. Screening for high-risk individuals, accompanied by ongoing normalisation and information provision. Involves consideration of variables that increase risk of PTSD, ASD, anxiety, depression and problematic substance use. 3. Referral of symptomatic individuals who meet clinical indicators of disorder to professional services.
Rudenstein and Calea (2015) recommend a three-phase approach to intervention in response to terrorism, what does it involve?
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Conservation of Resources Theory Developed as a theory to explain stress reactions
What is one of the leading theories of stress and trauma?
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Psychological stress reults from real or perceived loss of resources (material resources such as housing, transport, and/or psychosocial resources such as social support).
What does the Conservation of Resources theory state?
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1. When there has been an actual loss of resources, 2. Threat of lost resources, 3. A lack of gained resources where it was expected.
What 3 situations does stress transpire according to the Conservation of Resources?
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Yes - COR purports that people are resilient to resource loss to the extent that they can acquire and maintain resources that will buffer the stress resulting from the loss. In the case of terrorism, terrorism both results in resource loss (e.g., death of family/friends, loss of housing/employment) and depletes the resources needed to cope with the loss (e.g., sense of safety).
Does the COR theory believe that people are resilient?
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Catastrophising: expecting the worst to happen and expecting the consequence to be disastrous if it does occur (e.g., “If I fail this assignment, I’ll never finish my degree, never get into postgraduate studies and my life will be a failure”). Helplessness: a sense of being powerless that results after repeated failure or exposure to a traumatic event. Rumination: rumination is the process of repeatedly thinking about a problem or event. Although not a cognitive distortion in and of itself, greater rumination of distorted thoughts enhances them.
What are some cognitive distortions that have been implicated in the development and maintenance of psychological issues arising from terrorism?
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90-95% 4
What percentage of refugees have experienced at least 1 traumatic event? What is the average number of traumatic events experienced by refugees?
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29.5% 31%
In Australia, what % of West Papuan and Iraqi refugees meet the clinical cut off score for PTSD on the Harvard Trauma Questionnaire?
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3% ie more than 200 million people
What % of the world’s population are thought to be international migrants?
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- Very severe trauma - Shattered assumptions about the trustworthiness of the world - Loss of self-sameness/identity - Feel deeply isolated, can't share experiences with anybody - Physical disabilities and complaints - Insecure residency permit status - Cultural and social uprooting - Survivor's/perpetrator's guilt - Moral injury
What are some of the clinical challenges when working with severely traumatised refugees, as described by Maier (2015)?
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Moral injury
What is the name given to transgressions that lead to serious inner conflict because the experience is at odds with core ethical and moral beliefs?
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Different cultural views
What is one barrier for refugees seeking help?
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Mismatch between Western conceptualisations of the disorder and how it is presented and expressed in different cultures eg. Cambodian refugees may describe symptoms of night terrors and sleep paralysis, neither of which align with our diagnostic criteria, however, in Cambodian culture these symptoms are related to beliefs that PTSD reflects night hauntings by the spirits of people who have been killed in the homeland who torment survivors
What is one of the challenges of engaging with refugees, especially in PTSD?
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1. Extend the psycho-educational element of therapy 2. Explore their symptoms in their own words - makes them the expert of their experience + openness to accept their culture and views 3. Explore the impact of their trauma on their role functioning 4. Involve them in therapeutic goal-setting - likely to differ from what you think they're goals will be 5. Obtain supervision
What are 5 things you should focus on when providing CBT to traumatised refugees?
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Curiosity, trust and bravery
Julie Kuck: what does immigration and it's healing require of psychologists?
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Puppies and babies
Julie Kuck: what are examples of universal themes?
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1. Heart - compassion - how to create in unique and indiv ways 2. Gut - survival - how to construct and craft 3. Mind - knowing - how to do the work (requires instruction, teaching, inventing and perception)
Julie Kuck: what are the 3 brains that Julie refers to?
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Umbrella term encompassing theory and research in relation to what makes life worth living Learn how to flourish in life -\> well-being based on strengths of individuals Mindset skills
What is positive education
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- Promotes individual growth - Teaches students how to make themselves contented - Reduces depression - Happy students make high achievers - Makes teachers' lives easier - Increases student motivation
What are some of the benefits of positive education?
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Intended to increase students' ability to handle day-to-day stressors and common issues. Achieved by teaching students how to think realistically and flexibly about problems they encounter, as well as assertiveness, creative brainstorming, relaxation, decision-making. - Reduces helplessness - Reduces depression - Reduces anxiety - Reduces behavioural problems
What is the Penn Resiliency Program (PRP)? What are some of the benefits?
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1. three good things then write reflection answering three questions: "Why did this good thing happen?"; "What does this mean to me?"; "How can I increase the likelihood that further good things like this will happen?" 2. Using signature strengths in a new way. Students completed the VIA Signature Strengths test for children (www.authentichappiness.org) and learn to identify these in themselves and others.
What are 2 exercises used in the Strath Haven Positive Psych Curriculum?
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70s - self-esteem 90s - social skills programs 2000s - resilience programs Since then -\> anti-bullying initiatives, values programs and student wellbeing initiatives, including social and emotional learning programs
Where has positive education arisen from in the 70s, 90s, and 2000s?
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The coaching can enhance the training of the positive psychology intervention
What is the point of using positive psychology interventions and coaching psychology in schools?
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- Positive psychology and coaching psychology have much to offer schools. However, to increase sustainability, the successful integration and strategic application of both approaches is required - Customise programs for schools - Need for further research - Need for expert external consultants and educators to work collaboratively with schools to create and evaluate individualised programs
What conclusion can be drawn from the APS article on positive education?
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Positive emotions Engagement Relationships Meaning Accomplishment - Important areas that people pursue for their own sake, - Can be defined and measured independently of one another. - Five PERMA domains fall on the positive side of the mental health spectrum. That is, well-being is not simply the lack of negative psychological states, but is the presence of positive psychological states.
What are the five pillars that Seligman believed contribute to overall wellbeing? (PERMA)
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Methodologically suspect, Conceptually unclear, Faddish
What are some criticisms of positive psychology / education?
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1950s - 1070s - humanistic psychology - emphasis on positive self-fulfillment and self-education Positive psychologists fault humanistic psychology for its lack of scientific rigor, for ignoring wellness-enhancing social (as distinct from personal) variables, and for confusing description with prescription 1980s and 1990s - adaptability psychologies - coping, self-esteem, self-efficacy, self-determination theory, multiple intelligences, and emotional intelligence. Positive psychologists fault the adaptability psychologies for refusing to take seriously the moral factors that make life worth living for most people. eg. moral intelligence is missing from the list of multiple intelligences.
Kristjansson (2012): How has positive psych evolved over the years?
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Modifying postitive psychs happiness theory -\> purely objective account. Such a modification could eliminate some of the troublesome ambiguities at the heart of the theory and make it more amenable to practical application. Methods such as cognitive behavioral therapy and mindful meditation that had a long history before the advent of positive psychology tend to do best in effectiveness tests. The only educational intervention that is undeniably unique to the positive education program—the promotion of positive affect in the classroom via the broaden-and-build thesis—may lose some of its appeal if it turns out that fundamental statements in the thesis are of a conceptual rather than an empirical nature.
What are some conclusions of Kristjansson (2012) article on positive education?
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- They haven't had access to whole schools - Practically, it's easier to enforce change on an individual level, rather than large-scale political transformation
What are 2 reasons why positive psychologists haven't been able to address the 'positive institutions' pillar of happiness?
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In the last 50 years, Western society has grown more sensitive to harm and expanded their definition of what harm is
Why does Prof Haslam think concept creep has occurred?
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Horizontal expansion - qualitatively new phenomena Vertical expansion - quantitatively less extreme phenomena
In terms of concept creep, what does horizontal and vertical expansion mean?
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The adaptability and malleability of humankind - ie. humans respond to social reality and influence this reality. As such, this shift can have implications on how individuals perceive and characterise themselves
What is a potential reason for this shift in conceptualisation re: concept creep?
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- Abuse now includes emotional and psychological - Things that don't involve physical contact - Neglect - What constitutes emotional abuse is often diffuse and ambiguous - In terms of neglect, "What was not done, but should have been" is much less concrete than "What was done, but should not have been"
How has abuse shifted horizontally/qualitatively? How has abuse shifted vertically/quantitatively?
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- Cyberbullying - Workplace bullying - Ignoring or excluding behaviours - Less extreme bullying - Less repetitive bullying eg: posting one picture online - New questionnaire wording: "these things may happen repeatedly" - Element of power often doesn't exist with cyberbullying, perp is often anonymous - Perceived bullying is now a thing, intentionality is often missing
How has bullying shifted horizontally/qualitatively? How has bullying shifted vertically/quantitatively?
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- People need to deny the existence of racism, and oppose affirmative action policies to prove they're not racist - Symbolic racism - Aversive prejudice eg: having an unconscious antipathy for outgroup members based on fear, unease or discomfort - Microaggressions eg: faltering speech, trembling speech when discussing racial issues
How has prejudice shifted horizontally/qualitatively? How has prejudice shifted vertically/quantitatively?
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- Trauma to psychological state, not the body - Childbirth, sexual harassment, infidelity, emotional loss, grief
How has trauma shifted horizontally? How has trauma shifted vertically?
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- Bad habits, personal weaknesses, medical problems, and character flaws now considered mental disorders - Less versions of severe conditions eg: Aspergers - Normal worry, fear and sadness are creeping into mental disorders
How have mental disorders shifted horizontally? How have mental disorders shifted vertically?
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- Behavioural and process addictions - Bad habits and repetitive pleasurable activities considered addictions
How has addiction shifted horizontally? How has addiction shifted vertically?
