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Presentation on theme: "NORMALITY, MENTAL HEALTH AND MENTAL ILLNESS"— Presentation transcript:


2 Normality Generally psychologists agree that normality refers to patterns of behaviour or personality traits that are typical. Sometimes it is very easy to distinguish what is normal and what is abnormal. At other times it is harder to make this decision.

3 Look at the following behaviours and decide which are normal and which are abnormal.
Being scared of hairy spiders Enjoying sky diving Wearing black makeup and clothing Changing your plans because of a horoscope prediction Walking arm in arm down the street with a friend of the same sex Having a belly button that sticks out Being in love with someone you have never met Achieving an extremely high score on an IQ intelligence test Preferring to live alone, isolated from others Being able to provide help to someone in need of it, but choosing not to.

4 Normality and abnormality
There are six different approaches that have been proposed for describing normality and abnormality: Socio-cultural approach Functional approach Historical approach Situational approach Medical approach Statistical approach

5 Socio-cultural approach
Thoughts feelings and behaviour that are appropriate or acceptable in a particular society or culture are viewed as normal and those that are inappropriate or unacceptable are considered abnormal. The socio-cultural approach considers whether behaviour is typical according to the cultural values and beliefs of a particular society- whether the behaviour fits in with the norms of that society. Eg. In some cultures crying and wailing at the funeral of a stranger is expected and considered normal, whereas in other cultures that is considered abnormal.

6 Functional approach Thoughts, feelings and behaviour are viewed as normal if the individual is able to cope with living independently in society, but considered abnormal if the individual is unable to function effectively in society. The functional approach defines normality by the level of one’s ability to interact and involve oneself in society. Eg. Being able to feed and clothe yourself, find a job, make friends and so on is normal, but being so unhappy and lethargic that you cannot get out of bed, cannot eat properly and cannot find a job is abnormal.

7 Historical approach What is considered normal and abnormal in a particular society or culture depends on the era, or period of time, when the judgment is made. The historical approach to defining normality depends on the period of time, century or era in which the judgment is made. Eg. Prior to the 20th century, if a parent severely smacked their child for misbehaving, few people would have considered this to be abnormal, but in western societies and cultures today, such behaviour would be considered abnormal and perhaps even illegal.

8 Situational approach Within a society or culture, thoughts, feelings and behaviour that may be considered normal in one situation may be considered abnormal in another. The situational approach refers to the social situation, behavioural setting or general circumstances in which the behaviour occurs. Eg. If you were to come to school wearing pyjamas most of your friends would think that was abnormal, however it is considered normal to wear pyjamas to bed.

9 Medical approach Abnormal thoughts, feelings or behaviour are viewed as having an underlying biological cause and can usually be diagnosed and treated. According to the medical approach an individual is considered normal if they are physically healthy while abnormality is determined by having an illness that has an underlying physical cause. Eg. Someone who is colour-blind would not be considered as normal. Neither would someone with a common cold.

10 Statistical approach The statistical approach is based on the idea that any behaviour or characteristic in a large group of individuals is distributed in a particular way; that is, in a normal distribution. The statistical approach defines normality based on the experiences and behaviours of the statistical majority. Generally if a large majority of people, called the ‘statistical average’, think, feel or act in a certain way, it is considered normal. Eg. It is normal to laugh when tickled because most people do but to laugh when someone dies would be abnormal because not many people would do this.

11 Approaches to defining normality and abnormality
Psychologists acknowledge that none of these approaches is entirely satisfactory on its own. However, each approach has contributed to the understanding of normality or abnormality. Normality is often defined as a pattern of thoughts, feelings or behaviour that conform to a usual, typical or expected standard. These standards, however, may depend upon many different factors. In one form or another, each of the six approaches has influenced the way normal and abnormal thoughts, feelings and behaviour are viewed and studied.

12 Approaches to defining normality and abnormality
Identifying the meaning of abnormality in relation to mental processes and behaviour is of greater concern to psychologists because of the implications when diagnosing and treating mental health problems. Abnormality may be defined as a pattern of thoughts, feelings or behaviour that are deviant, distressing and dysfunctional.

13 Deviant, distressing and dysfunctional.
Thoughts feelings and behaviour are considered: Deviant when they differ or vary so markedly from social or cultural norms ‘governing’ behaviour that they can reasonably (or legally) be considered inappropriate or unacceptable Distressing when they are unpleasant and upsetting to the person experiencing them and/or others around them Dysfunctional if they are interfere with the person’s ability to carry out their usual daily activities in an effective way.

14 Health and illness According to the world health organisation (WHO) health is a state of complete physical, mental and social wellbeing and not merely the absence of illness or disease. Physical, mental and social wellbeing are all equally important to the overall health of any individual. Illness refers to a person’s subjective experience of feeling unwell in relation to one or more aspects of their health including the way they think about their physical, mental and social health.

15 Health and illness Physical wellbeing primarily involves the body and such activities as exercising regularly, eating well, being well rested, and maintaining a body weight that is biologically appropriate for the individual. Mental wellbeing primarily involves the mind and such activities as expressing feelings calmly even when angry or sad and rational thinking. Social wellbeing primarily involves personal relationships and interactions with others and such activities as getting along with family, friends and acquaintances, giving and receiving social support when needed and making and keeping friends.

16 Differentiating physical health from physical illness
Physical health refers to the body’s ability to function efficiently and effectively in work and leisure activities, to be in good condition, to resist disease and to cope in threatening or emergency situations. (Temperature, heart rate, blood pressure, cholesterol, breathing etc) Physical illness refers to our subjective experience of a disease or physical health problem that interferes with the normal functioning of our body and adversely impacts on our ability to function effectively in everyday life.

17 Differentiating mental health from mental illness
Mental health and mental illness primarily involve the mind whereas physical health and physical illness primarily involve the body. Mental health is the capacity of an individual to interact with others and the environment in ways that promote subjective wellbeing, optimal development throughout the lifespan and effective use of a person’s cognitive, emotional and social abilities. Characteristics of good mental health include being able to establish and maintain positive social relationships and to cope effectively with problems and issues that arise in everyday life.

18 Differentiating mental health from mental illness
Mental health is not something that we either have or do not have. Therefore, mental health is often represented as being on a continuum, ranging from: mentally healthy, when we are functioning well and coping with the normal stressors of life through to a mental heath problem through to a mental illness that may be serious or prolonged.

19 Mental illness describes a psychological dysfunction that usually involves impairment in the ability to cope with everyday life, distress, and thoughts, feelings and/or behaviour that are atypical of the person and may also be inappropriate within their culture. Dysfunction means that the person does not think, feel and/or behave as they normally do and it affects their ability to cope effectively with everyday life experiences. When a person experiences distress they are very upset, anxious and/or unhappy. Impairment in the ability to cope with everyday life is another characteristic of mental illness. If a person is unable to do the things they normally do on a daily basis because of their mental state, they are considered to have impaired functioning. Atypical means that the person responds in a way(s) that is not normal, or ‘typical’ for them.

20 The biopsychosocial framework
The biopsychosocial framework is an approach to describing and explaining how biological, psychological and social factors combine and interact to influence a person’s physical and mental health. This framework is based on specific factors from each domain which combine and interact to influence our wellbeing.

21 The biopsychosocial framework
Biological factors- involve physiologically based or determined influences, often not under our control, such as the genes we inherit and our neurochemistry. Psychological factors involve all those influences associated with mental processes such as how we think; learn; make decisions; solve problems; perceive our internal and external environments; manage emotions and deal with stress. Social factors are described broadly to include such factors as our skills in interacting with others, the range and quality of our interpersonal relationships, the amount and type of support available when needed as well as socio-cultural factors.

22 The biopsychosocial framework
This framework represents a holistic view of health meaning that it looks not only at the internal aspects of the individual but also the external circumstances. It views each of the three domains as equally important for both physical and mental health. Eg. A personality disorder might best be explained by the combined influence of an individual’s inheritance of certain genes and impaired functioning of part of the brain that controls impulsive behaviour (biological) poor self image and an intense fear of abandonment (psychological) and their strict upbringing and lack of skills required to develop and maintain social relationships (social).

23 Pic pg 555 Biopsychosocial model

24 Classifying mental disorders
Clinical psychologists, psychiatrists and other mental health professionals classify mental health problems and disorders in different categories according to characteristic patterns of thoughts, feelings and behaviour. Classification is the organisation of items into groups on the basis of their common properties. Often the groups into which items are organised through classification are referred to as categories or classes. Classification makes it easier to identify and understand relationships between different groups.

25 Categorical approaches to classifying mental disorders
To help provide guidelines and a standard for classification of mental illnesses, categorical approaches of defining mental disorders have been developed. Categorical approaches involve grouping psychological problems into broad categories, or groups, with common symptoms. This is a yes-no approach to classification. Categorical approaches classify a person’s symptoms in terms of which specific category of mental disorder they best fit or ‘belong’ to. The focus is on diagnosing whether the person has or does not have a disorder.

26 Categorical approaches
A system of classifying mental conditions and disorders that uses a categorical approach organises and describes mental conditions and disorders in terms of different categories and subcategories, each with symptoms and characteristics that are typical of specific mental conditions and disorders. A key principle of the categorical approach is that a mental disorder can be diagnosed from specific symptoms reported and/or presented by a client during a mental health assessment. These symptoms fit into a specific category which then represent the disorder that the person is suffering from.

27 Categorical approaches
This means that there are clear boundaries around each disorder and that disorders do not overlap. Eg. The pattern of thoughts, feelings and behaviour classified as OCD is clearly different from the pattern for antisocial personality disorder. Another principle of the categorical approach is the ‘all or nothing’ principle which means that an individual either has a diagnosable mental disorder or does not have a disorder. Categorical approaches therefore view mental illness in the same way as something like pregnancy; you are either pregnant or you are not pregnant.

28 Categorical approaches
Another underlying principle of this approach is that the system needs to be both valid and reliable. Validity means that the classification system actually organises mental disorders into discrete and distinct disorders which enables accurate diagnosis of the disorder. Reliability means that the classification system produces the same diagnosis each time it is used in the same situation. Inter-rater reliability indicates the degree to which different mental health professionals diagnose the same client with the same mental disorder.

29 Categorical approaches to classifying mental disorders
Two examples of categorical approaches to classifying mental disorders are those provided by the Diagnostic and Statistical Manual of Mental Disorders, Edition IV, Text revision (DSM-1V-TR) and the International Classification of Diseases, Edition 10 (ICD-10)

30 DSM-IV-TR The DSM-IV-TR is a categorical system for diagnosing and classifying mental disorders based on symptoms that are precisely described for each disorder. Since it was first published in 1952 it has been revised 5 times. There are 365 mental disorders described in the DSM-IV-TR. They are grouped in 16 major categories and there is one additional section, ‘Other conditions that may be a focus of clinical attention’. It lists known causes of these disorders; provides statistics in terms of gender, age of onset and prognosis; and also provides information about some research concerning optimal treatment approaches.


32 DSM-IV-TR Each disorder has a diagnostic criteria- this indicates the symptoms that are characteristic of the disorder and therefore enable assessment of the presence of the disorder. Inclusion criteria- are used to identify the symptoms that must be present in order for the disorder to be diagnosed. Exclusion criteria- identify the symptoms, conditions or circumstances that must not be present in order for the disorder to be diagnosed.

33 DSM-IV-TR- separation anxiety
Inclusion- the presence of at least 3 of the 8 symptoms, the symptoms must have been present for the last four weeks, the symptoms develop before the age of 18 years, and the symptoms cause distress or impairment. Exclusion- separation anxiety is not diagnosed if the symptoms can be explained by the presence of another mental disorder.

34 DSM-IV-TR The DSM-IV-TR also includes information on:
The typical course of each disorder The age at which the person is most likely to develop the disorder The degree of impairment How common the disorder is Whether it is likely to affect others in the family The relationship of the disorder to gender, age and culture

35 DSM-IV-TR- nightmare disorder
The DSM-IV-TR also includes information on: The typical course of each disorder (the child usually grows out of it) The age at which the person is most likely to develop the disorder (3-6 years old) The degree of impairment (sleepless nights and sleep deprivation) How common the disorder is (11-50% of children experience this disorder) Whether it is likely to affect others in the family (will affect parents) The relationship of the disorder to gender, age and culture (females report nightmares more often than men)

36 DSM-IV-TR When making a diagnosis using the DSM-IV-TR, information in relation to five different axes must be considered in order to completely evaluate an individual’s mental condition. This is why diagnosis in this system is called a multiaxial system. Together the five axes are intended to provide comprehensive and useful information when planning treatment.


38 DSM-IV-TR- axis I Axis I describes all the mental disorders in the DSM (except for those in axis II). This axis is used to identify the persons current mental condition and relevant disorders the person may be suffering from.

39 DSM-IV-TR- axis II Axis II describes only two categories of mental disorders: personality disorders and mental retardation. A personality disorder involves a pattern of inflexible and maladaptive ways of thinking, feeling and behaving that are often socially unacceptable and have been evident over a long period of time. A person with an intellectual disability has a significantly below average level of intellectual functioning and usually has difficulty in coping independently with everyday life activities.

40 DSM-IV-TR- axis III Axis III provides information about medical conditions that may be related to each of the mental disorders in axis I or II. These conditions may give information that is potentially relevant to understanding and planning treatment for the individual.

41 DSM-IV-TR- axis IV Axis IV provides information about potential stressors in an individual’s life that may be relevant to their disorder, and is used to identify current and recent stressors impacting on their thoughts, feelings and behaviour and which need to be considered when devising a treatment program. Eg. If a person had lost their job this may be a consideration in diagnosis and treatment.

42 DSM-IV-TR- axis V Axis V is used to assess an individual’s overall level of psychological, social and occupational functioning. This is achieved using the descriptions in the Global Assessment of Functioning (GAF) scale provided in the DSM. This information is obtained during a ‘clinical interview’ and provides an overall numerical rating on a 100-point scale on which ‘1’ indicates severe impairment and ‘100’ refers to superior functioning.

43 Global Assessment of Functioning
Table 11.4

44 ICD-10 The International Classification of Diseases and Related Health Problems (ICD) is a categorical system for diagnosing and classifying diseases and mental disorders based on recognizable symptoms that are precisely described for each disease and disorder. The ICD-10 consists of 21 chapters covering the whole of medical practice; that is, all physical and mental conditions and disorders.

45 ICD-10 Like the DSM-IV-TR, diagnosis of a mental disorder consists of identifying the disorder(s) that best matches or reflects the symptoms presented by an individual. Diagnostic guidelines are also provided for each disorder. Diagnostic guidelines identify the symptoms that are characteristic of the disorder and therefore indicate the presence of the disorder.

46 DSM-IV-TR & ICD-10 Although the ICD is used in the same way as the DSM and helps a mental health professional decide whether or not a person can be diagnosed with a mental disorder, the ICD is a less detailed categorical system that the DSM. The ICD provides a detailed description and diagnostic guidelines for each disorder, but it typically does not provide information about the course, prognosis and prevalence of each disorder as the DSM does.

47 Strengths of categorical approaches
Both diagnostic tools are based on ongoing scientific research and regularly revised on the basis of the research findings. They are comprehensive in terms of the number of disorders included and the detail provided for these disorders. Useful in educating mental health professionals and the community about mental disorders. Assists mental health professionals in the diagnosis of disorders and devising a treatment plan. User-friendly and provides a common language.

48 Limitations of categorical approaches
Low inter-rater reliability as different professionals often reach different conclusions about the diagnosis. 70% agree on the diagnosis while 30% disagree. At times the overlap in symptoms can lead to ‘fuzzy’ categories and uncertainty about the disorder and diagnosis leading to misdiagnosis. Valuable clinical information can be lost. That is, whenever we use categories the uniqueness of the person is overlooked.

49 Limitations of categorical approaches
Classifying in this way often involves labeling which can lead to many issues one of which is stigma. Stigma is a sign of social unacceptability or undesirability, often involving shame or disgrace. This can influence the way the person feels above themselves and they way they are viewed by others.

50 Dimensional approaches
Dimensional approaches are an alternative to the categorical approach. Dimensional approaches assume that normality and abnormality are end points on the same continuum with no clear dividing line between them. A dimensional approach quantifies a person’s symptoms or other characteristics of interests and represents them with numerical values on one or more scales or continuums, rather than assigning them to a mental disorder category. Classification is therefore accomplished by assessing a person on relevant dimensions and giving them a score on each of these dimensions.

51 Dimensional approaches
This can be done using an inventory or test with closed- ended questions requiring a yes or no answer or statements requiring a rating. A dimension is most commonly viewed as a cluster of related psychological and/or behavioural characteristics that tend to occur together and can be measured. A key feature of the dimensional approach is that a mental disorder is not considered in terms of whether it is present or absent. Rather, the focus is on grading a person in terms of the magnitude, degree or severity on particular dimensions rather than assigning them to a diagnostic category. This also helps to measure changes over time.

52 Dimensional approaches

53 Strengths of dimensional approaches
Many psychologists believe that the dimensional approaches overcome the limitations of the categorical approaches. They allow for the communication of a considerable amount of information through a single diagnostic label. Dimensional approaches usually take into account a wider range of a person’s symptoms and characteristics. They avoid slotting people into single diagnostic categories that fail to recognize the uniqueness of the individual.

54 Strengths of dimensional approaches
Dimensional approaches are also believed to reduce the stigma usually associated with the diagnosis of mental disorders because a person is not labeled in the same way as they are using the categorical approach.

55 Limitations of dimensional approaches
For most disorders in the DSM and ICD there is no developed inventory or system to support the dimensional approach. It would be difficult and time-consuming for mental health professionals to develop their own dimensional inventories for each disorder. There is also disagreement between mental health professionals about the number of dimensions that would suitably represent the wide range of mental disorder symptoms a person could experience.

56 Stress and health Chapter 12

57 Stress Exposure to stressful situations and events is a common human experience. These events can range from a hassle to a traumatic and overwhelming experience. When we are faced with a stressful situation, this is usually caused by a stressor. A stressor is any person, situation or event that produces stress.

58 Stressors may be: Physical (extremes in temperature, loud noise)
Psychological (changing schools, arguing with a friend) Internal (originating within the organism) External (originating outside the organism)

59 Stress Stress is an unpleasant state of physiological and psychological tension produced by internal or external forces, which is perceived as exceeding a person’s resources or their ability to cope.

60 Stress Stress can affect different individuals in different ways, depending on the severity or intensity of the stress response, its duration and the individual involved. Stress reactions or responses are the physiological, psychological, and behavioural responses (nausea, biting nails) that people experience when they are confronted by a stressor.

61 Stress Mild stress can be stimulating, exhilarating, motivating, challenging and sometimes even desirable. Acute stress that produces very high arousal levels suddenly, or chronic stress, which produces high arousal levels for a long period of time can effect the body both physiologically and psychologically.

62 Pic page 583

63 Physiological responses to stress.

64 Physiological responses to stress
Two of the most widely used models for describing and explaining physiological responses to stress are called the fight-flight response and the General Adaptation Syndrome. Both models describe a pattern of involuntary minor and major bodily changes that occur when we first become aware of a stressor. These changes involve the sympathetic nervous system and are generally the same for all individuals.

65 Physiological responses to stress
Any kind of immediate threat to your wellbeing is usually a stress producing experience that triggers a rapidly occurring chain of bodily changes. Without our awareness or conscious control our body responds to a perceived threat by automatically activating the fight-flight response.

66 Physiological responses to stress
Our awareness of our levels of physiological arousal varies; sometimes we are very aware of the changes and other times the changes are minimal and we are not aware of them. We can measure our level of arousal by measuring the level of activity in certain physiological systems.

67 Fight-flight response
The fight-flight response is a reaction that occurs automatically, resulting in a state of physiological arousal that prepares the body to deal with sudden threats by either confronting them (fight) or running away to safety (flight). This is an adaptive response to a threatening situation. The fight-flight response is triggered by both physiological threats and psychological threats (anxiety, fear of failure).

68 Fight-flight response
Walter Cannon (1932) found that the fight-flight response involves both the sympathetic nervous system and the endocrine (hormone) system. Changes associated can occur within seconds allowing the organism to react to the threat quickly. Once the threat has passed the parasympathetic nervous system will take over and restore normal functioning.

69 Fight-flight response
When threat is perceived, the hypothalamus is activated. This lower brain structure stimulates the nearby pituitary gland, which then secretes a hormone called ACTH (andrenocorticotropic). This travels through the bloodstream and stimulates the adrenal glands. This chain of reactions in the physiological response to stress involving the hypothalamus, pituitary gland and adrenal glands is known as the HPA axis. When the adrenal glands are stimulated they secrete stress hormones which include adrenalin, noradrenalin and cortisol.

70 Fight-flight response
Activity in the cardiovascular system causes the heart to beat faster. This enables the circulatory system to transport blood carrying adrenalin around the body more quickly. As adrenalin moves around the body other systems of the body are also activated. To provide energy stored fats and sugars are released into the bloodstream and transported to the skeletal muscles.

71 Fight-flight response
In order for these sugars and fats to be converted into energy for use by the muscular system, the body needs more oxygen. This means that the organism breathes faster, enabling the respiratory system to take in more oxygen. The visual system is also alerted as the pupils dilate to allow more light into the eye increasing the organisms ability to see.

72 Fight-flight response
All of these physiological changes occur within a fraction of a second. The physiological changes that take place when the SNS is activated are part of our body’s preparation to act in a threatening situation.

73 Fight-flight response
Changes in arousal levels are usually short- term particularly when the arousal is intense. The autonomic nervous system initiates decreases in arousal (via the SNS) and returns physiological functioning to normal (via the PNS). Once the threat is removed, the high level of bodily arousal subsides gradually, usually within about minutes.

74 Fight-flight response
When this arousal persists for a long period of time it can lead to a range of physiological and psychological effects. Prolonged or intense arousal brought about by the fight-flight response is often associated with a state of internal tension, and can lead to a range of physiological problems. This is because the body must use more resources to deal with the threat.

75 Fight-flight response
If hormones such as adrenalin, noradrenalin and cortisol, which fight the effects of stressors, remain at high levels for a prolonged period of time, then the body’s overall functioning will decline. The immune system becomes less effective.

76 Fight-flight response
Some experienced effects are: Dizziness Aches and pains associated with muscle tension Heart palpitations Skin rashes Fatigue General feeling of being unwell.

77 General Adaptation Syndrome
Hans Selye- earliest researcher to investigate stress. Exposed rats to a variety of stressors and observed their responses to these stressors. The responses were generally the same; adrenal glands were enlarged, stomach ulcers developed, weight loss occurred and vital glands began to shrink.

78 General Adaptation Syndrome
Selye concluded that stress is a condition that is non- specific and which can be brought on by either internal or external stressors. The condition of stress is the bodies response to both physical and psychological demands. On the basis of his observations, Selye proposed that the sequence of responses to stress that occur in an organism follows a consistent pattern which he called the general adaptation syndrome (GAS).

79 General Adaptation Syndrome
The general adaptation syndrome is a three stage physiological stress response that occurs regardless of the stressor that is encountered. The means that the GAS is non-specific as the same reaction will occur whatever the source of the stressor.

80 General Adaptation Syndrome
The GAS consists of three stages; - An alarm reaction stage - A stage of resistance - A stage of exhaustion.

81 Alarm reaction The first stage of the GAS is the alarm reaction stage, which is said to occur when the person first becomes aware of the stressor. Following exposure the body goes into a state of shock and its ability to deal with the stressor drops below its normal level.

82 Alarm reaction Physiologically the body reacts as if it were injured.
The body then rebounds from this level with a reaction called countershock when the sympathetic nervous system is activated and the body’s resistance to the stressor increases.

83 Alarm reaction The organisms response is a fight-flight response and it becomes highly aroused and alert as it prepares to deal with the stressor. Adrenaline is released into the bloodstream and the effects of the sympathetic nervous system are felt by the organism. This initial stage is a general defence reaction to the stressor, which results in a state of tension and alertness, and readiness to respond to the stressor.

84 Resistance If the source of the stress is not dealt with immediately and the state of stress continues, the organism will move into a stage of resistance. During the stage of resistance, the body’s resistance to the particular stressor rises above normal as it attempts to adapt and cope with the stressor.

85 Resistance Hormones such as cortisol are released into the bloodstream which helps to repair any damage that may have occurred. Cortisol also weakens the immune system and therefore interferes with the body’s ability to fight disease and to protect itself against further damage.

86 Exhaustion If the stressor is not dealt with successfully during the resistance stage the organism enters a state of exhaustion. This means that the effects of the stressor can no longer be dealt with. The body’s resources have been depleted and it becomes vulnerable to physiological and psychological illness.

87 Exhaustion This stage is characterised by: Extreme fatigue
High levels of anxiety and depression Nightmares Impaired sexual performance. Extreme exhaustion can bring on diseases such as the flu, heart disease, arthritis and high blood pressure. In extreme cases the organism may die.

88 Strengths of the General Adaptation Syndrome
There is extensive research evidence that suggests stress is associated with the initiation and progression of a wide range of diseases, from cardiac, kidney and gastrointestinal diseases to AIDS and cancer. These findings continue to be confirmed by modern researchers. Most theories on stress and stress responses include the findings from the GAS and fight-flight response. This means that stress can be a factor in diagnosing and treating related illnesses.

89 Limitations of the General Adaptation Syndrome
This theory assumes that everyone has the same general, predictable and automatic physiological responses to any stressor. This means that this theory does not take into account individual differences of responses to a stressor. It does not take into account any of the cognitive responses to stress or the brains psychological perspective of a stressor. Not all people respond to exposure to chronic stress in the same way. Most of the research is based on animal studied and therefore may be of little relevance to the human stress response.

90 Eustress and Distress Generally when we think about stress, we perceive it as being a negative thing. Not all stress is negative or ‘bad’. This lead to Selye’s identification of different types of stress- one being negative and one being positive. Eustress is a positive psychological response to a stressor, as indicated by the presence of positive psychological states such as feeling excited, enthusiastic, active and alert. Distress is a negative psychological response to a stressor, as indicated by the presence of negative psychological states such as anger, anxiety, nervousness, irritability or tension.

91 Eustress and Distress When stress is beneficial or desirable it can be described as eustress. When stress is objectionable or undesireable, it can be described as distress. This varies from individual to individual depending upon the cognitive interpretation that they make of the stressor.

92 Psychological responses to stress

93 Psychological responses to stress
Physiological responses described by the fight-flight response and the GAS are involuntary and occur automatically in response to a stressor. Psychological responses are not involuntary and most of the time we have control over them, depending on the individual. Psychological responses are not directly observable but can either be inferred from observable reactions to stressors or through self-reports or reflections from the individual.

94 Psychological responses to stress
Behavioural changes Emotional changes Cognitive changes The way a person looks Strained facial expressions A shaky voice Hand tremors Muscle spasms Jumpiness Increase of decrease in eating Change in sleep patterns Aggression Anxiety Tension Depressed Angry Irritable Short tempered Hopelessness Helplessness Feeling trapped Having a negative attitude about yourself A person’s perceptions of their circumstances and environment may change The way they learn and think may be effected Perceptions could be distorted or exaggerated Difficulty maintaining focus, making decisions and thinking clearly

95 Psychological responses to stress
Many factors can influence the psychological responses to stress: Prior experience with stressors and stress responses Attitudes Motivation Level of self-esteem General outlook on life Personality characteristics Coping skills Perception of control

96 Psychological responses to stress
Stress is a subjective experience that depends on how we interpret a stressor and also our own perception of our ability to cope. Richard Lazarus and Susan Folkman attempted to create a framework for evaluating how we cope with stressful events. The transactional model of stress and coping proposes that stressful experiences are a transaction between a person and their environment; if demands exceed resources, stress is the likely result.

97 Psychological responses to stress
In comparison to Selye’s biological explanation as to how we respond to stress, the transactional model suggests that our stress responses are mediated by our appraisal of the stressor and also by the social and cultural resources at our disposal. Appraisal refers to the act of estimating or judging the nature or value of something or someone. Lazarus and Folkman suggest that when responding to stress: we initially engage in a primary appraisal, in which we decide if a situation is threatening or positive, or relevant or irrelevant to our situation. this then sets in motion a process of secondary appraisal in which we assess what resources are available to us in terms if coping with the situation.

98 Psychological responses to stress
This model suggests that stress is seen as a result of how a person appraises a situation and their abilities to cope with it. Stress is thought to be experienced when the demands on an individual exceed the necessary resources present to deal with that stressor. Read example page 597.

99 Psychological responses to stress
Because we can’t escape the stressor we have to learn to cope. Coping is the process of ‘constantly changing cognitive and behavioural efforts to manage specific internal and/or external stressor that are appraised as taxing or exceeding the resources of the person. Problem-focused coping involves efforts to manage or change the cause or source of the problem; that is the stressor. Emotion-focused coping involves strategies to attend to our emotional responses to the stressor. This involves strategies to decrease the emotional component of the stressor. We may first have to deal with the emotional aspects of the stressor and then attend to solving the problem.


101 Strengths of the transactional model
This model focuses on psychological determinants of the stress response over which we have control and emphasises the personal nature and individuality of the stress response. This allows for more variability in an individual’s response to stress. It helps to explain why people respond in different ways to the same types of stressors. Has enhanced the understanding of the importance of stress management programs and strategies to deal with stressors effectively.

102 Limitations of the transactional model
The major limitation of this model is that it is difficult to test through experimental research. Because of its subjective nature, variability and complexity, reliable evidence is difficult to collect. There is doubt as to whether we actually need to appraise something as being stressful in order to experience a stress response. Individuals may not always be conscious of, or be able to label all of the factors that are causing them to experience a stress response.

103 Social, cultural and environmental factors that influence the stress response

104 Social, cultural and environmental factors that influence the stress response
According to the biopsychosocial framework, stress is also influence by social factors. These social factors include cultural and environmental factors. Each factor has an impact on how the stress response can be either exacerbated or alleviated.

105 Social, cultural and environmental factors

106 Social factors Social factors that can influence the stress response include: Our relationships and social interactions with others Loneliness Feelings of isolation Breaking up or reconciling a relationship (being in a bad relationship) Lack of social skills in forming and maintaining relationships Lack of social support Making a new friend or gaining a new family member Experiences during recreational activities

107 Social factors Social readjustment refers to the amount of change, or ‘adjustment’ in lifestyle a person is forced to make following a specific event in their life. Any change that requires an individual to adjust their lifestyle, will cause stress in varying amounts, depending on the stressor and the level of social readjustment required. Read example page 602.

108 Cultural factors For immigrants, refugees and asylum seekers, coming to another country can be both a stress release and a stressor. In some cases the person is escaping famine, poverty, war, torture, civil unrest etc which as a result of moving alleviates the stress response. However, the demands of adjusting to a new culture can produce or exacerbate the stress response.

109 Cultural factors People entering new cultures frequently encounter:
language difficulties racial prejudice lower socio-economic status separation from family conflicts over preserving their old values and beliefs while still adapting to the customs of their new culture coming to terms with the torture or murder of loved ones back home Research shows that belonging to an ethnic or cultural minority group significantly increases the risk of developing a stress related physical or mental health problem.

110 Environmental factors
Environmental factors that can influence the stress response include: Crowding (study page 606) Loud noise Air pollution Extremes in temperature Catastrophes (technological and natural disasters)

111 Allostasis The biopsychosocial framework does not explain how factors from within each domain actually combine, or come together, when we are exposed to a stressor. Theorists have developed a construct called allostasis to explain this. Allostasis refers to the body’s ability to maintain a stable physiological environment by adjusting and changing to meet internal and external demands. Allostasis therefore helps the body achieve stability by changing. There are however costs associated with allostasis that can result in permanent damage to the body.

112 Allostasis Allostasis revises and extends the biological construct of homeostasis. Homeostasis is the body’s ability to maintain a stable physiological environment by keeping certain bodily conditions constant, such as: Body temperature Blood oxygen levels Blood glucose levels pH acidity Water content While homeostasis helps to keep the body stable, allostasis helps the body achieve stability through changing.

113 Allostasis When internal and external events cause deviation from ideal physiological conditions, homeostatic mechanisms take corrective action and operate to restore the steady state or balance. Changes associated with homeostasis occur within a relatively narrow range with upper and lower limits. Eg. Body temperature Outside can change more than 20 degrees in a day Body temperature remains constant When something pushes our body temperature above or below its normal limits, homeostatic mechanisms trigger responses like sweating or chills to restore the body’s set temperature

114 Allostasis In contrast to homeostasis, allostasis emphasises that healthy functioning requires continual physiological fluctuations and adjustments. Allostasis enables our body to adjust beneficially to internal and external demands in a manner that is different from that of homeostasis. In fact the word translated= allo (different) and stasis (stability).

115 Allostasis Allostasis is achieved through the brain’s regulation of the activities of our allostatic systems. These include the HPA axis, the autonomic nervous system, and the immune and cardiovascular systems. In contrast to homeostatic systems, large variations in processes regulated by allostatic systems do not lead directly to death. When an individual perceives a situation as stressful and experiences a stress response, their brain activates, or ‘turns on’ their body’s allostatic response.

116 Allostasis When an individual has been successful in coping with the demands of a stressor, or the stressor has passed, the brain ‘turns off’ the allostatic response. As long as the brain can turn on the allostatic response when required and turn off the response when it is no longer needed, the body is able to adapt to the demands of a stressor and is not likely to suffer adverse long-term effects.

117 Allostatic load When the allostatic mechanisms are not ‘turned off’ after a stress-producing experience there is overexposure to stress hormones. Cumulative exposure to increased secretion of the stress hormones can lead to wear and tear on the brain and body known as allostatic load. The concept of allostatic load helps to explain how prolonged (chronic) stress can influence the onset of physical disorders such as cardiovascular disease, obesity, diabetes and mental disorders like depression and anxiety.

118 Allostatic load The allostatic model explains the biopsychosocial framework by explaining the stress response in terms of the interaction between biological, psychological and social factors. Example page 614.

119 Strategies for coping with stress

120 Strategies for coping with stress
Through studying stress and the impact it can have on the body and a person’s lifestyle, many programs and strategies have been developed to deal with prolonged and intense stress responses. Some of these are: Biofeedback Meditation and relaxation Physical exercise Social support

121 Biofeedback Physiological responses to stressors involve the coordinated interaction of numerous bodily processes, which usually operate automatically. With training, we can learn to control some of these automatically occurring responses. This then minimises the adverse effects of physiological responses when they are repeatedly turned on and off or occur at elevated levels for a long period of time. This can be achieved through biofeedback training.

122 Biofeedback Biofeedback is a technique that enables an individual to receive information (feedback) about the state of a bodily process (bio). With appropriate training we can learn to control a related physiological response using thought processes. During the process, sensors are attached to the patient that will give them feedback about the physiological responses to stress. This may show tension is a particular muscle, blood pressure or skin temperature. These signals are detected and analysed to provide the person with information about the state of their bodily processes. The person is then taught a series of physical and mental exercises to help them gain control over the stress response they are experiencing.

123 Biofeedback Biofeedback can be useful in helping people learn how to recognize and control physiological responses to stressors in their life. It is used most often to relieve stress induced problems like migraines, hypertension and headaches. Example page 618. One criticism of biofeedback is that although it can be successful in a clinical setting, the effects may not last when the patient leaves the clinic as they no longer have access to the expensive feedback device.

124 Physical exercise Physical exercise is physical activity that is usually planned and performed to improve or maintain ones physical condition. A distinction is made between aerobic and anaerobic exercise. Aerobic exercise requires a sustained increase in oxygen consumption and promotes cardiovascular fitness. Eg. running, swimming, bike riding. Anaerobic exercise involves short bursts of muscular activity that can strengthen muscles and improve flexibility. Eg. Weight training.

125 Physical exercise Physical activity and exercise is ranked second only to tobacco control in being the most important factor in overall health promotion and disease prevention in Australia. Being physically active can substantially reduce the risk of serious disease. Research evidence suggests that aerobic exercise is best for physical and mental health although anaerobic exercise is better than no exercise.

126 Physical exercise When an individual experiences stress the sympathetic nervous system and HPA axis is activated, releasing the bodies stress hormones. 1. Exercise uses up the stress hormones secreted into the blood stream, thereby helping the immune system return to normal functioning sooner. 2. Physical activity increases our stamina for encountering future stressors. 3. Many people experience short term psychological benefits during and after exercising because of chemical changes in the body. 4. Physical exercise can divert a persons attention away from the stressor and negative emotional states associated with stress. 5. People who exercise with others increase their social support networks.

127 Social support Social support is help or assistance from other people when needed. Social support can come from a number of interpersonal relationships: Family Work Teachers Friends Self-help groups

128 Social support Social support can take four main forms:
Appraisal support- help from another person that improves the individuals understanding of the stressful event and suggests possible coping strategies. Tangible assistance- provides materials such as financial assistance or good to help offset the effects of the stressful event. Information support- a person with experience can provide information about how to cope with a stressful event. Emotional support- targets emotional reactions by reassuring a person under stress that they are an individual who is cared for and valued.

129 Meditation and relaxation
When used for stress management, meditation is an intentional attempt to bring out a deeply relaxed state in order to reduce one or more effects of stress related symptoms. Relaxation is any activity that brings out a state of reduced psychological and or physiological tension. The activity may simply involve resting, going for a walk or jog, or reading a book. When in a relaxed or meditative state people typically report feeling calm, low level or absence of anxiety, and responses associated with lower physiological arousal.

130 Meditation and relaxation
Research findings indicate that a deep state of relaxation is essentially the opposite to a typical stress response. It has also been found that using these techniques is more effective than using no treatment. A key feature is that this technique does not involve the use of chemicals as medication does. Physical relaxation will lead to a state of psychological relaxation. Progressive muscle relaxation is a common strategy used to relax the body.

131 Anxiety disorder Phobia

132 Anxiety and anxiety disorders
Anxiety is a state of physiological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or that something unpleasant is about to happen. Feeling anxious in these situations is appropriate, and usually we feel anxious for only a limited amount of time. In everyday life, anxiety is an adaptive response. A severe anxiety response can be very useful in the short term to deal with threatening or dangerous situations. Mild to moderate levels of anxiety can also make is more alert and improve our ability to cope.

133 Anxiety and anxiety disorders
Anxiety should always be brief and temporary, and its intensity should be related to the significance of the situation. If anxiety is severe and does not subside, it can be counterproductive and disabling. It can reduce our ability to concentrate, learn, think clearly and logically, plan, make accurate judgments and perform motor tasks. Severe anxiety is generally accompanied by intense physiological sensations and responses like breathlessness, sweating, trembling, feelings of choking, nausea, dizziness, pins and needles and feelings of losing control.

134 Anxiety and anxiety disorders
The term anxiety disorder is used to describe a group of disorders that are characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect. People are likely to be diagnosed with an anxiety disorder when their level of anxiety is so severe that is significantly interferes with their daily life and stops them doing what they want to do.

135 Phobia We all have fears, but they are not necessarily severe enough to interfere with our daily lives. A phobia is an excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning. People with a phobia often become fearful even when they think about the object, situation or event that they dread. It is estimated that phobias affect approximately 3% of the Australian population. As is the case with other anxiety disorders, more women suffer from phobias than men. Most people who suffer from a phobia are very aware that their fears are excessive and unreasonable but may not know how they started.

136 Specific phobia Phobias are divided into three categories in the DSM:
Agoraphobia Social phobia Specific phobia A specific phobia is a disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour. The specific object or situation producing the fear associated with a phobia is commonly referred to as the phobic stimulus.

137 Specific phobia According to the DSM, any specific phobia falls into one of five categories: Animals (spiders, snakes, dogs, insects) Situations (lifts, bridges, enclosed spaces, flying) Blood, injections and injury Natural environments (heights, darkness, thunder, lightning) Other phobias (choking, vomiting, loud noised, costumed characters) All phobias share common symptoms but primarily differ in that they occur in response to different objects or situations.

138 Specific phobia When someone has a specific phobia, exposure to the phobic stimulus triggers an involuntary response that is like the stress response. In some cases the anxiety is so intense that it takes the form of a panic attack. A panic attack is the unexpected onset of intense anxiety that can last a few minutes up until an hour or so. Because of their awareness of their fear and the fact that they know it is unreasonable, often people with a specific phobia will be embarrassed or feel ‘stupid’.

139 Specific phobia People with a specific phobia begin to organise their life around avoiding the phobic stimulus. Anticipatory anxiety is the gradual rise in anxiety level as a person thinks about or anticipates being exposed to a phobic stimulus in the future. A diagnosis of specific phobia is only made if the fear of the specific object or situation has persisted for at least 6 months. This is the most common mental disorder among women and the second most common among men, second to substance related disorders.

140 Biological contributing factors
Research suggests that some people may be genetically predisposed or inherit a tendency to develop an anxiety disorder. One of the biological factors that may contribute to anxiety disorders is the role of the stress response. The other is the involvement of the brain’s neurochemistry, specifically the neurotransmitter called GABA.

141 Role of the stress response
The physiological component of specific phobia is similar to the physiological response to stress. Because there is a threat or impending harm at the sight of or thought of a phobic stimulus, the fight-flight response is activated. This means all the typical sympathetic nervous system responses occur. Phobic anxiety becomes a problem when the stress response is triggered in the absence of any threat or danger like clouds (nephophobia) or flowers (anthophobia). The stress response experienced as a result is often very severe and can persist at this high level for at least as long as the exposure to the phobic stimulus.

142 Role of GABA GABA and glutamate are naturally occurring neurotransmitters that carry messages between neurons in the brain. Gamma-amino butyric acid (GABA) is the primary inhibitory neurotransmitter in the central nervous system and works throughout the brain to make post-synaptic (receiving) neurons less likely to fire. This neurotransmitter stops excitory neurotransmitters, like glutamate, from getting out of control and causing reactions like a seizure. As a result both have important roles in regulating central nervous system functioning. It is also believed to play a role in anxiety.

143 Role of GABA The connection between the level of GABA in the brain and anxiety symptoms has led researchers to believe that some people develop anxiety because they have a dysfunctional GABA system. A dysfunctional GABA system can result in low levels of GABA in the brain. Eg. Participants diagnosed with a panic disorder had a GABA level that was 22% lower than that of the control group with no history or panic disorders.

144 Role of GABA The level of GABA in a persons brain may be effected by a range of factors like: Genetic inheritance Exposure to prolonged stress Environmental toxins Nutritional deficiencies such as vitamin B6 and citric acid High caffeine intake Some researchers have proposed that GABA levels can be increased ‘naturally’ by drinking green tea or eating foods high in GABA like beans, eggs or dairy products.

145 Role of GABA Drugs have also been used as substitutes to highlight the effects of GABA in anxiety. Benzodiazepines are a group of drugs commonly referred to as minor tranquillizers as they have the effect of ‘calming down’ the body by reducing physiological arousal and promoting relaxation. However, they induce drowsiness and are highly addictive. These are most commonly Valium, Serepax, Temazepam, Rohypnol and Xanax. Benzodiazepines are GABA agonists so they imitate the role of GABA and stimulate activity at the site of a postsynaptic neuron where GABA is received from a presynaptic neuron. This means that they reduce the symptoms of anxiety by acting as GABA should. Studies have shown that benzodiazepines are effective in the management of specific phobias, panic disorders and other anxiety disorders. Alcohol also has similar effects on the GABA receptors, which is why alcohol is typically experienced as relaxing.

146 Psychological contributing factors to phobia
Some of the models that have been proposed to describe how a specific phobia can develop due to psychological factors are: The psychodynamic model The behavioural model The cognitive model

147 Psychodynamic model First proposed by Sigmund Freud in the late 1800’s. The psychodynamic model is based on an assumption that all mental disorders are caused by unresolved psychological conflicts that occur in the unconscious part of the mind, beneath the level of ordinary conscious awareness. These conflicts begin in early childhood during which our urges and what society views as acceptable behaviour often clash.

148 Psychodynamic model According to Freud, the unconscious part of our mind is a storage place for all the information about ourselves that is not acceptable to the conscious mind. He believed the unconscious contains all the memories of experiences that may be a source of anxiety and therefore difficult for us to bring to our conscious mind. Although we are not aware of them, our unconscious thoughts can have a huge effect on our thoughts and behaviour.

149 Freud’s theory Following birth we progress through a series of five psychosexual stages: The oral stage (0-2 years) The anal stage (2-3 years) The phallic stage (4-5 years) The latency stage (6 years to puberty) The genital stage (puberty- early adult hood)

150 Freud’s theory Freud used the term sex to refer to something that was ‘physically pleasurable’ rather than something specifically sexual or involving sexual activity. As we progress through the stages, different parts of the body become the focus of pleasure. Each stage also has a crucial developmental conflict that must be satisfactorily resolved in order to move on to the next stage. When it is not resolved this can be a source of anxiety.

151 Freud’s theory Freud described anxiety as an uncomfortable or unpleasant psychological feeling that often arises from the fear that our instincts will make us do something we will be punished for. We protect ourselves from this by using defense mechanisms. Defence mechanisms describe the unconscious process by which the conscious part of our mind called the ego defends or protects itself against anxiety arising from unresolved internal conflicts. Defence mechanisms reduce anxiety by distorting reality at an unconscious level. According to this theory we are usually not aware that we are using defence mechanisms.

152 Freud’s theory According to Freud, a specific phobia, which he called anxiety hysteria develops as a consequence of an unresolved Oedipal complex. The Oedipal complex is a developmental conflict that emerges during the phallic stage of psychosexual development and describes the unconscious powerful, passionate love and desire that the male child has developed towards his mother. The boy then begins to fear that his father will become aware of this desire and punish him. This will take the form of castration (cutting off the male sex organ). As a consequence the boy will experience anxiety.

153 Freud’s theory In order to successfully resolve this conflict the male child uses a defence mechanism called repression to prevent these unacceptable desires to reach their conscious awareness. This means the boy begins to identify with his father and believe that his father will be less likely to castrate him. If repression does not work, another form of defence mechanism called displacement will be used to try and resolve the conflict. Displacement involves directing feeling away from the person or object onto a substitute object or person that is less threatening. This substitute object then becomes the phobic stimulus. The child can deal with their unresolved conflict and the anxiety associated with it by avoiding the phobic stimulus. Read Hans case study page 644.

154 Behavioural model According to the behavioural model phobias are learned through experience and may be acquired, maintained or modified by environmental consequences such as reward and punishment. The model assumes that phobias are learnt through operant and classical conditioning processes. Classical conditioning plays a role in acquisition while operant conditioning plays a role in the maintenance of a specific phobia. Eg. Little Albert (others page 646).


156 Cognitive model A cognitive model focuses on how the individual processes information about the phobic stimulus and related events. This refers to the cognitive or thought processes that accompany a phobia (perceptions, beliefs, memories and expectations). The model emphasised how and why people with a phobia have an unreasonable and excessive fear of a phobic stimulus. A key assumption of these models is that people have developed a cognitive bias. A cognitive bias is a tendency to think in a way that involves errors of judgment and faulty decision making.

157 Cognitive model Some types of cognitive bias are: Attentional bias
Memory bias Interpretive bias Catastrophic thinking

158 Attentional bias Attentional bias is the tendency to selectively attend to threat-related stimuli rather than to neutral stimuli. This means that a person with a phobia pays more attention to threatening information while ignoring non-threatening information in the environment. Eg. Someone with a spider phobia will see the spider web in the room whereas the person without the phobia will not even notice it. They also tend to be hypervigilint- always alert and constantly looking around for something relevant to their phobia that may be potentially threatening.

159 Memory bias Memory bias (also referred to as selective memory) occurs when recall or recognition is better for negative or threatening information than for positive or neutral information. Eg. A person with a phobia of spiders will tend to reconstruct their memory and describe a spider as bigger, faster or more frightening than it actually was.

160 Interpretive bias Interpretive bias is the tendency to interpret or judge ambiguous stimuli and situations in a threatening manner. Eg. A person may interpret a piece of fluff on the carpet as being a spider.

161 Catastrophic thinking
Catastrophic thinking is a type of negative thinking in which an object or event is perceived as being far more threatening or dangerous than it actually is and will result in the worst possible outcome. Eg. A person with a fear of driving may think if they get into a car they will definitely have a crash and die. Individual experience heightened feelings of helplessness and underestimate their ability to cope with the situation.

162 Socio-cultural contributing factors
Some of the socio-cultural factors that can contribute to the development of a phobia are: Specific environmental triggers Parental modelling Transmission of threat information

163 Specific environmental triggers
Many people who have developed a specific phobia often report of having a negative and traumatic experience in the past that attributes to the cause of their phobia. Eg. Phobia of driving after a serious car accident. These specific objects or situations in the environment produced or triggered an extreme fear response at the time, which is why the term specific environmental trigger is used.

164 Specific environmental triggers
The more severe the trauma associated with an unpleasant or harmful initial fear experience, the more likely it is that a phobia will develop. If the experience is significantly traumatic, one encounter may produce and maintain the fear response. People who develop a phobia after a single traumatic encounter with a phobic stimulus are usually able to identify the event as causing their phobia.

165 Specific environmental triggers
Different people may react to the experience differently causing one to develop a phobia while not affecting the other. This shows that developing a phobia is not always as a result of one direct experience, it may also be affected by other prior experiences. Eg. A person who has grown up with dogs may be less likely to develop a phobia of dogs after being bitten compared to an individual who is bitten the very first time they encounter a dog. Frequent exposure after the traumatic experience may reduce the likelihood of a phobia forming.

166 Parental modelling Observational learning or parental modelling can also be involved in the development of phobias through another person’s fearful behaviour towards a particular object or situation. Eg. A child who observes a parents reaction to a phobic stimulus or hears a parent discuss their fear may be more inclined to develop a similar phobia. This is because children do not know whether the fear is rational or appropriate. Fears developed through observational learning can be as strong as fears developed through direct experience, although direct experience seems to be the most common pathway to a phobia.

167 Transmission of threat information
Most people with a fear of flying have never been in a plane crash yet fear of flying is one of the more common phobias. Transmission of threat information refers to the delivery of information from parents, other family members, peers, teachers, media and other secondary sources about the potential threat or actual danger of a particular object or situation. Eg. A person may develop a flying phobia after watch graphic television coverage of a plane crash.

168 Socio-cultural contributing factors
Specific environmental triggers involve direct experience with the phobic stimulus whereas parental modelling and transmission of threatening information involve indirect experience.

169 Psychological management of specific phobias
Some of the therapies available include: Cognitive behavioural therapy (CBT) Systematic desensitisation Flooding

170 Cognitive behavioural therapy
This type of therapy involves altering the thoughts and behaviours that maintain a persons phobia. Cognitive behavioural therapy combines cognitive and behavioural therapies to help people manage mental health problems and disorders. Cognitive therapy is a type of talking therapy that focuses on the role of cognitions (thoughts, beliefs, attitudes) in determining emotions and behaviour. It helps people to become aware of their maladaptive thinking that can trigger and fuel a phobic response.

171 Cognitive behavioural therapy
Behavioural therapy is the clinical application of learning theories such as classical and operant conditioning. This form of therapy deals with maladaptive behaviours such as avoidance and reduced activity levels which can maintain or worsen a persons psychological problems. This is not necessarily a talking therapy. The therapist exposes their client to a new environmental condition designed to retrain them into more adaptive habits.

172 Cognitive behavioural therapy
CBT is based on the assumption that the way people feel and behave is largely a product of the way they think. Anyone can change the way they feel and behave by thinking about a situation in a more balanced and helpful way. CBT does not involve talking freely or dwelling on events in a person’s past to gain an insight into their psychological state.

173 CBT for specific phobias
When using CBT to treat specific phobia, mental health professionals encourage their client to first identify their fear and anxiety related thoughts. The client is then encouraged to look for evidence that supports their fear and evidence that does not support it. Sometimes the fear may arise from lack of information or from incorrect information. Therefore they are encouraged to gather accurate information about their phobic stimulus.

174 CBT for specific phobias
Once the person has identified their cognitive distortion and evaluated the evidence they are more able to evaluate their maladaptive thoughts. This will lead to changes in their feelings and behaviour, particularly a reduction in fear, anxiety and avoidance. The therapist may then ask the patient to engage in a behavioural experiment. This involves planned activities undertaken by the client to help them to realise that the likelihood of a traumatic event occurring is unlikely.

175 Behavioural experiment
A behavioural experiment may follow the following format: Make a prediction (the client specifies the maladaptive thought they are testing) Review existing evidence for and against the prediction Devise a specific experiment to test the validity of the prediction Note the results Draw conclusions

176 Systematic desensitisation/graduated exposure
Systematic desensitisation is a kind of behaviour therapy that aims to replace an anxiety response with a relaxation response when an individual with a specific phobia confronts a stimulus. The process involves unlearning the connection between the anxiety and the object and replacing feelings of anxiety with feelings of relaxation. The three step process requires the patient to learn to relax while gradually facing increasingly anxiety- producing phobic stimuli.

177 Systematic desensitisation/graduated exposure
The first step involves teaching the client a relaxation strategy that they can use to decrease the physiological symptoms of anxiety when confronted with the phobic stimulus. These strategies may include progressive muscle relaxation, visual imagery or the slow breathing technique (SBT). SBT involves learning to slow down the rate of breathing: Hold your breath for six seconds Breathe in and out on a six-second cycle, saying the word relax as you breathe out After one minute hold your breathe again then continue to breathe on a six-second cycle Repeat the sequence until anxiety has diminished.

178 Systematic desensitisation/graduated exposure
The second step in systematic desensitisation involves breaking down the anxiety-arousing object or situation into a sequence arranged from least to most anxiety arousing. A fear hierarchy is a list of feared objects or situations, ranked from least to most anxiety producing. Ideally fear hierarchies should consist of specific situations, each of which is rated and then ranked on a 100- point scale. Each situation should provide detail like time of day, duration of exposure and involvement of other people.

179 Systematic desensitisation/graduated exposure
The third step involves the systematic graduated pairing of items in the hierarchy with relaxation by working upward through items in the hierarchy one ‘step’ at a time. This can be in vivo (real life), visual imagery or virtual reality. At all steps the person is encouraged to relax and no advancement is made to the next step until relaxation is achieved.


181 Flooding Unlike systematic desensitisation, flooding does not have a relaxation component to it. Flooding involves bringing the client into direct contact with their most feared object or situation straight away and keeping them in contact with it until their fear and associated anxiety disappears. Unlike systematic desensitisation flooding is used to deliberately produce a massive amount of fear or anxiety in the client. Anxiety will be experienced at a very high level and then gradually diminish, thereby enabling the client to come to learn that it is actually quite harmless. The client will self-report their anxiety levels until it drops to a low level. Flooding can be an effective technique when correctly used.



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