PSYC3011 Notes

Health
1. Conceptualisations of health

Encapsulates:
o Prevention + treatment of illness
o Promotion of health
o Continuum of healthy behaviour: psychological disorder psychological
well-being
o Link between psychological and physical health: mind-body
connection; biopsychosocial model of health; Eastern/Indigenous notions
of health
o E.g. Holistic approach to health
The Mental Health Continuum (Keyes)
Operationalisation of mental health as a syndrome of symptoms of positive
feelings (emotional well-being/vitality) and positive functioning (psychological
& social well-being) in life
Social well-being is important as individuals are embedded in social structures and
communities and face countless social tasks and challenges
The Mental Illness Continuum
Clusters of symptoms used in DSM to diagnose e.g. a major depressive episode:
o Symptoms of depressed mood (loss of pleasure derived from activities)
o Symptoms of malfunctioning (e.g.
insomnia)
The Complete State Model: Two Continua Model
(Keyes)
Mental health and mental illness are highly
correlated but belong to separate continua
Therefore, the prevention and treatment of
mental illness will not necessarily result in more
mentally healthy individuals
Note: languishing, flourishing & mental
illness

Population approaches: Putting it back onto a one-

Population
dimensionalapproaches:
continuum! Putting it back onto a
one-dimensional continuum
Languishing

Struggling

Flourishing

Psychological
disorder
(Floundering
)

Moderate mental
health

Effect of a small shift in the population mean on the mental health spectrum (Huppert, 2005).
http://neweconomics.org/projects/five-ways-well-being).

2. The Major Western Treatment Approach?

Cognitive Behavioural Therapy (CBT)

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No
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illn
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A group of therapies
Cognitive strategies: learning to recognize the negative thinking habits that
cause distress, and using various techniques to develop more reasonable ways of
thinking
Behavioural strategies: undertaking various behaviours that help us change the
way we think and feel
o e.g. behavioural experiments, repeated exposure to feared situations,
practicing deep relaxation and breathing techniques, problem solving, goal
setting, using assertive communication, using social support and activity
scheduling

Nature of CBT
Focus on changing cognitions to change affect, and in turn, behaviour
Treatment is time-limited, educational and focused on discrete problem targets
CBT is an active therapy
Clients are seen as responsible and assumed to be motivated
Psycho-education in understanding the role of thoughts in generating negative
affect/emotions is important e.g. Giving psychology away and acknowledging the
psychological health continuum
Edelman (2013) draws on Albert Ellis ABC-D
A = Activating event/situation that triggers a response
C = Consequence emotions and behaviours
E.g. A (running late for appointment) C (anxiety, reckless driving)
But A does not directly cause C there is a mediating step:
B = Beliefs about the situation often negative, biased, unreasonable, held as
rigid rules or shoulds, can make us feel bad, make us behave in self-defeating
ways
Activating event Belief Consequence

E.g. A (running late for meeting) B (I must always be punctual) C (anxiety,

reckless driving)
D = Dispute the way we challenge the way we think about situations & our
beliefs
o E.g. While I prefer to be punctual; the boss usually does not mind when
people turn up a bit late; I am not critically involved at the start of the
meeting; its not my fault there was a crash which slowed the traffic

Relatedly: Cognitive appraisal & re-appraisal

Event: My girlfriend did not answer when I called her (=A)
She is rejecting me! (= appraisal = B) anger, anxiety, depression (=C)
The re-thinking strategy (=D) of cognitive re-appraisal involves thinking of
feasible alternative explanations e.g. she might be busy her phone may not
be working...
Emotions, cognitions & behaviours all interact: sometimes adaptive,
sometimes not

Cognitions -> emotionse.g. I might fail

my course -> anxiety
Emotions -> behaviours e.g. anxiety ->
work to finish assignment over the
weekend
Emotions -> cognitions e.g. fear->
perceive neutral event as threat
Cognitions -> behaviours e.g. people
dont like me -> avoid social contact
Behaviours -> cognitions e.g. Avoid social
contact -> dont see anyone -> reinforces
belief people dont like me
Behaviours -> emotions e.g. Avoid social
contact -> loneliness, depression

Criticismignores
motivational processes

Ellis tyranny of the shoulds a.k.a. Musterbation

E.g. I must be loved and approved by everyone; I should be treated fairly; People
should do things the way I do; The world should provide me with what I need
Faulty Thinking
Black-and-white thinking = tendency to see things in a polarised way
Overgeneralising = generalising from one negative instance to many instances
or situations
Personalising = feel responsible for things that are not our fault
Filtering = negative beliefs bias our perceptions
Jumping to negative conclusions .. on basis of too little evidence
Mind reading = assume negative evaluation
Blaming others for your situation, and not acting to solve problem
Labelling e.g. I am stupid; my boss is a jerk
Predicting catastrophe = habitual focus on negative consequences; what if?
Comparing = appraise status, personal worth by comparing to others
Just world fallacy = expectation that things should be fair
Hindsight vision = incorrect belief (usually) that should have known at time
that decision was wrong

Disputing negative cognitions: strategies

Local disputing: challenge rigidity of thinking and identify a more
balanced perspective e.g.
I must be loved and approved of by everyone ->
I prefer people to like me, but it is unrealistic to expect everyone to like me. I can cope if some people
dont like me, just like some people cope when I dont like them.
The world should be a fair place and I should always be treated fairly ->
I prefer things to be fair, but I acknowledge that the world is full of injustice. Lots of things arent fair,
and chances are that at times I am going to experience some injustice.
People should have the same values and beliefs as me, and they should do things the way I do them ->
People have the right to have different values and beliefs from mine, and will sometimes say and do
things I do not like. It would be nice if others always did what I believe is right, but there is not reason
that they must.
When I do something badly, I am a bad person, a failure, an idiot ->
Like everyone else, I sometimes make mistakes and do silly things, but that does not make me a failure
or a bad person.

Write it down, or use thought-monitoring forms

Positive actions (e.g. after a negative event, such as losing wallet)
De-catastrophise
Socratic questioning e.g.

( Edelman, 2013)

o What are the facts?

o What are my subjective perceptions?
o What evidence supports my perceptions?
o What evidence contradicts my perceptions?
o Am I making any thinking errors?
o How else can I perceive this situation?
Behavioural disputing/behavioural experiments
Goal-focused thinking

Example:

Sonia separated from her husband Don a year ago,

after he started a relationship with another woman.
Sonia feels anxious every time she thinks she might
see Don at social functions or when he comes to
pick up the children on weekends.
Sonia decides to challenge some of the unhelpful
cognitions that cause her to feel so vulnerable.
She writes the following notes on her thoughtmonitoring form:

3. Western adaptation of an Eastern well-being

approach
Multiple forms of mindfulness practice (formal and informal)
Hassed (2010):
Best known: Mindfulness
Based Stress Reduction (MBSR)
o 8 wks of 1-2hr
group
sessions
-Attention
trainingwith trained instructor; daily practice
in-between
-Cognitive technique
o Shown to be effective with decreasing psychological suffering of
pain patients,
increasingregulation
well-being,(Iand
-Emotional
am decreasing
angry vs I amill-being
experiencing anger)

Components of Mindfulness

-Non-judgmental attitude

Components of Mindfulness
Hassed (2010): -Metacognitive awareness
o Attention training
(being in the moment,
o Cognitive technique
reflective)
o Emotional regulation
(e.g. I am angry
vs. I am experiencing anger)
o Non-judgmental attitude
o Metacognitive awareness (e.g. being in the Model of underlying mechanisms: Shapiro et al. (2005)
moment, reflective)
Loving Kindness Meditation (LKM)
o People intentionally cultivate warm and
caring feelings (in both mind and body), and
direct them toward themselves and others
o Work-place wellness program: LKM vs. waitlist control
o 60min weekly sessions during lunch hour:
group meditation followed by
discussion and instruction
homework of daily meditation

Resource = inc. mindfulness, social support, purpose in life; dec. illn

Resource = inc. mindfulness, social support, purpose in life; dec. illness symptoms.

Evaluation: Seems promising as an approach to improve well-being

across the psychological health continuum
Further rigorous research required
Originally seen to be helpful in preventing relapse in
depression
Now more merged with mainstream approaches e.g. MBCT
(CBT + M)
Interesting research on benefits
for university students (study)

4. Further cognitive-behavioural approaches

Motivational Interviewing: a collaborative,
person-centred form of guiding to elicit and
strengthen motivation for change effective for
addictions
Acceptance Commitment Therapy (ACT):
Dialectical Behaviour Therapy (DBT):
Particular emphasis on mindfulness and
acceptance without the demands of
meditation practice, integrated into CBT
approach.
Originally designed to treat borderline personality disorder (BPD).
BPD
Now used for BPD, anxiety disorders, impulse control, eating disorders,
depression, anger, drug and alcohol misuse and complex comorbid
conditions. For adults and adolescents
Emphasis on acceptance of the person they are combined with
expectation that current behaviours need to change
Tension that arises between the need for both acceptance and change =
dialectical tension
o Dialectics: finding the middle ground between two opposites
5. Positive psychology approaches
Positive psychology: the study of the conditions and processes that
contribute to the flourishing or optimal functioning of people, groups and
institutions

..
Positive Psychology Interventions (PPIs)
PPIs: intentional activities or treatments designed to cultivate positive
feelings, behaviours or cognitions (and consequently, well-being)

PPIs may be relevant to everyone

PPIs can work at the level of the individual, group, organization, or society
Do PPIs increase well-being?
o Sin & Lyubomirsky (2009)
o Outlines some of the common PPIs e.g. active-constructive
responding, writing gratitude letters, replaying positive experiences,
practicing optimistic thinking
o Provides a meta-analysis, identifying factors which contribute most
to positive outcomes (i.e. boosting well-being, decreasing
depression)
o Notes limitations of review
Lyubomirsky & Layous (2013)
Positive activities
increase
wellbeing by
increasing
positive
emotions,
positive thoughts,
positive
behaviours, and
need satisfaction,
which in turn
increase
happiness.

The effect of
positive activities
on wellbeing is
moderated by
features of
positive activities
(eg dosage and
variety), features
of persons (eg
their motivation
and effort),
and personactivity fit.

Single,Lyubomirsky,
individualized
strategies or multi-faceted, whole-of-organisation
S., & Layous, K. (2013). How do simple positive activities increase well-being? Current Directions in Psychological Science, 22, 57-62.
approaches e.g. Geelong Grammar

Positive psychology: Too simplistic?

E.g. many situations involve motivational conflict
E.g. positive emotions may be both the consequence and antecedent of
adaptive goal-directed behaviour
Need theories that take into account motivational factors
E.g. Sheldons Self-concordant Model of Healthy Goal Striving
o Self-concordance: goal is consistent with
ones values and interests
o Sheldon & Houser-Marko (2001): an upward
spiral exists such that goal attainment
leads to even more goal attainment,
increased self-development and adjustment,
and thus well-being
o Goals can play a role in changing oneself
because:
Goals help guide identity
development and achieved goals
help solidify identity
One can be intentional in selfdevelopment by the goals they set
and pursue
Criticism of upward spiral: Should
include realistic goal-setting & achievement

Well-being: Philosophical and psychological approaches

Measures of well-being
Criticisms:
o Subjective measures only although correlated with psychological
and physical health. How to objectively measure well-being?
o Ignores motivational processes; mixes up processes and outcomes
A Motivational Approach
Deci & Ryan: Well-being is the result of satisfaction of the psychological
needs of autonomy, relatedness and competence
o Autonomy: sense of choice & volition in regulation of behaviour
o Competence: sense of efficacy one has with respect to both
internal and external environments
o Relatedness: feeling connected to and cared about by others
Intrinsic vs. extrinsic motivation; Sheldons model
Another (developing) motivational approach based on Sheldon, Bandura
and ACT
All underlying goals and actions are VALUES
Values (should) guide the formulation of short, medium and long-term
goals meaningful goals
To increase the chances of achieving our goals, we need to know the best
strategies e.g. time management & goal prioritization, SMART goals,
asking for help when needed
Intentionally acting on those strategies is likely to result in goal
achievement, although it is adaptive to have backup
plans/strategies/goals, learn from mistakes & know when to accept
Goal achievement:
o Results in satisfaction and positive feelings, and a sense of wellbeing
o Leads to the consolidation of ones identity as a successful role
e.g. student, partner, employee
o Leads to increased self-efficacy to take the first step towards
achieving the next meaningful goal = upward spiral

Model of Goals and Well-being (Cranney, Morris et al., in prep)