>>>PART 1<<< SLIDE 4 This unit will cover some fundamental concepts that underpin psychology, and specifically clinical psychology. You will also find a series of lectures on key mental illnesses, which will also uncover some common misconceptions. We will also evaluate our own beliefs and behaviours around mental health. The topics will at times be challenging, but it should be a rewarding process, and most importantly I hope that you learn a lot! So, what will the session look like? And what topics will be covered? Firstly, by way of super brief orientation, this unit consists of a series of learning modules, each containing a lecture component -such as this- and then starting from module 2, a live tutorial component, facilitated by the teaching team. The tutorial is further supported by pre-tutorial activities, which you should aim to complete (at least a first draft) before coming to class. SLIDE 5 Modules 1-5 of the unit will involve a discussion of health behaviours, teaching you behaviour change techniques and introducing you to psychological interventions applied to illness. The specific topics will include: > an introduction to health and psychology, which will be the focal of the current lecture > specific applications of psychology in understanding health enhancing and health risk behaviours > foundational models of health and illness - some of this will be introduced in this lecture, but will be the core focus of later discussion > in addition we will be looking at aspects of changing behaviour, which is a key goal of health psychology > and so related to this, we will also look at topics of psychological and health interventions SLIDE 6 The next broad segment of modules will introduce you to different mental illnesses, and consider both how these illnesses are treated and why it is important for health care professionals to be able to identify the presentation of these illnesses within their patients. Core topics in these lectures will cover > the approach to abnormality in Psychology > anxiety Disorders and Stress > mood disorders > eating disorders and addictions > personality disorders and schizophrenia SLIDE 7 And then in the final 2 weeks, we shift back to Health psychology as we examine Psychological aspects of injury and pain, as well as the Psychology of the patient. What is not made explicit in the lecture topics as outlined here, is that through the unit you will be equipped with the skills to become a critical thinker. There are many places we find information about our health (Dr Google, for example). I am sure that you have found this has happened to you, when the information your GP gives you is different to what the specialist has provided you or what you have found on the internet or even what a friend has told you. Who or what do you trust? Due to the cognitive biases, and other processes that affect us all, it is easy to fall into traps of non-critical thinking. At the end of the day, the one who has to make the decisions about your medical care, is you – you as a patient. And so, developing the skills of critical thinking can help to make better decisions about our health and wellness. More than that, it will help us better support other people if we end up in a role where our decisions might affect other people! Critical thinking is not only about common sense, it is about looking at the evidence and deciding whether that evidence is good, whether the data supports its conclusions, whether that data is reliable, and how that information fits with the rest of the information available. Indeed, a key part of the main assessment will be testing how effectively you can apply critical thinking skills when evaluating research and evidence around a health topic. SLIDE 8 On that note, let’s briefly go through your assessment tasks for this unit, just so you know what excitement lies ahead. SLIDE 9 The workbook assessment task is based on your responses to a set of activities and questions – these are intended to be part of your pre-tutorial activities, and will help to develop your understanding of the lecture content, as well as prepare you for the work involved in the tutorials. You can then further develop your answers after the tutorial, and/or after further reading and thinking. Fundamentally, this assessment is designed to encourage consistent work on the material being learned in this unit, through ongoing reflection and critical evaluation of key module concepts. The activities will be submitted at two points in the session, with details of the modules to include outlined on the learning site. From the portfolio of work, one will be selected for detailed evaluation, but all activities will be scanned for completion. Importantly, the two submissions will be marked separately, so both weighted at 15%, and both given 500 words. To be clear, the word limit is based on a single activity, not the whole document. This may seem like a lot of work, but please note that the activity work supports understanding of the module topics, which feeds into the tutorial experience, and helps to prepare for the quiz assessment task as well! SLIDE 10 The quiz assessment will test your understanding and comprehension of content covered in the lectures and readings Each quiz will have two attempts available, with 30 randomly selected MCQ in each attempt. Your highest mark in each attempt will be recorded for that Quiz, and then each quiz will contribute 15% to your final grade. SLIDE 11 Lastly, the main written assessment task for the unit is a 1,200 word report that critically evaluates psychological literature as it relates to a selected health topic. Your task is to collect and evaluate the current research surrounding psychological interventions for a selected illness (from a set list of options). These illnesses are typically perceived of as having ‘physical’ or ‘biological’ causes, but in each, psychology has a key role for management or treatment. OK, that’s it for the brief overview, from here we will move on to cover the key concepts of Psychology and Health. SLIDE 12 Very often in everyday life we can overlook the complex dynamic between the physical and the psychological. This unit will be diving into this complexity to develop a more comprehensive and effective way of being in the world. Let’s start with an example. Let’s say you start uni and you are very stressed because you are finding time management very difficult. You don’t know how to effectively cope with this situation. So in order to cope with that stress you overeat. Two years pass by and you have gained 30 kilograms and are now in the obese range and have mild diabetes. The doctor treats your diabetes with metformin, the diabetes is controlled. But you still continue to gain weight, because after you finish uni you realise that working is also very stressful for which you have few coping strategies. We can see that this isn’t solely a psychological or a health issue but a combination of both! But let’s break it down and look at these factors individually for now. SLIDE 13 Psychology is the scientific study of the human mind and its functions, especially those affecting behaviour. Although this unit covers fundamental aspects of psychology in general, we can also separate this into 2 distinct fields – these are, health psychology and clinical psychology. Health psychology is the study of psychological and behavioural processes in health, illness, and healthcare. Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction, and to promote subjective well-being and personal development. SLIDE 14 Psychology is a science, which means that it uses evidence and critical inquiry to: Describe, explain, predict, and where possible, intervene to control or modify behavioural and mental processes… Psychology as a discipline touches on many areas of life, and we really can only scratch the surface in a unit like this, although we will hopefully provide some good depth in key topics. If you do have the feeling that you want to know more, then I would recommend taking additional psychology electives, or even to pursue a psych degree because: As an important caveat, no introductory unit can enable anyone to safely or effectively diagnose or treat someone with mental illness. The knowledge and skills you develop will help to lay the foundations for this ability, and will promote your sensitivity to issues around mental illness, but this is only a first step on the path to further understanding. I also recognise that some subjects will be discussed only superficially – this is frustrating for some students, but is the nature of an introductory subject. If you find yourself impassioned about specialist areas, then that may be an indication for you to pursue that in further study. SLIDE 15 It is no mere hyperbole to say that everything in life relates to psychology! Fundamentally, there is a deep interrelation between thoughts, feelings and behaviours that can inform all experience. For example, let’s take the notion that University is stressful and demanding! This might be associated with thoughts, like: assessment requirements are unclear, I have to read so many articles, and I have so many deadlines to juggle! These thoughts might contribute to emotions, like: stress, guilt, shame, or anxiety And it might result in behaviours, such as: worry, avoidance, or overcompensation (like pulling all nighters to catch up on weeks of work) In contrast to this, we can shift negative patterns by implementing effective behaviours, and encouraging or rewarding steps that produce better outcomes. For example, we can make lists of priorities and goals, define a study and assessment schedule, plan ahead of time, and reward achievements to reinforce positive emotions. OK, so that is a very brief introduction to what psychology is, now let’s turn to the specific area of clinical psychology. SLIDE 16 Clinical psychology is a branch of psychology, primarily involved with understanding abnormal behaviour through psychological assessment and diagnosis. Clinical psychologists have training in the assessment and diagnosis of major mental illnesses and psychological problems. Through their training, clinical psychologists are qualified to provide expert opinion in clinical and compensation areas. Of course, flowing from this is a focus on Treatment! Clinical psychologists are trained in the delivery of a range of techniques and therapies with demonstrated effectiveness in treating mental health disorders. They hold particular skills for applying psychological theory and scientific research to solve complex clinical psychology problems requiring individually tailored interventions. Finally, research, teaching and evaluation are all integral to the role of clinical psychologists. Research is often conducted on prevention, diagnosis, assessment and treatment. Clinical psychologists are involved in the design and implementation of treatment strategies in various settings (such as primary care, psychiatric and rehabilitation) and in the subsequent evaluation of treatment outcomes. SLIDE 17 In this brief orientation to clinical psychology, it’s worth noting upfront that we can’t talk about “the cause” of mental illness, because there is such a complex interrelation between thoughts, feelings and behaviour – and of course the underlying physiological and genetic structures, and wider social and cultural forces. Still, we do have some useful models for understanding this complexity, with the biopsychosocial model probably standing at the forefront. We’ll pick this up a bit later. For now we’ll move on to a brief introduction of health. But before that, I wanted to note that early intervention is key – if you find yourself concerned about signs or symptoms of mental illness, please do not hesitate to seek support, either through university student services, or your own private support network. SLIDE 18 Rather than giving a definition of health right from the start, take a moment to consider what YOU understand as health? Do you have a solid definition for it? Or is it a vague sense of wellness in the background of your mind? We might all have different notions of what constitutes health, so let’s start with the most basic question… SLIDE 19 What makes someone healthy? When you think of someone in your life who you consider healthy, what concepts or factors did you consider to be most important? Is it mostly their physical status, like capacity for movement and athleticism? Or is it resilience against getting sick? Or do you think about the foods they eat, or qualities like good sleep. Perhaps you think more in terms of general good humour, or emotional resilience in the face of life’s struggles. And of course, maybe you think more in terms of living a balanced life. In 1994, A study of 9003 individuals answered exactly these kinds of questions about health. About 15% could not think of anyone who was very healthy! And about 10% could not describe what it was like for themselves to feel healthy. Interestingly, for some people (especially evident in young males), the inability to describe what it is like to feel healthy was driven by the fact that health is an unexamined background condition that is simply present – it was so taken for granted that they could not put it into words. By comparison, others (mostly older women) could not answer what it feels like to be healthy for the opposite reason – that is, they had been in poor health for so long that they either could not remember what it was like to feel well, or were absolutely pessimistic about the chances of feeling well in future. In either case, it is worth thinking about the value of understanding health in more detail – being able to articulate characteristic of good health and wellbeing can support us in seeking more optimal ways of being. Of course, this is no easy task, but we can note that several categories of health emerged from this large survey study, including: > Health defined as being free from illness – e.g., I am not sick, therefore I am healthy > Health as a reserve – e.g. I recovered quickly, I am strong/healthy > Health as a behaviour – e.g., what you do, how you look after yourself > Health as physical fitness and vitality – e.g., feeling fit, being lively, having good social relationships. SLIDE 20 Capturing this complexity, the WHO defines health as being a: ‘State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’ What is not explicitly addressed in the WHO definition of health are the socio-economic and the cultural influences on health, illness and health decisions. These factors can have far reaching impacts on our health! Indeed, some literature suggests that additional factors need to be considered, such as: • Intellectual • Financial • Environmental • Occupational • Spiritual The WHO definition also does not explicitly acknowledge the active role of the cognitive, behavioural and affective processes which play a major role in the development and experience of health and illness. Throughout this unit we will return to questions of what defines health, what makes us healthy, and the behaviours that contribute or take away from these outcomes. >>>PART 2<<< SLIDE 1 SPLASH FRAME SLIDE 2 OK, we pick up in part 2 with an outline of a key model of health – the biopsychosocial model. By the way, we will consider more nuanced versions of this model in future lectures. However, let’s start off with the model that preceded it (and unfortunately in some areas, is still preferred) – the biomedical model. SLIDE 3 The biomedical model of medicine has been around since the mid-19th century as the predominant model used by physicians in diagnosing diseases. It has three core elements, in that disease, trauma or some health condition impinges on the normal state, this creates a disease state, which is then managed through medical intervention – and ideally returns one to a normal state. Importantly, according to the biomedical model, health is largely defined as freedom from disease, pain, or defect. The biomedical model of health tends to focus purely on biological factors, excluding psychological, environmental, and social influences. This is limited, but moreso it can even be problematic as it can misconstrue what health actually means to individuals. SLIDE 4 The biomedical model posits that mental disorders are brain diseases caused by neurotransmitter dysregulation, genetic anomalies, and defects in brain structure and function. and emphasises pharmacological treatment to target presumed biological abnormalities. You may even hear sayings as such: “Many illnesses previously defined as ‘mental’ are now recognised to have a biological cause.” OR “When you have depression, chemicals in your brain called neurotransmitters are out of balance. OR “…mental disorders appear to be disorders of brain circuits.” “[Mental disorders] are illnesses of an organ, the brain, just like coronary artery disease is a disease of the heart.” OR “Drug addiction is a disease of the human brain.” OR “Mental illnesses are biologically based brain disorders.” Neuroscience has undeniably revolutionised our understanding of the brain. There are many wellestablished biogenetic contributions to mental disorders (Panksepp, 2004), but genetics and neuroscience have not identified a biological cause for any psychological diagnoses. This is despite vast improvements in brain imaging techniques, molecular genetic testing, and the like. From a social point of view, such a model may do us more harm than good as it creates a culture of mental health diagnoses following a dogmatic treatment model of drugs and therapy. Additionally, it can devalue therapies that do not focus on medication. Our healthcare system should change the way it views mental health issues such as depression, taking into account that sadness and despair can be a normal human response to crisis and loss, and acknowledging that the world we live in is full of stress and uncertainty. Depression certainly can have devastating effects on people’s lives, but by homogenising such experience as mental illness, we run the risk of making it socially acceptable to medicate common human emotions. Ultimately, sensitivity to complex contextual factors and application of critical judgement and evaluation makes the strongest argument against a simplistic biomedical approach. SLIDE 5 The biopsychosocial approach was developed at Rochester decades ago by Drs. George Engel and John Romano. While traditional biomedical models of clinical medicine focus on pathophysiology and other biological approaches to disease, the biopsychosocial approach in our training programs emphasise the importance of understanding human health and illness in their fullest contexts. The biopsychosocial approach systematically considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. Flagging one of the later modules, considering the social aspect reveals the importance of effective patient practitioner interaction – something that is absolutely true both in mental health context and in any form of physical or medical therapeutic setting. SLIDE 6 In fact, despite the heavy focus on genetic factors and traditional medical care, behavioural factors have even more impact on health status than those two combined. An interesting example of this are in a group of people termed supercentenarians… SLIDE 7 These are people who live to over 100 years. Studies show that genetics actually make up a relatively small proportion of their longevity. Moreover, long-lived individuals have little in common with one another in terms of education, income, or profession. The similarities they do share, however, reflect their lifestyles — many are non-smokers, are not obese, and cope well with stress. Also, most are women. Because of their healthy habits, these older adults are less likely to develop age-related chronic diseases, such as high blood pressure, heart disease, cancer, and diabetes, than their same-age peers. The study of longevity genes is a developing science. It is estimated that about 25 percent of the variation in human life span is determined by genetics, but which genes, and how they contribute to longevity, are not yet well understood. SLIDE 8 Now that we have developed some ideas around health and psychology, let’s move on to the question of what is health psychology…? SLIDE 9 It may be no revelation to say that health psychology is an interdisciplinary field concerned with the application of psychological knowledge and techniques to health, illness, and health care. However, it does cover all the bases! There is rapid growth in this field, which can be attributed to: > The increasing awareness of the vast amounts of illness and mortality that are determined by behaviour; > A strengthening of the ideology in western societies that individuals are responsible for their own health; > A disenchantment with traditional biomedical health care SLIDE 10 The main goals of health psychology (derived from Matarazzo’s 1982 definition) are to develop our understanding of the biopsychosocial factors involved in: > Promotion and maintenance of health > Improving health care systems and health policy > Prevention and treatment of illness > Causes of illness, e.g. vulnerability/risk factors. This is evidently a broad area and requires input from a range of multidisciplinary researchers, clinicians, and educators, as well as politicians, policy makers, and other individuals and groups involved in public health. SLIDE 11 For example, does anyone recognise this “Swap it, Don’t Stop It” campaign? It’s a bit dated now (launched in 2011), so don’t worry too much if you don’t recognise it! The Australian Government launched this campaign to encourage overweight Australians to take steps to reduce their waistline. Swap It, Don’t Stop It was part of a staged plan to encourage overweight Australians to engage in more physical activity, and it followed an initial awareness phase intended to promote knowledge of the link between an increased waistline and chronic diseases such as type 2 diabetes, cardiovascular disease and some cancers. This kind of staged plan leverages psychological principles to promote health behaviour, and demonstrates the kind of inter-disciplinary effort that goes into health promotion. SLIDE 12 We now come to the final section of the lecture, and given the broad base of students who take this unit, possibly a question that is in the back of many of your minds… How is this unit relevant to you? SLIDE 13 In most, if not all areas of professional and academic life – and especially in the human and health sciences, we are dealing with people and all their complex thoughts, feelings, emotions and behaviour. Taking a snapshot of health science, we can view it as the broad discipline of applied science which deals with human and animal health. There are two parts to health science: the study, research, and knowledge of health, and the application of that knowledge to improve health, cure diseases, and understand how humans and animals function. This definition aligns very closely with the role of health psychology. But even if we were to separate out the different roles of health science and health psychology, it is crucial to understand that every illness is multidimensional! Stress for example is both a psychological and physiological response. Similarly, having an injury or suffering a physical ailment can have impacts on psychological wellbeing, leading for instance to depression or anxiety. What’s more, we must always consider that individuals may have more than one diagnosis – obesity can be strongly comorbid with depression, phobia or anxiety may co-occur with OCD, and even seemingly unrelated ailments, such as hives and anxiety, or tinnitus and schizophrenia! Of course, you may well be studying a pathway that will never be involved with diagnosis and treatment of mental or physical problems. Even so, the core learning in this unit develops skills of critical inquiry. Yes, this is applied to our understanding of health and wellness, but also to understanding important concepts like normality and abnormality, sensitivity to individual context, behavioural change techniques. There are many more possible applications to individual discipline areas, I hope that you will explore these in the upcoming semester, especially when tutorials commence and we have the opportunity for more lively discussion! SLIDE 14 This brings us towards the end of this intro lecture. The modules to come will cover the core topics introduced here in more detail, as well as diving into selected focal topics. In essence you may think of this unit as an introduction to clinical health psychology, a specialised area that investigates and implements clinical services across diverse populations and settings to promote health and well-being; and to prevent, treat and manage illness and disability. Clinical health psychology has evolved as a specialty area of knowledge and practice with foundations in health psychology, the field of psychology that addresses the interactions of psychological, social, cultural and biological factors as they relate to health and well-being across diverse populations and settings. SLIDE 15 I appreciate that we are very early on in semester, and for many of you this will be a continuation of your first year of study – things are still likely to be new and potentially confusing. Let’s look at the key ways to find help and support in this unit. SLIDE 16 First and foremost, the unit vUWS site hosts a range of resources you can turn to for support. Most importantly, the Learning Guide outlines all of the essential information you need to get started in the unit. Please ensure that you read through this carefully in your first week of study. The Discussion board is also a great tool to get involved and get support – conversations there can help to support understanding for everyone in the unit, so don’t be shy about sharing! Aside from this, you can contact the Unit Coordinator via email, which may be preferred if your questions require some sensitivity or confidentiality. And where needed zoom consultations may be arranged. Lastly, your tutor is there to support and guide you in-class – however, please be mindful that they are not able to engage with you outside of that time. As a final note, if you need helps or assistance beyond this unit, please know that the university offers a variety of student support services, which you can explore from the WSU website. I’ll leave you now with the warmest of wishes for an interesting, challenging, and most of all rewarding semester! Catch you next time!