This is the Chapter 15 of the book Psychopathology (Davey, G. C., 2021). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Ch. 15: Neurocognitive disorders

• Disorders have psychological (experiences that give rise to problematic ways of thinking and behaving and may cause distress and form the basis for diagnosable psychopathologies)
• Neurocognitive disorders have their origins in damage or abnormalities in the biological substrates that underlie thinking and behaving
  
  • They are biological as they are identified as biochemical imbalances in the brain and nervous system or direct or indirect damage to brain tissue
• Rehabilitation programmes:
  
  • 1. Restoring previously affected cognitive and behavioural functions
  • 2. Helping to develop new skills to replace those that have been lost as a result of tissue damage
  • 3. Providing skills and advice to help them structure their living environment in a way that will help them to accommodate changes in cognitive and behavioural abilities

The Diagnosis and Assessment of Neurocognitive Disorders

Cognitive Impairments in Neurocognitive Disorders

Learning and memory deficits

• Amnesia: common feature of many neurocognitive disorders
  • Anterograde amnesia: when neurological condition caused by a specific traumatic event --> unable to recall anything after the injury

Deficits in attention and arousal

Language deficits

• Aphasias: language deficits. Most common feature of neurocognitive disorders. It can take many forms:
  • Inability to comprehend or repeat speech accurately and correctly
  • Fluent aphasia: production of incoherent, jumbled speech
  • Non-fluent aphasia: inability to initiate speech or respond to speech with anything other than simple words
  • Broca’s aphasia: disruption of the ability to speak, consisting of difficulties with word ordering, finding the right word and articulation --> associated with damage to the left frontal lobe
  • Wernicke’s aphasia: deficit in the comprehension of speech, involving difficulties in recognising spoken words and converting thoughts into words --> associated with damage to regions behind the frontal lobes

Deficits in visual-perceptual functioning

• Agnosia: unable to recognize everyday objects, persons, sounds, shapes or smells while the specific sense is not defective and there is no significant memory loss

Motor skills deficits

• Apraxia: loss of the ability to execute or carry out learnt (familiar) movements, despite having the desire and the physical ability to perform the movements

Deficits in executive functions

• Prefrontal cortex: brain area important in maintaining representations of goals and the means to achieve them
• Wisconsin card sorting task: test of executive functioning where individuals must sort cards for a number of trials using one rule (e.g. colour) and then sort cards using a different rule (e.g. shape)

This is the Chapter 1 of the book Psychological Diagnostics in Health Care (Luteijn & Barelds, 2019). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

The Diagnostic Process

Introduction

• Clinical psychodiagnostics: professional activity based on 3 elements  
  • 1. The problems/complains and problematic behaviour
  • 2. Operationalization and its subsequent measurements
  • 3. The application of relevant diagnostic methods

Steps in the diagnostic process

• Diagnostician analyses client’s request for help and the referrer’s request, and formulates question questions that arise during the first meeting
• Diagnostician will construct a provisional theory about the client, which describes what the problems are and how they can be explained
  
  • Testing this theory requires:
    
    • 1. Converting the provisional theory into concrete hypothesis
    • 2. Selecting set of research tools which can either support or reject the formulated hypothesis
    • 3. Making predictions about the results or outcomes from this set of tools, to give a clear indication as to when the hypotheses should be accepted/rejected
    • 4. Applying and processing instruments
    • 5. On the basis of the results --> hypotheses accepted/rejected --> results in the diagnostic conclusion

Five basic questions in clinical psychodiagnostics

• 1. Recognition: What are the problems; what works and what doesn’t?
• 2. Explanation: Why do certain problems exist and what perpetuates them?
• 3. Prediction: How will client’s problems subsequently develop in the future?
• 4. Indication: How can the problems be resolved?
• 5. Evaluation: Have the problems been resolved as a result of the intervention?

Recognition

• To understand the problem, the diagnostician identifies:
  • Complaints
  • Adequate behaviour of the client
• Recognition includes:
  
  • Inventory and description
  • Organization and categorization in dysfunctional behaviour clusters or disorders
  • Examination of the seriousness of the problem behavior
• Types recognition:
  
  • Criterion-oriented measurement: recognition as a result of comparison to a predefined standard
  • Normative measurement: comparison to a representative comparison group
  • Ipsative measurement: comparison to the individual himself (e.g. to the individual at a previous point in time)
• Classification: clinical picture is assigned to a class of problems (e.g. DSM categories)
  
  • All-or-nothing principle: when client assigned to category
  • More-or-less principle: client is given a profile of scores for a number of dimensions (e.g. dimensions of personality tests)
• Diagnostic formulation: focuses on the individual and his own unique clinical picture
  
  • Whereas classification leads to labelling, diagnostic formulation allows do the uniqueness of the individual

Explanation

• Answers the question of why there

This is the Chapter 2 of the book Psychological Diagnostics in Health Care (Luteijn & Barelds, 2019). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Diagnostic quality

Introduction

• Diagnostic process described as an indictive-deductive process
• Diagnostic quality will be discussed with the following diagnostic components:
  
  • 1. Frames of reference in diagnostic
  • 2. Explanation of these frameworks in models
  • 3. Tests

Quality requirements for frames of reference, models and tests

• Psychodiagnostics defined as:
  • A. Diagnostic frames of reference or theories
  • B. Explanation of fames of reference in test theory models and statistical models
  • C. Tests
• Frames of references:
  
  • 1. Individual differences: based on the principle that we can understand or explain behaviour by examining individual differences.
  • 2. Development: assumed that we can understand/explain behaviour by studying development over time
  • 3. Context: behaviour can only be understood/explained if it is changed or perpetuated by causes (e.g. manipulatable social context)

The quality of the frames of reference

• Frames of reference determine the way in which practices are described, understood and explained and consequently determine the diagnosis and treatment.
• Van der Werff (2000)’s frames of reference with regard to personality criteria:
  
  • 1. Have the elements and relations from the theory been tested?
  • 2. Is the theory written in such a way that examination is possible?
  • 3. Is the theory inspiration for empirical research?
  • 4. Has research been conducted into the practical applications of the theory and what was the result of this research?
• We use Van der Werf's criteria to evaluate the frames of reference

“Van der Werff considers the trait approach, biopsychology and orthodox social learning theories to be the best”

• Trait approach: led to a wide range of reliable and valid intelligence tests and personality tests
• Biopsychology approach: Even though this has been called a reductionist framework, is has been successful in changing behaviour, cognition and emotion.
• The social learning theories: success designing of effective interventions. The client is regarded as an outcome of his perceived reinforcement history
  
  • 1. Determine the behaviour that is to be influenced
  • 2. Construct relevant measurement
  • 3. Choose an experimental design
  • 4. Establish a success criterion

“Van der Werff considers a large part of the psychoanalytic, humanistic and existential psychology to be 'substandard'. The ideas cannot always be verified and empirical research is lacking. […] its scientific status is poor, even if it is 'widespread and there are many therapeutic applications”

• Psychoanalysis: not one of the best approaches, as research is scarce and inconclusive --> however,

This is the Chapter 1 of the book Psychopathology (Davey, G. C., 2021). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Introduction to Psychopathology: Concepts, Paradigms, and Stigma

Introduction

• Psychopathology: thinking and behaving that seem to deviate from normal or everyday modes of functioning and cause distress to those exhibiting these behaviours
• Clinical psychology: branch of psychology responsible for understanding and treating psychopathology
• Mental health problems do not conceive of them as disorders or illnesses, but as a product of perfectly healthy psychological processes in response to stressful or extreme life experiences

Brief History of Psychopathology

• Demonic possession: historical explanations of psychopathology
  • Changes in personality or behaviour are some of the first symptoms that are noticed --> historically people tended to describe those symptoms as being ‘possessed’ in some way
  • Exorcising these spirits involved physical attacks on the sufferer’s body --> the effect was increasing distress and suffering of the victim
• Medical model: explanation of psychopathology in terms of underlying biological or medical causes
• Asylums: hospices of the confinement of individuals with mental health problems
  
  • Philippe Pinel: considered to be the first to introduce more human treatment sin asylums
    
    • Moral treatment: approach to the treatment of asylum inmates, pioneered by the Quaker movement in the UK, in favour of understanding, hope, moral responsibility, and occupational therapy
  • Social breakdown syndrome: inpatients diagnosed with mental health problems developed confrontational and challenging behaviour, physical aggressiveness, and lack of interest in personal welfare and hygiene
  • Milieu therapies: first attempts at structuring the hospital environment for patients, creating a therapeutic community that would develop productivity, independence, responsibility, and feelings of self-respect
    
    • “Patients exposed to milieu therapy were more likely to be discharged from hospital sooner and less likely to relapse” (Cumming & Cumming, 1962)
  • Token economy: programmes based on operant reinforcement --> patients would receive tokens (rewards) for emitting desired behaviours, and tokens could subsequently be exchanged for a variety of rewards
    
    • Despite apparent success, use has been in decline, due to legal and ethical difficulties of withholding desired materials
  • Community Mental Health Act (1963): specified rather than treated in hospitals, people with mental health problems had the right to receive a broad range of services in their communities, including outpatient therapy, emergency care, preventative care, and after-care.

The Medical or Disease Model

• Middle 17^th century: religious, spiritual, and superstitious explanations of psychopathology were replaced for more objective, medical explanations
• Psychiatry: approach to identify the biological causes of psychopathology and treat them with medication or surgery
• Implication medical model for the current view of

This is the Chapter 2.1 of the book Psychopathology (Davey, G. C., 2021). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Classification and Assessment in Clinical Psychology

Discussion of the range of assessment techniques available to clinicians

Classifying Psychopathology

• Classification & Categorisation
  • Help to understand how different causes relate to different symptoms
  • Provide a common language for reporting and monitoring mental health problems
  • Are based on clusters of symptoms

Development of Classification Systems

• Emil Kraepelin: 1^st person to develop comprehensive classification system. Suggested that psychopathology could be classified according to cause, and could be described as a set of symptoms called syndrome
• International list of causes of death (ICD): involved an extensive system for classifying psychopathology developed by WHO --> DSM is an extended version by APA

Diagnostic and Statistical Manual (DSM)

• DSM system:
  • Provides definition for mental health emphasizing on distress (chronic experience of pain or distressing emotions) and disability (distress can lead to impairment in one or more areas of functioning)
  • Objectives:
    
    • 1. Provide necessary and sufficient criteria for correct differential diagnosis
    • 2. Provide means of distinguishing ‘true’ psychopathology from non-disordered human conditions
    • 3. Provide diagnostic criteria that allows them to be applied systematically by different clinicians in different settings
    • 4. Diagnostic criteria theoretically neutral --> they do not favour one theoretical approach over another
  • What it offers:
    
    • Essential features of the disorder --> those that define the disorder
    • Associated features --> those that are usually, but not always, present
    • Diagnostic criteria --> list of symptoms that must be present for diagnostic label
    • Differential diagnosis --> to differentiate a disorder from another

Problems with classification

• 1.  Classificatin based on symptoms can be problematic (e.g. psychopathologies that look the same but have different causes and require different forms of treatment)
• 2. Can be stigmatising and harmful
• 3. Mental health problems might be dimensional rather than discrete entities
• 4. Describes different categories of disorders --> comorbidity: co-occurrence of two or more distinct psychological disorders
  
  • The frequency of comorbidity suggests that disorders might not be independent discreate disorders but may represent symptoms of:
    
    • Hybrid disorders: disorders that contain elements of a number of different disorders
    • Disorder spectrum: higher-order categorical class of symptoms

DSM-5:

• Changes that it entails:
  • 1. Reduced the number of criteria necessary to establish diagnostic
    • Has been a problematic issue, and future DSM should stick to well defined mental disorders

This is the Chapter 4 of the book Psychological Diagnostics in Health Care (Luteijn & Barelds, 2019). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Ch.4: Behavioural Observation

Introduction:

• Van de Sande (1986): observation of the client's behaviour is perception, with the intention to draw conclusions
• Celestin-Westreich and Celestin (2017) defined observation as gathering information about:
  
  • others, with whom a person communicates either directly or indirectly
  • relationships and situations, in which a person is either involved or not involved;
  • the person himself (self-observation).
• Rating scale: written behavioural examination that draws on psychological knowledge (evaluation) --> e.g. client's medical history, intake interview and clinical interview are elements of a rating scale'
• Observation scale: written behavioural examination that draws on observation (findings)
• Observation instrument: instruments within which the actual observation takes place in a structured manner --> e.g. Health of the Nation Outcome Scales (HoNOS) and the Psychopathy Checklist-Revised (PCL-R)

Unstandardized observation

• Observation is not standardized --> be easily influenced by a variety of processes that disrupt the perception and information processing
  • Sources of errors:
    • Leniency effect: tendency to rate friends and acquaintances more positively on certain traits
    • Halo effect: examine all traits in the direction of a general impression, instead of an isolated impression
    • Logic error: tendency to pass similar judgments on traits that seem to be logically linked, although, in reality, the traits are detached from one another
    • Contrast error: tendency to judge a certain trait in a person against that same trait in others
    • Primacy and recency effects: tendency to attach greater weight to the nrst or, conversely, the last observation
    • Tendency to mostly give average scores and to avoid making extreme judgment
    • Actor-observer phenomenon: people’s tendency to contribute the cause of their own behaviour to external, situational factors, while attribute behaviour of others to their stable traits/personality traits
  • To rule out the likelihood of the influence of such observer biases --> important to provide psychologists with behaviour-oriented training
• Heuristics (on the context of observation)
  
  • 1. Availability: immediate availability of certain memories
  • 2. First impression: people's tendency to hold on to their first impression, even when there is additional information that contradicts the initial impression.

Standardized observation

• The rise of behavioural therapy has played a particularly important role

Content of the observations

Selectivity

• Observation is carried out within the framework of a particular question and this question determines which behaviours are of interest.

Molar vs molecular

• Once the content of the observation has been established, a distinction needs to be made

This is the Chapter 16 of the book Psychopathology (Davey, G. C., 2021). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Childhood and Adolescent Psychological problems

• Organised into 2 broad domains based on behavioural characteristics
  • Externalising disorders: outwardly directed behaviour problems (e.g. aggressiveness, hyperactivity, noncompliance, or impulsivity)
  • Internalising disorders: inward-looking and withdrawn behaviours (e.g. separation anxiety, generalised anxiety disorder (GAD), and major depressive disorder)

Diagnostic and prevalence

Difficulties associated with diagnosis

• Diagnosis dependent on individual being able to communicate with practitioners their experience of distress --> many children are unable to communicate clearly, as they lack self-knowledge
• Childhood/early adolescence developmental changes occur rapidly --> psychological problems can escalate quickly and dramatically

Childhood psychopathology as the precursor of adult psychopathology

• Childhood adversity:
  • Within family: maternal depression, family financial stress, parental conflict, family anger, maternal role overload, negative parenting
    • Parental mental health problems and household dysfunction affect two out of every three children by the age of 18
    • Childhood maltreatment doubles risk of mental health problems in adulthood
  • Severe stress during childhood --> affect expression of genes that would help to regulate mental health
• Developmental psychopathology: maps how early childhood experiences may act as risk factors for future psychological disorders and attempts to describe pathways by which early experiences may generate adult pathologies

Disruptive behaviour problems

E.g. attention deficit hyperactivity (ADHD) and conduct disorder

ADHD

• Persistent pattern of inattention and/or hyperactivity-impulsivity
• Hyperactivity: excessive fidgetiness and not remaining seater
• Impulsivity: impatience, difficulty in appropriately delaying responses, interrupting others, desire for immediate rewards over delayed rewards

Diagnosis of ADHD

• DSM-5 diagnostic criteria:
  • Impairment present before 12 years of age
  • Found in two or more contexts
  • Two diagnosis subtypes
    
    • ADHD predominantly inattentive presentation
    • ADHD predominantly hyperactive/impulsive presentation  
    • Comorbid presentation: when both elements are present

Prevalence:

DSM-5 estimates around 5% of school-age children and 2.5% of adults worldwide

• More common in boys than in girls
• Rates of ADHD have increased dramatically --> from  7.9% in 2003 to 11.0% in 2011

The consequences of ADHD

• Disruptive consequences of ADHD behaviour --> family members often view it as intentional and irresponsible --> can cause resentment within family
• Predominantly inattentive: suffer most in terms of academic achievement
• Predominantly hyperactivity/impulsivity: suffer most in terms of peer rejection and accidental injury

Aetiology of ADHD

Psychological an biological causes

Biological factors

This is the Chapter 12 of the book Psychopathology (Davey, G. C., 2021). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Personality Disorders (PD)

• Personality: global term describes how you cope with, adapt to, and respond to a range of life events, including challenges, frustrations, opportunities, successes, and failures. Inward experience that is outwardly projected
• DSM-5 personality disorder:
  
  • Enduring pattern of inner experience and behaviour that deviates markedly from expectations of the individual’s culture
  • Pervasive and inflexible
  • Onset in adolescence/early adulthood
  • Stable over time, and leads to distress and impairment

Contemporary issues in diagnosis of PD

• DSM-5 grouped personality disorders:
  • Cluster A: characteristics that resemble schizophrenia without loss of touch with reality nor experiencing hallucinations (e.g. paranoid personality disorder, schizotypal personality disorder, schizoid personality disorder)
  • Cluster B: dramatic/emotional personality disorder --> tend to be erratic in their behaviours, self-interested to the detriment of others (e.g. antisocial personality disorder (APD), borderline personality disorder (BPD), histrionic personality disorder)
  • Cluster C: exhibit anxious and fearful behaviour. Comorbid with some anxiety disorders (e.g. avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder)

Problems with Categorical model

• PD do not exists as ‘categories’ --> they are in fact dimensional extensions of ‘normal’ personality traits
• Why all-or-none approach does not fit:
  
  • 1. PD may not be disorders as such but simply represent extreme cases on conventional personality disorders 
  • 2. PD have characteristics that overlap --> high comorbidity
  • 3. Studies suggests that as many as half of individuals diagnosed with personality disorder, do not receive same diagnosis 2 years later

DSM-5 alternative model

• 3 personality ratings designed to provide ratings of individual’s personality on a series of personality dimensions
  • Level of personality functioning: disturbances in self and interpersonal functioning predict presence of PD, with the severity of impairment indicating whether individual has more than one personality disorder
    • Pathological personality traits: impairment in personality functioning
  • Personality disorder types: six PD traits
  • Personality trait domains: five personality trait domains covering negative affectivity, detachment, antagonism, disinhibition, and psychoticism
• DSM-5 criteria for general PD:
  
  • Rigid patterns of thought and behaviour that is significantly different from expectations of the person’s culture, displaying manifestations in:
    
    • Cognition
    • Affectivity
    • Interpersonal functioning
    • Impulse control
  • Pattern is constant and long lasting and can be traced back to adolescence/early childhood

Personality disorders and their diagnosis

Only when personality traits are inflexible and maladaptive and cause significant functional impairment/distress are they diagnosed as personality

This is the Chapter 8 of the book Psychological Diagnostics in Health Care (Luteijn & Barelds, 2019). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Personality questionnaires

• Personality: more or less refers to a person's stable traits. These traits are fairly consistent across different situations and explain why one person differs from another

Characteristics and principles of personality questionnaires

• When constructing a personality questionnaire:
  • 1. Formulating the construct
  • 2. The underlying test theory
  • 3. Items are checked to see whether they meet stylistic and formal criteria (Luteijn, 1974)
    
    • Items contain less than 20 words
    • Language is clear and simple
    • Double negatives are avoided
    • Content of item should be unambiguous
    • Item focuses on single topic
    • Item that can be confirmed by almost everyone or almost nobody should be avoided
• Scale construction: items are grouped together by adhering to the following criteria
  
  • 1. A priori or rational method: combination of items that measure the same trait, a method that is based on expert judgment and not on empirical research
  • 2. Internal consistency method: items combined on the basis of an empirically derived structure/relation --> structure of items determined by:
    
    • Inter-item correlation
    • Item-rest correlation
    • Facor analysis: grouping items on the basis of the correlations between them
    • --> Disadvantage: structure is not derived from theory/model, is data dependent
  • 3. Empirical method: identify items that make a distinction between test groups --> these are then combined in one scale (e.g. In the case of extraversion, the only items would be included in an extraversion scale would be those for which answers given by group of extroverts differ significantly from non-extroverts)
    
    • --> Disadvantage: leads to heterogeneous series of items, theoretically difficult to interpret
  • Combining the 3 methods of scale construction is advisable and is an option frequently chosen
    
    • (E.g. if a questionnaire contains an extraversion scale that has been constructed in accordance with the a priori a priory method, a factor analysis or confirmatory factor analysis may be carried out at a later stage, during which we would hope to find one extraversion factor. In addition, we could remove the items in the extraversion scale that do not discriminate between groups of extraverts and introverts)
• Item Response Theory (IRT): attempts to explain relationship between laten traits and theory manifestation
• When the scales have been constructed, the psychometric quality must be determined on the basis of reliability and validity studies
  
  • When determining validity, the following peculiarities occur
    
    • Inventory perspective or correspondence perspective: assumed that answers to

This is the Chapter 6 of the book Psychological Diagnostics in Health Care (Luteijn & Barelds, 2019). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Intelligence and intelligence tests

• Definition & History:
  • Binet and Simon: developed a test for mapping out different intellectual functions --> consisted of items that increased in difficulty --> considered to be the first intelligence test --> also known as Stanford-Binet test
  • Stern (1912): intelligence measure involved determining the ratio between mental age and the chronological age --> intelligence quotient (IQ)
• Theories:
  
  • Spearman: assumed there was something like a general intelligence (called g) which mainly explained person’s performance on intellectual tests
    
    • Also founder of factor analysis
  • Cattell-horn-carroll theory (CHC theory): hierarchically structured including
    
    • Stratum III: includes g
      
      • Fluid intelligence (gf): ability to use inductive reasoning --> more sensitive to disruptive factors
      • Crystallized intelligence (gc): verbal ability --> remains relatively unaffected by disruptive factors (e.g. age, brain damage)
    • Stratum II: contains broad cognitive abilities
    • Stratum I: distinguishes between large number of specific cognitive abilities
  • Hebb (1942): classified intelligence on the basis of his observations of brain-damaged patients
    
    • Inelligence A: biological capacity for solving problems
    • Intelligence B: culturally determined
  • Monozygotic/dizygotic twins studies: the majority of intelligence has a genetic basis, and less than fifty percent of intelligence is determined by the environment

Measurements of intelligence

• General intelligence test: consist of a number of subtests to assess specific intellectual skills, containing verbal, spatial, numerical and abstract items
  • A person’s final performance on an intelligence test is compared with performance of a group of peer and is expressed in a standard score: IQ

Intelligence tests:

Includes most famous tests in the Netherlands

• Wechsler Adult Intelligence Scale-lV (WAIS-/V-NL): raw scores are converted to scaled scores on the basis of age-related norms
• Second version of the Groningen Intelligence Test: normed using a nationwide sample, divided into age groups. Norms don’t correct for gender
  
  • Vocabulary: measures verbal comprehension and verbal knowledge
  • Puzzles: measures spatial abilities
  • Sailing instructions: measures ability to reason logically with numbers
  • Sorting: measures ability to reason logically with shapes
  • Figure discovery: measures an aspect of perceptual intelligence
  • Doing sums: subjects must draw on his numerical ability
  • Rotating cards: measures spatial representation
  • Matrices: measures ability to reason logically with verbal materials
  • Word enumeration: measures the fluidity of association and verbal fluency
• Kaufman Adolescent and Adult Intelligence Test (KAIT):
  
  • Crystallized intelligence -->

This is the Chapter 4 of the Handbook of Insomnia (Taylor et al., 2014). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Ch.4 – Treating insomnia

Lifestyle adjustments

• Avoid exercise, large meals, excessive fluids, nicotine and alcohol within 2 hours of bedtime; avoid caffeine within 6 hours of bedtime; and create a sleep environment that is cool, dark, quiet, and comfortable.
  • Sleep hygiene
  • Psycho-educational lifestyle -->  Lifestyle adjustments are often crucial for successful treatment and prevention of insomnia

Behavioural therapy

• Often combined with sleep education, sleep hygiene, and cognitive intervantions
• Effective treatment, with positive long-term outcomes

Stimulus control

• Based on the theory that insomnia is perpetuated by repeated association of the bedroom with poor sleep, as well as worrying, planning, or recreation --> patients are therefore told to use the bed only for sleep in an attempt to extinguish the maladaptive associations
• Common stimulus control instructions:
  
  • Step 1: do not use the bed or bedroom for anything but sleep (or sex)
  • Step 2: go to bed only when ready to sleep
  • Step 3: leave the bed and do something in another room if sleep onset is greater than 15 minutes
  • Step 4: return to bed only when feeling a strong sleep urge
  • Step 5: if you do not fall asleep quickly upon returning to bed, start over at Step 3 as many times as is necessary
  • Step 6: use an alarm to awaken at the same time every morning; and
  • Step 7: do not nap during the day

Sleep restriction

• Based on the theory that people who develop acute insomnia cope by spending too much time in bed --> patients are, therefore, told to reduce total time in bed to more accurately reflect the amount of time they spent sleeping on a typical night
• Sleep compression: reduction in time in bed is done incrementally --> decrease patient anxiety about losing sleep

Relaxation therapy

• Based on the theory that people with insomnia have elevated levels of physiological and mental arousal that can inhibit sleep --> patients are taught relaxation procedures that they can practice on their own to counteract this (e.g. progressive muscle relaxation [PMR])

Cognitive therapy

• Posits that patients with insomnia tend to ‘over focus’ on sleep and have distorted beliefs about sleep and its impact on daytime performance
  • For example, patients can develop negative, sleep-related thought patterns related to their frustration over their inability to sleep, over focus on well popularized ideals (e.g. “I need 8 hours of sleep, because that’s the amount everyone needs”), and concerns about the impact of sleep on health
  • Sometimes

This is the Chapter 1 of the Handbook of Insomnia (Taylor et al., 2014). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Ch:1 -- Clinical features of insomnia

Chronic, clinically significant insomnia is found in 10% of the population

Definition

• Insomnia: difficulty in initiating or maintaining sleep at least three nights per week for at least three months, accompanied by impaired daytime functioning --> often precipitated by stress or a mental disorder, but usually evolves into an independent, self-sustaining problem
• Insomnia burden:
  
  • Greater functional disability
  • Greater healthcare utilization
  • Experience more injuries
  • Experience an increased incidence of depression and anxiety
• Risk factors:
  
  • Most common in women and older adults
  • Patients with anxious and worry-prone personality types
  • Increased arousal predisposition
  • Emotional suppression
  • Noise, light, intemperate and uncomfortable surroundings of the bedroom
  • Genetics may also act as a risk factor

Clinical presentation and symptoms of insomnia

• Sleep-onset insomnia: difficulty with falling asleep
• Sleep maintenance insomnia: waking up in the middle of the night and having difficulty returning back to sleep
• Terminal insomnia or early morning awakenings: waking up early in the morning and not being able to return to sleep 
• However, in the majority of cases, patients report that their insomnia affects more than one portion of the night. Over time, an individual’s pattern of insomnia can also change

Classification

• DSM-5: requires complaints of poor sleep + associated daytime impairment -->  sleep disturbance must occur on average at least three times per week for at least 3 months
• ICSD-3: similar to DSM-5 criteria -->  same frequency, duration, and opportunity standards
  
  • Added a qualifier to account for instances when insomnia is a by-product of another sleep disorder
  • Added 3 symptoms of impaired function that do not appear in DSM-5
    
    • Daytime sleepiness
    • Proneness for errors and accidents
    • Worries about or dissatisfaction with sleep

This is the Chapter 3 of the Therapist's guide to Positive Psychological Interventions (Magyar-Moe, 2009). Which is content for the exam of the Theory component of Module 5 (Mental Health) of the University of Twente, in the Netherlands

Positive Psychological tests and Measures

Values in action inventory of character strengths

• The Values in Action Inventory of Character Strengths (VIA-IS): popular strengths measure --> similar to the DSM, as it provides important information and a common lexicon for therapists to use in describing strengths
  • It provides:
    • Information such as ways to assess and apply each strength
    • Interventions that foster the strengths
    • Theoretical and research underpinnings of the strengths
    • The known correlates and consequences of the strengths
    • How the strengths develop and manifest across the life span
    • Gender differences, and cross-cultural aspects of the strengths

Cultural Considerations of the VIA-IS

The measure should always be interpreted within the broader context of the lives of the clients who complete the measure

• Strengths are not universal -->  culture and individual differences must always be considered
  • E.g. The VIA-IS includes only optimism as a strength, thereby leading one to conclude that pessimism is a weakness --> research suggest that there is a type of pessimism, called defensive pessimism, that works very well for some people --> in this context ‘pessimism’ should be seen as a strength
• Context of client’s life
  
  • E.g. A client who is struggling in school because he is spending more time making jokes and teasing his classmates than he is paying attention to his teacher may have humour and playfulness come up as a top strength on the VIA-IS. However, in this context, humour and playfulness are not serving him well and therefore not working as a strength for him

Clifton strengths finder

• The Clifton StrengthsFinder 2.0 (CSF 2.0): measure personal talents, developed based upon semi-structured interviews. Through the interview data, the 34 talent themes were identified
• A resource book to accompanies it --> highly useful for helping clients to develop ways to implement their talents in their daily lives
• Upon completion --> clients receive a report on:
  
  • Their top five talent themes
  • 10 ideas for putting each of their top five talent themes into action
  • A “strength-based action plan” for designing and implementing short and long-term goals for utilizing talents building strengths

Positive and negative affect schedule

• The Positive and Negative Affect Schedule (PANAS): useful tool for tracking changes in positive and negative emotion as they engage in day-to-day life
  • The scale is sensitive to momentary changes in affect

Satisfaction with life scale

• The Satisfaction with Life Scale: utilized