Promoting Psychological Wellbeing in Children and Families

Bruce Kirkcaldy

• Publisher: Palgrave Macmillan
• Year: 2015
• ISBN:
  9781137479969
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Psychology's contribution to health research and clinical practice continues to grow at a phenomenal pace. In this book a global and multidisciplinary selection of outstanding academics and clinicians focus on the psychological well-being and positive health of both children and families in order to 'depathologise' mental disorders.

1

Introduction – Enhancing Mental Health and Psychological Well-Being

Bruce Kirkcaldy

Over the last century (1900–2000), there have been significant improvements in medical health care. For the US and most European countries, the infant mortality rate has dropped from 140 deaths per 1000 to 5.8 deaths per 1000. Crude mortality rates have halved and people are living 30 years longer on average, for example, from 47 years in 1900 to 78 years in 2000 (Centers for Disease Control and Prevention (CDCP), 1999; Hicks & Allen, 1999). Several ailments no longer have potentially lethal consequences, for example, tuberculosis, gastroenteritis, and diphtheria. Looking back further, Blagosklonny (2010) reported that three centuries ago ‘life expectancy was less than 16 years and 75% of people born in London in 1662 died before they reached the age of 26 (Graunt’s life table)’. Causes of death among the young were less related to age diseases as they are today but rather occurred through starvation, violence, and epidemics (e.g., smallpox, cholera, tuberculosis).

What about psychological health? What are the rates of psychological disorders in the general population and what evidence, if any, is there that they have changed over the last decades? In a large cross-cultural survey of European nations (Alonso et al., 2004), the prevalence rate of a lifetime history of mood disorders was 14%, of anxiety disorders 13.6%, and alcohol disorders 5.2%. A meta-analysis a year later showed that 27% of adult Europeans are or will have been affected by at least one major mental disorder during the previous 12 months, with the most likely being anxiety, depressive, somatoform, and substance dependence disorders.

Christensen and coworkers (2012) estimated that one in ten children between the ages of 5 and 16 years has a clinically diagnosable mental health problem, one-half of which are conduct disorders, followed closely by anxiety, depression, and severe attention-deficit disorders. One-half of those with lifetime mental illness issues will display symptoms by the age of 14 years and three-quarters before their mid-20s. Moreover, self-harming behaviour among the young is fairly common (10–13% of 15–16-year-olds). Of children and adolescents between 11 and 16 years of age, those exhibiting an emotional disorder are more likely to smoke, drink, and use drugs. Young persons in prison are 18 times more likely to commit suicide.

Some researchers suggested that, over the last decades, a marked increase has been observed in the incidence of mental illnesses. For example, there has been a reported fourfold increase in suicides in the years after the economic crisis in 2007, with 10,000 more suicides being observed in North America and Europe. Others have argued that the observation of higher rates of mental ill-health in the population may simply be a product of better screening and identification methods.

A third intriguing explanation is that the construct of mental illness/health changes over time and, depending on its definition, more or fewer individuals will be ‘inflicted’. Psychiatric diagnosis has been a ‘guild monopoly’ of the American Psychiatric Association, although psychiatrists constitute only 7% of all mental health clinicians and ‘experts in clinical care, epidemiology, health economics, forensics and public health’ (Frances, 2013, p. 219) have been ignored. Frances (2013) used the term diagnosis inflation to refer to the substantial increase in the number of children being diagnosed as suffering from attention-deficit disorder, bipolar disorder, and autism. He argued that the over-diagnosis coupled with overenthusiastic drug company marketing strategies implies that significant numbers of the population will be wrongly prescribed medications (e.g., antidepressants, anxiolytics, sleeping pills, analgesics), leading to ‘a society of pill poppers’. He reported that expenditures on antipsychotics tripled and on antidepressants quadrupled from 1988 to 2008, with 80% prescribed by primary care physicians.

Contemporary research (e.g., Heitler, 2012) indicated that psychotherapy is effective and that the average effect sizes are larger than those of medication for ameliorating adverse negative affect such as anxiety, depression, and anger. Psychotherapy has also been found to reduce physical and emotional disability, death rates, and psychiatric hospitalizations, as well as to improve functioning at work. The American Psychological Association (Nordal, 2010) observed that the percentage of persons in outpatient mental health care had remained approximately the same over the last decade (3.2–3.4%) but the pattern of care had changed. Yet, there has been a decrease in the use of psychotherapy alone or indeed psychotherapy combined with medication, but a dramatic increase in medication alone. In 2008, 57.4% received solely medication. More particularly, there was a marked increase in the prescription of psychotropic medications (e.g., antipsychotics) among children and adolescents. Further, research has seriously questioned the appropriateness of widespread use of antidepressants for children and youth.

There has been a paradigm shift in mental illness treatment, with dramatic improvements with the application of cognitive behavioural therapy, and developments in acceptance and commitment therapy and mindfulness training. Added to this has been the recognition of emotional intelligence and social skills training in the educational context to promote psychological wellbeing. This edited volume is an attempt to address these issues. The constituent chapters of the book offer insightful and creative approaches to the treatment of families, children, and adolescents in promoting a culture of improved psychological wellbeing and mental health relying on the empirically demonstrable psychotherapeutic tools available. This collection of essays is an attempt to bridge theoretical and research concepts and findings with clinical practice, adopting interdisciplinary and cross-cultural perspectives. It reveals determinants and other factors that are implicated in the effectiveness of health promotion and therapeutic interventions as well as in the identification of reliable diagnostic and health programmes and/or the enhancement of learning and teaching programmes. Over the last few decades, we have witnessed advancement in psychological models of health – incorporating biological, psychological, and sociocultural factors – which stand in contrast to the traditional medical model of illness, which we address in this book.

The opening chapter (2) by Adrian Furnham and Bruce Kirkcaldy focuses on personal, lay ideas, models, and theories of health as opposed to formal scientific models. There is not necessarily any clear consensus with respect to the scientific model: A biomedical approach in medicine assumes that ill-health and disease are directly and exclusively caused by physical and biological diseases and their specific pathological processes. Wade and Halligan (2004) claim that biomedical models of illness that have dominated medicine for the last century seem deficient in explaining both psychological and physical disorders, as they stem ‘partly from three assumptions: all illness has a single underlying cause, disease (pathology) is always the single cause, and removal or attenuation of the disease will result in a return to health’ (p. 1398). Overall, the evidence for the medical model is sorely lacking. The biopsychosocial approach, on the other hand, suggests we best understand chronic conditions by also considering the patient, his or her physical condition, the social context of both, and the health care system.

The biomedical approach represents an essentially reductionist and sometimes exclusionist concept. It underlines a biological rather than a clinical approach, which is more inter-disciplinary and promotes wholeness. Such a biopsychosocial model emphasizes the indissoluble nature of the mind–body link in contrast to clinical practice, which is nearly always dualistic. We know that somato-psychic and psychosomatic illness calls for drugs and counselling. According to the biopsychosocial model, the healthy process occurs for three reasons: the self-healing properties of the body; the patient–doctor relationships; and the medicines and treatments prescribed. Subsequently, medical health professionals generally offer cognitive, emotional, and pharmaceutical care.

Consistent with the idea of elaborating on a paradigm shift in mental health, Ahmed Hankir and Dinesh Bhugra provide a brief introduction to the traditional medical model concept of symptom reduction as central to psychiatry and go on to explore disease versus illness and explanatory models. The authors suggest a broader focus than what traditional psychiatry has pursued, shifting from the focus of symptom removal (elimination of symptoms, diagnosis, and classification) towards concepts associated with improved social functioning. They emphasize the need for medical health professionals to familiarize themselves with sociology and anthropology to gain a better understanding of the social context from which our patients originate. This chapter offers succinct and creative openings for mental health care in the future and identifies challenges and possible solutions.

There then follows a contribution from Carmel Cefai and Valeria Cavioni, which underlines the value of educational psychology’s contribution to emotional and social skill training within the school setting. The rapid global social, economic, and technological changes taking place in the adult world today are exposing children to unprecedented pressures and challenges at a young and vulnerable age. As many as 20% of schoolchildren experience mental health problems during the course of any given year and may need the use of mental health services; this may increase to 50% among children coming from socially disadvantaged areas such as urban regions (Adelman & Taylor, 2010). According to the 2001 US Surgeon General’s Report on Mental Health, 11% of children have significant functional impairment and 5% have extreme impairment, constituting a significant economic burden on the country’s resources, including health and social services.

The current interest in positive education and resilience education underlines the shift towards a broad-based, holistic conceptualization of child development and education, a proactive approach to the promotion of growth, health, and wellbeing. It is making us rethink the objectives of education and the role of schools as primary settings for health promotion. While one may argue that schools are not therapeutic centres and that teachers are not psychologists or mental health workers, Chapter 4 will describe the role schools may have in promoting the mental health and wellbeing of children and youth. It presents a mental health promotion framework for schools, depathologizing mental health and positioning the classroom teacher as an effective and caring educator in both academic and social and emotional learning. It focuses on prevention and universal interventions for all schoolchildren in mental health and wellbeing, while providing targeted interventions for children at risk of, or experiencing, mental health problems. This perspective is clearly different from interventions simply targeting students experiencing social, emotional, and behaviour difficulties, though the latter are not excluded. Besides promoting health and wellbeing, universal interventions often lead to a reduction in multiple problem areas in children, particularly at a time when their personality is still developing and serious behaviour problems are not yet manifest. At the same time, they are accompanied by complementary targeted interventions, thus having an additive, reinforcing effect.

A final contribution in this first section (‘Understanding Mental Health. A Shift in Paradigm’) of the book is Peter Breggin’s personal contribution titled ‘Shame, Guilt, and Anxiety’ drawn on a long career in psychiatry. He removes the clouds that surround the origins of guilt, shame, and anxiety to show how these processes developed during our biological evolution as nature’s way of inhibiting wilfulness and violence in close relationships. For millions of years, humans have evolved as both the most violent and the most sociable creatures on Earth. Human survival depended on its unique combination of ferocity and cooperation, enabling small bands to bring down and butcher creatures much larger than modern elephants.

However, if humans routinely unleashed violence when frustrated in their close personal relations, the human branch of evolution would have been short-lived. Natural selection came to the rescue by favouring the survival and propagation of individuals born with emotional inhibitions against unleashing violence in their closest relationships. This is the origin and function of our negative legacy emotions of guilt, shame, and anxiety, namely, to protect ourselves from each other within the family and also the clan or tribe. Negative legacy emotions are primitive in that they developed during biological evolution before the advent of culture and because they are triggered in early childhood before mature judgement or ethics. They are prehistoric in that they developed before recorded history and were triggered before we can remember in early childhood. Even if we can recall some of the early events associated with the development of our guilt, shame, and anxiety, it is but the tip of the iceberg of biological evolution and childhood.

Understanding the source of negative legacy emotions allows us to identify them and to reject them as guidelines for our conduct. It also helps us realize that, while we may feel guilty, ashamed or anxious, it has nothing to do with our real value or with the actual merit of our thoughts or actions. This realization enables us to let go of these self-defeating emotions while we learn to guide our adult lives with reason, sound principles, and love.

The second section of the volume (‘Children and Adolescents’) makes a transition to applying some of these ideas into work with children and adolescents. Mark Holder and Robyn Weninger, Canadian psychologists, examining many areas of research from psychology, education, and medicine, have emphasized identifying and treating deficits and dysfunction. Although this approach has proved valuable, it does not exhaust the range of the human experiences and behaviours that researchers should investigate. In addition to deficits and dysfunction, it is important to understand human strengths and what contributes to humans’ thriving. The past two decades have witnessed the active development of a complementary approach to cataloguing and correcting illness. This approach, now referred to as positive psychology, is focused on wellbeing instead of on ill-being. New studies are reporting the correlates of happiness, hope, and life satisfaction. This research has identified some of the factors associated with children’s wellbeing (e.g., friends, spirituality, physical activity). This identification represents only the initial stage of understanding children’s positive wellbeing, including their happiness. The next and critical stage of research is to use the recent research findings to develop and assess strategies and interventions to encourage enduring enhancements of children’s positive wellbeing. The present chapter first reviews some of the relevant research on children’s wellbeing. The authors then suggest several possible interventions based on these research findings, which investigators need to replicate in terms of their potential efficacy in enhancing children’s positive wellbeing.

Over the last decade, the third wave of behavioural therapy, acceptance and commitment therapy (ACT), has stimulated much interest both in clinical practice and in research endeavours. Two of the pioneers in this area are the Australian psychologists, Louise Hayes and Joseph Ciarrochi, who use contextual behavioural processes to promote vitality among children and adolescents. They argue that young people are on a social and emotional journey of discovery, perhaps one of the most profound journeys of human life. ACT is a revolutionary approach that can promote wellbeing and fulfilment on this journey. Numerous published studies have shown that ACT is useful in treating clinical problems such as anxiety, depression, eating disorders, and addiction. As a broad science of human psychology, ACT is also effective for dealing with school-based teaching issues such as education, managing stress, promoting wellbeing, thriving, health, and performance. ACT is founded on a comprehensive model of human adaptation and change called contextual behavioural science. This model views the challenges of young people functionally, by seeing them as adaptations to context rather than deviations from the norm. ACT brings to light how the traps of language, culture, and social norms influence our suffering and, in this way, we approach these struggles from a paradigm of normality rather than deficit. ACT helps young people to overcome unhelpful mental habits and self-doubt, live more fully in the present moment, and make choices that help them to reach their potential. This chapter provides an overview of this practical theory using a flexible intervention model that can harness young people’s energy in multiple settings. ACT can bring vitality into a young person’s life, promote growth, compassion, and connection, and help young people develop resilience.

There then follows a German contribution (Chapter 8) from Axel Schölmerich and his colleagues Birgit Leyendecker and Alexandru Agache. Child wellbeing indicators as used in international comparisons (UNICEF, OECD) are highly aggregated measures. Typically, the proportions of cohorts with certain characteristics are reported (e.g., teenage pregnancies, smoking, children living in poverty). Much less attention is given to positive development, for example, the 5C model (competence, character, confidence, connection, and caring) measurable through the assessment of developmental achievements (e.g., language development, social–emotional maturity). With existing large-scale data sets (e.g., SOEP ‘German Socioeconomic Panel’, and FID ‘Familien in Deutschland’ in Germany), such indicators can be obtained, which offer a window on individual development. If relationships between such indicators are studied longitudinally and/or the influence of contextual variables is of interest, the measurement model is of particular relevance. Measurement equivalence of combined indicators at the configural, metric, and scalar levels needs to be estimated. This chapter summarizes research with existing indicators from international comparisons and reports age-appropriate indicators based on SOEP and FID data. The authors go on to suggest several important take-home messages for mental health professionals.

Kathleen Ares, Lisa Kuhns, Nisha Dogra, and Niranjan Karnik next examine child mental health and risk behaviour over time. The authors begin by exploring the normative role of risk-taking in the development of children establishing peer relationships. They then consider the ways that aetiological factors increase risk due to trauma, environment, and individual characteristics. In the course of examining aetiological patterns, they specifically explore family breakdown, substance misuse, and mental health, as well as community violence and risk, as components of this complex environmental influence. Next the authors explore the counter force of resiliency and the ways that special talents, family and peers, and early interventions may mitigate risk behaviours. They close by outlining specific pathways for risk development including substance use, self-harm/borderline personality, sexual risk, and criminality/anti-sociality.

Alexander Antoniou, Eftyhia Mitsopoulou, and George Chrousos, Greek psychologists, next provide a comprehensive examination of the research literature on psychosocial factors related to suicidal behaviour in adolescents. Suicide rates are the second most common cause of death in young people globally. Psychiatric, psychological, social, and cultural factors, as well as genetic vulnerability, play an important role in suicide and self-harm in general. The rates of suicidal ideation and suicide attempts increase dramatically during adolescence, making it a critical period when potential aetiological factors such as chronic stress should be investigated. Both life event stress and chronic stress significantly predict suicidal ideation and suicide attempts. Evidence exists linking high levels of stress and poor problem-solving skills with high levels of suicidal ideation among inpatient adolescents. Moreover, studies confirm an increased link between suicidal behaviours (thoughts, plans, acts) and posttraumatic stress disorder (PTSD). Psychological factors, particularly psychological distress, are among the most importa...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Figures and Tables
• Notes on Contributors
• 1. Introduction – Enhancing Mental Health and Psychological Well-Being
• 2. Lay People’s Knowledge of Mental and Physical Illness
• 3. A Paradigm Shift: Social Functioning Rather Than Symptom Reduction
• 4. Mental Health Promotion in School: An Integrated, School-Based, Whole School
• 5. Understanding and Overcoming Guilt, Shame, and Anxiety: Based on the Theory of Negative Legacy Emotions
• 6. Understanding and Enhancing the Subjective Well-Being of Children
• 7. Using Acceptance and Commitment Therapy to Help Young People Develop and Grow to Their Full Potential
• 8. Child Well-Being: Indicators and Measurement
• 9. Child Mental Health and Risk Behaviour Over Time
• 10. Psychosocial Factors and Suicidal Behaviour in Adolescents
• 11. It Takes a Global Village: Internet-Delivered Interventions Supporting Children and Their Families
• 12. Becoming Invisible: The Effect of Triangulation on Children’s Well-Being
• 13. Special Education in the Complex Institutional Environment of Health Care and Social Work – Structural Frame and Empirical Reality
• 14. Parental Acceptance and Children’s Psychological Adjustment
• 15. Rehearsals! for Growth: Enhancing Family Well-Being Through Dramatic Play
• 16. Trauma and Development: Holistic/Systems-Developmental Theory and Practice
• 17. Relationships Between Grandparents and Their Grandchildren: An Applied Dyadic Perspective
• 18. The Psychology of Possibilities: Extending the Limits of Human Functioning
• Index