PDH/PE STAGE 5 REVISION Mental Health
Table of Contents Table of Contents... starts page 3 Section 1: Mental Health... starts page 3 Section 2: Motivation... starts page 8 Section 3: Anxiety... starts page 12 Page 2 // 15
Section 1: Mental Health Section 1: Mental Health Alzheimer s disease is a progressive mental illness that results in communication blockage between nerve cells, disrupting brain function and corroding memory, Suicide is an intended self-inflicted injury that is fatal. Parasuicide is an attempted suicide that is not fatal and is often impulsive. 1. Defining Mental Health Mental health is the ability to accept yourself and others, adapt to and manage emotions, and deal with the demands and challenges you meet in life. Generally adolescents with good emotional and mental health will: be realistic about their strengths and weaknesses be responsible for their own behaviour avoid high-risk behaviours, such as drug taking, unsafe sexual behaviour and dangerous activities respect both their own needs and the needs of others be open minded and flexible be fun loving and able to relax alone and with others express their emotions in ways that do not hurt themselves and others put their talents and abilities to good use spend time to develop some good, worthwhile relationships Poor mental health, on the other hand, is a problem facing thousands of people. Almost everyone has periods of sadness, anxiety and anger; times when nothing is going right, but for most people these are short lived. However, if these problems last for weeks, months or years and begin to interfere with a person s daily activities and behaviour, that person could be suffering from a mental health problem or disorder. Adolescent mental health problems are increasingly causing concern. They are often identified when a young person s feeling, behaviours and thoughts cause distress to themselves and others. Young people aged between 18 and 24 years have the highest rates of mental disorders of any adult age group. Mental illness affects not only the individual, but also their family and friends and the community as a whole. There can be an increase in the risk of physical harm to the individual and an increase in drug use, which has serious implications for society as well as for the individual and their family. It is important to realise that mental illness, like a physical illness, can be managed and treated very successfully. Unfortunately, some people are reluctant to seek treatment for their problems because they feel embarrassed and ashamed for themselves or their family, or simply do not know where to go. 2. Nature of Mental Health Problems The impact of mental illness on people s level of health and wellbeing was underestimated until recently. Previously, the stigma and suspicion attached to the notion of mental illness have been barriers to the effective treatment and prevention of this widespread problem. Examples of mental health problems and mental disorders include depression, schizophrenia, personality disorder, major depression and post-traumatic stress disorder. These illnesses cause much suffering for those directly affected and often for their family/carers and social network. Page 3 // 15
Section 1: Mental Health Poor mental health in childhood and adolescence may underpin a lack of self-care in adulthood. Drug abuse, physical neglect and early pregnancy are examples of poor health choices that may result. Mental health disorders in children and young people are a strong indicator of poor mental health in adulthood. Mental disorders can be caused by a physical illness or an injury that affects the brain. Brain tumours, infections, chemical imbalances, exposure to drugs and toxins, or injuries result in brain damage. Research is ongoing into the effects of illegal drugs, especially marijuana and ecstasy, and their contribution to the onset of mental illnesses such as schizophrenia and depression. Disorders result from heredity, stress, emotional conflict, fear, ineffective coping skills and other conditions. They can be tied to disturbing events in childhood, such as abuse, serious illness or the traumatic death of a close relative. They can also be caused by a recent event such as divorce or economic hardship. There are two main categories of mental illness. Psychotic illnesses include conditions like schizophrenia and bipolar disorders. Non-psychotic illnesses include depression, anxiety and eating disorders. The most common mental illnesses adolescents face today are depression and disordered eating. Depression can vary from mild to severe and last from a few hours to years. An episode may occur only once or it can recur over many years. Depression usually results from an chemical imbalance in the rain and requires professional help. This problem is diagnosed as a depressive illness when it recurring and severe. This is a serious condition that requires treatment, as it is a strong risk factor for suicide. The symptoms include persistent sadness, inability to enjoy activities that used to be pleasurable, feelings of helplessness and hopelessness, reduced energy, poor concentration, inability to perform at school or works and major changes in eating and sleeping patterns. Treatment is readily available and will include medication, counselling and some lifestyle changes Eating disorders include both anorexia nervosa and bulimia nervosa. Anorexia involves the irrational fear of becoming obese and results in severe weight loss from self-induced starvation and excess exercise. These people will have a distorted view of their bodies, thinking they are fat when, in fact, they are very thin, sometimes to the point of almost looking like a skeleton. Bulimia involves cycles of overeating and some form of purging, or clearing of the digestive tract. People with bulimia tend to feel out of control where food is concerned. A wide range of physical health conditions result from bulimia, including serious heart conditions and kidney failure which can led to death. Both of these diseases can be treated successfully with counselling and medical intervention. Anxiety disorders are also fairly common in the community. This is a condition in which real or imagined fears are difficult to control. People with anxiety disorders often arrange their lives to avoid the situations that make them feel anxious or fearful. The most common anxiety disorders are phobias, obsessive-compulsive disorders and panic disorders. Page 4 // 15
Section 1: Mental Health 3. The Extent of Mental Illness in Australia The scope of mental illness in Australia was estimated in 1997 in the National Survey of Mental Health and Wellbeing as part of the National Mental Health Strategy. According to the survey: an estimated 18% of Australian adults had experienced the symptoms of a mental disorder in the 12 months prior to the survey one in five Australian adults will suffer a mental illness at some stage in their life women were more likely than men to have had symptoms of anxiety disorders men were more likely as women to have symptoms of substance use disorders young adults aged 18-24 years had the highest prevalence of mental disorder (27%), which could be related to high rates of substance abuse the prevalence of mental disorders decreased with age (except for mental disorders such as dementia and Alzheimer s disease, which have a high prevalence in the aged population) women were more likely than men to have mood disorders such as depression, particularly women aged 18-24 years More recent data were obtained by the Australian Bureau of Statistics for the 2004 National Health Survey. Some of the results are shown below. Note, however the respondents to this survey based responses to some degree on selfdiagnosis; that is, they had not necessarily been diagnosed with a mental health condition by a medical practitioner. About 2.1 million (one in ten) Australians said they suffering from a long-term mental or behavioural problem. By age group, this represented: 6.7% of children under 15 years 9.4% aged 15-17 years 12.3% aged 18-64 years 9.5% for persons aged 65 and over. About 19% of respondents aged over 18 years (about 2.9 million Australians) said that they used medication for mental wellbeing. This was common in females (23.9%) than males (14.3%) According to the Australian Institute of Health and Welfare (in Australia s Health 2006, page 97) around 13% of the disease burden in Australia in 2003 was due to mental ill health. It is a national priority area because of the extent of its impacts and because it is possible to reduce this impact through prevention and treatment. Page 5 // 15
Section 1: Mental Health 4. Suicide Suicide is an intended self-inflicted injury that is fatal. For the person that takes their life, suicide is a perceived solution to a seemingly unresolvable problem. Drugs or violence is usually involved in this premeditated act. Parasuicide is attempted suicide that is non-fatal; it is often impulsive and usually involves a drug overdose. The following profile is an overview of suicide in Australia: Suicide is now the leading cause of fatal injury in Australia, having overtaken motor vehicles in 1991. It accounted for 26% of all injury deaths in 2004. Australia has the highest rate of youth suicide recorded in industrialised countries, and suicide is the second main cause of death (after transport accidents) of people aged 15-24 years in this country (20% of deaths of 15-24 year olds). Suicide of intentional self-harm was the cause of death of 1661 males in 2004 (2.4% of all deaths). Rural male youths have significantly higher rates of suicide than those of urban youths. The male age groups with the highest rates of suicide are the 15-24 years age group and the group aged 75 years and over. Female deaths from suicide (437 in 2004) appear to have remained fairly stable over the past two decades. Yet, the data may not reflect the true situation. Women tend to favour non-violent forms of attempted suicide, which have an increased chance of discovery and effective intervention. In 2003-04, the highest rate of hospitalisations, due to intentional self-harm, were of females aged 15-19 (397 per 100,000). The rate for males of the same age was substantially lower (122 per 100,000) Risk Factors and Determinants of Suicide Suicide is a particularly complex problem. Many reasons for suicide have been suggested, including: Depression: possibly associated with perceived failures, difficulties in personal relationships, unemployment and family dysfunction among younger people. Mental illness: such as schizophrenia. Physical illness: such as terminal illnesses in the aged. Marginalisation of some groups: such as people in prison custody Social isolation Attempted suicide is considered to be a precursor to completed suicide, and thoughts of suicide (including an expression of intent) are a strong risk indicator for attempted suicide. Groups at risk of suicide include: people suffering chronic depression elderly people people with a physical illness, particularly a terminal illness alcoholics people who have made previous suicide attempts people who talk about ending their lives teenagers, particularly those for whom life seems to be worthless young gay and lesbian people. Page 6 // 15
Section 1: Mental Health 5. Depression Depression is one of the most common types of mental illness, and it is something that many people suffer from at some time in their lives. Depression is diagnosed according to a range of signs and symptoms. It is characterised by overwhelming feelings of sadness and despair, and can range in severity from mild depression to major depression. We all suffer from normal depressed moods throughout our lives. These moods occur as a result of negative experiences such as relationship breakdowns, loss of a loved one, or personal or work-related stress. We react to these negative experiences in a normal way by feeling sad, upset, angry, anxious or lethargic. Generally, though, we recover from these experiences. It is when these negative feelings persist that mild chronic depression may result. Mild depression is characterised by: chronic depressed mood poor self-esteem loss of interest decreased energy feelings of sadness low level of symptoms of major depression. Major depression is characterised by: feelings of despair and hopelessness loss of interest in life inability to feel pleasure loss of appetite or weight irritability or agitation insomnia feelings of guilt difficulties with decision poor concentration Depression can be triggered by a number of factors, both physical and psychological. These include: mental illness chemical changes within the brain drug and alcohol abuse life stresses such as loss of a loved one or work stress high anxiety negative experiences Often, major depression can occur without any triggering factors. People with major depression suffer unbearable misery, and are at risk of suicide. Statistics reveal that an estimated 25% of sufferers of major depression attempt suicide. Depression is a major health concern that is treatable. Because the symptoms are many and varied, it takes professional judgement to diagnose depression. Depression can be treated or prescribed antidepressants or psychological therapy. Page 7 // 15
Section 2: Motivation Section 2: Motivation motivation is an internal state that activates, direct and sustains behaviour towards achieving a particular goal. positive motivation occurs when an individual s performance is driven by previous reinforcing behaviours. negative motivation is characterised by an improvement in performance out of fear of the consequences of not performing to expectations. intrinsic motivation is motivation that comes from within the individual extrinsic motivation (or external motivation) occurs when the individual s internal state is modified by sources originating from outside the person. Motivational factors play an important role in performance at all levels of sporting rivalry. Each week in elite competition, we see individuals who appear to go beyond the discomforts of pain and fatigue to produce superior performances. No-one doubts the contribution of physical training to making the body capable of the performance, but motivation is the principal driving force that allows this to happen. Motivation is one of a number of mental abilities that can be enriched within individuals. Together with relaxation, arousal control and mental rehearsal, motivation provides a balanced mental package to support the physical, tactical and technical skills acquired through training. The extent to which we can harness and direct our mental abilities has a greater impact on performance consistency than any other factor. We know physical factors such as fatigue and injury directly affect performance; however, beyond these factors, the consistency with which we perform will be due to how we understand and cope with intangible mental elements such as feelings, drive, effort, determination and interest. The level of motivation we are able to achieve is affected by factors that include: Self-esteem that is, how, we feel about ourselves Expectation in terms of our personal goals The standard of competition The impact of environmental factors such as wind, rain and heat Spectator support specifically, our reaction to friends, peer and others whom we respect The state of the event that is, how close individuals or teams are to winning or losing The ability of a coach to motivate that is, to encourage individual players and the team as a whole. Motivation can be classified as either positive or negative motivation: 1. Positive Motivation Sports people commonly experience positive motivation, but the degree to which it is experienced varies immensely from one individual to another. It occurs when the athlete performs because they have received rewards for similar actions in the past, and they realise that continuing to perform as required will result in additional rewards. To a certain extent the athlete is conditioned to perform in expectation of the reward. Positive motivation relies on continual self-reinforcement and reinforcement by the coach, family, friends, spectators and media, for example. If the coaching situation varies and favourable reinforcement is diminished or not forthcoming, then the athlete s effort will be affected accordingly. To maintain high levels of positive motivation, coaches must continually strive to find unique ways of reinforcing the desired behaviour in the athlete. This may require techniques such as providing incentives, developing personal progress charts or perhaps, looking to others for Page 8 // 15
Section 2: Motivation reinforcement. Positive motivation can be further enhanced by recognising achievement, handling mistakes constructively, developing respect for athletes and taking the time to listen when they speak. Page 9 // 15
Section 2: Motivation 2. Negative Motivation Not all motivation is driven by previous gains from performance. In some cases, athletes may be inspired to perform more from a fear of the consequences of not performing than as a result of a motivated behaviour. This is referred to as negative motivation. A player may work hard on the hockey field to avoid, for example, being ridiculed at the end of the game. Persistent negative motivation can erode an athlete s self-esteem and self-confidence, particularly if the individual feels it is unwarranted. While some players may respond to negative motivation on an irregular basis, the general long-term effect can be the destruction of confidence, initiative and belief in oneself the reverse of what motivation is supposed to achieve. Positive motivation is more effective than negative motivation. The simplest way to develop positive motivation is to establish a gradual sequence of challenges for the athlete. Challenges are positive and motivating whereas threats are negative and destructive in the long term. Threats distract the athlete from the task, because the athlete is confronted with the consequences of failing and ultimately fear of being punished. Further, positive motivation is more sustainable. Some athletes may be responsive to negative motivation on particular occasions, but positive motivation is better on an ongoing basis. 3. Intrinsic Motivation A specific level of motivation can originate from either intrinsic or extrinsic sources. Intrinsic motivation is a selfpropelling force that encourages athletes to achieve because they have an interest in a task or activity and they enjoy learning and performing the movements. Some individuals are motivated by the need to become competent at the task for example, to be able to hit the ball further by increasing their technical proficiency. For these athletes, establishing competence in the process is sufficiently challenging in itself. They often chose activities that involve a contest, finding enjoyment in meeting the inherent demands of competition. This type of intrinsic motivation is referred to as task orientation. Studies reveal that most children and adolescents participate more as a result of internal motivation than other factors. The sport or activity provides a continuing source of enjoyment, sufficiently motivating the individual to sustain their effort and interest. 4. Extrinsic Motivation Although internal motivation is important for continued interest, extrinsic motivation may be necessary to help provide focus and lift athletes to the levels of which they are capable. External motivation arises from behaviours that result in some kind of reward for the effort. The reward could be in the form of financial remuneration, a trophy or even praise from the coach. Athletes most responsive to this type of motivation are keen to respond to challenges, to demonstrate their ability and to be appropriately rewarded. While the responsibility for motivation needs to be shared between the athlete and their coaches/parents/peers, sustained motivation relies much more on internal factors than on external factors. Athletes who practise in order to improve their performance are likely to stay motivated for longer than those who perform in order to gain rewards from external sources. A noticeable characteristic of high achievers is that they seek to match their physical and technical skill against others of similar ability, whereas lower achievers often select competitions in which they know they will be successful. Page 10 // 15
Section 2: Motivation Page 11 // 15
Section 3: Anxiety Section 3: Anxiety anxiety anxiety is a predominantly a psychological process characterised by fear or apprehension in anticipation of confronting a situation perceived to be potentially threatening. stress stress is the non-specific response of the body to a demand placed on it. arousal arousal is the level of anxiety before or during a performance. Anxiety is a complex emotion identified by various levels of agitation. At the extreme, it disrupts and unsettles behaviour by lowering the individual s concentration and affecting their muscular control. We experience various levels of anxiety throughout the day, but uncontrolled anxiety experienced in sport contributes to poorer performances. (It is sometimes described as choking.) Two types of anxiety have been identified: trait and state anxiety. 1. Trait Anxiety Trait anxiety refers to a general level of stress that is characteristic of each individual. It is evident in how we respond to daily situations, of which many are new and cause concern. What may prompt anxiety in one person may not generate any emotion in another. Trait anxiety varies according to how individuals have conditioned themselves to respond to and manage the stress. Increased levels of such anxiety can be controlled in most cases by the use of relaxation techniques such as progressive muscular relaxation. 2. State Anxiety State anxiety is more specific. It refers to a heightened pressure of distress in response to a particular situation. State anxiety can be evident when an athlete has to shoot a target or throw a basket, for example, when the risk of failure is high. It can contribute to a degree of physical and mental paralysis, preventing performance of a task that is otherwise a routine task and has been repeated many times in practice situations. As a preventative measure, some world champion golfers, for example, use the long putter to try to maintain control of their fine motor movements at times of appreciable stress. 3. Sources of Stress Stress is a normal part of everyday life. However, it is also very relevant to sport performance situations. Stress causes a unique body reaction with which we are all familiar, particularly in times of crisis. We feel stress building within us, produced by adrenaline (a stimulant hormone), which readies the body for action. It is characterised by: Increased blood supply to skeletal muscles. More oxygen to lungs. Increased glucose production to provide extra fuel. Increased sweat production to cool the body. Tightened muscles to prepare the body for action. Stress can be real or imagined. Being chased by a dog, for example, is a real stress when it actually happens. All the body reactions outlined above will intensify. However, thinking about the same situation or sporting situations that cause concern will also cause stress. The body will react to a perceived situation as if it is real because the mind, in responding neurologically to situations, does not differentiate between the real and imagined experience. Just thinking about something that may make us uncomfortable such as missing a match-winning goal in a grand final, going to the dentist or travelling in planes can bring about symptoms such as an increased heart rate and sweating. Page 12 // 15
Section 3: Anxiety However, stress is a personal attribute. It depends on predisposition that is, how each person perceives the stressors as a result of their genetic make-up and learned coping mechanisms. This will reflect: past experience routines expectations the amount of support the frequency of similar occurrences Factors that produce stress are called stressors. In real life these can develop from: lack of sufficient income family problems an inability to get along with others illness and misadventure However in practice and competitive sporting environments, they can develop from: Personal pressure: that is, individual pressure imposed by the desire to win, achieve or fulfil goals. Competition pressure: that is, pressure exerted by opponents on the field of play Social pressure: that is, pressure from coaches, parents, peers and others who are held in esteem by the athlete. *Physical pressure: that is, the pressure of having to perform learned skills under the demands of the competition. Athletes, indeed anyone, can learn to cope with stress by using strategies such as: practice relaxation techniques such as meditation developing concentration skills that require focusing on the immediate task rather than on the perceived reaction to it. developing confidence planning strategies to cope with the situation 4. Arousal and Optimal Arousal Arousal is different from anxiety. While anxiety is predominantly is psychological state, arousal is essentially a physiological process. Arousal is a necessary ingredient in sports performance, although its level can either facilitate or hinder the execution of specific skills or task components. The individual performs a skill most successfully when the level of arousal is optimal for that particular task and that individual. A runner in a 100-metre sprint, for example, may complete a time far worse than expected. This could be partly attributable to a low level of arousal, perhaps resulting from distraction, disinterest or a depressed level of motivation. The other extreme is a state of over-arousal, whereby the athlete is unable to perform the required movements with precision because they are excessively tense and unable to concentrate. Levels of arousal vary considerably between individuals. Generally, athletes who have a high disposition towards anxiety require less arousal than those who have a low disposition towards anxiety. Both over-arousal and under-arousal contribute to adverse performance. The role of the coach and athlete is to ensure the level of arousal is optimal for each performance. All athletes respond to different stimuli to raise or lower their levels of arousal. Some can achieve optimal arousal by thinking about what they need to do in the game or activity. Others may require input from a coach, parents or peers. This suggest that arousal has drive properties that is, the manipulation of factors that affect anxiety, such as motivation, can increase or decrease arousal. Page 13 // 15
Section 3: Anxiety Page 14 // 15
Section 3: Anxiety The inverted U hypothesis illustrates the connection between arousal and performance. It suggests there is an optimal level or arousal for any performance. It suggests there is an optimal level of arousal for any performance. The optimal level of arousal varies from one skill to the next. Generally, when the difficult tasks involving a few muscle groups are involved for example, archery and putting in golf levels of arousal need not to be high to be optimal. However, many other activities that may be easier to execute or that involve larger body movements for example running and weight-lifting require an increase in the level of arousal for performance to be optimal. Optimal arousal levels for a given task vary between athletes, and largely depend on the individual s personality and factors that include: Self-expectation: such as how the individual expects to perform. Expectation by others: including how the individual perceives others expect them to perform (for example, the perceived expectation of the parents and coach) Experience: which determines how the individual handles the increased pressure at higher levels of competition Financial pressures: such as whether the individual s livelihood depends on their performance The level of competition: such as whether the individual is playing a round or a final The degree of difficulty: with higher levels of arousal generally being associated with more difficult tasks Skills finesse: with fine motor skills (for example, shooting and balancing) generating higher levels or arousal than generated by gross motor skills (for example running). Arousal affects performance when it becomes a focus. When the individual shifts the focus from thinking about feelings to concentrating on the task, anxiety will be revealed for what is a heightened state than can be controlled and that can actually assist performance. Eustress Performance Sleep Death Level of Arousal Page 15 // 15