13 Psychology, Psychiatry and Health

Introduction

This chapter will provide an overview of the roles of psychology and psychiatry as part of the multidisciplinary team (MDT) within mental health services. The field of psychology is broad and many who study in psychology will choose a specialisation, such as cognitive psychology, behavioural psychology, health psychology or clinical psychology. Psychologists can work in many settings, including but not limited to schools, human resources teams, health services, government departments (such as our law and correctional systems), and return to work support services. Psychiatrists, different to psychologists, are medical officers who have trained specifically in understanding mental health conditions and the associated symptoms, treatments, and medications that may be involved in providing care for a person who is experiencing a mental health condition. This chapter will outline the psychology and psychiatry professions and further explore some of the psychological theories and therapies that are commonly used in Australian health services.

Registration of Psychologists in Australia

In Australia, there are a variety of psychology qualifications that entitle a qualified person to practice in certain areas. In order to register and practice as a psychologist (including as a clinical psychologist), a person will have to complete an undergraduate degree as well as postgraduate study (such as a masters degree) in psychology (Psychology board of Australia 2016).

In Australia the terms ‘psychotherapist’ and ‘counsellor’ are not regulated. This means individuals are allowed to use these terms to describe themselves without proving their qualifications. There are some independent bodies that offer ‘registration’ to certain individuals who have completed bachelor-level courses with a certain degree of training in relevant approaches, such as counselling or family therapy.

Psychiatry in Australia

In Australia, psychiatrists are medical practitioners (doctors) who have undertaken specialist training in the field of psychiatry.

The program, termed a ‘fellowship’ in Australia, can only be undertaken by doctors who have completed two years of practice experience after their standard medical training. The fellowship takes an additional 5 years of study which includes practice across multiple settings under the supervision of an experienced psychiatrist (The Royal Australian & New Zealand College of Psychiatrists, 2024).

Psychiatrists, and registrars in the fellowship training program, will have specialised knowledge in assessing, diagnosing, and treating mental health conditions. In the community, a private psychiatrist may undertake assessment of people for ADHD or other neurodevelopmental conditions and provide referrals or coordinate specialist treatment such as Electro-Convulsive Therapy (ECT). Not everyone with a mental health condition will need to, or engage with, a psychiatrist.

In Australia, psychiatrists also commonly work in tertiary services (as opposed to primary services such as GP clinics) that provide mental health services, such as psychiatric wards within hospitals, and specialist public mental health care teams.

Biology and Psychology

The field of psychology is broad, with many specialisations in particular areas of psychology. Psychology is not just the study of our thoughts and emotions, it has also been instrumental in identifying the different biological processes that occur inside our bodies and brains. For example, the field of biological psychology (linked closely with the field of neuroscience) has explored how different chemicals (such as hormones and neurotransmitters) and brain-body systems influence our experiences and behaviour. This field of study involves linking of biology, physiology, and psychology concepts (Myers, 2010).

Through biological psychology, we know which structures in the brain are involved in certain processes, such as the amygdala’s role in emotion, the hippocampus being linked to memory, and the hypothalamus being involved in our reward pathway (the part of our system that makes us feel good when we achieve something) (Myers, 2010). When people experience particular interruptions to their usual brain functioning, the changes can be observed at the physiological level, for example changes in the structure and activity of the hippocampus for people who have experienced traumatic events.

Another significant advancement in our understanding of the interconnected nature of brain and body wellbeing, is the role of the parasympathetic nervous system and vagus nerve in regulating our stress response systems. Many of the mindfulness and breathing techniques used to calm and regulate when a person is stressed or anxious engage the parasympathetic nervous system and vagus nerve.

 

Treatments in psychiatry and psychology

In our recent history, the availability of treatment for mental health conditions was limited. Lobotomies and psychosurgeries to alter behaviour and emotions are no longer approved, although had been a part of medical practice in the attempt to treat behavioural disturbances for a long time (only being removed from practice in the 1950’s) (Faria, 2013). Currently, our treatment guidelines, which have been developed from best-practice evidence over the last 70 years, suggest that medication and psychotherapy combined is the most effective treatment option for many mental health conditions.

Cognitive Behaviour Therapy

One of the most widely researched psychotherapies, and one we have previously mentioned in this text, is cognitive behaviour therapy or CBT. Dr Aaron Beck is the renowned psychiatrist who originally developed the cognitive behavioural therapy framework and dedicated many years of research to establishing it as an effective treatment option for a wide range of populations and conditions (The Beck Institute for Cognitive Behaviour Therapy 2024).

Beck’s CBT has been developed into structured treatment programs, with sets of exercises that support a service user to identify unhelpful patterns of thinking (termed cognitions), try out behavioural experiments with the aim to challenge their thinking patterns, improve their self-efficacy, and replace unhelpful thinking with more helpful ways of thinking.

Web-based CBT in Australia

CBT has been the underlying therapy for a huge range of internet-based interventions that have been developed and researched in Australia. CBT has been shown to effective for stress, anxiety, and depression even when delivered in self-help type formats, making online programs accessible and effective for a wide range of people.

There are some therapies which have emerged from cognitive behaviour therapy as a foundation. Marsha Linehan’s Dialectic Behaviour Therapy (DBT) was developed from her studies of the limited efficacy of known therapies for people who had recurrent suicidal ideation – predominantly those with the borderline personality disorder diagnosis (Swales, 2018). Linehan drew upon behaviourism more distinctly in DBT, which supports consumers to identify the reinforcers which continue to prompt unhelpful or harmful behaviours. The skills training element of DBT also provides consumers with explicit helpful coping behaviours that they are encouraged to implement during times of emotional dysregulation and distress.

Personality and health

There are newly emerging understandings ‘personality disorders’ that challenge the historically categorical thinking of personality disorders. Previously, personality disorders were thought to be a rigid set of traits, or patterns in thinking and behaviour, that were able to be categorised and distinguished as separate clinical disorders (using a set of diagnostic criteria).

Within the Diagnostic and Statistical Manual of Mental Disorders – 5^th Edition (the text used for identifying and classifying mental health conditions), a dimensional approach to regarding personality disturbances is proposed (APA, 2022). This approach considers that personality disturbance can be viewed as a scale, with one end of the scale having very low or no levels of dysfunction in personality and severe dysfunction on the other end. It also views all personalities as being made up of multiple traits of varying intensities, for example someone may exhibit strong perfectionistic traits, however experience very minimal dysfunction in areas of wellbeing, work, and relationships. While another person may be intensely focused on themselves and their needs (egocentric or narcissistic traits) and this may severely impact their ability to get along with others, work well in a team, and may result in personal anguish when perceiving others treatment of them as unjust.

In the DSM-5, the diagnostic criteria for borderline personality disorder (from the categorical approach) can still be useful in describing the types and intensity of challenges someone with these personality traits may experience.

Image Credit: American Psychiatry Association

Within the set of DBT emotion regulation skills, there are also strategies for managing extreme emotions which draw upon neuroscience and our understanding of the parasympathetic nervous system. So, you can see how many current-day treatments draw upon knowledge from a range of psychology fields to support the health and wellbeing of individuals facing mental health challenges.

Behaviourism and health

Behavioural psychologists are those with a special interest in what influences human behaviour. They draw on theories including social learning theory, developmental theory, and Freudian theories (Myers, 2010).

One of the most famous behavioural experiments is Pavlov’s dog. Through this experiment, it was seen that a certain response can be elicited through the process of conditioning (Rehman et al 2023). Conditioning involves prompting an unconditioned (automatic) response and then creating an association with a particular stimulus to prompt this response, at which point it becomes a conditioned response. Further behavioural research has demonstrated concepts such as negative and positive reinforcement.

Negative reinforcement: removing a perceived negative element, e.g. a teacher allows all students who have completed every reading across the course to forego the end of semester quiz

Positive reinforcement: Adding a positive outcome or element, e.g. a student has a goal to bring their lunch from home every day during the week, if they achieve this goal they treat themselves to breakfast out on the weekend.

Developmental theories draw upon studies which have demonstrated different motivations and behaviours that occur at typical developmental age stages throughout life. For example, around age 2 there is great development in the brain and children often start to experience new and more complex emotions. They may start to feel guilt, shame, and jealousy. As children continue to develop and build skills in manipulating objects around them, they begin to develop motivations for independence, often becoming upset if others do things for them but also becoming easily frustrated when their own skills are not up to the challenge of tasks, for example doing up buttons.

In adolescence, humans become more aware of their peer relationships and start to go through a period of differentiation from their family unit. Adolescents will often explore different facets of their identity, test out values that may be different from their family’s’, and often go to significant lengths to be accepted by peers.

Parenting styles and their influence on development of children is another area that has extensive research within the psychology profession and will often be drawn upon in talking therapies where the client seeks to understand what has influenced their own behaviours and thinking patterns.

Many of these theories shape our public and population health initiatives in Australia, for example using adolescent ‘peers’ in advertisements encouraging young people to stop using e-cigarettes or ‘vapes’.

https://youtu.be/U7vZ02nvVl4

Psychology theories in application

By having a basic understanding of psychological theories, health professionals can support service users to experience health care more positively. By encouraging a service user to talk through their concerns, even if you can’t solve all of them, they may experience catharsis – particularly if you are empathetic and supportive in your listening.

For a service user who finds particular health routines challenging, e.g. physical rehab exercises, or swallowing tablets, you could support them to identify a positive reinforcer that they can use to help motivate them.

You might also notice that a service user has come to expect pain with movement, and as such are conditioned to tense up when asked to mobilise. You can then support them to notice this, slow down, and engage in some relaxation exercises such as deep breathing, before mobilising.

Summary

There are many areas of psychology practice. Psychologists and psychiatrists who offer therapy to individuals will draw on a range of psychological theories and models. There are practitioner competencies as well as registration standards to ensure that psychologists practice in safe, ethical, and evidence-based ways.

There are a variety of theories and understandings developed from different fields in psychology, such as neuroscience and behavioural psychology, that inform health services at many levels, including the population level.

For individuals who are seeking mental health services, many will find benefit from medication and psychotherapy combined.

---

References

American Psychiatric Association (2022). Personality Disorders in DSM-V-TR https://doi.org/10.1176/appi.books.9780890425787.x18_Personality_Disorders

Bargh, J. A., & Morsella, E. (2008). The Unconscious Mind. Perspectives on psychological science : a journal of the Association for Psychological Science, 3(1), 73–79. https://doi.org/10.1111/j.1745-6916.2008.00064.x

The Beck Institute for Cognitive Behaviour Therapy. (2024). Dr. Aaron T. Beck: A life well lived. https://beckinstitute.org/about/dr-aaron-t-beck/

Faria, M. Jr. (2013). Violence, mental illness, and the brain – A brief history of psychosurgery: Part 1 – From trephination to lobotomy. Surgical neurology international, 4, 49. https://doi.org/10.4103/2152-7806.110146

Myers, G. (2010). Psychology. Worth Publishers, New York.

Rehman, I., Mahabadi, N., Sanvictores, T., Rehman, C. (2023). Classical Conditioning. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470326/

The Royal Australian & New Zealand College of Psychiatrists. (2024). About the Fellowship Program. https://www.ranzcp.org/become-a-psychiatrist/psychiatry-training/about-fellowship-program

Psychology Board of Australia. (2016). Registration Standard: General Registration. Psychology Board Australian Health Practitioners Agency. https://www.psychologyboard.gov.au/Standards-and-Guidelines/Registration-Standards.aspx

Swales, M. A. (2018). Dialectical Behaviour Therapy: Development and Distinctive Features. In M. A. Swales (Ed.), The Oxford Handbook of Dialectical Behaviour Therapy. Oxford University Press. https://doi.org/10.1093/oxfordhb/9780198758723.013.45

Zaidel Aboody, M. A. A. (2022). The Contemporary Freudian Tradition: Past and Present, edited by Ken Robinson and Joan Schächter, Routledge, Abingdon and New York, 2021, 370 pp. The American Journal of Psychoanalysis, 82(2), 333-338. https://doi.org/10.1057/s11231-022-09346-x