Are Your Tennis Errors Mental Or Technical

Scores of tennis players believe that most of their problems on the tennis court are technical (eg. The action of hitting a forehand, backhand etc) and not mental (thought process behind the action).

Players practice the technical aspects of their shots or pay huge sums of money to coaches to work on areas of their game that probably don’t need as much technical attention as they may think.

Here’s my advice.

When you play a match you need to focus at the other end of the court tactically. Every shot you play must have a purpose to either neutralise or hurt your opponent tactically. The only thing you must be aware of at your end of the court is the ball and where you are aiming to hit it.

During a match you MUST NOT think technically. As soon as you do, more often than not you lose the match. Why? Because it’s almost impossible to mend a shot during a match.

When you play a match you go into battle with what you have and you have to make the best of it. If you try to hit shots you have not mastered in practice then you will probably end up disappointed.

Most errors are mental because they have a lack of purpose or the players’ concentration is on technique and not where the ball is being aimed!

Here’s a typical example:-

A player came to me after a recent match and said that his forehand needs a lot of work because it let him down big time in his last match.

Now I know this guy can hit great forehands and does so regularly in lessons. I asked him “When did your forehand let you down?”

He answered “It was okay at first but once I made a few errors it just seemed to get worse and worse from them on.”

This statement told me a lot. It told me he was analysing his technique because of an error and became more and more conscious of what he was doing at his end of the court instead of trying to affect the points tactically at the other end.

So we hit a few rallies and played some points out. Something went wrong as I approached the net and his forehand flew out the back of the court.

I asked him what he was trying to do? His answer was “I didn’t cover the ball with enough topspin and lost control.”

He was right – his ball flew out because it had no topspin on it. BUT, it wasn’t a technical error.

So I asked him the same question again but wanted a more specific answer. So I said “tell me exactly where you pictured the ball going and where you expected it to land?”

His answer was “Cross court somewhere!”

This guy wanted a technical answer, but the answer was mental. His ball went ‘cross court somewhere’ and that’s all he’d asked from himself. So in effect he actually succeeded.

If you want to hit a short angled topspin forehand cross court to a target and you miss then that’s a technical error and we can then work on that.

BUT if you are not aiming specifically and don’t know where you want the ball to land without first visualising it, then how can you be upset when you miss?

If you don’t know where you are aiming then that is a mental error. Your racket can’t do the aiming for you, no matter how much it cost you!

If this guy had pictured the exact shot he wanted he would have automatically covered the ball, and hit with more topspin, and been successful, because he has done it in many practices before.

You wouldn’t shoot a gun without aiming would you, as it would be dangerous? To hit a tennis shot without purpose is effectively doing the same thing and is a danger to your confidence.

How many people do you know who don’t aim their second serve but just try to get it in? (are you one of those people?!).

Visualise and aim. You have a much better chance of hitting the target and succeeding.

So the key is to practice these shots and scenarios, so you know what to do in these pressure situations. You will then build up a visual memory of succeeding under pressure.

Then all you need to do is watch the ball and visualise what you want to happen. What you focus on in life becomes reality.

If the shot has been practiced enough it will begin to happen in those pressure situations as pure muscle memory. (See it, then do it!)

Is it really Mental Health as well as Addiction

Usually speaking, people who abuse drugs and alcohol will show with psychiatric signs and symptoms also. These may include: depression, irritability, moodiness, unexpected or rapid changes in individuality, compelled speech, poor reasoning, poor impulsive manage, trouble judgement, and infrequently difficulty with truth examining including hallucinations and delusions. Due to changes in personality functioning it’s not uncommon to hear the term “borderline” used. Read more information click here addiction diagnosis

While researching options for addiction treatment it actually is critical to find out exactly what their licensed to treat. Some services are simply licensed to treat Mental Health issues while others are registered to treat only addiction. There are also others that are registered to treat both mental health and also addiction also recognized because co-occurring disorders or dual-diagnosis. Cure medical center can determine themselves because being “dual-diagnosis” by virtue of having a professional on-staff. This doesn’t mean that they are the best choice for specific requirements.

Figuring out which arrived first (the addiction or mental health) disorder is important in order to help treatment. Not really task whether a problem exists. If you are reading this article probabilities are problems exists. Several mental health disorders require a higher level of care (i.e., acute inpatient) treatment in a locked facility that has 24-hour nursing workforce, psychiatric technicians, social employees, psychiatrists and basically just what is called a “multi-disciplinary treatment team”.

Addiction treatment clinics also have “multi-disciplinary teams” but most are “free-standing” meaning they aren’t part of a hospital or medical service. They can be approved to offer detoxification companies..Still, not furnished to control more serious cases of psychological illness. It is really need to learn just what is giving the affected individual the most problems (addiction or mental health) concerns just because a individual with psychotic symptoms or hallucinations will have a very tough time including with an addiction society that they are unable to connect with.

For treatment to be effective there wants to be an institution of faith, sympathy, compassion, interpersonal connectedness, inter-dependence, and these are relational features that the afflicted person wishes to either possess already or be able of developing as treatment progresses. While searching about a certain service ask really whether they have a psycho therapist on staff. Is the psychiatrist registered by the American Society of Addiction Medicine? Is the psychiatrist Board Qualified in General Psychiatry or basically Board Eligible? Some services simply because they deal with a forensic public which means individuals with mental conditions that take part in the legislation.

Generally they may want addiction services while undergoing assessment to identify whether their offense was devoted as a result of substance use, abuse, or addiction. Then based upon the evaluation it is decided whether the individual is competent to stand trial. The doctor will decide whether there’re other elements that should be taken into concern when sentencing a person. It is a very specific area. Read more information click here addiction diagnosis

A lot of addiction treatment programs offer “tracks” that are particular to certain difficulties that co-occur with the addiction such as: trauma, eating disorders, individuality disorders to name a few. These tracks commonly involve specialized teams aimed at managing mental intensity, regulating mood, mindfulness, tension reduction, harm reduction (not entirely removing the behavior; but lowering its impact). When asking about these systems inquire about the testimonials of the therapists working with this patient society.

Professionally and morally a treatment service and/or “counselor, therapist, behavioral health tech” should not be offering clinical advice, guidance, direction, analysis, interpretation of difficulties that fall outside the realm of their own professional training. Because someone has training in a certain area, doesn’t mean they are “competent” to treat a particular difficulty. Ask if the individual treating you has access to “clinical supervision”. This may guide you know how strong of a medical team there is at the service.

Experts who practice in an ethical and professional manner are great at realizing their limits. They seek the input of their co-workers. Programs with specialty tracks commonly have a primary therapist working in association with a specialty therapist who has unique experience in other models of therapy commonly termed as: Dialectic Behavioral Therapy, Somatic Experiencing, EMDR (Refer to Francine Shapiro) on Google to get specific information on EMDR. When working with an EMDR therapist inquire about where they gotten their training.

You may want to understand just what level practitioner they are? Those who offer these services frequently belong to specialist groups. Ask whether they’re active in qualified companies. Choose how they compare whether someone is ready for a specific therapy or service. EMDR isn’t recommended for some cases of complex trauma. It is actually essential to ensure that the individual working with you has access to good medical supervision.It’s also valuable that the treatment is paced in such a way that you do not become re-traumatized. Trauma work will take time. There are no quick fixes.

Treatment facilities usually have to report to your insurance every 2-3 days or at set intervals determined by the insurance organization when they wish to be updated about your treatment in order to confirm whether you meet their “medical necessity criteria” for the “level of care” the facility is requesting “authorization” or “pre-certification” for. Detox is the highest level of care, followed by inpatient or residential, followed by partial hospital that often has housing connected to it.

Insurance organizations need to see that your treatment is growing; the targets are realistic and that you need to be there. If a place is licensed to treat both mental health and substance abuse it is not uncommon to see them bill under mental health once benefits have been exhausted under substance abuse. Several policies only approve 30 calendar days a year. Others authorize an limitless number of days. It is again all dependent upon medical need.

Check with the facility to decide whether you’re dependable for “room/board” charges if the level of care gets dropped to “partial hospital” also known as “day programming”. Some ask the patient to pay the difference among what exactly is billed and paid. When a facility is “in-network” with your insurance primarily they’re agreeing to allow whatever rate is negotiated between the insurance company and their business office team.

Be careful of or concerned when a center questions within minutes for your insurance facts. There are many treatment centers that out-source calls to third-party marketers that do not necessarily work for the treatment center directly. They are independent contractors whose goal is to ensure the beds are filled in that facility. The focus with these entities is not so much on whether you are going to get the right of help as much as meeting his/her commission or quota requires. You should also be careful of treatment centers that allude to your trouble being resolved in 30-days.

Analysis is showing that the longer a person stays in treatment (not necessarily residential) but is some form of structured, supportive, monitored, phased type of treatment that their chances of achieving long-term achievement in recovery improves greatly. Do not be pressured into going to the specific provider the person recommends. Many recommend only places they are affiliated with. If they’re connected to a place financially and are profiting from your referral to a specific place this would be concerning.

In closing, do your homework, ask questions —–speak directly with clinical staff regarding clinically related questions. Don’t commit to long-term stays, large down-payments ($5,000-10,000) and have them give you a bill to submit to your insurance because your treatment needs to be authorized “in advance” not after services are rendered.

When it feels like the person your speaking to is more of a profits individual chances are that’s all they are rather than someone who has an interest in ensuring your needs will be met. Do your analysis and if feels right then go with what feels right. If not ask questions. Remember, it is your treatment, your recovery, your life, your happiness and you need to know your making the right options in whatever you choose. Read more information click here addiction diagnosis

Why Should One Opt For Mental Health Recovery

There are a number of people in this World who suffer from ill mental health and varied mental abilities which calls for constant recovery and help from these sufferings. There are no instant fix to these problems and sometimes one just has to live with it but there are options that can be availed to regain ones self-confidence, inspite of these problems. A person suffering from ill mental health is subjected to constant ridicule and pity but organizations like Hearing Voices Network have sprung up to eradicate this issue and help these patients to survive as well as enjoy life through recovery.

It is the right thing to do

Many question the importance of these recovery organizations and their mode of treatments as many think these patients to be untreatable. This is completely opposite. The recovery programmes help the patients to live a prosperous life by assuring them to live their lives independently. When you procure a fever, you go to the doctor for remedies and to ease your suffering and not condemn yourself for life. So do these patients and the recovery treatments help them overcome their sufferings to enjoy life.

To resolve ones emotional distress

People, who are suffering from ill mental health as well as their families supporting them, are usually emotionally distressed due to social pressure. There are many organizations that have separate bodies for the families of the patients that organize counseling and self-help groups to help them talk and cope with their feelings. Each person with a problem grabs special attention from the helpers, thus, easing the pain to some extent.

Mental Health Accommodation: for special care and needs

There are certain recovery organizations that provide accommodations for patients with special need of care. There are a number of options available, depending on the problem a particular patient is facing and the extent of pain. The accommodations are fully furnished along with daily facilities and care is taken to ensure that the patients are comfortable in their niche. They ensure that the patients are on their path to a full recovery while surrounded by a positive and relaxed environment.

Conclusion

Every patient who is mentally ill has their individual requirements and the recovery is extensively based on that. For people, who need special support or want it, Mental Health Accommodation WA is provided especially for them. It is important to preserve ones sanity and mental well-being and the recovery organizations does exactly that.

Conceptualizing Mental Health Care Utilization Using The Health Belief Model

Article Text

The process of change in psychotherapy, regardless of the clinician’s orientation, length of treatment, or outcome measure, begins with this: The client must attend a first session. However, several national surveys in the past decade converge on a rate of approximately one-third of individuals diagnosed with a mental disorder receiving any professional treatment (Alegra, Bijl, Lin, Walters, & Kessler, 2000; Andrews, Issakidis, & Carter, 2001; Wang et al., 2005). A review of the literature surrounding mental health utilization reveals evidence that a complex array of psychological, social, and demographic factors influence a distressed individual’s arrival to a mental health clinic. Thus, developing effective strategies for decreasing barriers to care is a critical task for clinicians and administrators. The

aim of this article was to review current research focused on appropriate utilization of mental health services and to use the Health Belief Model (HBM; Becker, 1974) as a parsimonious model for conceptualizing the current knowledge base, as well as predicting and suggesting future research and implementation strategies in the field.

First, it is important to address whether increasing mental health service use is an appropriate public health goal. A World Health Organization (WHO) survey comparing individuals with severe, moderate, or mild disorder symptoms indicated that approximately half of those surveyed went untreated in the past year (WHO World Mental Health Survey Consortium, 2004), with even less treatment among those with more severe symptoms. Many costs are associated with untreated mental disorders, including overuse of primary care services for a variety of reasons (Katon, 2003; White et al., 2008), lost productivity for businesses and lost wages for employees (Adler et al., 2006), as well as the negative impact of mental disorders on medical disorders, such as diabetes and hypertension (Katon & Ciechanowski, 2002). These com

bined expenses have been calculated to rival some of the most common and costly physical disorders, such as heart disease, hypertension, and diabetes (Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008).

The consequences of providing additional services to address unmet need may vary by the cost-effectiveness of treatment, availability of providers, and the interaction of mental health symptoms with other illnesses. Medical cost offset and cost-effectiveness research address these questions (for further review, see Blount et al., 2007; Hunsley, 2003). Medical cost offset refers to the estimation of cost savings produced by reduced use of services for primary care as a result of providing psychological services. Reduced medical expenses could occur for several reasons: increased adherence to lifestyle recommendation changes such as diet, exercise, smoking, or taking medications; improved psychological and physical health; and reduction in unnecessary medical visits which serve a secondary purpose (e.g

., making appointments to fill social needs; Hunsley, 2003). In comparison with the indirect costs to society, the individual, and the health care system, costs for providing mental health treatment are quite low (Blount et al., 2007).

However, debate continues regarding how to facilitate mental health care utilization. Identification of mental health need through primary care screening for depression is one research area that highlights the complexity of this issue. Palmer and Coyne (2003) point out several important issues in developing a strategy for addressing this goal: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are similar in primary care patients who have detected depression and those who have not (e.g., Coyne, Klinkman, Gallo, & Schwenk, 1997; Williams et al., 1999). This is supported by research indicating a large gap between the number of individuals who are identified through screening and referred to care, and those who actually receive care (Flynn, O’Mahen, Massey, & Marcus, 2006). Second, it is critical to evaluate attempts to increase utilization, rather than to assume they will be successful, cost-effective, and targeting the appropriate individuals. Therefore, a theoretical framework that addresses both psychological and practical factors associated with treatment utilization will be a beneficial addition to this literature.

Little systematic research has been conducted on the specific topic of psychological factors related to seeking mental health services. However, extensive work has been conducted within two broad, related areas of research: help-seeking behavior and health psychology. Many models have been proposed to explain help-seeking and health-protecting behaviors, none of which has been accepted as wholly superior to the rest. The HBM (Becker, 1974; Janz & Becker, 1984; Rosenstock, 1966) is one of several commonly used social-cognitive theories of health behavior. This model will be reviewed, followed by a brief discussion of several other models. A discussion of the strengths of the HBM and its applicability to mental health treatment utilization research will follow.
Health Belief Model
The HBM (Rosenstock, 1966, 1974), based in a socio-cognitive perspective, was originally developed in the 1950s by social psychologists to explain the failure of some individuals to use preventative health behaviors for early detection of diseases, patient response to symptoms, and medical compliance (Janz & Becker, 1984 ; Kirscht, 1972; Rosenstock, 1974). The theory hypothesizes that people are likely to engage in a given health-related behavior to the extent that they (a) perceive that they could contract the illness or be susceptible to the problem (perceived susceptibility); (b) believe that the problem has serious consequences or will interfere with their daily functioning (perceived severity); (c) believe that the intervention or preventative action will be effective in reducing symptoms (perceived benefits); and (d) perceive few barriers to taking action (perceived barriers). All four variables are thought to be influenced by demographic variables such as race, age, and socioeconomic status. A fifth original factor, cues to action, is frequently neglected in studies of the HBM, but nevertheless provides an important social factor related to mental health care utilization. Cues to action are incidents serving as a reminder of the severity or threat of an illness. These may include personal experiences of symptoms, such as noticing the changing shape of a mole that triggers an individual to consider his or her risk of skin cancer, or external cues, such as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker (1988) added components of social cognitive theory (Ba ndura, 1977a, 1977b) to the HBM. They proposed that one’s expectation about the ability to influence outcomes (self-efficacy) is an important component in understanding health behavior outcomes. Thus, believing one is capable of quitting smoking (efficacy expectation) is as crucial in determining whether the person will actually quit as knowing the individual’s perceived susceptibility, severity, benefits, and barriers.

Other health care utilization theories

Other models for health care utilization have been proposed and used as a guide for research. In general, these theories pull from a number of learning theories (e.g., Bandura, 1977a, 1977b; Lewin, 1936; Watson, 1925). Two such models, the Theory of Planned Behavior (TPB; Ajzen, 1991) and the Self-Regulation Model (SRM; Leventhal, Nerenz, & Steele, 1984), share many commonalities with the HBM. Ajzen’s TPB proposes that intentions to engage in a behavior predict an individual’s likelihood of actually engaging in the given behavior. Ajzen hypothesizes that intentions are influenced by attitudes toward the usefulness of engaging in a behavior, perceived expectations of important others such as family or friends, and perceived ability to engage in the behavior if desired (Ajzen, 1991). This theory has been applied to a variety of health behaviors and has receiv

ed support for its utility in predicting health behaviors (Ajzen, 1991; Armitage & Conner, 2001; Godin & Kok, 1996). However, its relevance in predicting mental health care utilization has received relatively little attention (for two exceptions, see Angermeyer, Matschinger, & Riedel-Heller, 1999; Skogstad, Deane, & Spicer, 2006). Similarly, the SRM (Leventhal et al., 1984) focuses on an individual’s personal representation of his or her illness as a predictor of mental health treatment use. The SRM proposes that individuals’ representation of their illness is comprised of how the individual labels the symptoms he or she is experiencing, the perceived consequences and causes of the symptoms for the individual, the expected time in which the individual would expect to be relieved of symptoms, and the perceived control or cure of the illness (Lau & Hartman, 1983).

The HBM, TPB, and SRM are well-estab

lished socio-cognitive models with similar strengths and weaknesses. The models assume a rational decision-making process in determining behavior, which has been criticized for not addressing the emotional components of some health behaviors, such as using condoms or seeking psychotherapy (Sheeran & Abraham, 1994). There is substantial overlap in the constructs of these three models. For example, an individual’s perception of the normative beliefs of others can be seen more generally as a benefit of treatment (e.g., if I seek treatment my friends will support my decision) or as a barrier (e.g., my family will think I am crazy if they know I am seeking professional help). The SRM lacks a full description of the benefit and barrier aspects of decision making identified in the HBM. However, the illness perceptions about timeline, identity, and consequences do provide a more complete conceptualization of aspects of perceived severity, and in this way the SRM can inform the HBM with these factors.

Andersen’s Sociobehavioral Model (Andersen, 1995) and Pescosolido’s Network Episode Model (Pescosolido, 1992; Pescosolido, Brooks Gardner, & Lubell, 1998) emphasize the role of the health care and social network system in influencing patterns of health care use, while Cramer’s (1999) Help Seeking Model highlights the role of self-concealment and social support in decisions to seek counseling. In particular, the Network Episode Model hypothesizes that clear, independent choice is only one of seve

ral ways that clients enter treatment, along with coercion and passive, indirect pathways to care. According to Cramer’s model, individuals who habitually conceal personally distressing information tend to have lower social support, higher personal distress, and more negative attitudes toward seeking psychological help. Thus, according to this model, self-concealment creates high distress, which pushes an individual toward seeking treatment, but also creates negative attitudes toward treatment, pushing an individual away from treatment. The HBM includes system-level benefits and barriers to utilization, but these three models more fully emphasize the social-emotional context of decision making.
Critiques and limitations of the HBM

The HBM has received some criticism regarding its utility for predicting health behaviors. Ogden (2003), in a review of articles from 1997 to 2001 using social cognition models, questions whether the theory is disconfirmable. She found that two-thirds of the studies reviewed found one or more variables within the model to b

e insignificant, and explained variance accounted for by the model ranged from 1% to 65% when predicting actual behavior. Yet, Ogden writes, rather than rejecting the model, the majority of authors offer alternative explanations for their weak findings and claim that the theory is supported. While authors’ conclusions about their findings may be overstated in many cases, some explanations of insignificant findings are valid limitations of the model. For example, some (e.g., Castle, Skinner, & Hampson, 1999) point out that construct operationalization could be improved for the particular health behavior being studied. However, insignificant results should not be explained away without considering alternative models as well. Certainly, the HBM has received strong support in predicting some health behaviors (Aiken, West, Woodward, & Reno, 1994; Gillibrand & Stevenson, 2006), but questions remain as to its ability to predict all preventative health situations. The usefulnes

s of the HBM in predicting mental health utilization has not adequately been tested to our knowledge.

The HBM may be limited further by its ability to predict more long-term health-related behaviors. For example, from an early review of preventive health behavior models including the HBM by Kirscht (1983), we can anticipate that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. Thus, these outcomesattending one therapy appointment versus completing a full course of psychotherapy treatmentshould be clearly distinguished from each other.
Strengths of the HBM

Researchers have not explicitly investigated mental health utilization patterns using the HBM framework; however, much of the

existing literature can be conceptualized as dimensions of severity, benefits, and barriers, indicating that the model may be a useful framework for guiding research in this area. For example, cultural researchers often examine barriers to treatment and perceived severity of symptoms and benefits of treatment in various ethnic populations (e.g., Constantine, Myers, Kindaichi, & Moore, 2004; Zhang, Snowden, & Sue, 1998). In general, the focus of these studies has been to examine cultural differences in beliefs about symptom causes (Chadda, Agarwal, Singh, & Raheja, 2001), changing perceptions of mental health stigma among various ethnic groups (Schnittker, Freese, & Powell, 2000), and cultural mistrust or perceived cultural insensitivity of mental health providers as a barrier to effective treatment (Poston, Craine, & Atkinson, 1991). These studies lay the groundwork for using the HBM as a framework for understanding mental health care utilization for all populations.
Parsimonious and Clear

The model’s use of benefits and barriers opposing each other provides a dynamic representation of the decision-making process. In this “common sense” presentation, the impact of each positive aspect is considered in the context of the

negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one clear framework.
Useful and Applicable

One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of such models. By identifying attitudes that may inhibit appropriate help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or inaccurate beliefs about mental health and its treatment. Therefore, socio-cognitive theory provides a useful focus for research that ultimately may result in programmatic changes to benefit clients. Once developed, perception-change interventions can be evaluated through changes in observed treatment utilization.

Within the HBM framework, three general approaches can be used to increase appropriate utilization: increasing perceptions of individual susceptibility to illness and severity of symptoms, decreasing the psychological or physical barriers to treatment, or increasing the perceived benefits of treatment. The following discussion will highlight how each perception can be increased or decreased, and the implic

ations for such intensification of the perceptions. Examples of intervention strategies that can serve as individual or system-level “cues to action” will be reviewed within each domain of the model. In addition, where appropriate, the discussions will highlight how sociodemographic factors such as age, sex, and ethnicity impact the perceived threat from the disorder and the expectations for the benefits of therapy. The model we discuss assumes that the individual seeking therapy is autonomous in this decision making. That is, it is not directly applicable to those who are required to seek therapy by the judicial system, a spouse, or their place of employment, nor does it address children’s mental health care utilization. We will address some of these issues briefly later in our discussion.

Figure 1 is a visual representation of the model we propose for conceptualizing mental health care utilization using the HBM as a framework. The studies reviewed in each section below were designed primarily without use of the HBM framework. However, the model is a useful heuristic tool to organize and draw in research from a variety of disciplinesmarketing, public health, psychology, medicine, etc.

Sociodemographic variables in the HBM
Several demographic variables consistently predict utilization of mental health services. Despite similar levels of distress, some groups are less likely to seek professional treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services include men, adults aged 65 and older, and ethnic minority groups in the United States (Wang et al., 2005). Within the HBM framework, these demographic variables are hypothesized to influence clients’ perceptions of severity, benefits, and barriers to seeking professional mental health services. Studies exploring the relationship between demographic variables and HBM constructs will be highlighted throughout this article.
Systems approaches to addressing perceived susceptibility and severity

According to the HBM, individuals vary in how vulnerable they believe they are to contracting a disorder (susceptibility). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to include acceptance of the diagnosis (Becker & Maiman, 1980). In addition, increasing an individual’s perception of the severity of his or her symptoms increases the likelihood that he or she will seek treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived severity (i.e., Do I have the disorder and how bad is it?), and so they will be discussed together. In health-related decisions, the majority of consumers are dependent upon the expertise and referral of the medical professional, usually the trusted general practitioner (Lipscomb, Root, & Shelley, 2004; Thompson, Hunt, & Issakidis, 2004). Unlike decisions about the need for a new vehicle or a firmer mattress, determining whether or not feelings of sadness should be interpreted as normal emotional fluctuation or as indicators of depression is a decision often left to an expert in the area of mental health or a primary care physician. This places a great responsibility on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the severity of a client’s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Severity and Symptom Awareness

The American Psychological Association (APA) provides ethical guidelines for clinicians about how to inform the public appropriately about mental health services. According to the 2002 Ethics Code (American Psychological Association, 2002), psychologists are prohibited from soliciting testimonials from current therapy clients for the purpose of advertising, as individuals in such circumstances may be influenced by the therapistclient relationship they experience. Additionally, psychologists are prohibited from soliciting business from those who are not seeking care, whether a current or potential client. This may include a psychologist suggesting treatment services to a person who has just experienced a car accident or handing out business cards to individuals at a funeral home. However, disaster or community outreach services are not prohibited, as these are services to the community. Psychologists are prohibited from making false statements knowingly about their training, credentials, services, and fees, and are also prohibited from making knowingly deceptive or exaggerated statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in vulnerable situations.
Identification of Symptoms

What, then, does an ethical symptom awareness intervention look like? It would involve clearly differentiating between clinical and nonclinical levels of distress, with an indication of what types of intervention strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be encouraged to use a stepped care approach beginning with bibliotherapy, psychoeducation, and increases in social support. Also important is the provision of accurate, research-based information regarding symptoms of psychological disorders and treatment options. This may call for challenging our assumptions that psychotherapy is helpful for all psychological distress. Recent studies of grief counseling and postdisaster crisis counseling, for example, suggest there may be an iatrogenic effect of therapy for some individuals (Bonanno & Lilienfeld, 2008). On the other hand, some research indicates that individuals with subclinical levels of distress who receive treatment early may avoid developing more severe pathology (e.g., prodromal psychosis; Killackey & Yung, 2007). In programming for all components of health beliefs, not just severity, the credibility of psychotherapy is dependent upon ethical, appropriate public health statements and service marketing.

Many examples of mental health education campaigns have been discussed in the literature, often focusing simultaneously on increasing awareness of mental illness, destigmatizing individuals with mental illness, and increasing awareness of mental health resources. The Defeat Depression Campaign of the UK was designed with these goals in mind, and results of nationally representative polls before, during, and after the campaign indicated positive changes in public attitude toward depression and recognition of personal experiences of symptoms (Paykel, Tylee, & Wright, 1997). Similarly, more recent national campaigns in Australia have provided some evidence that education increases public accuracy in identifying mental illness (Jorm & Kelly, 2007). National screening day initiatives for depression, substance abuse, and other psychological disorders also aim to increase awareness of illness severity for individuals who may not recognize symptoms as signs of illness warranting treatment.

Approximately 71% (Lipscomb et al., 2004; Thompson et al., 2004) of individuals report looking to their primary care physician for mental health information, treatment, and referrals. However, many physicians lack the appropriate knowledge to identify mental health problems (Hodges, Inch, & Silver, 2001). After examining five decades (19502000) of articles evaluating the adequacy of physician training in detecting, diagnosing, and treating mental health, Hodges et al. (2001) offer several suggestions for improving primary care physicians’ training to effectively identify patients with mental health issues. Beyond learning the diagnostic criteria for the major disorders and providing appropriate medications when needed, however, physicians also need to be aware that they can act as a “cue to action” in the patient seeking psychotherapy. Such cues would alert the patient that his or her symptoms of distress or depression had reached severe levels and that the trusted family physician believes additional treatment is needed.
Influence of Demographic Variables on Perceived Severity

An individual’s personal label of the symptoms and illness are thought to contribute to perceived severity. In a study of four large-scale surveys of psychiatric help seeking, Kessler, Brown, and Broman (1981) found that women more often labeled feelings of distress as emotional problems than men did, a factor thought to help explain the consistent finding that men seek mental health services less often than women even when experiencing similar emotional problems. Similarly, Nykvist, Kjellberg, and Bildt (2002) found that among men and women reporting neck and stomach pains, women were more likely to attribute pains to psychological distress, while men were more likely to indicate no significant cause and little concern regarding the somatic symptoms.

Relatively little research has been conducted regarding how individuals of diverse backgrounds perceive the severity of their mental illness symptoms. However, some evidence suggests that individuals of different ethnic backgrounds appraise the severity of their illness symptoms differently, such that individuals from minority cultures are more influenced by their own culture’s norms about mental illness symptoms than White Americans (Dinges & Cherry, 1995; Okazaki & Kallivayalil, 2002). Cues to action from providers may be more effective if they are framed in a way that is congruent with individuals’ attributions about symptoms. In other cases, education about symptoms, provided in a culturally sensitive manner, may be necessary. This is an area where additional research is needed to determine practice.

Older adults are more likely to seek treatment when they perceive a strong need for treatment (Coulton & Frost, 1982). However, some aspects of aging may influence whether or not older adults perceive ambiguous symptoms as psychological in nature or due to physical ailments. For example, among older adults, particularly those experiencing chronic pain or illness, somatic symptoms of mental illness may be interpreted as symptoms of physical illness or part of a natural aging process, rather than as symptoms of depression or anxiety (Smallbrugge, Pot, Jongenelis, Beekman, & Eefsting, 2005). In this way, some depression symptoms may be overlooked by older individuals and the physicians who see them (Gatz & Smyer, 1992).
Systems approaches to addressing perceived benefits
Even if clients do view their symptoms as warranting attention, they are unlikely to seek treatment if they do not believe they will benefit from professional services. Thus, increasing perceived benefits of treatment is a second approach to increasing appropriate utilization.

Public Perceptions of Psychotherapy

In response to changing health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to inform consumers about psychological care, research, services, and the value of psychological interventions (Farberman, 1997). Results of preprogram focus group assessments indicated that participants were frustrated with changes in health care service delivery in the United States and many participants did not know whether their health insurance policy included mental health benefits. Participants indicated that they did not know when it was appropriate to seek professional help, and often cited lack of confidence in mental health outcomes, lack of coverage, and shame associated with help seeking as main reasons for not seeking treatment. Participants reported that the best way to educate the public about the value of psychological services was to show life stories of how they helped real people with real-life issues. Informed by the focus groups and telephone interviews, APA launched a pilot campaign in two states using television, radio, and print advertisements depicting individuals who have benefited from psychotherapy, as well as an 800 telephone number, a consumer brochure, and a consumer information website. During the first six months of the campaign, over 4,000 callers contacted the campaign service bureau for a referral to the state psychological association to request campaign literature, with over 3,000 people visiting the Internet site weekly (Farberman, 1997). In sum, addressing perceived benefits of treatment means answering the question, “What good would it do?” When individuals are made aware of how treatment could improve their daily functioning, they may be more motivated to overcome the perceived barriers to treatment. Especially for individuals who have not previously sought mental health treatment, describing realistic expectations for treatment may be an essential first step in orienting individuals to make informed treatment decisions.
Public Preference for Providers of Care

Many different types of professionals serve as mental health service providers, and individuals’ beliefs about the relative benefit of seeking help from various lay and professional sources likely impact decisions to seek help. Roles have shifted in treatment over time, with the introduction of managed care and the increased role of the PsyD, master’s-level psychologist or counselor, and MSW as treatment providers. Counseling has been considered a primary role of clergy for many decades; however, specificity of counseling training has changed over time, with some clergy receiving specific training as counselors within seminary education. Primary care physicians have been relied upon for treatment through pharmacotherapy with the development of improved medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct traditional therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important potential gateway for psychotherapy (Mickus, Colenda, & Hogan, 2000).

Level of distress may also influence where individuals seek help: Consumer Reports’ popular survey of over 4,000 participants found that individuals tend to see a primary care physician for less severe emotional distress and seek a mental health professional for more severe distress (Consumer Reports, 1995), while Jorm, Griffiths, and Christensen (2004) found that individuals with depressive symptoms were most likely to use self-help strategies in mild to moderate levels of severity and to seek professional help at high levels of severity.

Some support has been found for the importance of a match between individuals’ perceptions of the cause of symptoms and the type of treatment they seek. In a German national survey, perceptions of the cause of depression and schizophrenia significantly predicted preferences for professional or lay help. Those who endorsed a biological cause of illness reported they would be more likely to advise an ailing friend to seek help from a psychiatrist, family physician, or psychotherapist, and less likely to advise seeking help from a confidant. Perceptions of social-psychological causes of illness, such as family conflict, isolation, or alcohol abuse, were related to advising a confidant, self-help group, or psychotherapist rather than a psychiatrist or physician (Angermeyer et al., 1999).
Demographic Variables and Perceived Benefits

Perceptions of mental health treatment as beneficial are likely shaped by cultural influences as well as an individual’s personal experience. In a subset of randomly selected individuals from a nationally representative survey, Schnittker et al. (2000) compared Black and White respondents’ beliefs about the etiology of mental illnesses and their attitudes toward using professional mental health services. Black respondents were more likely than White respondents to endorse views of mental illness as God’s will or due to bad character, and less likely to attribute mental illness to genetic variation or poor family upbringing. These beliefs predicted less positive views of mental health services, and the authors found that more than 40% of the racial difference in attitudes toward treatment was attributable to differences in beliefs about the cause of mental illness.

Older adults’ reluctance to seek psychological services has been connected with more negative attitudes toward psychological services (Speer, Williams, West, & Dupree, 1991). Attitudes toward psychotherapy appear to improve by aging cohort, however. Currin, Hayslip, Schneider, and Kooken (1998) assessed dimensions of mental health attitudes among two different cohorts of older adults and found that younger cohorts of older adults hold more positive attitudes toward mental health services. Thus, attitudes among older adults may be less attributable to age than to changing cultural acceptance of mental illness over time. Older adults who have engaged in professional psychological treatment tend to see mental health treatment as more beneficial than their counterparts who have never sought treatment (Speer et al., 1991).

Across diverse religious orientations, beliefs in a spiritual cause of mental illness have been associated with preference for treatment from a religious leader rather than a mental health professional (Chadda et al., 2001; Cinnirella & Loewenthal, 1999). For individuals who interpret psychological distress symptoms as spiritually based, a religious leader may be viewed as a more beneficial provider than a traditional mental health professional. Some clients prefer to see clergy for mental health concerns. Some psychologists have formed relationships between religious organizations and mental health providers to foster collaboration and access to many care options for community members (McMinn, Chaddock, & Edwards, 1998). Benes, Walsh, McMinn, Dominguez, and Aikins (2000) describe a model of clergypsychology collaboration. Using Catholic Social Services as a medium through which collaboration took place, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention (public speaking about mental health topics, parent training workshops) through intervention (1-800 access numbers, support groups, and counseling services). The authors note that bidirectional referralsnot simply clergy referring to cliniciansand a sharing of techniques and expertise are keys to the success of such programs. Providing care to individuals through the source that they consider most credible or accessible is an innovative strategy for increasing perceived treatment benefits and decreasing barriers
Marketing Psychological Services

While the idea of marketing psychological services may seem unappealing to some psychologists, marketing strategies designed to encourage appropriate utilization may serve as both a strategy for the field of psychology as well as an outreach service to improve public health. In order to benefit from psychotherapy, individuals must view it as a legitimate way to address their problems. Strategies may include marketing psychological services at a national level, such as the APA’s 1996 public education campaign (Farberman, 1997); at a group level, such as a community mental health system providing rationale for increased funding; or at an individual level, such as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and problem-solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory

Rochlen and Hoyer (2005) identify social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three principles define social marketing: negative demand, sensitive issues, and invisible preliminary benefits (Andreason, 2004). Negative demand describes the challenge of selling a product (psychotherapy, in this case) that the individual does not want to buy. In the case of individuals who see therapy as unhelpful or a frightening experience, addressing negative demand would include considering the viewpoint of a reluctant audience and perhaps utilizing the Stages of Change model (Prochaska & DiClemente, 1984), in which the goal of the marketing campaign would be to move an individual from the precontemplation stage to the contemplation stage of change. Social marketing theory also takes into account the degree of sensitivity in the task being encouraged; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, such as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to seek psychological help are often not seen immediately, as they are when receiving a pain medication. Therefore, marketing strategies for mental health must make consumers aware of psychotherapy’s benefits and the long-term prospect of improving quality of life.