What do we mean by “vulnerability”?
•Do we all have the same vulnerability to stress?
•What do we mean by ”protective factors”?
•Give some possible examples of protective factors which may make us less likely to experience stress..
"Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions)."
NHS (2019)
"Psychosis (also called a 'psychotic experience' or 'psychotic episode') is when you perceive or interpret reality in a very different way from people around you. You might be said to 'lose touch' with reality."
Mind (2020)
You will learn more about psychosis later in the module.
The stress vulnerability model was proposed by Zubin and Spring (1977). It proposes that an individual has unique biological, psychological and social elements. These elements include strengths and vulnerabilities for dealing with stress.
Within this model, a person with a high vulnerability for stress is considered more at risk of developing a psychotic illness.
A person with lots of “protective factors” would be considered to be less at risk of developing a psychotic illness or having a relapse (i.e. these factors are protective against the person developing a psychotic illness or having a relapse).
Increasing coping skills or altering environmental factors (family, work, finance, housing etc.) and use of anti-psychotic medication can reduce vulnerability and build resilience. Attending the hearing Voices group may help to build self-efficacy, self-esteem and self-acceptance all of which may be protective against relapse and forms a buffer to demoralisation (Davidson, 1999). We will revisit the hearing voices network later in the presentation.
The development of mental health problems is complex and there is interplay between biological, psychological and social factors.
"Vulnerability" refers to our basic susceptibility to mental health disorders
"Stress" refers to the challenges faced in our lives.
"Protective factors" are conditions or attributes (skills, strengths, resources, supports or coping strategies) in individuals, families, communities or the larger society that help people deal more effectively with stressful events and mitigate or eliminate risk in families and communities
There are many biological, social and psychological factors that may be considered stressors, vulnerabilities or protective factors.
An example biological vulnerability might be a family history of psychosis or a physical illness or disability.
"Susceptibility genes" have been identified for the development of schizophrenia and bi-polar disorder (e.g. Craddock, O Donovan and Owen (2005)
There is also evidence to suggest that people with chronic health problems are more likely to have mental health problems (and vice versa) - e.g. Mental Health Foundation, 2020)
Example biological protective factors might include good phyiscal health or compliance with medication.
Example psychological vulnerabilities might include low self esteem or experiencing abuse or trauma in childhood.
For example, low self esteem has been linked to the maintenance of persecutory delusions and hallucinations in people with schizophrenia
(Garety, Kuipers, Fowler, Freeman and Bebbington, 2001)
Example psychological protective factors might include participating in regular mindfulness or relaxation exercises or high self esteem and self efficacy.
Example social vulnerabilities might include isolation, low income, housing issues
A history of homelessness is common in patients with psychosis using inner urban mental health services and is associated with poorer engagement with psychiatric services. (Holmes et al, 2005)
Example social protective factors might include having stable housing and income, a supportive social network.
You may find it helpful to watch the video below which also helps to explain the stress-vulnerability model.
Notice that the persons vulnerability threshold remains the same; a persons vulnerability to mental health problems is likely to be due a combination of biological and early life experiences.
Day to day stressors cause varying amounts of stress; some of these may tip over the persons "vulnerability threshold" (leading to the development of psychotic symptoms).
Protective factors such as medication or psychological or social factors can "protect" against high levels of stress.
•Risk “acts in concert” with vulnerability but they are not synonymous (Rutter, 1988).
•Consideration to be given to stress and vulnerability over time. Does a person's vulnerability remain the same? Does a person become more vulnerable after each psychotic episode?
•Additive or Ipsative? i.e. stress or vulnerability or risk OR stress AND vulnerability AND risk.
•Can we change the size of out bucket? (see next section i.e. the amount of stress we are able to tolerate) “Vulnerability is stable but not immutable” Ingram and Luxton (2005)
•Ingram and Luxton (2005) explore these themes in more detail – see references / further reading.
What do you consider to be some of the strengths and weaknesses of this model? You may have some additional ideas to those considered below.
Offers Hope
Offers an explanation of individual differences
Offers a bio-psycho-social approach
May be applicable to other mental health problems e.g. depression (Mazure, 1998)
Is it too simplistic?
Some argue “Vulnerability” is a negative or judgemental term
1977 – still relevant?
Doesn’t explain why extreme stress is not linked to psychopathology for all individuals (Monroe & Hadjiyannais, 2002)
Please go to the top left menu to select the next section - The Stress Bucket