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Welcome to MRC Psycho Dick Go Version Stage. My name is I missed Hiny and the West Coast. Like many of you spend a lot of time for YouTube. So I started this podcast to help you revise in the goal. Each episode breaks down one high topic mapped to the syllabus. This is then followed by five questions to help reinforce your learning. So grab your headphones, turn travel time into revision time, and let's get started. In episode 27, we explored how life events and daily hassles contribute to the stress burden. In this episode, we explore two further sources of psychological stress, conflict and trauma. We begin with psychological conflict, a form of internal stress that arises when an individual faces competing motivational demands. The systematic study of motivational conflict was pioneered by Kurt Lewin, a German American psychologist widely regarded as one of the founders of modern social psychology. Lewin was born in 1890 in what is now Poland, but was then part of the German Empire. He served in the German army during the First World War and was wounded in combat. While recovering, he wrote one of his earliest papers, The War Landscape, using his emerging ideas about psychological space to describe how a soldier perceives a battlefield compared to a civilian. It was a sign of things to come. Lewin later fled Nazi Germany in 1933 and spent the rest of his career in the United States. He was famously restless and prolific, and colleagues recalled that he would sketch out entire theories on restaurant napkins during lunch. One of his most quoted lines was that there is nothing so practical as a good theory. Lewin borrowed concepts directly from physics, including fields, vectors, and valences, to describe human motivation. His central equation was simple but powerful. Behavior is a function of the person and their environment. Approach forces act like vectors driving individuals towards desirable goals. Avoidance forces repel individuals from aversive ones. The balance between these forces determines behavior. From this framework, he identified three fundamental types of conflict. The first type is approach approach conflict, or two good things. This occurs when an individual is attracted to two equally desirable but mutually exclusive goals. For example, a junior doctor offered two equally appealing specialty training posts in different cities must choose one and forgo the other. Although both options are positive, the requirement to choose creates psychological tension. Lewin noted that this is typically the least distressing form of conflict because whichever option is chosen, a desirable outcome is secured. The second type is avoidance avoidance conflict, or two bad things. This occurs when an individual must choose between two equally undesirable options. The classic idiom describing this is being caught between a rock and a hard place. A clinical example is a patient with schizophrenia who is stable on clozapine, but is experiencing significant weight gain and metabolic side effects. Stopping the medication risks relapse and hospitalization. Continuing it risks long-term physical harm. Neither option offers relief. Lewin observed that avoidance avoidance conflict tends to produce the most sustained distress, as neither option offers relief. Individuals may vacillate indefinitely or attempt to escape the situation entirely. The third type is approach avoidance conflict, or the single goal. This occurs when a single goal is simultaneously attractive and aversive. For example, a patient may desire recovery from addiction, but simultaneously fear the loss of the coping mechanism that alcohol has provided. Lewin noted that as an individual approaches the goal, the avoidance gradient steepens more rapidly than the approach gradient. This means the closer the individual gets to achieving the goal, the stronger the pull to retreat. This dynamic is highly relevant to clinical work and maps directly onto ambivalence in motivational interviewing. Remember, Kurt Lewin identified three types of motivational conflict based on approach and avoidance forces within a person's psychological environment. These three types of conflict are approach approach, involving two desirable but incompatible goals avoidance avoidance involving two equally undesirable options, and approach avoidance, in which a single goal is both attractive and aversive. We now turn to trauma, a qualitatively different and often more severe form of psychological stress. Trauma refers to exposure to an event or series of events involving actual or threatened death, serious injury or sexual violence. Traumatic events overwhelm the individual's usual coping capacities and leave a lasting psychological imprint. But not everyone exposed to a traumatic event develops a psychiatric disorder. The psychological impact of trauma depends on multiple factors, including the nature, severity, and duration of the event, the individual's prior trauma history, available social support, and biological vulnerability. When the psychological impact of trauma is sufficiently severe and persistent, it may result in posttraumatic stress disorder or PTSD. Post traumatic stress disorder is a formal psychiatric diagnosis characterized by persistent symptoms following exposure to a traumatic event, including re-experiencing the trauma, avoidance of reminders, negative changes in mood and thinking, and heightened arousal. We will explore PTSD in much greater depth in the next episode, including its ICD 11 diagnostic criteria, its neurobiology, and the treatment approaches used in clinical practice. Now let's test your recall. I will read out five exam style questions. After each one, I will pause for 10 seconds so you can attempt them before hearing the answer. Question one. A patient with anorexia nevosa says she desperately wants to recover and gain weight, but becomes increasingly distressed and resistant the closer she gets to her target weight. Which type of conflict does this illustrate?

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Approach avoidance conflict.

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As she approaches her goal weight, the avoidance gradient steepens more rapidly than the approach gradient, increasing the pull to retreat. Question two A junior doctor is struggling with burnout but cannot decide whether to take sick leave or continue working. Taking leave feels like failure, and continuing feels unsustainable and is worsening his mental health. Which conflict type explains his paralysis?

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Avoidance avoidance conflict.

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Both options are aversive. Lewin observed that this type of conflict produces the most sustained distress because neither option offers relief. Question 3. A consultant offers a patient with depression a choice between two equally effective antidepressants, both of which the patient is happy to try. The patient cannot decide and asks the consultant to choose. What does this suggest about approach approach conflict? Even when both options are desirable, the requirement to choose and forgo the alternative creates psychological tension. Approach approach conflict is the least distressing of the three types, but it can still produce paralysis, particularly in individuals with high anxiety or perfectionism. Question four. A survivor of domestic abuse attends her first outpatient appointment. She is guarded, gives minimal history, and leaves before the session ends. Her behavior is documented as non-engagement. What alternative formulation should be considered? Her presentation may reflect avoidance behavior secondary to trauma. Avoidance is a core feature of PTSD and is the mind's attempt to manage overwhelming distress, not a conscious choice to disengage. Lastly, question five. A patient tells you that he experienced a serious assault two years ago, but has never developed any psychiatric symptoms. His friend, who witnessed the same assault, has since developed PTSD. What factors might account for this difference in outcome? The outcome following trauma is shaped by multiple factors. These include the individual's prior trauma history, biological vulnerability, the availability and quality of social support in the aftermath, personal coping style, and the meaning attributed to the event. Let's summarize what we have learnt today. Kurt Lewin described three types of motivational conflict approach approach, avoidance avoidance, and approach avoidance. Remember AAA. Trauma involves exposure to actual or threatened death, serious injury or sexual violence, and overwhelms normal coping capacities. Not all trauma leads to psychiatric disorder. The outcome depends on multiple individual, social and biological factors. In our next episode, we take a much closer look at PTSD, including its diagnostic criteria, the neurobiology that explains why its symptoms are so persistent, and the evidence-based treatments used in clinical practice. Thank you very much for listening to this episode of MRC Psych on the Go provision essential. I hope this episode helped to move your provision forward. If you have any questions or just want to continue the discussion, you can find me a link to MRC Psych on the Go. MRC MC on the goal.