Abnormal Psychology, Exam I Study Cards
April 30, 2017 | Author: Vanessa | Category: N/A
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Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Psychopathology
Abnormal Behavior
Study of why people think, behave, and feel in abnormal, unexpected ways.
Given social, cultural, and situational factors, any behavior or thought that is maladaptive or has a negative affect Characteristics:
“something wrong with a person’s psychology”
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Personal Distress (emotional pain and suffering)
A search by clinicians for the reasons why people behave, think, and act in abnormal ways. Focus is on
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Disability (impairment in a key area)
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Violation of Social Norms (makes others uncomfy)
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Description
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Causes
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Treatment
Cultural relativism: behavior determined by culture and society •
Dysfunction: Wakefield’s harmful dysfunction
DSM-IV-TR includes all these characteristics Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Stigma
What are the three historical views?
Having a negative connotation – how we think about mental illness. Labeling someone based on our assumptions, and negativity is attached in a big way.
(guiding perspectives over time)
Apply label refers to undesirable attributes people seen as different discrimination
Supernatural: mental illness is due to supernatural forces (demonology, God, possession, etc) Biological: originated with Hippocrates, says that psychopathology is due to dysfunction in the brain, it is similar to physical disease Psychological: says that psychopathology is due to something in the environment like stress or trauma These views dictated how mental illness has been treated, and how people with mental illness were treated
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Freud
Behaviorism
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Influenced by Bruer
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Emphasized stages of psychosexual development
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Importance of unconscious processes Repression and defense mechanisms
Suggests that behavior develops through classical conditioning, operant conditioning, or modeling. People with symptoms just need to reinforce OTHER behaviors. Shift was towards observing things that we can see, and moving away from unconscious •
John Watson father of behaviorism, focused on learning and observable behavior
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BF Skinner: positive and negative reinforcement, showed that operant conditioning can shape behavior
Influenced psychoanalytic theory: •
Free association
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Analysis of transference
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Understand conflicts and find healthier ways dealing with them,.
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Cultural Relativism
Wakefield’s Harmful Dysfunction
Says that behavior is determined by culture and society, and that there is no universal for human behavior.
Says that must be harmful to the self or society, and must be an element of dysfunction, something operating in a way that deviates from how it should operate.
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Think of gender roles in different parts of the world
Someone might deny harm to themselves or society but actually be doing harm!
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Demonology
Hippocrates
Earliest idea of mental illness. Believed that demons and evil spirits possessed the mind to cause mental illness, and that exorcism was the only treatment. They drilled holes in the skull to let the, escape (trepanning)
Gave earliest biological explanation Thought that mental illness was caused by natural as opposed to supernatural causes, and that it was located In the brain •
Imbalance of four humours of the body Black bile (infection) Yellow bile (anxiety) Phlegm Blood
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Timeline of Psychopathology
Lunacy Trials
Supernatural Biologicacl (Hippocrates) Dark Ages (supernatural) Witches Lunacy Trials Aslyums (Priory of St Mary of Bethlehelm Pinel (humanitarian treatment) William Tuke and Society of Friends Dorthea Dix NAME can be inherited (Behavioral genetics) Eugenics Psychological Approaches Mesmer Bruer Freud (psychoanalytic theory) Neo-freudians Adler Behaviorism (Watson, Thorndike, skinner) Modeling (Bandura and Menlove) Behavior therapy
Organized by the government (13th century England) to determine sanity. Lunacy refers to theory that attributes insanity to misalignment of the room and stars
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Priory of St. Mary of Bethlehelm
Phillipe Pinel
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One of the first mental institutions
Pioneered humanitarian treatment
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Exploited those with mental illness
Took Control of Aslyum
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Origin of term bedlam
Wanted to treat people with dignity, like humans, to cure
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Treatment non-existent or harmful
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Moral Treatment
Dorthea Dix
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William Tuke and Sociey of Friends, York Retreat
Crusaders for prisoners and mentally ill in the United States
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Provided a calming environment
Urged improvements in institutions
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Gave patients purposeful activity
Established 32 new public hospitals,
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Talked with attendants
But too large to maintain moral treatment Hospitals staffed with physicians
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Kraepelin
Behavioral Genetics - emergence
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Pioneered classification of mental illness based on biological cause
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Noticed groups of symptoms tended to co-occur, called it a syndrome, evidence of a biological cause
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Published first psychiatry text Dementia Praecox (schizo) and manic depressive psychosis (bipolar disorder)
“The extent to which behavioral differences are due to genetics” After Kraepelin noticed that symptoms tended to co-occur and termed this a syndrome, was noted that these syndromes ran in families and could be inherited, so investigated causes Eugenics: only those with desirable traits should be allowed to “breed” (period of enforced sterilization”
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Psychological Approaches
Freud
View mental illness as due to psychological functions
Psychoanalytic theory: Human behavior is determined by unconscious forces, things we aren’t aware o that an observer cannot see
Dysfunctional thinking patterns, behavior determined by reward/punishment, things in the brain that couldn’t be understood due to biology Mesmer: used animal magnetism and hypnosis to treat hysteria Bruer: Used hypnosis to facilitate catharsis
Psychopathology results from conflicts among these unconscious forces ID: unconscious, energy is libido, operates according to pleasure principle, reduces tension through wish fulfillment and fantasies EGO: develops to consciously control the ID, conscious and operates according to reality principle SUPEREGO: our conscience, societal influence
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
**Stages of Psychosocial Development
Defense Mechanisms
Oral Stage
Rationalization: justifying with socially acceptable reasons over real
Anal Stage
Repression: blocking threatening memory from consciousness
Phallic Stage
Regression: return to more primitive levels of behavior
Latency period
Denial: refusing to admit something unpleasant happening
Genital Stage
Reaction formation: transforming anxious thoughts into opposite Displacement: taking it out on someone/something else
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
**Conflict between ID,EGO,Superego
Neo-Freudians (Jung and Adler)
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ID vs EGO
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EGO vs Superego
Jung: Analytical psychology Collective unconscious
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Superego vs ID
Archetypes Adler: individual psychology Striving for superiority Inferiority complex Move towards rational thinking
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Conditioning
Conditioning continued (Skinner)
Classical Conditioning: Pavlov, learning by temporal association
Skinner Box
When two events repeatedly occur close together in time, they become fused in mind before long, respond in same way to both events
Positive and Negative Reinforcement and Punishment
US (meat) --> UR (salivate) US (meat) + bell --> UR (salivate) CS (bell) --> CR (salivate) Operant Conditioning: (Thorndike) Looked at learning through consequences.
(provide definitions and examples) Positive Reinforcement: something added increases behavcior Negative reinforcement: something taken away increases behavior, so behaviors that terminate a negative stimulus are strengthened Positive punishment: something added decreases behavior Negative punishment: something removed decreases behavior
Law of Effect: any behavior followed by a pleasurable consequence will be repeated, unpleasant consequence will be discouraged.
Chapter 1 Introduction and Historical overview
Chapter 1 Introduction and Historical overview
Modeling and Shaping
Behavioral Therapy
Modeling: Learning without any reinforcement
“Application of procedures and principles used in operant conditioning”
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Bandura and Menlove (children and fear of dogs)
Shaping: reward a sequence of responses that approximate a final response (rats and pushing a lever)
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Must identify problems causing behavior and replace
them with better ones. Therapist is like a coach Counterconditioning: causing same stimulus to elicit a different response (instead of fearing the bridge, being able to drive over it) Systematic Desensitization: used often in treatment of phobias and anxiety disorders. Identify phobia and then use relaxation techniques and expose to what afraid of at different levels, lead up to ultimate fear **Aversive Conditioning**
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Paradigm
Genetic Paradigm
A conceptual framework or general perspective.
Says that psychopathology is caused or influenced by heritable factors. Heredity plays some role in most behavior!
Ways that people think about mental disorder, how we organize information around it, has implications for how people are treated Helps shape what we investigate treat and how we define abnormal behavior
Genes and the environment interact, and this leads to psychopathology. Think of nature via nurture Gene Exoression: proteins influence whether the action of a specific gene will occur Heritability: extent to which variability is due to genetics. Is a group rather than an individual indicator Shared environment: events and experiences family members have in common Nonshared environment: events and experiences unique to member
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Neuroscience Paradigm
Psychoanalytic Paradigm
Emphasizes the role of the brain, neurotransmitters and other systems like the HPA axis in psychopathology. View that behavior can best be understood by reducing it to its basic biological components. Ignores more complex views of behavior.
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Derives from the work of Freud
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Contemporary contributions are in treatment, including ego analysis and brief therapy
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Criticized, but highlights importance of childhood experience, the unconscious, and that causes of behavior aren’t always obvious
Axon includes: Cell body, dendrites, axon, and terminal button Treatment is often via drugs and biological treatments to rectify specific problems of the brain. Neurotransmitter: chemical substance released in the synapse of a presynaptic neuron Receptor sites on postsynaptic neuron absorb NT (excitatory or inhibitory reaction) Reuptake: reabsorption of leftover NT by the presynaptic neuron
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Cognitive Behavioral Paradigm
Emotion (and factors across paradigms)
Behavior is reinforced by consequences!
Plays a predominant role in a number of disorders
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Attention, escape or avoidance, sensory stimulation, access to desired object or events
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To alter behavior, alter the consequences
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Systematic desensitization
Emphasizes schemas, attention, and irrational interpretations and their influence on behavior as major factors in psychopathology •
Has usually blended cognitive findings with the behavioral in an approach to intervention that is referred to as the cognitive behavioral (beck and ellis focused on altering patients negative schemas and interpretations)
Expression, experience, and physiology of emotion can be disrupted Expression: showing emotion Experience: feeling it Physiological: how the experience of the emotion affects physiological state •
Disturbance of emotion seen in 90% of disorders
Other factors important in psychopathology: Culture, ethnicity, gender, social support, relationships. Women more likely depressed than men, social support determines success of therapy
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Diathesis-Stress
Behavior Genetics
Integrates several points of view
Study of individual differences in behavior attributable to differences in genetic makeup
Assumes that people are predisposed to react adversely to environmental stressors. Diathesis: underlying predisposition: m ay be genetic, neurobiological, or psychological and may be caused by
Genotype: genetic material inherited by an individual, unobservable Phenotype: expressed genetic material, observable behavior and characteristics
Stress the triggering event, like early childhood experience, genetically influenced personality trait, or sociocultural influences •
Diathesis is within a person (genetic neurobiological) and stress is external to person
So phenotype = genotype + environment interaction! Gene Environment Interaction: ones response to a specific environmental event is influenced by genes, interaction is recipricol.
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Epigenetics
Neurotransmitters and Psychopathology
Study of how the environment can alter gene expression or function
Norepenephrine: anxiety disorders
Rats born to mothers with low parenting skills and RAISED by mothers with high parenting skills showed lower levels of stress reactivity, AND increased gene expression implicated in stress response
Seratonin and Dopamine: depression and schizophrenia GABA: anxiety Possible Mechanisms:
Graph: having at least one short Allele means greater lilklihood of developing depression.
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Excessive or inadequate levels
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Insufficient reuptake
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Excessive number or sensitivity of postsynaptic neuron
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Brain Structure and Function
Autonomic Nervous System
Sulci: define regions or lobes
Responsible for involuntary functions, involved in anxiety disorders
Frontal: thinking and reasoning abilities
Sympathetic Nervous System: (fight or flight): excitatory functions
Parietal: touch recognition
Parasympathetic Nervous System: quiescent function, except for gastrointestinal activation
Occipital: recognition of sights and sounds, long term memory Temporal: integrates visual input Hemispheres: halves of the brain separated by corpus callosum LEFT: speech and analytical thought RIGHT: spatial relations and pattern re cognition
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
HPA Axis (Neuroendocrine System)
Contemporary Psychodynamic Paradigms
Involved in the stress response
EGO ANALYSIS:
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Hypothalamus triggers release of CRF
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Pituitary gland releases ACTH through blood
3)
Adrenal cortex triggers release of cortisol, stress hormone
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emphasis on the ego vs ID
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focus on interaction with the environment
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current experience (vs childhood events)
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Proponents were Horney, Freud, Erikson, Rapaport, etc
Blood sugar elevated and metabolic rate increases
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Brief Psychodynamic Therapy
Criticism of Psychoanalysis
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Time limited
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No formal research
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Active therapist involvement
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Inadequate and non-representative samples
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Concrete goals
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Continuing impact
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Development of coping skill
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Current life and experiences
GOOD POINTS…
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Transference downplayed
Personality shaped by early childhood
Most in response to criticism from insurance companies that it takes too long! Must have diagnosis within three sessions
Behavior influenced by unconscious
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Systematic Desensitization
Cognitive Science
Expose someone who has fear of object or event to what they fear in combination with relaxation techniques
Cognition: a mental process which includes perceiving, judging, reasoning, conceiving, and recognizing
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Important treatment for anxiety disorders
Causes of behavior not always apparent or obvious
Schema: Organized network of previously accumulated knowledge Role of attention in psychopathology: anxious individuals more likely to attention to threatening stimuli
Chapter 2 Current Paradigms in Psychopathology
Chapter 2 Current Paradigms in Psychopathology
Beck’s Cognitive Therapy
Ellis’s Rational-Emotive Behavior Therapy
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Therapy that helped to identify and then change maladaptive thought patterns. “Nothing ever goes right for me!”
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Originally developed for depression (BDI) – depression caused by information processing biases. Made patients search for evidence as support of their biases
Identified and challenged patients’ irrational beliefs Irrational beliefs: Internal, repetitive thoughts that reflect assumptions abot the self “in order to be happy, I must be loved!” •
Musts or shoulders that are commonly unrealistic demandws that we place on ourselves and others
Eg people shouldn’t make mistakes”
Chapter 2 Current Paradigms in Psychopathology
Chapter 3 Diagnosis and Assessment
Paradigms of Psycopathology
Diagnosis and Classification
Psychodynamic Neurobiological
Diagnosis: provides the first step into thinking about causes of symptoms and in planning treatment Advantages:
Cognitive-Behavioral
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Communication among professionals, clinical care
Genetic
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Advances search for causes and treatments
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Diagnosis is important – must be made within 3 sessions
Diathesis-Stress
Classification: of disorders is by symptoms and signs so the diagnosis is a cluster of symptoms **only in psychopathology does classification and diagnosis get hazy because we don’t have discrete tests
Chapter 3 Diagnosis and Assessment
Chapter 3 Diagnosis and Assessment
Reliability
Validity ACCURACY How well test measure what we are trying to find out
Consistency of measurement Inter-rater reliability: agreement of observers or clinicians. Why we have the DSM – so two doctors from different backgrounds can look at same patient and make same diagnosis (.7 is acceptable) Test-retest reliability: similarity of scores across repeated test administrations or observations (mood may not have it) Alternate forms: similarity of scores on tests that are similar, but not identical. Similar forms meant to test same thing should have similar results… trying to test the same thing in a different way Internal Consistency: extent to which items on a test are related to one another
Content Validi: extent to which measure samples domain of interest Criterion Validity: extent to which a measure is associated with another measure Concurrent means that two measures are given at same time (Hopelessness and depression) Predictive means the ability of the measure to predict another variable measured at some future point in time (GPA and salary) Construct Validity: correlating multiple indirect measures of the attribute to give abstract construct legitimacy (if we find correlation) DIAGNOSES in DSM are constructs, strong one predicts many char.
Chapter 3 Diagnosis and Assessment
Chapter 3 Diagnosis and Assessment
DSM-IV-TR
History of the DSM
Manuel used for making diagnoses Diagnostic and Statistical Manual of Mental Disorders In the 4th edition, 5th by 2010, multiaxial system Published by American Psychological Association (APA) Axis I: Clinical Disorders (come and go) Axis II: Mental and Personality Disorder (permanent) Axis III: general medical conditions Axis IV: Psychosocial and environmental factors Axis V: GAF Score (global assessment of functioning)
DSM-1952: Called “reactions” because thought that soldiers came back from WWII and reacted to trauma DSM II 1968: Neuroses (disorders) and psycos (categories) DSM III (1980) major revision (disorders and multiaxial system) DSM III-R 1987 DSM IV TR background of disorders added DSM V 2010? ** Most concerned with inter-rater reliability and construct validity
Chapter 3 Diagnosis and Assessment
Chapter 3 Diagnosis and Assessment
Axis I Disorders
Improvements in DSM-IV-TR Specific Diagnostic Criteria: less vague!
Childhood/Infancy/Adolescent Disorders: Learning and Developmental Disorders Substance related disorders Schizophrenia and Psychotic disorders Anxiety Disorders (GAD, Panic disorder, OCD
More extensive descriptions •
Essential features
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Associative features (lab findings)
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Differential diagnoses (helps to distinguish 2 disorders from one another)
Mood Disorders (major depression and bipolar)
Increasing number of categories: comorbidity 45%
Eating Disorders (Anorexia nervosa and Bulimia Nervosa)
Issues and diagnostic categories in need of further study Increased cultural sensitivity (cultura bound syndromes)
Chapter 3 Diagnosis and Assessment
Chapter 3 Diagnosis and Assessment
Diagnosis: Cultural/Ethnic Influences
Criticisms of the DSM
Culture can influence:
Categorical vs Dimensional Diagnosis:
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Risk factor for disorder
Categorical Classification: Yes or no, it’s there or not
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Symptoms experienced and how described
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Willingness to seek help
Dimensional Classification: having more of a gradation, degree to which a symptom is present
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Availability of treatments
New DSM-IV-TR includes framework for evaluating role of culture and ethnicity, and a description of the cultural factors of each disorder
DIMENSIONAL better capture an individuals functioning CATEGORICAL has advantages for research and understanding, but clinicians don’t like because a person might be impaired in certain areas, but doesn’t meet full criteria doesn’t get funded for treatment
Chapter 2 Current Paradigms in Psychopathology
Chapter 3 Diagnosis and Assessment
Should we Classify in the first place?
Psychological Assessment
Criticisms of classification:
Techniques employed to:
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Label stigma
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Have basis for making decision
Treated differently by others
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Describe client’s problem
Difficulty finding a job
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Determine causes and come to diagnosis
Never goes away, changes to “in-remission”
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Develop treatment strategy
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Monitor progress of treatment
Categories don’t capture uniqueness of person, and don’t define the person. Classification may emphasize trivial similarities, and relevant information might be overlooked
Ideal assessment involves many measures and methods (interviews, personality assessment, inventories)
Chapter 3 Diagnosis and Assessment
Chapter 3 Diagnosis and Assessment
Psychological Assessment Methods
Neurobiological Assessment Brain Imaging:
Interviews Clinical (pay attention to how questions answered, if there is appropriate emotion) and Structured (on paper) Paradigm influences information sought in interview. Good rapport is essential. Psychological Tests Personality Tests (MMPI) self report measure yields profile of psychiatric functioning with a subscale to catch fakers, Projective Tests,: response to ambiguous stimuli reflect unconscious process Intelligence Tests: good for detecting mental retardation Direct Observation Antecedents consequence unit Self Observation self monitoring, problem is reactivity
CT or CAT scan (computerized axial tomography): reveals structural abnormalities by detecting differences in tissue density MRI (magnetic resonance imaging): higher quality than CT fMRI: allows to look at blood flow (blood oxygenation levels) as an indication of neural activity. Structure and function PET Scan: Positron Emission Tomography: Brain function, less common, inject radioactive isotope, radioactively tagged glucose emits positrons that are picked up from scanner ** not good methods for diagnosing disorder
Chapter 3 Diagnosis and Assessment
Chapter 3 Diagnosis and Assessment
Neurotransmitter Assessment
Psychophysiology
Post Mortum studies: look at brain after someone has died
study of bodily changes that accompany psychological characteristics or events. How behaviors and cognitions are linked to these bodily changes
Metabolite Assays: (byproduct of NT deactivation) can measure this amount in the person’s body – but not great reflection of NT in brain because is also gives NT in the entire body. Limited measure of causation
Electocardiogram (EKG): heart rate measured by electrodes placed on chest
Neuropsychologist: someone who studies how abnormalities in the brain affect aa perons’s cognition, and behavior
Electrodermal responding (skin conductance) : sweat gland activity measured by electrodes placed on hand
Neuropsychological Tests: interviews that measure brain or cognitive functioning (batteries)
Electroencephalogram (EEG): Brain’s electrical activity measured by electrodes placed on scalp
Chapter 3 Diagnosis and Assessment
Chapter 4 Research Methods
Cultural Bias and Assessment
Terms of Research
Measures developed for one culture or ethnic group my not be valid or reliable for another clture. Most are developed for white men, not just a language barrier. But also a factor
Science: The systematic pursuit of knowledge
Not just a matter of translation, meaning may be lost in translation Cultural bias can lead to minimizing or exaggerating psychological problems in people that come in for help
Theory: method of explaining and predicting phenomena that is supported by empirical evidence taken as fact, set up to be disproven •
A good theory is falsifiable
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A set of prepositions developed to explain what is observed
Hypothesis Specific testable predictions about what will occur if a theory is correct
Chapter 4 Research Methods
Chapter 4 Research Methods
Research Methods in Psychopathology
Case Study
Case Study: Descriptive biographical information about an individual
Detailed biographical description of an individual
Correlation: Relationship between two or more variables. No manipulation by scientists, what is happening in nature. Most common and easiest to conduct
Family history, Medical history
Experimental Studies: Manipulation of an independent variable and DV. DV is what we are looking fo9r change. And there is random assignment
Ethnicity, Gender, Personality and adjustment issues Social support around them, day to day environment Childhood Educational background, and experience with therapy Usefulness: rich description, good for hypothesis, rare disorders, good for disproving hypothesis, also good hypothesis generator Limitations: BIAS (paradigm may influence observations) Cannot rule out altere explanations, and generalizability is limited
Chapter 4 Research Methods
Chapter 4 Research Methods
Correlational Method
Longitudinal vs Cross Sectional Study
Correlational Coefficient ranges from -1 to 1
Longitudinal: study done over many years with the same people to see if causes are present before disorder develops
Direction Negative relationship: variables move in opposite directions Positive relationship/correlation: variables move in same direction Constant: no relationship Strength (magnitude): the higher the absolute value, the stronger the relationship
High Risk Model: include only those who are at greatest likelihood of developing a disorder – reduces the cost of longitudinal research Cross Sectional Design: looking at simultaneous factors, taking data at one point in time and looking at two different things, causes at effects measured at the same time.
Statistical Significance: probability less than .05% something other than chance is happening here! Larger samples increase likelihood that result is significant CORRELATION DOES NOT IMPLY CAUSATION (confounding variable)
Chapter 4 Research Methods
Chapter 4 Research Methods
Correlational: Epidemiological Research
Correlational: Behavioral Genetics
Study of the distribution of disorders in a population Three features of a disorder •
Prevalence: number of cases that are here long
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Incidence: number of new cases that occur
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Risk Factors: associated with higher chance of having a disorder (men vs women)
Index cases/Probands: people who actually have the illness, a sample of individuals with psychopathology Concordance: Co-occurencec or similarity of diagnosis (concurrent people have the same diagnosis) Family studies: degree to which people are related in a family, and relationship of degree of relatedness and degree of disorder Twin Studies Monozygoric twins : 100% genes Dizygotic twins 50% Adoptee Method: Study of adoptees who have biological parents with psycopathology Cross Fostering: Study of adoptees who have adoptive parents with psychopathology
Chapter 4 Research Methods
Chapter 4 Research Methods
The Experiment
Analogue Experiment
Provides information about ausal relationships (does x cause y?) involves Independent variable, DV, Random assignment
Experiments that aren’t possible in psychopathology (if not ethnical) we can examine related or similar behavior in the lab… people with a certain diagnosis may come into the lab, and then there is a manipulation done…
Can evaluate treatment effectiveness – most often used in psychopathology research Internal validity: extent to which experimental effect is due to independent variable (so if groups differ too much, bad thing! GOOD internal validity means that change is probably due to experiment
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Elicit symptoms
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Select samples with similar attributes
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Animal research
Control Group: People that don’t receive treatment, the standard against which treatment effectiveness is judged (placebo) External Validity: extent to which results generalize beyond study
Chapter 4 Research Methods
Chapter 4 Research Methods
Single Subject Experimental Research
Integrating Findings from Multiple Studies
Examine how individual participants respond to changes in the independent variable
Meta Analyses: allows us to come to some conclusion about if hypothesis supported
Reversal ABAB Design (girl in book that was afraid of sharp foods)
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Identify relevant studies
Baseline (A) Treatment (B) Withdrawal (A) Reinstatement (B)
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Compute effect size (transform to common scale)
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Smith et al meta analyzed 475 outcome studies and said that psychotherapy is effective
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Fear vs Anxiety
Anxiety Disorders
Anxiety: apprehension about a future threat
Deal with atypical, maladaptive levels of anxiety. As a group are the most common psychiatric disorders. 25% of people report anxiety at some point, phobias most common
Fear: response to an immediate threat – the present oriented mood state triggers the fight or flight response
Major Anxiety Disorders: **both can be adaptive: May save life (fear) and anxiety can increase preparedness (improve performance)
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Specific phobia or social phobia
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Panic Disorder
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GAD
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OCD
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PTSD
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Acute Stress Disorder
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Phobia
Etiology of specific phobia
Disruptive fear of a particular object or situation that causes concern
Mowrer’s Two Factor Model:
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Fear out of proportion to actual threat
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Realization that is excessive
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Symptoms must interfere with job or social life
Two types: specific and social Animals (snake most common) Situations
Step 1: Classical Conditioning: pairing of stimulus with aversive UCS leads to fear (classical conditioning) so we are attaching fear to an unconditioned stimulus based on a bad experience UCS = dog bite (seeing, hearing about, experiencing) Step 2: Operant conditioning: avoidance maintained through negative reinforcement… avoiding what we are afraid of to ease anxiety and feel good
Natural environment - Comorbid with physical disorders
Problems: many people never experience interaction with aversive object (what if they dob’t remember?) specific types alludes to prepared learning (innate)
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Social Phobia
Etiology of Social Phobia
Blood, infection, injury (only parasympathetic response)
Two Factor Model Persistent, intense fear of social situations •
Fear of attention, scrutiny, evaluation
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33% also diagnosed with avoidant personality disorder
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Often beings in adolescence
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Depends on range of situations avoided, could be
Generalized or specific
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Avoidance and safety behaviors
Safety behaviors may actually make other person uncomfortable (looking away, fidgeting) to make first person even more awkward •
Cognitive factors
Negative self evaluation Fear of negative evaluation by others High standards and performance in front of others
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Treatment of Phobias
Panic Disorder
Psychological treatments that emphasize exposure procedure – fqce what triggers anxiety, and see that it’s not so bad
Marked by frequent panic attacks that are unrelated to specific situations… bouts of unexplainable anxiety
Systematic desensitization: relaxation plus imagined exposure to feared object. For social phobia, might be exposure in small group setting/interaction. Also use social skills training to reduce use of safety behaviors
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Must also be worried about having attacks in the future
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At least one month after the first case
Sudden intense episode of apprehension, fear, impending doom. •
Sweating, nausea, labored breathing, dizziness, heart palpitations,
Cognitive Therapy: good for social phobias but not specific phobias, because specific phobia people KNOW they have distorted beliefs, and most of cognitive therapy is figuring that out.
Depersonalization: feeling like out of own body
Medication: but if affect fear response system not as great because we don’t get symptoms when exposed to what we fear.
Derealization: feel like things around you aren’t real. Can be cued or uncued
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Etiology of Panic
Treatment of Panic and Agoraphobia
Neurobiological Factors LC (norepenephrine)
PCT (panic control therapy)
Genetic predisposition (identical twins: 30% chance) Interoceptive conditioning: classical conditioning response to somatic symptoms Cognitive Factors: fear of bodily changes and fear of fear hypothesis
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Exposure to somatic sensations with relaxation and hierarchy
Cognitive Behavioral Therapy: Increase awareness of thoughts about physical sensations, patients learns to challenge maladaptive beliefs
Exoectations about negative consequences of attack in public
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
War Article
Symptoms of Anxiety Disorders
Greater Risk: those with greater threat of loss or actual loss
Somatic, emotional, cognitive, and behavioral
Those with fewer coping resources
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Generalized Anxiety Disorder (GAD)
Obsessive Compulsive Disorder (OCD)
Trademark symptom: constant worry, lasts at least 6 months
Obsessions: intrusive, recurring and uncontrollable thoughts or urges that are experienced as irrational. Most common are contamination, sexual, and aggressive
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Restlessness, fatigue, interferes with daily life, often begins in adolescence
Etiology of GAD: GABA deficits Borkovec’s cognitive model: worry is reinforcing because it distracts from negative emotions and images that may be more painful for a person to confront – worry is tolerable compared to this. There is no exposure, so anxiety never distinguishes. Treatment: cognitive behavioral models, challenge and modify negative thoughts, increase ability to tolerate uncertainty, worry only during scheduled times
Compulsions: impulse to repeat certain behaviors or mental acts. Extremely difficult to resist the impulse, may involve elaborate ritual Etiology: Hyperactive regions of the brain (Anterior cingulate, orbitofrontal cortex, Caudate nucleus). Operant reinforcement: compulsions are negatively reinforced by reduction of anxiety. Person wants to engage in compulsion to get rid of anxiety generated by obsessions.
\ Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Treatment of OCD
PTSD (Post traumatic stress disorder)
Exposure plus response prevention (ERP): most widely used treatment – enduce something to cause to perform compulsion, then NOT let them do that, then gradually expose t anxiety, and extinguish compulsion.
Extreme response to severe stressor, event leads to intense fear of helplessness, for diagnosis symptoms must be present for at least a month
Cognitive Therapy: challenge beliefs about anticipated consequences of not engaging in compulsion Medication
Symptoms 1)
Reexperiencing the traumatic event
2)
Avoidance of stimuli (avoid situations or numbing)
3)
Increased arousal (startle response, hypervigilance)
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Etiology of PTSD
Treatment of PTSD
Nature of trauma: highest risk most severe trauma) Neurobiological: Smaller hippocampal volume, increases receptor activity to cortisol
•
Exposure to memories and reminders of original trauma Either direct (in vivo) or imaginal, treatment may originally INCREASE symptoms
Behavioral: two factor model
Cognitive Therapy: enhance beliefs about coping abilities
Psychological
Medications:
Perception of control
Treatment of ASD may prevent PTSD
Avoidance coping, dissociation, memory suppression
Chapter 5: Anxiety Disorder
Chapter 5: Anxiety Disorder
Acute Stress Disorder
Comorbidity Anxiety Disorder
Symptoms of ASD are similar to PTSD
¾ with anxiety disorder have another disorder
Duration is what is different (short term reaction)
60% meet criteria for major depression
Experienced by 90% of rape victims
½ individuals with anxiety disorder meet criteria for another one
More than 2/3 with ASD develop PTSD
General and Sociocultural Factors Genetics; twin studies suggest heritability for phobias Neurobiological: overactive fear circuit (and amygdale) NT: serotonin, gaba, NP
Chapter 5: Anxiety Disorder
Chapter 6: Somatoform Disorders
Risk Factors Anxiety Disorder
Somatoform Disorders
Cognitive: perceived control (those who believe have little control are more vulnerable) and attention to threat (pay more attention)
Pain Disorder
Social: negative life events often precede disorder onset
Body dysmorphic disorder Hypochondriasis,
Somatization disorder
Conversion Disorder Psychosomatic Disorders: Physical illness present, psychological factors contribute to illness Malingering: Deliberate faking of physical symptoms to avoid unpleasant situations Factitous Disorder: Deliberate faking of physical symptoms to gain medical attention
Chapter 6: Somatoform Disorders
Chapter 6: Somatoform Disorders
Pain Disorder
Body Dysmorphic Disorder
Person experiencing severe, prolonged pain
Some sort of defect with the body focus
Cannot be accounted for by organic pathology Is caused or intensified by psychological factors like stress Individual is unaware of psychological origins Diagnosis is challenging
Preoccupation with and extreme distress over imagined or exaggerated defect in appearance Attempt to camoflague or hide defect ½ have suicidal thoughts, onset is adolescence, sluightly more common in women than men, prevalence less than 1% High levels of comorbidity: Some think BDD and OCD are the same thing
Chapter 6: Somatoform Disorders
Chapter 6: Somatoform Disorders
Hypochondriasis
Somatization Disorder
Preoccupation with fears of having a serious disease, despite medical assurance, lasting at least six months
Someone with physical symptoms (with no apparent cause) that would warrant medical attention, but are calm, accepting, stoic about it.
Usually critically of medical professionals Onset is typically early adulthood, and is comorbid with anxiety and eating disorders
Maybe people feel that distress is more appropriately expressed through physical symptoms?
Chapter 6: Somatoform Disorders
Chapter 6: Somatoform Disorders
Etiology of Conversion Disorder
Conversion Disorder
Psychoanalyic perspective: Individual experiences distressing event, and unable to express emotional distress, so memory of event pushed into unconscious In women linked to electra complex No empirical support Social and Cultural Factors: Decrease in incidence since first half of 19th century, does it have to do with more repressed sexuality? • More prevalent in rural areas and lower SES, and in non western cultures Cognitive Behavioral Model: preoccupation with body or physical health, gross misinterpretation of symptoms/feelings, negative thoughts exacerbate symptoms
Lose functioning in different parts of the body
Chapter 6: Somatoform Disorders
Chapter 6: Somatoform Disorders
Etiology of Conversion Disorder
Treatment Somatoform Disorder
Psychoanalyic perspective: Individual experiences distressing event, and unable to express emotional distress, so memory of event pushed into unconscious In women linked to electra complex No empirical support Social and Cultural Factors: Decrease in incidence since first half of 19th century, does it have to do with more repressed sexuality? • More prevalent in rural areas and lower SES, and in non western cultures
Pain Disorder: antidepressants and psychotherapy (validate pain, teach relaxation, and coping strategies) BDD: Antidepressants and CBT (also for hypochondriosis and somatization disorder) Somatization Disorder: validate physical complaints, minimize use of tests and medicine, avoid prolonging attention, treat underlying depression and anxiety Conversion Disorder: Reinforcement of high functioning behavior may help
Chapter 6: Somatoform Disorders
Chapter 6: Somatoform Disorders
Dissociative Disorders
Dissosicate identity Disorder (DID)
Disruption of consciousness, but more severe in disorders Defining feature is disruption in consciousness, memory, or identity All experience dissociation at some level, like zoning out :P lala…
Used to be multiple personality disorder
Dissociative amnesia Dissociate fugue Depersonalization disorder Dissociative Identity Disorder DID
Rare disorder! Symptoms: headache, hallucination, self harm suicide attempts
Sensory or motor function impaired but no known neurological cause Vision impairment, seizures, coordination problems, Anesthesia, Aphonia, Anosmia, La Belle Indifference
Onset: usually occurs after significant stressor Cormorbid with substance abuse, personality disorder, BDD, prevalence less than 1% Somatization disorder has symptoms in several areas of body, conversion is localized to sensory and motor function
Each with unique behaviors, relationships, and memories Memory gaps are common when alters are in control
Comorbid with: PTSD, depression, borderline personality disorder, substance abuse, phobias More common in women than men
** best way to study is with case study
Chapter 6: Somatoform Disorders
Chapter 6: Somatoform Disorders
Epidemiology DID
Treatment of DID
Major increase in diagnosis since 1970s because of media attention
Mainstays of most treatments:
DSM III (1980) made more explicit diagnostic criteria to address this surge
Empathetic support of therapist REALLY important
Etiology of DID, Two major theories Posttraumatic model: results from sever psychological and or sexual abuse as child
Integration of alters into one fully functioning individual Improved coping skills Psychoanalytic approach adds Re-experience the traumatic event thought to underly the disorder (hypnosis)
Sociocognitive model Is a form of roleplay in suggestible individuals Can be done by hypnotized students Only partial memory deficit in DID patients Differs by clinicians, few clinicians diagnose, after therapy starts gnose the majority of cases Chapter 6: Somatoform Disorders
Chapter 7: Stress and Health
Summary of Somatoform Disorders
Defintiions
Features somatoform disorders: physical problems without organic cause Features dissociative disorders: extreme distortions in perception, memory, or identity BOTH rare but we have quote few movies because they are interesting
Coping: how people try to deal with problems Social Support Structural: person’s basic network of social relationships (marital status and friends) Functional: quality of a person’s relationships Stress: Body’s alarm reaction Resistance Exaustion Allostatic load: price body pays in response to stress and high levels of cortisol, becomes more susceptible to disease
Chapter 7: Stress and Health
Chapter 7: Stress and Health
Psychophysiological Disorder
Cardiovascular Disease Include hypertension and coronary heart disease
Physical diseases produced or influenced in part by psychological factors of stress, social support, and negative emotions • Life stress is relevant to all disorder, so appears on Axis III Etiology diathesis: stress in nature, but stress described in psychological or biological terms Biological diathesis: emphasize effects of allostatic load or changes in the immune system caused by stress Psychological diathesis: emphasize focus on how emotional states, personality traits, cognitive appraisals, and specific types of coping with stress
Etiiology: tendency to respond to stress with increases in blood pressure or heart rate Anger, hostility, cynicism, anxiety, are linked to these conditions
Most successful accounts of etiology are those that integrate both Chapter 7: Stress and Health
Chapter 7: Stress and Health
Asthma
AIDS
Respiratory systems overresond to allergies or have been weakened by prior infection
Arises from behavior that appears irrational and generally is preventable by psychological means
Psychological factors are anger, anxiety, depression, stressful life events, and family conflict
Chapter 7: Stress and Health
Treatment Psychophysiological Disorder Physical dysfunction is valid – so medication used Primary aim is to reduce stress, anxiety, depression, or anger Focus is on changing unhealthy behavior, encouraging breast self exam, intervention, adhering to medical treatment intervention Stress Management Intervention: help people without diagnosable problems avail themselves of techniques that allow them to cope with the inevitable stress of everyday life and ameloriate toll of stress on body.
Focus of prevention is to change people’s behavior - to promote safer sex and discourage sharing of needles
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