Abnormal Psychology Study Guide

Abnormal Psychology Study Guide DISCLAIMER – this is not a completely exhaustive list of teating disorderhings that you will be tested on, but it is intended to give you a general guide of things to focus on and a guide about the level of detail that you are expected to master. Topics – here is a list of things to know (or be able to do) for the exam Chapter 1- Abnormal Psychology: Past and Present (see also Rosenhan, 1973) ● abnormal psychology - field of study of abnormal behaviors, thoughts, emotions ● Abnormal behavior - the 4 D’s o Why is it so hard to define? o 4 Ds (deviance, distress, dysfunction, danger) ▪ deviance - violate a norm (a societal standard; implicit, explicit) ● but which norms do we use? cultural differences of norms? abnormal vs eccentric? ▪ distress - psychological pain ● what about serial killers though? ▪ dysfunction - difficulty performing daily functions ● isn’t always psychological in nature (eg. physical ailment, own choice) ▪ danger - behaviors that are threatening to themselves or other people ● vast majority of people who have a mental disorder are not dangerous o Sasz’s argument against labeling of mental illness a disease ▪ mental illness provides an ideological justification for state-sponsored social control as medical treatment ▪ people experience different things ▪ deviations that society calls abnormal are only problems in living ▪ societies label people as mentally ill in order to better control or change people who threaten the social order ● General information about prevalence rates of mental illness o comes from epidemiology o In US, adults and children/adolescents have similar rates ▪ adults- anxiety is highest ▪ children/adolescents- ADHD is highest o not just the fault of modern American society ▪ historical records demonstrate that every society had psychological abnormalities and had its own form of treatment o Us is highest among countries for prevalence of mental illness ● Treatment/therapy - procedure designed to change abnormal behavior (thoughts, emotions) into more normal behavior (thoughts, emotions) o 3 essential features: ▪ sufferer who seeks relief from a healer 1/44 ▪ trained, socially accepted healer ▪ series of contacts b/w healer and sufferer ● Be familiar with the history of mental illness. How did people view the causes of mental illness, and what did they do to treat it during the various time periods? o Prehistoric – abnormal behavior = evil spirits, cure = trephination, exorcism ▪ knowledge from inferences from archaeological findings and is limited o Greek & Roman – Hippocrates’ definition and treatment ▪ many psych disorders were identified - melancholia, mania, dementia, hysteria (no apparent physical cause), delusions, hallucinations ▪ Hippocrates - father of modern medicine ● abnormality = disease due to internal physical problems o unbalance of 4 humors: yellow bile, black bile, blood, phlegm o Middle Ages – rise of the church (rejection of scientific study), abnormality = conflict b/w good (God) vs. evil (Devil), mass madness (St. Vitus’s Dance, tarantism, lycanthropy - wolf), exorcism re-emerged ▪ end of MA = decline in demonology o Renaissance – family care (kind of like hospice, support by church and community), asylums (eg. Bedlam), phrenology (Gall) o 19th Century – asylum reform, moral treatment and its decline ▪ Benjamin Rush - father of American psychiatry ● used harsh treatments → restraint chair o Early 20th Century – ▪ somatogenic perspective (abnormal functioning has physical causes), Kraepelin (father of psychopharmacology, developed 1st classification for mental illness, described various syndromes → # of different symptoms that cluster together, did research on effects of drugs), lobotomies, ECT, ▪ psychogenic perspective (abnormal functioning is psychological and psychological treatments should be used to treat), Mesmer (worked w/people with hysteria, placebo, hypnotism based on him, power of suggestion, hypnotism = psychological and physical), Freud (unconscious processes at the root of abnormality, biggest figure in psychogenic movement, father of psychoanalysis), psychoanalytic approach (had little effect on treatment of severely disturbed patients in mental hospitals) o Mid 20th Century – psychotropic medications discovered, deinstitutionalization, rise in outpatient care o Current Trends – prevention, multicultural focus, managed care (dominant form of insurance coverage), mental health parity (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008), Obamacare (mental health care, substance abuse treatment included in 10 essential benefits for plans on exchanges) ● Rosenhan- know the: o Main findings, implications for science and practice of psychology/psychiatry ▪ Abnormality “in” the individual vs. “in” the environment, stickiness of labels, fundamental attribution error 2/44 ● fundamental attribution error - over attribute to individual, under attribute to situation ● self fulfilling prophecies ● confirmation bias - note taking behavior ▪ Difficulties in distinguishing normal from abnormal ● “but, any diagnostic process that lends itself so readily to massive errors of this sort cannot be a reliable one” - Rosenhan ● abnormality resides in interaction b/w patient and environment ▪ changes in mental health care since Rosenhan Study ● better diagnostic practices, but still limited ● depersonalization and powerlessness of psychiatric patients, but no longer beatings ● replication study by Slater in 2004 o Strengths, weaknesses of the study ▪ strengths- high validity, provides depth and detail into diagnostic system of hospitals ▪ weaknesses- ethical issues, bias Chapter 2 - Research in Abnormal Psychology (see also Adams et al., 2004; Benton-Hardy & Lock, 1998; Dannon et al., 2002) ● What can research tell us ● Definition of research ● Nomothetic vs. idiographic approaches ● Hypothesis, independent variable, dependent variable ● Internal and external validity ● Case studies, correlation studies, experimental studies – What are they? How are they different? When is each used? What are their strengths and weaknesses? Describe the internal and external validity of each. ● Direction of effect problem, third variable problem ● Blind designs ● Quasi-experiment, natural experiment, analogue experiment, single-subject experiment Chapter 3 – Models of Abnormality (see also Leahy, 2009) 3/44 ● research support, how they conceptualize mental illness, what the theories say about the etiology of mental illness, therapeutic goals and techniques ● Biological o Brain dysfunctions → brain anatomy, chemistry, peripheral illnesses ▪ peripheral illness- something outside CNS that affects brain functioning, something physical of nature that is causing neurological symptoms ● syphilis- delusions of grandeur (people believe they are allamazing) ● cancer- low energy, down depressed mood, other symptoms of depression o Frontal, occipital, parietal, temporal lobes and MAIN functions of each ▪ frontal - attention, planning, social skills, executive functions (delegating out tasks, longer term planning, etc.), personality perhaps ▪ occipital- visual cortex ▪ parietal- touch, spatial, kinesthetic ▪ temporal- hearing, language comprehension o Neuron (dendrite, axon, synapse, neurotransmitters) - nerve cells, billions of them; some disorders due to problems with communication b/w neurons, number and structure of neurons ▪ dendrite- receive impulse ▪ axon- impulse travel down this long fiber extending from the neuron’s body ▪ synapse- tiny space that separates neurons from each other ▪ neurotransmitter- a chemical that is released from nerve ending and travels across synaptic space to receptors on dendrites of neighboring neurons; play key role in moving info through the brain ● excitatory- fire o anxiety = lots of firing ● inhibitory- stop firing 4/44 ● major neurotransmitters implicated in pathopsychology include (not 1:1 for neurotransmitters:disorders): o serotonin o dopamine o norepinephrine o GABA (eg. ADHD) o Genetics, Diathesis-Stress Model, viral infections ▪ Genetics- contribute to ~50% to development of behavior or personality ● gene- segments that control characteristics and traits a person inherits; may be mutated (abnormal form) o Evolution and genes → better genes for survival = more likely to be passed on ▪ genetic inheritance of abnormalities o polygenic - multiple genes involved (eg. in development of mental disorder) ● including mood disorders, schizophrenia, MR (mental retardation), Alzheimer’s, anxiety, etc. ▪ Viral infections - may change brain structure, chemistry ● damaging virus may enter fetus’ brain and remain dormant there until individual reaches adolescence or young adulthood (eg. symptoms of schizophrenia later) ▪ Diathesis-Stress Model ● diathesis - having risk factors for disorder ● stress - thing that turns on gene ● diathesis ------> disorder o condition (stressor) in b/w arrow o Treatment ▪ Psychotropic medication - drugs that mainly affect emotions and thought processes ● anxiolytics/antianxiety - Xanax, Valium ● antidepressants - SSRIs, Prozac, Zoloft ● antibiploar drugs/mood stabilizers - Lithium, Depakote ● antipsychotics - Haldol, Risperdal ▪ ECT (electroconvulsive therapy) - used currently ● broad current causes brain seizure ● used particularly on those whose depression fails to respond to other treatments ● problems: memory loss, confusion, broken bones, involuntary use ● controversial ▪ TMS (transcranial magnetic stimulation) - more focused electrical stimulation ● FDA approved for depression ● significant side effects ● maybe new and modern incarnation for ECT? 5/44 ▪ Neurosurgery/psychosurgery - brain surgery for mental disorders; considered experimental and used only after certain continuous severe disorders that do not respond to any other form of treatment ● roots- trephining (chipping a hole in skull) ● modern procedures derived from lobotomy (cut connections b/w frontal lobes and lower regions of the brain) o Good research support (although much is animal based), limits of the biological model ▪ limits ● biological treatments are capable of producing significant undesirable effects (eg. drugs side effects) o ~60% who take medication find relief ● some people take too far - try to reduce all behavior, emotions, thoughts to biology, neglecting other influences ● Psychodynamic (oldest and most famous) o Behavior, thoughts, emotions driven by unconscious psychological forces/drives o Problems with early experiences, defense mechanisms, unconscious drive conflicts ▪ early experiences - relationships w/parents (esp. moms b/c primary caregiver, but it may be different nowadays since fathers tend to do more caregiving now), toilet training (micro-cause b/w child and physiological and parents can tell child what to do, but can’t ultimately force child to do it, child takes control over their body) ▪ conflicts b/w forces and drives occurring within person’s unconscious (id,ego,superego) ▪ defense mechanisms run amok (may work a little bit, but no work in longhaul) o Id, ego, superego – what they are, what they try to do ▪ id ● instinctual needs, drives, impulses ● pleasure principle - seeking immediate gratification (usually sexual in nature, according to Freud) ▪ ego - develops once we recognize that the natural and social environment are not going to meet all our needs that the id is trying to seek ● reality principle - knowledge acquired through experience shows that it can be unacceptable to express our id impulses outright o planning id impulses for right appropriate time, looking at reality ● ego defense mechanisms - to control unacceptable id impulses and avoid/reduce anxiety they arouse o repression - forget something that happened and pushing things into unconscious, in response to internal threats o denial - denies the reality, refuse to acknowledge source of stress (eg. domestic violence victim), in response to external threats 6/44 o projection - attribute our negative aspects (projecting your own insecurities onto other people) o reaction formation - crusade against our own urges (eg. ministers that say that child porno is wrong, but they have the porno on their computer) o displacement - we put issue onto something else (eg. someone’s having really hard time at work and they go home and kick the dog) o regression - take upon child-like state under stress o sublimation - taking out unacceptable impulses and putting them in a different way (eg. go to shooting range for anger) o rationalization - reasoning out of bad feelings (eg. sour grapes -- Essox fable) o intellectualization - thinking our way through the process/emotion o last three are healthy ▪ superego ● values (parents’) and ideals, societal rules/values o bring these into our own values → values are introjective ● morality principle - sense of right and wrong o superego is conscience ▪ all operate on unconscious level o Fixation - stuck at some early stage of development, happens when adjustments to (id,ego,superego) are not successful in face of challenge ▪ eg. “that person is so anal” = person is neat freak, controlling ● person is stuck in anal stage where they are trying to gain control over their body and bodily function (toilet training), thus they try to exert excessive control on their environment o Free association, interpretation, dream analysis -- mediator’s insight ▪ free association - patient describes any thought, feeling, or image that comes to mind, even if it seems unimportant ▪ interpretation - therapist looks for maladaptive patterns ● resistance - unconscious refusal to participate fully in therapy, what person is resistant to talk about ● transference - patient act/feel/treat toward therapist as they do toward important persons in their lives (and connect that to patient’s early relationships) ▪ dream analysis- unconscious bubbles up in dreams ● dreams - defense mechanisms operate less → reveal unconscious instincts, needs, wishes o Evaluation of model ▪ influential in development of psychological theories ▪ hard to research → little empirical support and research ● there is a bit empirical support for short-term psychological dysfunction 7/44 ● Behavioral o Behavior is shaped by experience o behavior = response to environment o B.F. Skinner and rat experiments o Pavlov’s Dogs o Operant conditioning (rewards, punishment) - shaping behavior o Classical conditioning (unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response) ▪ 2 events occur closely together, become fused, and react to one as though the other were happening ▪ CR == UR ▪ CS has to come first before US in order for fusing and conditioning to occur ▪ reinstatement of CS and UR is easier if had experience before ▪ extinction (of CR) - happens when CS is continuously offered with no US o Modeling - learn by observing others’ behavior (if people we are observing are rewarded, we are more likely to do the same), we don’t necessarily have to have the experience ourselves ▪ Bandura’s Bobo Doll Study - modeling of aggression ● kids that saw model do it → aggressive behavior + generalize behavior (beyond what model did) ▪ maybe we just need to watch someone take out their aggressive urges for us to also let out our aggressive urges → catharsis o Therapeutic techniques: behavior modification, parent training, token economies, exposure therapy, extinction, systematic desensitization, fear hierarchies ▪ operant conditioning - get rid of maladaptive behavior by rewarding adaptive behavior (rewards are much more effective than punishments) ● behavior modification o eg. parent training ▪ extinction-verse - behavior gets worse when try to extinguish it (but slowly get better and better) ▪ crying is adverse stimulus for mom, so try to get rid of aversive behavior by going in and soothing child ● token economies - used in inpatient facilities or prisons, good behavior days = token each day for good behavior = extra privileges ▪ classical conditioning - exposure therapy (like extinction) ● for fears → see decrease in linkage b/w fear and fear response o systematic desensitization → fear hierarchy (similar situations that produce similar fear in person) o What disorders/problems it is good to treat ▪ phobia ● systematic desensitization - fear hierarchy ● eg. fear of dark + abuse 8/44 ▪ compulsive behavior ▪ social deficits (eg. Autism) o Good empirical evidence to support effectiveness to treat specific things (listed above) o Limitations of the behavioral model ▪ improvements in therapist’s office do not always extend to real life nor do they necessarily last w/o continued therapy ▪ too simplistic - concepts fail to account for complexity of behavior (eg. leaves out cognition and thinking, anticipation, interpretation) ▪ not clear that symptoms are acquired through conditioning, or modeling ● Cognitive o Assumptions, attitudes, interpretations influence perceptions and conclusions (and behavior) o dysfunction happens when we have maladaptive cognitive patterns (sometimes illogical thoughts) which leads to misinterpretations of events, distress, maladaptive behavior or other impairment o Cognitive errors (recognize them and be able to give some examples – see table in lecture notes) ▪ all of nothing thinking - believing the world/oneself/others is/are all good or all bad ▪ catastrophizing - exaggerating negative aspects of an event ▪ emotion reasoning - letting emotions overwhelm common sense (stop thinking rationally) ▪ fortune-telling - “I should’ve known” ▪ mind reading - “everyone hates me” ▪ overgeneralization - thinking that if something happened once, it will always happen again ▪ perfectionism - requiring oneself to perform flawlessly ▪ unquestioning acceptance of critics - letting others define one’s self worth ▪ comparing - judging by others’ standards rather than by one’s own performance, feelings, values o Beck’s approach to cognitive therapy ▪ therapists help clients recognize negative thoughts, biased interpretations, and errors in logic that dominate their thinking and cause them to feel depressed ▪ challenge these maladaptive thoughts in therapy ▪ try out new interpretations of events ▪ apply new way of thinking in and outside of therapy o What disorders/problems it is good to treat ▪ depression, panic disorder, other anxieties, sexual dysfunctions o Limitations of the cognitive model ▪ precise role has yet to be determined ▪ therapies do not help everyone (but still helps many people) ▪ too narrow (cognition is only one part of human function) ▪ unclear what (if any) problematic cognitive processes are central to many disorders (eg. schizophrenia) 9/44 ● Humanistic-Existential (more like philosophy) o Basic arguments of both humanists and existentialists (and the difference between them) ▪ Humanists: people are driven to self-actualize, unconditional positive regard, more optimistic -- human beings are born w/natural tendency to be good ● self-actualization - fulfill natural tendency to be friendly, cooperative, constructive, experience personal growth ● client-centered therapy ▪ Existentialists: people must have authentic lives (self-aware, personally meaningful) in order to function well, accepting responsibility to live meaningful life, therapist-client relationship ● existential therapy - encourage people to accept responsibility for their lives, to recognize their freedom to choose a different course, and to choose to live with greater meaning ● grew out of past WW2 era o Humanistic Theory ▪ what causes dysfunction? ● if do not self-actualize -- not becoming your own best person ● if do not recognize and accept strengths and weaknesses and pursue personally satisfying goals ▪ need unconditional positive regard from people in our lives (esp parents) ● if have it, will have more unconditional self-regard, more likely to self-actualize ● if you have to distort how you view yourself in order to get positive regard and conform to external demands, you will not be able to self-actualize o Roger’s client-centered therapy - clinicians try to help clients by conveying acceptance (unconditional positive regard), accurate empathy (skillful listening and restating), and genuineness (sincere communication) ▪ supportive environment ▪ clients accept and view self honestly ▪ has not fared very well in research ▪ paved the way for psychologists to practice psychotherapy o Gestalt therapy (Fritz Perls) - clinicians actively move clients toward selfrecognition and self-acceptance by using techniques such as role playing and selfdiscovery exercises ▪ skillful frustration - patient gets challenged and frustrated sometimes even ▪ “I” language ▪ focus on here and now (vs past) ▪ same goal as client-centered, but different techniques ▪ role playing ● “empty chair technique” - imagine person sitting in chair, talk to person, then switch chairs and role-play that person, then go back to your chair and be yourself o Existential Theory & Therapy 10/44 ▪ what causes dysfunction? ● being inauthentic (not self-aware, not true to your own evaluation) ● failure to realize responsibility to give life meaning o you need to make a choice, you are not a victim ▪ therapy ● reflect on life ● accept responsibility for life and problems o you can control how to respond to events → finding more agency ● choose to live differently and with more meaning ● techniques - use the therapist-client relationship o no techniques seen as absolutely essential ● therapist needs to be authentic themselves and have respect, honesty, faith in client o What disorders/problems it is good to treat ▪ substance abuse, stigmatized populations (minorities, sexual orientation, etc.), developmental crisis, victims of loss, mid-life crisis o Evaluation and Limitations of the model ▪ broadly appealing ▪ focuses on areas missing in other models ▪ optimistic tone ▪ now when used, usually used as a philosophical backdrop for other therapies ▪ difficult to research ● some limited empirical evidence to support but evidence is mixed vs control o “mixed” = blended with another therapy approach ● Sociocultural o Abnormality should be considered within the social and cultural environment o Labeling, roles (Sasz, Rosenhan) ▪ Rosenhan - pseudopatients had a hard time convincing others they were well once they had been given diagnostic label ● behaved normally and stopped reporting symptoms as soon as they were admitted ● label of “schizophrenia” kept influencing the way staff viewed and dealt with them ● label becomes the person -- self fulfilling prophecy? individuals in turn follow the role implied by such a label o Problems with social networks, family structure and communication, societal labels and roles, cultural factors, religious factors ▪ people who are isolated and lack social support or intimacy in their lives are more likely to become depressed when under stress and to remain depressed longer than are people with supportive spouses or warm friendships 11/44 ▪ structure and communication patterns of some families actually force individual members to behave in a way that otherwise seems abnormal ● behavior may be functional within family context, but may be abnormal outside from (and vice versa) o eg. binge drinking in college vs 45 year old ▪ societal labels and roles ● people are put into box (eg. kids and ADHD - label gives kids freedom to be impulsive) ▪ Cultural and religious factors ● multicultural perspective - individual’s behavior, whether normal or abnormal, is best understood when examined in the light of his/her unique cultural context, including values and external pressures faced by members of culture ● spirituality and involvement in religious activities are protective factors, but can increase OCD w/ thinking religiously…... o Therapeutic approaches: culturally-sensitive therapies, group therapy, self-help groups, family therapy, marital therapy, prevention programs ▪ group therapy - therapist meets with a group of clients who have similar problems and they work on problems together ▪ self-help group/mutual help group - group made up of people with similar problems who help and support one another without the direct leadership of a clinician ▪ family therapy - therapy format in which the therapist meets with all members of a family and helps them to change in therapeutic ways ▪ marital therapy/couple therapy- therapist works with 2 people who share a long-term relationship, focus on structure and communication patterns in relationship ▪ prevention programs ● primary prevention - efforts to improve community attitudes and policies ● secondary prevention - identifying and treating psychological disorders in the early stages before they become serious ● tertiary prevention - provide effective treatment as soon as it is needed so that moderate/severe disorders do not become long-term problems ▪ culturally sensitive therapy- approaches designed to help address unique issues faced by members of cultural minority groups o Pros and cons of the approach ▪ pros - take overlooked factors into account, clinicians have become more aware of impact of clinical and social roles, treatment formats sometimes succeed where traditional approaches have failed ▪ cons - findings are often difficult to interpret, fail to establish that family/cultural factors is cause of disorder, inability to predict abnormality in specific individuals ● most research is correlational (direction of effect problem) o no RA for correlation research 12/44 o direction of effect - don’t really know what cause is ● Integrative Perspective(s)/models o Biopsychosocial models ▪ abnormality results from interaction of genetic, biological, developmental, emotional, behavioral, cognitive, social, cultural, and societal influences ▪ Diathesis-stress models ● people must first have biological, psychological, or sociocultural predisposition to develop a disorder and must then be subjected to episodes of severe stress ● “diathesis” - predisposed tendency, vulnerability ▪ Reciprocal effects model - our biology influences our behavior which influence how our social context is going to respond to us but that in turn influences our behavior which influences our biology ● where advances in the field are probs going to come from o 27% of psychologists, 53% of psychiatrists use integrative approaches ● many models, none consistently superior Biology vs Psychosocial ● Frances - psychiatrist, believes in psychotherapy > neuroscience+drugs ● Tom Insel- agrees that psychotherapy has a role, but just that we do not know enough and that “the gap b/w what we know and what we do is unacceptable” ○ current thinking - we need to make “a return to behavior”, “we know well enough what works. Our problem is that we’re not doing it” (referring to social and behavioral/psychotherapy interventions, not medication)l Chapter 4 – Assessment, Diagnosis, & Treatment (see also Frances, 2012 and Kupfer, 2012 readings) ● Be able to define assessment, diagnosis, treatment, case conceptualization, comorbidity o comorbidity - having multiple disorders at the same time o assessment - systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder ▪ used to determine most likely effective treatment(s) and evaluate treatment progress o diagnosis - do client’s symptoms/syndrome match a known disorder? if so, which one? ▪ some diagnoses fit and some do not (we rule some diagnosis in or rule them out aka diagnosis is not true for individual) o treatment - change abnormal behavior (thoughts,emotions) into more normal behavior (thoughts, emotions) o case conceptualization??? ● Necessary characteristics of assessment tools: standardization, reliability (test-retest, interrater), validity (face, predictive, concurrent) o standardization = same way, reference group 13/44 ▪ administration ▪ scoring ▪ interpretation o reliable = consistency ▪ test-retest reliability - similar results for test every time it is given to the same people ▪ interrater reliability - do clinicians agree with each other, should come up with same diagnosis ● kappa statistic - goes from 0 to 1, closer to 1 = more agreement o valid = accurate ▪ face validity- looks like what it measures ● problem: people can lie on purpose (fake good/bad), not trustworthy ▪ predictive validity- predicts future symptoms ▪ concurrent validity- agrees with other measures Be able to describe the three main clinical assessment tools (clinical interviews, tests, observations) ● Clinical interviews (most common tool) o purpose - gather detailed info about personal history, symptoms, circumstances (eg. loss of a loved one) as viewed by the client o focus determined by theoretical orientation (different things important to different assessors) of assessor/therapist o typically includes: ▪ presenting problem - what client is presenting (eg. says) to therapist ▪ prior treatment - see if any previous diagnosis, medication and side effects, symptoms recurring, effectiveness of prior treatment, effectiveness of prior therapy ▪ social/interpersonal context - …current relationships client has right now, who is clients social support, who is causing difficulties in client’s life, who we can build on ▪ developmental history - complicated birth process? develop on time? problems w/social relationships early on? ▪ occupation/educational history - functioning over lifetime, where client is at right now ▪ stressors and resources o face to face encounter, 1st one b/w client and therapist o unstructured - clinician asks mostly open-ended questions; unstandardized ▪ used to follow leads and explore relevant topics that could not be anticipated before the interview ▪ appeal to humanistic and psychodynamic clinicians o structured - clinicians ask prepared (specific) questions; standardized ▪ interview schedule - standard set of questions designed for all interviews ▪ mental status exam - set of questions and observations that look for grossfunctioning and systematically evaluate the client’s: ● appearance ● attitude 14/44 ● mood/affect o mood - person’s subjective experience, their own report o affect - what we see, external ● speech - rhythm, volume, pitch, how articulate, pace ● thought process - preoccupied? delusional? ● thought content - ask Q’s and see what they say ● perception - false sensory experience? ● cognition - oriented-to-person, -place, -time, general intelligence (w/o IQ test) ● judgment - prosocial or antisocial? problem-solving? o eg. “see envelope on ground, what to do?” ● insight - does person have insight into problem that brought person in o eg. “do you know why you’re here?” ▪ used to ensure that clinicians will cover the same kinds of important issues in all of their interviews and compare responses of different people ▪ appeal to behavioral and cognitive clinicians ▪ standardized = clinicians should get same answers o strengths ▪ o weaknesses ▪ lack of validity or accuracy ● intentionally misleading of individuals ● individuals’ inability to give accurate report (eg. depressed people) ● interviewer bias and judgment mistakes ▪ lack of reliability (structured interviews) ● response of interviewee to interviewer ● Clinical Tests – Projectives, personality inventories, response inventories, psychophysiological, neurological/neuropsychological, intelligence – For each know purpose, strengths and weaknesses, and examples o devices for gathering info about a limited, few aspects of a person’s psychological functioning, from which broader info about person can be inferred ▪ projective tests - clients interpret vague stimuli such as inkblots or ambiguous pictures, or follow open-ended instructions such as “draw a person” ▪ responses = projections of unconscious processes or personality traits ▪ mainly used by psychodynamic practitioners ▪ most popular - Rorschach Test, Thematic Apperception Test (TAT), sentence completion test, drawings ● Rorschach test - show inkblot cards and ask respondents what they see o testers pay attention to style of responses and themes/images o testers record verbatim response of client o hypothesis-generating, but no diagnosis 15/44 o deviations and commonality of answers ● Thematic Apperception Test (TAT) - pictorial projective test, 30 cards w/black and white pictures of individuals in vague situations, asked to make up dramatic story about each o clinicians believe people always identify with one of the characters on each card o hypothesis generating o people put their own themes to pic ● sentence-completion - test-taker completes a series of unfinished sentences (“I wish…”, “my father….”) o good springboard for discussion o quick and easy way to pinpoint topics to explore o hypothesis generating ● drawings - client draw human figures and talk about them o Draw-a-Person (DAP) test - “draw a person” and then draw a person of the other sex, “draw your family” ▪ most popular of drawing tests ▪ more for kids and children ▪ personality inventory - measure broad personality characteristics, consisting of statements about behaviors, beliefs, and feelings that people evaluate as either characteristic or uncharacteristic of them ● Minnesota Multiphasic Personality Inventory (MMPI) - most widely used (MMPI-2, MMPI-A) o more than 500 self-statements “true” “false” “cannot say” o 10 scales o efficient b/c computerized/paper-pencil o standardized o greater test-retest reliability ● not highly valid ● cultural limitations ▪ response inventory - ask people to provide detailed info about themselves, but focus on one specific area of functioning ● affective inventories - measure severity of emotions like anxiety, depression, anger ● social skills inventories - respondents indicate how they would react in a variety of social situations ● cognitive inventories - reveal a person’s typical thoughts and assumptions and can help uncover counterproductive patterns of thinking ● not great standardization, reliability, and validity ▪ psychophysiological tests - measure physiological responses as possible indicators of psychological problems ● heart rate, blood pressure, body temp, galvanic skin response, muscle contraction o typically all responses associated with anxiety 16/44 o galvanic skin response- 2 electrodes on hand, exposure to stressful situations == sweat ● polygraph (lie detector) - electrodes attached to various parts of body detect changes in breathing, perspiration, and heart rate while person answers questions; most popular o control questions o test questions ● expensive equipment with high maintenance ● equipment may be sometimes frightening ● physiological responses also subject to change when measured repeatedly in a single session ▪ neurological tests - directly assess brain function by assessing brain structure and activity ● electroencephalogram (EEG) - electrodes on scalp that measures electrical activity/records brain waves (electrical activity that takes place within brain as a result of neurons firing) o sleep related disorders, sensory deficits, brain tumors ● neuroimaging/brain scanning techniques o CAT/CT scan - reconstruction of brain through x-ray slices (layering) ▪ non-invasive ▪ injury, brain tumors, other structural abnormalities ▪ static, get one x-ray at one location ● can’t see how things are changing over time in the brain ▪ exposure to radiation with x-rays ▪ ventricles- fluid filled spaces in the brain ● large ventricles correlated with schizophrenia ▪ can’t conclusively diagnose disorders ▪ can be used as part of assessment process for disorder ▪ used to rule out organic/gross biological cause of disorder o PET scan - radioactive tracer that binds to blood, oxygen, or glucose ▪ shows which parts of brain are active ▪ allows us to locate which parts of brain are active under certain conditions o MRI - magnetically images brain structure ▪ no radiation exposure ▪ better resolution o fMRI - looks at brain function ▪ not static -- can see changes over time in brain flow as person thinks/feels/reacts 17/44 o widely used, but sometimes unable to detect subtle brain abnormalities ● neuropsychological tests - indirectly assess brain function by measuring cognitive, perceptual, and motor performances on certain tasks o Bender Visual-Motor Gestalt Test ▪ ● “look at this” “now copy it” ▪ visual = perceiving ▪ motor = perceiving and remembering ▪ used in conditions where there could be fundamental brain problem with associated psychological disorder we see ▪ intelligence test - measure intellectual ability, both verbal and nonverbal skills (attention, memory, reasoning, comprehension), IQ ● intelligence quotient (IQ) - overall score derived from intelligence tests ● tests may not necessarily agree with one another ● IQ tests - series of smaller tests ● among most carefully produced of all clinical tests o standardized o high reliability o high validity ● diagnose and track mental retardation (intellectual disability), dementia, traumatic brain injuries ● used in work and school settings ● used in learning disability evaluations ● most popular o wechsler adult intelligence scale (WAIS) o wechsler intelligence scale for children (WISC) o Stanford-Binet intelligence scale ▪ used less often than other two ▪ applicable across age ranges ● other factors can greatly influence test performance ● cultural biases in language/tasks that place people of one background at an advantage over those of another 18/44 ● members of some minority groups may have little experience with this kind of test/may be uncomf w/test examiners of a majority ethnic background ● Clinical Observations – systematic observation of behavior o naturalistic - clinicians observe clients in their everyday environments ▪ focus on parent-child, sibling-sibling, teacher-child interactions and on fearful, aggressive, disruptive behavior ● observations made by participant observers (key people in client’s environment) and reported to clinician ▪ tougher to do, so we want to habituate person to situation o analog - clinicians observe clients in an artificial setting (eg. clinical office or lab) ▪ focus on children interacting w/parents, married couples attempting to settle disagreements, speech-anxious people giving a speech, phobic people approaching an object they find frightening ▪ evoking issues in therapy session o self-monitoring - clients are instructed to observe/monitor themselves ▪ useful in assessing behavior that occurs infrequently and those that occur so frequently ● behaviors that you can’t see in therapy setting (eg. binge eating) ▪ may be only way to observe and measure private thoughts or perceptions ▪ problem with validity ▪ unintentional changing of behaviors o not always reliable o not always valid or accurate ▪ overload ▪ observer drift - steady decline in accuracy as a result of fatigue or other things ▪ observer bias - judgments may be influenced by already known info/expectations about client ▪ client reactivity - behavior may be affected by very presence of observer o lack of cross-situational validity Overview of Assessment Tools: Strengths/Weaknesses Strengths Weaknesses Tool Clinical Interview ·Wide range of information ·Low reliability (esp. unstructured) ·Low validity, bias (e.g., theoretical orientation, ethnicity, gender of tester) Projectives ·Good to generate hypotheses ·Low reliability, validity ·Biased against ethnic minorities (esp if interpreted by biased clinician) 19/44 Personality Inventories ·Vs. projectives ·Cannot know validity – no real objective -easier, cheaper, faster, more valid ·Objective, standardized measure of personality; (validity is only based on correlation with other personality inventories) ·State dependence of individual (eg. Depressed person) ·Cultural differences (need to make sure who the normative group is) Response Inventories ·Strong face validity Neurological & Neuropsych. Tests ·High reliability, ·Usually requires many tests to be used together validity, standardization (a battery – series of tests, each targets specific skill; long and expensive) ·Hard to find well-trained people to administer neuropsych tests Intelligence Tests no lie scale associated with it) ·Not all standardized, reliable, valid ·High reliability, validity, standardization ·Carefully designed! Clinical Observations ·Careless, inaccurate responding (esp if there is Naturalistic/Analog · Can see things “in action” as they happen in real life in the natural environment · Outside observer, less bias (get more objective read) ·Only an indirect measure intelligence (intelligence is an inferred measure) ·Influenced by other factors (e.g., test taking experience, anxiety, cultural biases) ·Often poor reliability, validity Self-monitoring ·Requires training for individual (eg. Monitor cognitive biases) ·Sometimes inaccurate ·Changes behavior you measure (person may do it less often b/c they are observing themselves) Self-Monitoring ·Good for infrequent behaviors, private thoughts ● Diagnosis o case conceptualization - person’s diagnosis/diagnoses, what triggered them, and what maintains the disorder ▪ not exactly the same as diagnosis b/c added parts o determine if person’s problems reflect a particular disorder or syndrome o based on an existing classification system (DSM-5) o several disorders, each composed of symptoms o highly influenced by clinician’s theoretical orientation o symptom criteria (for disorders) = a checklist o classification systems: o DSM-5– diagnostic and statistical manual of mental disorders (5th edition) ▪ system of classifying psychological disorders ▪ published by American Psychiatric Association (APA) ● psychiatrist is decision maker, not psychologist o DSM have more medical approach b/c put out by APA 20/44 ▪ main purpose: establishes common definition of mental disorder and specific criteria for each diagnosis ● clinician's all mean the same thing ● specific criteria are set across clinics and everywhere ● diagnoses include: o clinical(more episodic in nature), personality (more enduring types of disorders), intellectual developmental (learning disorders, intellectual impairment)disorders o physical or medical conditions o psychosocial stressors (eg. did the person give birth recently, did person spouse died recently) o measure of severity - each specific set of disorders has its own rating within disorder ▪ new in DSM 5 ▪ all physical health disorder + mental disorder ▪ most commonly used in US, since published by an American association (APA) ▪ ICD - creates code, WHO puts out ICD ● has classification to mental health disorder, very highly linked to DSM but not preceisly the same ● DSM and ICD influence each other a lot (mainly DSM influence ICD → american’s exporting our knowledge to the world) ▪ Strengths and weaknesses? (see book; lecture; Frances, 2012; Kupfer, 2012) ● Kupfer (2012) - Chair of task force of DSM V o strengths- good interrater reliability in field studies using DSM 5 criteria (in general he’s correct) ▪ field trials showed 14 diagnoses ranked “good” or “very good” reliability (including schizophrenia, ADHD, PTSD, somatic symptom disorder, ASD) ▪ he believes that low reliability is still acceptable ▪ he believes that field trial represented a truer version of reliability vs previous version of DSM ▪ argue that reliability is same thing as validity (esp. ASD) ● in DSM4, there is asperger’s and ASD -based on research evidence the underlying processes that give rise to disorders are the same (so merge them in DSM5 -- INCREASE symptom criteria and threshold for diagnosis) -parents with children with ASD, should feel “comforted” with high interrater reliability -- but really question is validity NOT reliability 21/44 ● ● ● ● o weaknesses- field trials showed 6 diagnoses with acceptable but low reliability (including MDD, GAD, two of the most commonly diagnosed conditions) → shows difficulty clinicians may have in reliably diagnosing both conditions, either b/w they often occur w/other conditions or b/c they are accompanied by symptoms that can fluctuate greatly Frances (2012) - chair of task force for DSM IV o strengthso weaknesses- DSM-5 field trials were a colossal waste of money, time and effort -- low kappa value (poor and scattered), poor execution of study protocol, quality control step (second field trial) was cancelled because ran out of time ▪ glary exceptions in important categories (esp GAD, MDD) reliability was quite low (below acceptable for those categories), which represents a decrease in reliability ▪ a lot of variability across sites of field trial in terms of reliability statistics -- low kappa value ● may indicate that trial itself is poorly designed and administered or that there are problems with DSM 5 criteria (eg. not enough training of clinicians) task force begins with criteria from previous version of DSM, then make proposed changes for criteria based on new research findings and clinical experience of applying criteria in clinical settings, then subject new proposed criteria to rigorous testing in the form of field trials -- initial tests/pilot tests of new criteria, then based on how criteria perform in different settings they make changes on criteria and then publish criteria in DSM textbook o strengths- stronger validity b/c conduct extensive reviews of research and consulting with numerous clinical advisors o weaknesses- criteria and categories are based on weak research, gender/racial bias lecture o reliability - different diagnosticians agreeing on a diagnosis ▪ DSM-5 greater reliability than earlier DSMs (except DSM-IV-TR) ▪ reliability is still a concern ▪ levels of agreement = levels of inter-reliability (low/high) o validity - accuracy of the diagnostic categories provide ▪ DSM-5 greater validity than any DSMs 22/44 ▪ validity is still a concern ▪ predictive validity - how well we can predict the course of illness of the person and how well we can predict which treatments they will respond to ▪ What criticisms are there for the DSM? ● categorical system - based on biological tradition of psychopathology (back to Emil Kraeplin) o assumes disorders are qualitatively different from normal behavior ▪ assumes each disorder has distinct physical causes that each have its own way of treatments o reliance on discrete diagnostic categories ▪ each category has to be completely distinct from another category ▪ clear distinction b/w normal and abnormal ▪ pros- provides easy communication across clinicians, assists with treatment planning, aligns with reimbursement model ▪ cons- oversimplification (reducing people down to single label), treatments aren’t effective for everyone in a category → maybe think about things in more dimensional terms and are more on a continuum, people who are just over/under threshold for diagnosis are treated as completely different from one another ● dimensional system - more idiographic picture, continuum of disorder o DSM-5 has ratings of severity, but it is still fundamentally a categorical system ● comorbidity problems o comorbidity - disorders exist within the same person o high levels - many patients receive multiple labels for the same underlying condition o question of validity ● misdiagnosis issues o DSM-5 has significant reliance on clinical judgment o judgment is subjective process, so has inaccuracies with that ● labeling, stigma, self-fulfilling prophecy issues o self-fulfilling prophecy - people getting a label and acting in a way consistent with label; eg. kids with ADHD) ● cultural limitations o very much American based diagnoses o affects treatment outcomes 23/44 o DSM-5 set up to catch disorders as they would present in dominant American culture, so might not pick up same disorders in individuals from different culture backgrounds ▪ Describe the potential alternatives to DSM ● RDoc (research domain criteria) - initiative of NIMH (began under Tom Insel) o initially aimed at improving drug therapies by identifying biological factors and mechanisms o goal: reach across levels from genomics to self-report, but in practice focus on fundamental levels o based on 4 assumptions ▪ A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories, ▪ Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior, ▪ Each level of analysis needs to be understood across a dimension of function, ▪ Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment o represents a research framework o grew out of some criticisms from Tom Insel: “while DSM has been described as a bible for the field, it is as best a dictionary” ▪ lack of success of drug treatments up to that point was due to problems in classification system and the research based on that system, his idea was to create a framework to understand better the fundamental of mental illness and the structure of it ▪ wanted to wipe out DSM-5 and build from bottomup again ▪ fundamental levels - basic biological processes in mental illness ▪ psychotherapy and psychological processes that has been left out of Rdoc, less focus on them in it o ▪ matrices across different areas that each represent different functioning that can go awry ▪ different combos of issues should be then combined 24/44 for us to understand what the fundamentals of disorders are ▪ research is fitting into different areas of matrices ● HiTOP (2017, new) (Hierarchical Taxonomy of Psychopathology) - international consortium of psychologists and psychiatrists o focus on mental health problems as a continuum o simplification of disorders and the system o higher-order factors all the way down to signs and symptoms o specific symptoms and maladaptive traits ▪ symptoms that would be listed in DSM-5 ▪ restructure/reorder symptoms in hierarchical fashion → gives better understanding overall of mental health o based on very good, solid evidence, but little back and forth, so unclear for critical analysis so far ● Treatment – three essential features, treatment plans, effectiveness o treatment - change abnormal behavior (thoughts, emotions) into more normal behavior (thoughts, emotions) o 3 essential features ▪ sufferer who seeks relief from a healer ▪ trained, socially accepted healer ▪ series of contacts b/w healer and sufferer o treatment plans - use assessment data and diagnosis to create treatment plan o other factors: ▪ therapist’s theoretical orientation - people like to practice within their own areas of competency ▪ current research ● idiographic data - things specific to individual ● nomothetic data - things we get from group as a whole (most typically from research) ▪ general state of clinical knowledge - including empirically supported, evidence-based treatment ● empirically/evidence-based supported treatment - therapy that has received clear research support for a particular disorder and has corresponding treatment guidelines ● treatment plans are much more evidence based and planful than they were in the past ● some people believe treatment plans are pulled out of the blue o specific goals of treatment plan: symptom reduction, over what time period, specific techniques used to try to achieve symptom reduction o Treatment research: how to define success (complicated), how to measure improvement ▪ Is therapy in general effective? ● sometimes therapy is actually harmful (~5% get worse with 25/44 treatment) o can be combo w/personality characteristics and therapy technique ▪ Are particular therapies generally effective? ▪ Are particular therapies effective for particular problems? ▪ Are particular therapies effective for particular people with particular problems? ▪ positive development in treatment research o therapy outcome studies conclusions: ▪ people in therapy are usually better off than people with similar problems who receive no treatment ▪ various therapies do not appear to differ dramatically in their general effectiveness ▪ certain therapies or combinations of therapies do appear to be more effective than others for certain disorders Chapter 5 – Anxiety Disorders ● Be able to define and distinguish between anxiety and fear o anxiety - mood state characterized by apprehension & worry, vague sense of threat or danger ▪ 3 components: (PCB) ● physiological - how do they feel in their bodies ● cognitive - thoughts when you have anxiety ● behavioral - fight/flight response o fear - immediate alarm reaction, sense of serious threat to one’s well-being ▪ huge PCB response ▪ present-oriented (vs worry is future-oriented) o look at 4 D’s ● What are the anxiety disorders? o most common mental disorders in US o common feature: presence of extreme or disabling anxiety in the absence of a real threat or danger that results in a disruption in mood, cognition, and/or behavior ▪ GAD ▪ social phobia ▪ specific phobia ▪ panic disorder ▪ agoraphobia ▪ OCD ▪ sometimes consider PTSD ▪ acute stress disorder o clinical descriptions o etiology: common factors ▪ etiology - factors that are causing disorder o etiology: specific disorders 26/44 o treatment ● What are the symptoms of each disorder? o GAD - excessive, persistent anxiety across most situations and about most things (over 6 months); free-floating anxiety ▪ worry is difficult to control ● lots of different worries ▪ 3 or more of: ● physical signs - restlessness, easily fatigued, muscle tension, sleep disturbance ● other signs - difficulty concentrating, irritable ▪ chronic course (hard to treat) ● GAD sticks w/person (relapse, etc.) o specific phobia ▪ phobia (vs fear) = more intense, persistent (hyperarousal, really worked up), excessive ▪ criteria: ● fear of specific object or situation (eg. flying) ● object or situation almost always provokes immediate fear ● avoid simulus or endured with intense distress and anxiety ● fear is out of proportion to the danger of particular object or situation and cultural context ● last >= 6 months ● interferes with normal routine or functioning o social phobia (social anxiety) - unwarranted fear of social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others ▪ core fear → fear of being negatively evaluated by or offensive to others (eg. public speaking) ▪ anxiety almost always produced by exposure to the social situation(s) ▪ avoidance of social situation(s) ▪ distress, impairment ▪ social phobia exposures ● social mishap exposures - embarrassing social situations o repeatedly or for a prolonged period to reduce fear eventually o going to a bookstore and saying to an employee, “excuse me, I was looking for books about farting” ● Have a general sense for the prevalence of each and any interesting patterns in the prevalence rates (e.g., gender ratio). o GAD ▪ past year prevalence: 3% of general population (rate that holds across other western countries) ▪ lifetime prevalence: 6% ● usually first appear in childhood or adolescence ▪ about ⅔ of patients with GAD are female ▪ growing prevalence among the elderly → anxiety about health issues 27/44 (rates of 7%) ▪ about ¼ of those with GAD are currently in treatment o specific phobia ▪ fear of any object or situation (12.5%) - greatest among all ▪ fear of animals (5.7%), heights (5.3%) ▪ preparedness theory - more phobias of life-threatening things ● we are “evolutionarily” “prepared” to have phobias of lifethreatening things ▪ about double women vs men (2:1) ● biological and social reasons ▪ exposure theory is successful, but people tend to not go to therapy b/c they know they will be exposed to their fear ▪ differs among racial and ethnic minority groups o social phobia (social anxiety) ▪ in a given year: 7% ▪ in lifetime: 12% ▪ slightly more women than men (1.5:1) ▪ peak onset during adolescence (b/c of high school) ▪ poor people are 50% more likely than wealthier people to have social anxiety disorder o panic disorder ▪ in lifetime: 3.5% ▪ ⅔ women ▪ usually begins in adolescence ▪ 20% of patients with panic disorder reported attempted suicide o OCD ▪ in lifetime: 2-3% ▪ more boys vs girls, but equally common in men and women ▪ average age of onset is early adolescence - young adulthood ▪ typically runs a chronic course ● What is the course of the various anxiety disorders? Be able to distinguish between unexpected (uncued) and expected (cued) panic attacks. o panic = experience of intense fear accompanied by physical symptoms which occurs in absence of real danger o panic attack- abrupt surge of intense fear (peaks within 10 minutes) ▪ criteria (>=4) ● palpitations/pounding heart/accelerated heart rate, sweating, trembling/shaking, shortness of breath, choking, chest pain, nausea/abdominal distress, dizziness/faintness, chills/hot flashes, paresthesias (numbness, tingling; neurological symptom), derealization/depersonalization (derealization - feelings of unreality, detachment from surroundings, depersonalization detach from one self, sense of being an observer for oneself, having an out of body experience), fear of losing control (“going crazy”), fear of dying 28/44 ● physiological + cognitive symptoms ▪ panic cycle ● safety behavior - “I need to sit down” “I need to take a xanax” “I need to leave classroom” o people start to think they have to engage in safety behavior in order for attack to go away, even though symptoms naturally go away o reinforcement of safety behavior ▪ types ● unexpected (uncued) - no obvious internal/external trigger, out of the blue o at least some panic attacks have to be uncued in order to be diagnosed with panic disorder ● expected (cued) - internal/external trigger o about ½ people have expected and unexpected panic attacks o situationally bound - attack always only happen in a particular situation o pre-disposed - more likely to have panic attack in a particular situation ▪ can be added as a specifier for other disorders - “social phobia with panic attacks” → specifying which social phobia person has ▪ PTSD, phobia, less common with GAD, major depression ▪ nocturnal panic attack - wake up in the night, out of the blue, experience panic attack in middle of sleep cycle ● 60% experience this ▪ Be able to describe the interplay between cognitions and biology that constitute a panic attack o panic disorder ▪ recurrent unexpected panic attacks ▪ persistent concern about having another attack or worry over the implications or consequences of the attack (aka “fear of the fear”) ● increases people’s sensitivity for physiological symptoms → increases fear even more 29/44 ▪ significant change in behavior related to the attacks (eg. avoidance of settings, people, etc. where attacks have happened in the past) o panic attacks are common, but panic disorder is not as common ▪ ~30% of people in US report experience at least 1 panic attack in lifetime ● 3-5% in past year o agoraphobia ▪ “agora” = marketplace beneath Athens → agoraphobia = fear of the marketplace (crowds, being around other people) → general sense ▪ used to be paired with panic disorder, but realized that agoraphobia can be developed on its own without panic disorder ▪ marked fear/anxiety about >=2: ● using public transportation ● being in open spaces ● being in enclosed places (eg. elevator) ● standing in line, being in a crowd ● being outside of home alone ▪ fear cannot escape, or get help ▪ avoid situation, require a companion, endure with strong fear/anxiety (out of proportion to actual danger with situation, last >= 6 months) o Obsessive Compulsive Disorder (OCD) ▪ obsessions = persistent, intrusive and nonsensical thoughts, images, or urges ● attempt to ignore/suppress/neutralize ▪ compulsions = repetitive and rigid behaviors or mental acts that people feel they MUST do to prevent or reduce anxiety ▪ obsessions and/or compulsions cause marked distress, are time consuming, or significantly interfere with the person’s daily routine ▪ obsessions and compulsions are frequently paired together for OCD ▪ most common obsessions: ● contamination (eg. hand washing) ● aggressive impulses - worries about hurting other people ● sexual content - worries about thinking sexually and/or sexual acts ● somatic concerns (physical health) ● symmetry (keeping things in order, doing things in a particular way) ▪ most common compulsions: ● checking ● ordering/arranging ● washing ● cleaning ▪ Describe how obsessions and compulsions are typically linked ▪ exposure therapy can be effective if individual goes to it ▪ high levels of relapse ● Etiology: common factors o Barlow’s Triple Vulnerability Theory (Barlow) 30/44 ▪ biological factors (inherited vulnerability, genetic influence) ● dysfunction in GABA, norepinephrine, serotonin systems ● overactive “fear circuit” (hypothalamic pituitary adrenal axis (HPA axis) ● people with anxiety may inherit tendency to be uptight/tense → inherited personality ● if your parent has panic disorder, you’re more likely to have one of the clusters (more of a broad risk than specific risk) ▪ psychological factors ● early experience o parental modeling - child sees when parent is anxious and what they are anxious about → child is anxious about that thing → child is socialized (child is socially referenced) into having anxiety disorder o parent themselves can be overprotective and over intrusive ▪ child may have more social anxiety b/c they didn’t have the time to develop social skills b/c overprotectiveness of parents ● behavioral conditioning ● cognitive errors - overestimating likelihood of something terrible happening ▪ social factors ● stress (trigger for biological or psychological diathesis) o underlying risk may be there and then stress comes in and then disorder comes out o Mowrer’s Two-Factor Model and its extensions ▪ Clicker Questions: ● marvin’s fear of pitbulls was classically conditioned o unconditioned response is fear of dog who attacked his neighbor o conditioned response is fear of all pitbulls b/c he generalized his fear of that one pitbull to all pitbulls ▪ Mowrer’s Two-Factor Model ● light blue part of graph ▪ Extensions of Mowrer’s conditioning model (phobia happens in aqua part) ● fear goes down after avoidance of thing that caused fear → more likely to avoid that thing again = negative reinforcement 31/44 o reduction of fear negatively reinforces avoidance behavior ● 3 ways conditioning could take place: o direct experience o vicarious experience - seeing somebody else go through experience o false alarm/unexpected panic attack ▪ eg. have unexpected panic attack while teaching → associated teaching with panic attack → phobia of teaching → avoid teaching ● preparedness - some phobias are easier for us to be conditioned into having vs others ▪ exposure therapy - expose people to fear so that they may learn to not avoid the thing o Factors that contribute to the development of social phobia, panic disorder, GAD, OCD ▪ development of social phobia ● behavioral conditioning o negative social experiences o modeling (seeing others), conditioning mechanisms ▪ avoidance ▪ negative reinforcement patterns (seen prev w/specific phobia section) ● cognitive errors o higher standards for self o negative beliefs about consequences of own behavior o high self-monitors - monitor own behavior a lot more than other people do ▪ eg. looking out for errors they might do that somebody else might judge them for ● inhibited (shy temperament) - temperament is inherited part of our personality o biological/genetic factor 32/44 ▪ development of panic disorder ● psychological and biological vulnerability o people who are more physiologically reactive/more focused to anxiety-producing situations, they will develop more anxiety ● interoceptive conditioning - bodily sensations o interoceptively conditioned - conditioned fears is related to bodily sensations/stimuli ● feedback loop - vicious cycle happens within panic attack and across different panic attacks ● biological factors: (fight/flight response in absence of real danger) o abnormal activity in the circuit that produces panic rxns o levels of norepinephrine o vicious cycle - bio dysfunction + increased sensitivity to bodily cues + misinterpretation of bodily cues ▪ development of GAD ● understand the least, even though most common anxiety disorder ● sociocultural - dangerous, stressful societal conditions o poverty - one of the most powerful forms of societal stress ▪ rate of GAD is almost twice as high among people with low incomes as among those w/higher incomes o racial minority is closely tied to stress in US, sometimes prevalence of GAD is tied to race (eg. African Americans, Hispanics) o problem: can’t pinpoint who in the group will develop GAD, less evidence, has to be combined with other things to decide whether or not individual will develop GAD ● psychodynamic - high early anxiety, poor defense mechanisms o control id impulses o overprotected children, shielded by their overprotective parents from all frustrations and threats, have little opportunity to develop effective defense mechanisms 33/44 ● humanistic - lack of unconditional positive regard (people become more critical of themselves → develop more anxiety in situation), overly critical of self ● cognitive o Ellis, Beck - basic irrational assumptions of things ▪ basic irrational assumptions - inaccurate and inappropriate beliefs held by people with various psychological problems ▪ overestimating likelihood of bad things happening ▪ overestimating seriousness of event if it actually does happen o second-generation cognitive explanations → indicate other problems that go on on cognitive side that helps us understand development of GAD ▪ metacognitive theory (Wells) - implicitly hold both positive and negative beliefs about worrying, (thinking about our thinking) ● positive - worrying is a useful way of appraising and coping with threats in life o “If I stop worrying, then everything is going to go bad” ● negative - worrying is in fact harmful → worry about the fact that they are worrying → GAD ▪ worry as avoidance (Borkovec) - worrying allows people to avoid more powerful emotions (eg. fear) o have more evidence for ● biological - GABA inactivity o GABA - inhibitory neurotransmitter o have trouble rebounding from physiological rxns → people with GAD takes a lot longer to calm down ▪ development of OCD ● psychodynamic - obsession (id), compulsions (ego) ● behavioral - operant conditioning of compulsive behavior o focus on compulsions NOT obsessions (thoughts) o rituals → have to do them in order to reduce anxiety → rituals are reinforced o treatment- focus on compulsions and not as much on obsessions (obsessions will fade away if we can handle the compulsions) ● cognitive - predisposition to repetitive thoughts, act to neutralize the thoughts 34/44 o thought suppression - increases likelihood of having obsessions later ▪ “don’t think about white bear” → think about white bear o thought-action fusion - thinking about it is fused w/action, thinking about it is as bad as doing it ▪ people feel like they have to control thoughts → more likely to have thoughts in future ▪ if they have belief → more thought suppression and control → more likely to have those thoughts in future ● biological - overactivity in specific regions of the brain (orbitofrontal cortex, caudate nucleus, anterior cingulate), low serotonin ● Describe major treatments: o Pharmacological ▪ Medications: Benzodiazepines, SSRIs, Xanax ● take effect quickly (within one hour of taking) ● not great for long term o shouldn’t prescribe Xanax for panic attacks b/c used as safety behavior o better use for anxiety disorders is to use SSRIs o Behavioral Therapy ▪ Exposure therapy ● systematic desensitization - fear hierarchy ● flooding ● modeling ● exposure and response prevention (behavioral) o OCD ERP treatment ● treatment for panic disorder o psychoeducation o promote accurate interpretation o interoceptive exposure ● Mechanisms of exposure – habituation and inhibitory learning o habituation - need to habituate (reduction of fear) during exposure trial and b/w trials o inhibitory learning ▪ less about habituation (decreasing CS-US-fear link) ▪ more about ● building competing associations o linking CS with non-feared stimuli/cognitions 35/44 o building a non-fear (inhibitory) structure to compete with fear (excitatory) structure ● violating expectancies o Cognitive-behavioral therapy – exposure plus cognitive restructuring o Relaxation training ▪ progressive muscle relaxation, deep breathing techniques, and imagery ▪ meditation (guided meditation for stress relief) Chapter 6 – Trauma & Stress Disorders ● What are the stress disorders? ● What are the symptoms of each disorder? ● What is the difference between acute stress disorder and PTSD? ● Terms to know – stressor, stress response (physical, emotional, cognitive), reexperiencing, avoidance, reduced responsiveness, numbing, increased arousal ● Know the basics of the physiology of the fight or flight response o Autonomic nervous system – sympathetic and parasympathetic nervous systems o Hypothalamic-pituitary-adrenal axis ● What are the criteria for an event to be considered a trauma according to the DSM? Examples of traumas? ● Have a general sense for the prevalence and course of each and any interesting patterns in the prevalence rates (e.g., gender ratio). ● What factors influence the development of PTSD? ● Be able to describe and apply Foa’s information processing theory (inappropriate assimilation, overaccommodation), ● Describe major treatments for acute stress and PTSD: o Medication o Behavioral exposure (including EMDR) o Cognitive restructuring o Group therapy o Critical incident stress debriefing Chapter 6 –Dissociative Disorders ● Dissociative disorders o Know what dissociation is, when it is normal vs. abnormal o Know these terms ▪ Depersonalization ▪ Derealization ▪ Episodic vs. semantic memory ▪ Subpersonalities, alters ▪ Primary, host personality o Know the main symptoms of (and be able to explain the differences between) ▪ Dissociative amnesia (and subtypes: localized, selective, generalized, continuous) ▪ Dissociative fugue 36/44 o o o o ▪ Depersonalization/Derealization Disorder ▪ Dissociative identity disorder (DID) Know the biological evidence for DID Be able to explain the etiological theories for dissociative disorders: ▪ Abuse history (Trauma/Stress) ▪ Psychodynamic ▪ Behavioral ▪ Socio-Cognitive ▪ State dependent learning ▪ Self-hypnosis ▪ Know the similarities and differences among those theories Be able to provide a brief description of the treatments for dissociative disorders and which treatments are used for which disorders ▪ Psychodynamic ▪ Hypnosis ▪ Medication (“truth serums”) ▪ Integration of alters Know the epidemiology of dissociative disorders, including ▪ General prevalence rates ▪ Interesting patterns of the prevalence rates (as described in the lectures) Chapters 7, 8, 9 (Mood Disorders and Suicide) • Know the structure of mood disorders – Unipolar: • Major Depressive Disorder • Persistent Depressive Disorder (Dysthymia) – Bipolar: • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder • Know what mood episodes are and what the symptoms are for each – Major depressive episode – Manic episode – Hypomanic episode – Also know the mixed features specifier • Know what combinations of episodes are required for each of the diagnoses – Major Depressive Disorder – Dysthymic Disorder/Pervasive Depressive Disorder – Double Depression – Bipolar I Disorder – Bipolar II Disorder – Cyclothymic Disorder • Terms to know – Anhedonia – Psychomotor agitation and retardation – Grandiosity 37/44 • • • • – Expansive mood – Double depression – Labile mood – Pressured speech Know the epidemiology of mood disorders, including – Prevalence rates for MDD, dysthymia, bipolar disorders, cyclothymic disorder – Interesting patterns of the prevalence rates (as described in lecture) Know and be able to explain the major etiological theories for each of the disorders, including: – Biological factors for unipolar and bipolar depression – Psychodynamic theory for unipolar depression – Behavioral theories for unipolar depression (including Lewinsohn’s) – Cognitive theories for unipolar depression, including: • Theory of negative thinking (Beck) – schemas, negative cognitive triad, automatic negative thoughts • Rumination (Nolen-Hoeksema) • Learned helplessness (Seligman) • Helplessness theory (Abramson and colleagues) – internal, global, stable attributions – Sociocultural theories of unipolar depression, including: • Interpersonal theories (Coyne, Joiner) Know and be able to explain the treatments for unipolar and bipolar depression, including (also refer to the case from the homework for help with the bipolar treatments): – Medications for unipolar and bipolar depression, including undesired side effects of medications for bipolar disorder – Relevance of ECT – Psychodynamic treatment for unipolar depression – Behavioral treatment for unipolar depression (including Lewinsohn) – Cognitive treatment for unipolar depression (Beck’s cognitive therapy and its stages) – Marital therapy for unipolar depression (Beach & O’Leary) – Interpersonal psychotherapy (Klerman & Weisman) – grief, interpersonal role disputes, role transitions, interpersonal deficits – Goals of psychotherapy for bipolar disorders – Know which treatments (or treatment combinations) are considered to be the best, according to empirical research Suicide – Types of suicide victims: • Death seekers, initiators, ignorers, darers – Factors that increase the likelihood of suicide (including triggers) • Three step theory – (Klonsky and May, 2015) – Suicidal Ideation, Connectedness, Action/Behaviors – Theories of suicide • Psychodynamic • Sociocultural (Durkheim) – egoistic, altruistic, anomic • Biological 38/44 – Treatment • After an attempt • Therapy • meds depending on problem • Prevention • Crisis interventions • Ineffectiveness of no suicide contracts (versus generating reasons to live) • Means restriction Chapter 11 (Eating Disorders) ● Anorexia Nervosa – know diagnostic criteria/symptoms and associated features o Subtypes: restrictive and binging/purging o Medical complications o Cognitive problems ● Bulimia Nervosa – know diagnostic criteria/symptoms and associated features o Know definition of binge eating and compensatory behaviors o Medical complications ● Binge Eating Disorder – know diagnostic criteria/symptoms and associated features ● Prevalence rates and interesting patterns of those prevalence rates ● Associated features of eating disorders (e.g., comorbidity) ● General issues regarding etiology o Biological risk factors/explanations ● Genetics ● Serotonin ● Hypothalamus functioning o Family influences ● Minuchin’s theory ● Sick role ● Modeling ● Family values o Sociocultural influences ● Thin ideal, and patterns over time and across cultures ● Gender ● Race, ethnicity o Psychological factors ● Psychodynamic (Bruch) ● Cognitive factors ● Etiology specific to Binge Eating Disorder – Binge eating cycle ● General issues regarding treatment o Treatment goals – multimodal, multidisciplinary approach ● weight gain/stability, nutritional stability o Individual Therapies related to Anorexia ● Refeeding ● CBT for anorexia 39/44 ● ● ● ● ● Family therapy for anorexia o Individual therapies for bulimia ● Cognitive ● Interpersonal psychotherapy ● Behavioral – stimulus control, exposure and response prevention ● Antidepressants ● Nutritional counseling, supportive nursing care o Individual therapies for BED ● CBT ● Interpersonal Psychotherapy ● Behavioral Therapy ● Behavioral weight loss management o Ethical issues Be able to describe how eating disorders are similar to and different from OCD Be able to argue whether reverse anorexia should be considered to be an eating disorder or not Be able to describe similarities and differences between anorexia and bulimia in terms of o Symptoms/criteria o Personality traits o Family conflict and interpersonal relationships Terms to know o Amenorrhea o Ego-syntonic o Ego-dystonic o Multidisciplinary o Multimodal o Dichotomous Thinking Chapters 14, 15 (Schizophrenia and Severe Mental Illness and Treatment) ● Know and be able to describe the three types of symptoms of schizophrenia o Positive = behavioral, emotional, or thought excesses ▪ Hallucinations, delusions, disorganized thinking and speech (know the types), inappropriate affect ▪ Also, know what psychosis is and what the common types of hallucinations and delusions are ● Hallucinations o Auditory, visual, tactile, somatic, gustatory, olfactory ● Delusions of o Persecution o Reference o Grandeur o Control ▪ Know the types of disorganized thinking and speech 40/44 ● ● ● ● ● ● ● Loose associations ● Neologisms ● Perseveration ● Clang ● Word salad o Negative – 4 As ▪ Alogia, avolition, asociality, flat affect o Psychomotor ▪ Awkward movements, catatonia Know the diagnostic criteria and categories Know and be able to describe the three phases of schizophrenia o Prodromal o Active o Residual Other terms to know o Formal thought disorder o neuroleptics Know the prevalence of schizophrenia and the interesting patterns described in lecture Know and be able to the theories of etiology of schizophrenia and the level of empirical support that each has o Diathesis-stress model o Biological factors ▪ Genetics ▪ Dopamine ▪ Serotonin ▪ Sensory Processing ▪ Viral exposure ▪ Brain structural factors o Psychodynamic ▪ Freud’s theory ▪ Schizophrenogenic mothers o Behavioral ▪ Operant conditioning o Cognitive ▪ Interpretation of odd experiences and sensations o Sociocultural ▪ Multicultural factors ▪ Social labeling ▪ Family dysfunction ● double-bind communication ● high expressed emotion Know and be able to describe the treatments of schizophrenia and their effectiveness o historical ▪ institutionalization ▪ Community Mental Health Act 41/44 ▪ improvements through milieu therapy, token economy o drug treatments ▪ conventional antipsychotics and their negative side effects ▪ atypical antipsychotics o psychotherapies ▪ cognitive behavioral (know the goal and primary techniques used) ▪ family therapy (know the techniques used) ▪ social therapy (know the focus) o know the current model of care and its limitations Chapter 16 – Personality Disorders ● Definitions of personality and personality disorders o DSM-5 definition of personality o Millon’s definition of normal personalities o How personality disorders are defined by DSM-5 ● Know and be able to distinguish between Clusters A, B, and C personality disorders ● Know and be able to discuss issues with how personality disorders are structured in DSM-5, including o Symptoms overlap o High levels of comorbidity o Low interrater reliability o Degree to which they differ from Axis I disorders ● Have a general sense for the prevalence rates of the personality disorders and gender differences in the rates for the different disorders ● Know the main symptoms of, be able to explain the differences between, and be able to recognize (in case studies) the patterns of o Paranoid Personality Disorder o Schizoid Personality Disorder o Schizotypal Personality Disorder o Histrionic Personality Disorder o Borderline Personality Disorder o Antisocial Personality Disorder o Narcissistic Personality Disorder o Avoidant Personality Disorder o Dependent Personality Disorder o Obsessive-Compulsive Personality Disorder ● Know the main etiological theories and treatments for the different disorders (hint: you should pay particular attention to the theories and treatments for antisocial and borderline PDs) Chapter 17 – Childhood Disorders ● Have a general sense for the prevalence rates of the childhood disorders and gender differences in the rates for the different disorders (as discussed in lecture) ● Be able to discuss the general ideas that 42/44 o Children experience many of the same disorders as adults, but they look different in children o Certain disorders start in (or are limited to) childhood ● Know the main symptoms of and be able to explain the differences between o Oppositional Defiant Disorder o Conduct Disorder o DMDD o ADHD (and its subtypes) o Autism Spectrum Disorder ● Know the main etiological theories and treatments for the different disorders, including o Disruptive behavior disorders ▪ Etiology ● Genetics, drug use, poverty, trauma, community violence ● Family issues, parenting ● Parental problems ▪ Treatment ● Parent-Child interaction therapy ● Parent management training ● Therapeutic foster care ● Prevention programs ● Problem-solving skills training ● Anger Coping, Coping Power o DMDD ▪ Etiology ● Emotion regulation, frustration regulation problems ▪ Treatment ● Antipsychotic to help with irritability ● Therapy – parent training, behavior management, managing irritability o ADHD ▪ Etiology ● Biology ● Sociocultural ● Interpersonal problems ▪ Treatment (and which is the best for which subgroups) ● Medication ● Behavior therapy ▪ Autism Spectrum Disorder Etiology ● Sociocultural ● Psychological – Theory of Mind ● Biological ● NOT vaccines ▪ Treatment ● Behavioral (applied behavioral analysis, modeling, operant conditioning) 43/44 ● Communication training ● Parent training ● Community integration ● Know about and be able to discuss the following issues: o The pros and cons of diagnosing mental illness in children o Issues of comorbidity for disruptive behavior disorders o Age and gender differences in the presentation of disruptive behavior disorders 44/44