Abnormal Psych Exam 2
Exposure therapy can be administered in different ways. Describe two different "paces" of exposure therapy for a specific phobia.
Exposure graduated: gradually being exposed to anxiety provoking stimuli. Flooding: exposing them to anxiety provoking stimuli quickly
These theorists invented a unique method of therapy supervision. What is it called, and how does it work?
"BUG IN THE EAR" therapist in room with a wire, get info thru head unit from another therapist outside of the room (assists you in seeing everything among a family. one therapist might not be enough) — Did you notice the pattern between Tommy and mom? — Did you see Tommy's rxn? Fitzgerald and Best
Name one of the following from each category that is associated with anxiety disorders: - region of the brain: - neurotransmitter: - hormone: - nervous system:
- region of the brain: Amygdala, Prefrontal cortex, Anterior cingulate cortex - neurotransmitter: GABA - hormone: adrenaline, cortisol, and DHEA - nervous system: sympathetic (fight or flight)
What might a "hierarchy" contain in the context of exposure treatment for SAD?
1) Talk about a normal conversation 2) talk about asking someone out 3) talk about a embarrassing situation 4) talk to someone you know 5) talk to someone new 6) ask someone out on a date ect.
What would happen if someone was experiencing high levels of anxiety in a particular situation, and therefore decided to leave before the anxiety got worse? [an ideal answer here would involve 1) what happens to the person's anxiety, 2) what happens to the "avoidance behavior", and 3) what the person misses "finding out" if s/he were to have remained in the situation]
1) The individual's anxiety would decrease 2) the avoidance behavior is reinforced 3) the individual misses finding out if anything bad was going to happen
List three things that a cognitive behavioral therapist might do in working with someone who has social anxiety disorder.
1. Helping them face the social beliefs and expectations that work against them 2. Help them view themselves better and put away their thoughts of being unattractive or not being perfect 3. Help them find control over their feelings of anxiety ( I just made these up from what their fears are he didn't give us actual treatments)
Describe three common types of obsessions.
1. Hoarding 2. Cleanliness obsessions 3. need for things to be symmetrical "in order"
What are the three different components of a panic attack and some symptoms from each category?
1. PHYSICAL: heart racing, sweating, shortness of breath 2. COGNITIVE: fear of dying, fear of going crazy or losing control 3. AFFECTIVE: intense fear, anxiety
How prevalent is social anxiety disorder? Are there gender differences? SOCIAL ANXIETY DISORDER
7.1% year prevalence, can be generalized (fear all social situations) or specific (confined to a particular action)
MSE domains: Orientation
A client is assessed in orientation to time, place, person, and (occasionally) purpose of the interview - the essential question is, is the person aware of both self and the environment?
MSE domains: Mood
A client's self report of his or her own feeling state Euphoric mood is elevated above normal, dysphoric mood is depressed, and euthymic mood is "normal"
Addiction Severity Index (ASI)
A structured clinical interview for substance abuse and dependence
Specific phobias are often considered one of the "easiest" psychological disorders to treat. Describe one treatment for phobias, and indicate why these disorders might be considered "easy."
A treatment for phobias would be cognitive: restructuring the thoughts related to the anxiety or behavioral: systematic desensitization in vivo (real life) exposure. This can be considered "easy" to treat because you have one specific thing you are treating.
Both social anxiety and agoraphobia have, as a core fear, that one will be humiliated or embarrassed. So, how are these two disorders different?
Agoraphobia = the fear of being in situations that escaping may be difficult or embarrassing, or help is unavailable if panic-like symptoms were to occur. Social anxiety disorder is severe or persistent fear of social or performance situations in which scrutiny by others or embarrassment may occur.
Generalized anxiety is commonly related to many other psychological conditions. Which one, in particular, is highly comorbid with GAD?
Agoraphobia, Social Anxiety Disorder, Panic Disorder GAD twice as likely in women
Standardized assessment procedures
An assessment can be said to be standardized if there is an established protocol for administering and scoring the test (for example, the Beck Depression Inventory involves asking about a number of symptoms of depression; clients' scores are computed by summing the number and intensity of the symptoms endorsed) The quality of a standardized test is determined by its psychometric properties
What is the rapprochement movement in treatment development/research?
An effort to identify a set of common strategies that characterize the work of all effective therapists.
Describe two behavioral treatments for obsessive compulsive disorder. How might each one work?
Exposure and response (ritual) prevention - clients experience high-risk situations without engaging in compulsive behaviors, thought stopping
Personality and diagnostic testing: objective personality test
An objective personality test has relatively standardized scoring/interpretation that, theoretically, requires little judgment on the part of the interviewer The most widely used test of this type is the MMPI-II (Minnesota Multiphasic Personality Inventory) This test has three validity scales which let you know if the administration of the test, with a given person, is a valid administration There are ten clinical scales of the MMPI-II, each corresponding to a particular characteristic. These roughly correspond to some of the Axis I disorders Another widely used test is the Millon Clinical Multiaxial Inventory (MCMI-II), which as an objective test for Axis II personality disorders
What are the two pathways activated by the hypothalamus that lead to fear and arousal?
Autonomic nervous system and the hypothalamic pituitary adrenal pathway
How do humanists define psychological distress?
Best thing you can do for your patients is to give them unconditional positive regard She should realize what a good person she is and that she has the potential to be anything
What are the pros and cons of different pharmacological treatments for panic disorder? [benzodiazepines, SSRIs/SNRIs, and beta blockers]
Beta blockers help with attacks but you have to take them if you're having an attack they aren't preventative. SSRIs work on serotonin which may help but panic disorder is really a nervous system malfunction. Benzodiazepines attack the nervous system and GABA so are great for panic disorder but can have a numbing effect on the brain
Why do people develop a psychological stress disorder?
Biological Genetics Personality Childhood Experiences Social Support Multicultural Factors Severity of Trauma
What is in vivo exposure? How is it different from having a client to think about touching a spider, for example?
Exposed to the fear in real life
List several common situations that might be difficult for someone with agoraphobia.
Crowded areas, public speaking, rooms with limited exits, situations where everyone will look at them if they try to leave
Validity
Does it measure what it is intended to measure? If a test says someone is depressed is that a valid test of their depression
MSE domains: Judgment
Does the person make reasonable decisions, or does judgment seem to be impaired?
What is the core feature of generalized anxiety disorder? GAD
Excessive anxiety under most circumstances, worrying about practically anything
How does exposure therapy work? What are some key principles of exposure-based treatment of anxiety disorders?
Exposure therapy = 2 factor (biological and psychological) 1. Biological = SSRIs 2. Psychological = thought stopping Support Groups: could be super hard to get a group together, but it helps a lot Home-Based Self-Help Programs: Bringing the treatment to the person. Relying on giving the tools the person needs in order to be their own therapist Exposure to feared situation and remaining in situation until anxiety subsides. Uses both operant and classical conditioning (behavioral therapy) flooding = person to approach fear from the very beginning
How is fear different from anxiety? What are the three components of anxiety? Be able to describe elements of each of these components for a particular disorder.
Fear is instinctual, biological, and immediate. Anxiety is future oriented, worrying about the future and has multiple components. The three components are Psychological, cognitive, and affective.
Name several common specific phobias
Fear of heights, injection, blood, germs
What is agoraphobia, and how is it associated with panic disorder?
Fear of situations from which escape may be difficult or embarrassing. Anxiety about not being able to escape a situations.
MSE domains: Perceptual disturbances
Hallucinations are the experience of a stimulus that is not actually present; they can occur in any sensory modality (i.e., tactile, auditory, visual, olfactory, and gustatory) Illusions are different from hallucinations in that they involve the misperception of an actual stimulus
What would Freud say about OCD?
He would say you got stuck in the anal phase because they would be obsessive and uptight because they did not master control
Name the four OCD-related disorders we discussed in class, and be able to explain each of these
Hoarding disorder: compulsive saving of possessions trichotillomania: obsessive hair pulling body dysmorphic disorder: people perceive part of their body as ugly or flawed and spend significant time masking the "defect" excoriation (skin picking) disorder
What is unconditional positive regard, and why would a therapist use this principle, according to Rogers?
It means caring for the client, but not in a possessive way or in such a way as simply to satisfy the therapist's own needs It means caring for the client as a separate person, with permission to have his own feelings, his own experiences People also nurture our growth by being accepting—by offering us what Rogers called unconditional positive regard
Other types of assessment
Know the basic idea behind neuropsychological assessment. What types of tests might be used, and what would they indicate about a client's functioning. Be able to name a couple of assessments that might tell you about brain structure and/or function.
How to define abnormality according to Sociocultural and Multicultura models?
MULTI: How do race, gender, and sexual orientation impact individuals' lived experiences? Minority stress (Ilan Meyer) SOCIO: Problems in the larger, external environment are internalized by the individual or exert pressures through discrimination
What are new-wave cognitive perspectives on GAD? Be able to explain each of the three new-wave perspectives from the book and from class discussion.
Metacognitive Theory: Positive: worrying is a useful way of coping with life threats Negative: worrying is harmful (mentally and physically) and uncontrollable Intolerance of uncertainty theory: cannot tolerate knowing that negative events may occur, worrying constantly that such events are going to occur Avoidance theory: Greater bodily arousal → worrying serves to reduce arousal (distraction from unpleasant feelings)
What is an overriding behavioral principle that can be used to explain the anxiety disorders? (Hint: think Mowrer). Describe the different parts of this principle, what types of learning are associated with each part, and give an example of how an anxiety disorder might develop from this perspective.
Mowrer's Avoidance theory: Avoidance and escape, anxiety comes from classical conditioning where you learn to fear something because of paired associations. Escape or avoidance is connected to operant conditioning because you remove yourself from the stimulus which reduces the anxiety and conditions you to fear.
Behavioral assessment
There are two major types: 1.behavioral self-monitoring (the client is responsible for taking note of his or her own behavior) 2. Observation of the client by the clinician. Be able to give examples of behavioral assessment.
MSE domains: Thought processes
Normal thought processes are described as "logical, linear, and goal directed" Departures from normality may include illogical thinking, circumstantiality (meandering from the topic being discussed, but eventually returning to the topic), tangentiality (departing from the topic and not returning to a train of thought), flight of ideas (shifting from topic to topic rapidly, as if one is trying to follow a rapidly shifting attention) A distinction here is made between poverty of speech (not saying much) and poverty of content (speaking, but saying things that mean relatively little)
MSE domains: Observations of appearance and behavior
Noteworthy observations about the client's appearance might be: poor hygiene, dressed inappropriately for the time of year (e.g., a parka in August), etc. During the interview, did the client behave unusually? (for example, pacing frequently or staring out of the window)
How are compulsions related to obsessions?
Obsessions are recurrent and unwanted thoughts while compulsions are a need to perform repetitive and rigid actions
What is the lifetime prevalence of OCD? When does it usually appear? Is there a gender difference?
Onset: 4-25 years, similar across genders and cultures, yearly prevalence: 1-2%
What is the difference between a panic attack and panic disorder?
Panic attacks are typically short, occur randomly, and eventually pass. Panic disorder is marked by anxiety about having another attack and unexpected and recurrent attacks.
What is meant by a "parsimonious" diagnosis?
Parsimonious: best explanation of observed behaviors.
What is anxiety sensitivity? How is it related to interoceptive cues?
People with panic disorder are able to better perceive internal cues and anxiety and are likely able to "scan" their body to predict an attack
What is an obsession? What has psychological research indicated to us about attempts to banish obsessive thoughts from consciousness?
Persistent thoughts, ideas, impulses or images that are repeatedly experienced, intrusive, and cause anxiety
Describe a cognitive approach to understanding and treating specific phobias.
Phobias defend against impulses of the id. Catastrophizing cognitions. Two factor learning: the original fear reaction develops through a UCS-CS pairing. Anxiety is maintained through avoidance. To treat: restrust maladaptive thoughts related to anxiety.
Who is qualified to give a diagnosis? What are four professions in which a person may give a diagnosis? Be able to describe the training involved in each of those professions.
Physiatrists (M.D.), Psychologists (Ph.D, Psy.D) can prescribe in certain jurisdictions ...
From an evolutionary perspective, why might phobias have developed and been passed down among generations?
We are biologically prepared to be afraid of things that could cause harm.
What's involved in a sociocultural and multicultural treatment?
SOCIO: providing a safe environment, helping the person to navigate through a potentially hostile environment
What is Gestalt therapy? What is existential therapy?
Self-recognition and acceptance (humanistic) whole being (organismic, holistic, self-acceptance)
Name three types of evidence we have that OCD may be biologically caused.
Serotonin and dopamine levels, orbitofrontal cortex and caudate nuclei, having strep in childhood may be related to OCD-like behavior
MSE domains: Thought content
Several potential observations can be made here Obsessions - thoughts that come to a client's mind repeatedly and cause distress Delusions - by definition, a "fixed false belief" that cannot be explained by a person's culture Ideas of reference - a person's belief that things in his or her environment have particular significance for him or her (for example, if I believe that the newspaper headlines are meant to give specific messages to me) Several other common types of delusions = delusions of grandeur, delusions of persecution, thought broadcasting, thought withdrawal, and thought insertion Violent thoughts, directed toward the self or toward others Guilty or depressed thoughts (often indicated by Beck's cognitive triad of negative thoughts about one's self, world, and future)
All people have things that they are afraid of. Why don't we say that everyone has a specific "simple" phobia?
Severe and persistent fear of a specific object or situation. Object or situation almost always provokes immediate fear, is actively avoided or endured with intense fear, fear is out of proportion to actual danger posed, fear/anxiety or avoidance lasts at least six months
Reliability
Test-retest reliability refers to consistency of a client's responses over time, if administered the same test again Internal consistency - do items within the test "hang together" in a meaningful way? Does how a person answers one item predict how s/he will answer similar items on the same test? Interjudge or interrater reliability - would another person, administering the same test, reach the same conclusions?
What does the concept "identified patient" mean, according to this theoretical perspective? FAMILY
The family member in whom the family's symptom has emerged or is most obvious.
Ways of measuring intelligence
The oldest standardized intelligence tests are derived from Binet's work for the French government; they are called the Stanford - Binet Tests These are based on the concept of intelligence as one's mental age divided by one's chronological age The problem with this method, however, is that as people age into adulthood, this formula is no longer relevant David Wechler's scales, the WAIS-III (Wechsler Adult Intelligence Scale) and WISC-III (Wechsler Intelligence Scale for Children) are based on the concept of a deviation IQ, which is a measure of how far one's intelligence differs from established norms An important consideration in all intelligence testing is the degree to which tests are culturally appropriate. Can they be used in other cultures? Are they appropriately administered to people of vastly different backgrounds, just because they live in the same country?
MSE domains: Affect
The outward expression (of mood) that is observed by the interviewer Someone's affect may be described in a number of ways: Appropriateness (e.g., "inappropriate affect" is seeming happy while discussing a very sad event), Intensity - "flat" affect lacks emotional intensity, heightened affect might indicate mania Mobility - how the person shifts from one emotional state to another; rapidly shifting states is described as "labile affect" Range - does the person display the typical highs and lows of emotion that characterize human experience? If not, affect may be described as "restricted range"
International Personality Disorders Examination (IPDE)
This interview is a method of assessing personality disorders
What is metaworry? How is it related to GAD?
This is someone who worries about worrying this is related to GAD because this is a general thing to be worried about people with GAD worry about practically anything.
Be able to explain thought-action fusion and thought suppression, and how they are related to OCD.
Thought-Action Fusion: people confuse or conflate having a thought with acting upon that thought. They can have a thought but it doesn't mean it will happen. Thought Suppression: Pushing away the thoughts that are unwanted actually makes them come back stronger. Difference between people with normal and abnormal obsessions primarily in the degree to which they resist their own thoughts and find them acceptable. People with OCD engage in frequent, streneous, and time-consuming attempts to control intrusive thoughts but not generally effective
What do meta-analyses tell us about whether or not treatment works?
Treatment typically always works, when there is a specific problem, specific treatments work the best. Moderate depression is equally treated by meds and therapy, severe depression is best treated by a combination of meds and therapy.
MSE domains: Speech
Typically, observations made about a client's speech have to do with the rate, rhythm, or volume of the speech Observations in this area could mean a number of things; for example, the client who speaks very loudly may be anxious or manic "Pressured speech" is often used to describe someone with mania, who appears to be thinking faster than s/he can speak
Intelligence testing
What is intelligence? the ability to acquire and apply knowledge and skills. Ability to perceive relationships One major theory is Charles Spearman's concept of "g," or general intelligence, which the ability of a person to perceive relationships among things (e.g., cause and effect) = how different things relate to one another. There is also specific intelligence. Competing theories, such as Howard Gardner's, posit that there are many different "intelligences," and that our testing systems do not adequately tap into all of them = music, interpersonal, intrapersonal, verbal, bodily, logical, visual
How long does one need to have symptoms of GAD in order to meet a diagnosis?
Worry more days then not for at least 6 months
According to Family-Social and Family Systems Perspectives, what is abnormality? What's the cause of abnormal behavior?
abnormal behavior is best understood in light of the broad forces that influence an individual, such as societal norms, culture, etc. Problems are caused by maladaptive family relationships and patterns of interaction
Mental Status Exam
an interviewer's recording of a number of different domains of client behavior The MSE is different from the Mini Mental Status Examination (MMSE), which is a short measure that can be administered to determine a client's overall level of cognitive functioning (sample items include: draw two intersecting pentagons, say the sentence "no ifs, ands, or buts")
How do social labels and roles impact behaviors?
assigned to troubled people. When people stray from the norms of society, society calls them deviant and "mentally ill". When people are viewed in this way, they gradually learn to accept this role and act more like it.
A Rogerian approach is also described as client-centered. What does this mean?
based on providing unconditional positive regard
Interview: Structured
comprised of a set of predetermined questions that the interviewer follows in order. Some of the most commonly used structured interviews are: International Personality Disorders Examination (IPDE) and Addiction Severity Index (ASI)
What is the process of differential diagnosis (and what are differential diagnoses)?
differentiating between two or more conditions that have the same or similar symptoms.
What is minority stress and how is it related to psychological difficulties?
particular stresses of gender identity, socioeconomic status, discrimination, sexual orientation (people start blaming themselves and not society, feel as though they will be victimized, hurt, looked down at = PTSD!!!
How do race, gender, sexual orientation, and intersecting identities impact behaviors?
particular stresses of gender identity, socioeconomic status, discrimination, sexual orientation... people start blaming themselves and not society, feel as though they will be victimized, hurt, looked down at = PTSD!!!
What role do social networks play?
people that are isolated and lack social support are more likely to be depressed and remain depressed networks perform important and beneficial functions in securing social stability through providing emotional support to children and socializing them into society's culture so they conform to social norms and values. A series of social relationships that links a person directly to others, and through them indirectly to still more people.
Personality and diagnostic testing: projective personality tests
require more interpretation on the part of the interviewer. They are a product of psychoanalytic thinking, which includes the belief that most of an individual's behavior is driven by unconscious processes. The test-taker, therefore, projects these unconscious thoughts onto ambiguous stimuli The most famous of these is Henry Rorschach's test, which has black and white as well as colored inkblots as stimuli The Thematic Apperception Test (TAT) shows ambiguous scenes (drawings), and asks the client to describe what is going on in the pictures Both projective and objective tests, therefore, give a more complete sense of the client than one would get in an interview alone. However, they provide very different information. A therapist's theoretical orientation would influence the choice of one type of test over another.
What's Maslow's theory? How would this relate to therapy?
self-actualization theory hierarchy of needs (meet physiological needs, then safety, love/belonging, esteem, then self-actualization)
How is the relationship between socioeconomic status (SES) and mental illness explained (there should be two primary models here)?
social causation: social exclusion, high stress, malnutrition, reduced access to social capital social selection (or "downward drift"): increased health expenditure, loss of employment, reduced productivity
What is comorbidity?
the co-occurrence of one or more diagnosis at the same time.
MSE domains: Insight
the narrowest definition of insight is whether or not the person realizes that s/he has a psychological problem. We typically speak of insight in broader terms, however, as one's understanding of the world (a.k.a. "psychological sophistication")
Interview: Unstructured
without relying on a predetermined set of questions, the assessor and client discuss the client's problems. The assessor (if s/he is a good diagnostician) will use a mental "decision tree" to make diagnostic decisions. For example, if a client endorses racing thoughts, the clinician will follow up with questions to determine whether or not this thought process might be part of a manic episode.
