psych exam 3
cognitive behavioral therapy
-focus on directly changing maladaptive cognitions and behaviors -skills based (not insight focused) -active and collaborative -involves homework, assignments, collecting data -time limited -the most well researched and supported
biological cause of anxiety disorders
-genetic vulnerability for being shy, inhibited -genetic vulnerability for high trait neuroticism
biological factors of mental illness
-genetics (twin studies, adoptee studies) -prenatal development (malnutrition, maternal illness) -neural dysfunction (neurotransmitters, brain regions)
biological causes of schizophrenia
-high genetic contribution -> the closer someone is genetically related to someone with this mental disorder, they are at a greater risk of developing it -structural abnormalities in the brain -dopamine hypothesis -.... interacting w dysfunctional family environment
social factors of mental illness
-interpersonal (from relational contexts, someone dealing with a death, divorce, bully, etc) -cultural, demographic (age, gender, race, etc)
social causes of depression
-interpersonal events (ex. death, divorce) -demographic; cultural differences
assessment techniques
-interviews -behavioral techniques (overly familiar, pressure to speak) -instruments (questionnaires, testing)
lifetime prevalence of major psychological disorders
-more females have social or specific phobias -more females have major depression -more males have alcohol dependance
how do we treat psychological disorders?
-need to be managed over time with treatment -most can be treated in more than one way, require a team approach
Natural (innate) immunity
-non specific defenses -created by the body's natural barriers (skin, mucus, stomach acid) -rid the body of pathogens (elimination, fever, vomiting) -present at birth
degree of bias on IAT predicts
-nonverbal behavior in subsequent interracial interaction -doctor's medical decision-making about white v black patients -employer's response to job applicants
variability of ringelmann
-not culturally universal -less among friends v strangers -less among women v men -less when its a complex task (v simple task) -more intrinsically rewarding
what moderates stress?
-personality -predictability and control -coping -social support
cognitive behavioral factors of mental illness
-principles of learning (conditioning, tied into how people come to fear things through learning) -distorted thinking (large emphasis on thought patterns)
humanistic therapy techniques
-show empathy -emphasis on emotions/feelings -non directive, open ended statements -reflective listening, paraphrasing
behavioral (vegetative) symptoms
-significant appetite or weight change (>5% body weight) -insomnia or hypersomnia -psychomotor agitation or retardation -fatigue or loss of energy
two pathways from hypothalamus to adrenal glands
-sympathetic nervous system -HPA axis
deindividuation is most likely to occur when
-tense, highly emotional situations -feeling anonymous -diffusion of responsibility -victims are dehumanized
behavior therapies
-views the problem as one due to learning -uses conditioning principles in treatment
Generalized Anxiety Disorder (GAD)
-what if? -free floating, incessant worry (across multiple domains-work, health, relationships) -common symptoms -->hyper vigilance, distractibility --> disrupted sleep -->somatic symptoms (headaches, pain, tension in body)
increased risk of depression
-women -unemployed -low SES/poverty
proportion of Americans who have a mental illness in any given year
1 in 4
proportion of Americans who receive treatment over any 2 year period
1 in 5
humans try to reduce cognitive dissonance by...
1. changing behavior 2. changing attitude 3. changing cognition (add another thought, thinking differently, rationalize, make sense of it)
implicit association test (IAT)
1. classify word as good or bad 2. classify face as white or black 3. intermixed reaction time-> most people are faster at good/white and bad/black
slopen et al (2012)
10 year prospective study of 22,000+ women healthcare professionals ; chronic job stress (high demand, low control) -women with high job strain were 38% more likely to experience a cardiac event than women with less job strain
amount of people in US affected by depression
13-14 million
Carl Rogers
1902-1987; Field: humanistic; Contributions: founded person-centered therapy, theory that emphasizes the unique quality of humans especially their freedom and potential for personal growth, unconditional positive regard, fully functioning person
prevalence rate of bipolar depression
2-3% rate for US adults; no gender difference
gender depression difference
2:1; largely applies across the world; differences emerge at puberty
rosengren et al (2003)
50+ Swedish men with numbers of life events -high emotional support- lower mortality -social support is protective (buffers) the stress-mortality link
rosenman et al 1964
8.5 year prospective study on 3,500 middle aged men (free of cardiovascular disease at beginning of study) -assessed type a personality and behavior -assessed CVD risk factors -risk of heart attack was 2X greater for type a men (hyper reactive, high arousal)
Tricyclics
A class of antidepressant drugs that increase the level of norepinephrine and serotonin; elavil
psychoanalytic (psychodynamic) therapy
Focus on bringing unconscious struggles into consciousness (free association, dream analysis); Insight: Increase patient's understanding of their own psychological processes; Freudian (drives, conflicts (id-ego-superego), defenses); focuses on early childhood experiences and emotions
Musturbation
A term coined by Ellis to refer to behavior that is absolutist and rigid. We tell ourselves that we must, should, or ought to do or be something. 1. Everyone must think that I'm perfect or I will be worthless 2. Everybody has to act the way I want them to act 3. The universe has to give me what I want and the way I want it
systematic desensitization
A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.
conformity
Adjusting one's behavior or thinking to coincide with a group standard.
exposure therapy
An approach to treatment that involves confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response
perfectionism
An unhealthy compulsion to do things perfectly.
trepanning
Ancient practice where holes were cut into ill person's head ; Release evil spirits causing mental illness
Countertransference
Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life.
Hikikomori
Common among young adults in Japan; Victims isolate themselves for months or years; epidemic
cognitive therapy
Distorted thoughts produce maladaptive behaviors and emotions; treatment strategies attempt to modify these thought patterns
center for epidemiological studies depression scale (CESD)
-"I felt that I was just as good as other people" -> less than 1 day -> 1-2 days -> 3-4 days -> 5-7 days
specific (acquired) immunity
-"learns" to identify specific antigens, develops tools for antigens -specific white blood cells produce antibodies -vaccines -T cells produce cytokines (chemical messengers of immune system)
affective (emotion) symptoms
-> depressed mood OR -> loss of interest/pleasure in activities -feelings of worthlessness or excessive guilt
cognitive causes of anxiety disorders
-attentional biases for threat (more likely to pick up on a threat cue)
how to measure stressors
-checklists (limitations: situational) -interviews that are coded (1=low, 5=high)
environmental/learning causes of anxiety disorders
-classical conditioning (little Albert) -social observational learning (learn fear from a parent)
Biological causes of depression
-concordance rates are higher in MZ (46%) v DZ (20%) twins -neurotransmitters- low serotonin, chemical imbalances
two way connection between immune and nervous systems
-cortisol ("stress hormone")- released by brain, can affect immune system -cytokines- released by immune system, can affect brain
economic impact of depression in US
-cost in 2000-> $83.1 billion -mostly from sick days in workplace costs
cultural relativity of mental illness
-culture bound/shaped syndromes -disorders/illnesses represented around the world; find less evidence in other areas of the world -behaviors that might impair functioning in one system may have less interference in another culture system
DSM-V
-current model -emphasizes observable symptoms, meeting criteria -idea that symptoms are not the actual disorder but the overlying cause of the disorder -greater flexibility for presenting diagnostic conclusions compared to prior model -primary and secondary format is retained -recommends reporting psychosocial and contextual factors -expanded section on culture-bounded
positive (additive) symptoms of schizophrenia
-delusions -disorganized speech and behavior -hallucinations
cognitive symptoms
-difficulty thinking, concentrating, being indecisive -thoughts of death
what factors predict obedience in Milgram's study?
-distance of "student" -distance of experimenter -role model of defiance -legitimacy of authority
brain abnormalities in schizophrenia
-enlarged ventricles -blood flow abnormalities -fewer total neurons in the thalamus
mania
-euphoria -high mood, feeling high, on top of the world -excessive activity (speech, reduced sleep) -flight of ideas -racing thoughts, loosely connected -increase in goal directed activity -risky behavior -inflated self esteem, grandiosity, invisible feeling --> followed by an episode of major depression
negative (deficit) symptoms of schizophrenia
-flat/blunted affect -social withdrawal -apathy
RC week 2
instill intergroup competition; week long athletic tournament, increase in ethnocentrism (callings names, physical aggression)
health psychology
integrates research on health and psychology; applies psychological principles to promote health and well-being
impression formation
integrating information to form an overall judgement about a person; thin slices of behavior; importance of non verbal cues
traumatic event
intense fear, helplessness, horror; direct threatened or actual fear of death or injury on yourself or witness it
social support
kind of support/comfort we gain from relationships
flat/blunted affect
lack of emotional response; no expression of feelings; voice monotonous and face immobile
depression
low mood
brain washing
make (someone) adopt radically different beliefs by using systematic and often forcible pressure; using principles of cognitive dissonance; ex. POW in Korea, made prisoners write anti-US essays, started to agree with what they were writing, 20 prisoners ended up staying in Korea after war
greatest proportion of disability in developed nations
mental illness
social facilitation
mere presence of other people enhances performance (arousal); -facilitation of simple tasks -inhibition of complex tasks -culturally universal process
Segerstrom and Miller (2004)
meta analysis of acute v chronic stress (300 articles)
priming
method for assessing strength of association between concepts
Psychoneruoimmunology
mind, brain, immune system -chronic stress reduces efficiency of the immune system
MAOIs
monoamine oxidase inhibitors; increase serotonin and norepinephrine; Nardil
Beck's cognitive triad
negative views about the self, the world and the future
neurodevelopmental disorders
neurologically based disorders that are revealed in a clinically significant way during a child's developing years
delusion of reference
neutral events are given special and personal meaning "The person on the TV is talking to me"
What is mental illness?
normal psychological functioning <---> abnormal psychological functioning
delusion of control
one's thoughts or actions are controlled by the outside "the CIA is controlling my mind"
chronic stress
overall immune-supression (aren't designed to deal with longterm stress); decreased lymphocytes, decreased ability to ward off tumors (animal studies); more likely to die, more colds, impaired wound healing (human studies)
resistance
parasympathetic nervous system returns physiological functions to normal; recovery
Festinger's 1959 cognitive dissonance study
participant doing a boring task-> ask them to lie to someone and tell them that the task was fun for either a $1 or $20 reward; the $1 reward wasn't sufficient justification for lying so participants ended up actually believing the task was fun; dissonance led to altering of attitudes about enjoyability of task
Ambady & Rosenthal (1993)
participants viewed soundless 30 sec clip of a college professor lecturing, rated professor on various traits-- thin slice judgments agree with one another, mean reliability .72; thin slice judgments also predicted end of semester course evaluations--statistically significant .76**; thinner slices of 2 or 5 sec still have statistically significant findings
Ataque de nervios
people become hysterical, exhibiting violence and sometimes not even remembering the event; found mostly in middle aged women; uncontrollable screaming during periods of crisis
social cognition
perception; thinking about other people (impressions, judgement, inferences); make judgments within the first few seconds of meeting someone
Stanford prison study revisited
person who had a breakdown was faking it; guard had fake attitude (improv exercise); no mention of ability to leave study in informed consent form; audio recording says guards were told to be tough
Hans Selye
physician /endocrinologist; coined the term "stress"
Albert Ellis
pioneer in Rational-Emotive Therapy (RET), focuses on altering client's patterns of irrational thinking to reduce maladaptive behavior and emotions
derubeis, siegle and holen (2008)
placebo, SSRI, therapy groups -study 1: 8 weeks, therapy and antidepressants doing better 16 weeks, all doing better -study 2: continue SSRI or therapy, less relapse in symptoms for therapy
prognosis
prediction about course
ferrai et al (2013)
prevalence of diagnosed clinical depression: -most depressed countries- in Middle East and Africa, Afghanistan (>20%) -least depressed countries- Japan (<2.5%), China, Mexico (collectivist cultures)
Benzodiazepines
primarily increases the activity of GABA (calming neurotransmitter); typically short term use (may lead to dependance, dangerous when combined with alcohol); Xanax, Ativan, valium
anxiety disorders
psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety (ex. generalized anxiety disorder)
personality disorders
psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning (ex. narcissism, borderline)
stereotypes can be
publicly expressed (explicit), privately held (explicit) or unconscious (implicit)
sympathetic nervous system
quick; fight or flight; releases epinephrine and norepinephrine; adrenaline
obsession
recurrent, intrusive thoughts/mental images, can't prevent thoughts (ex. might have hit someone with my car)
mere exposure effect
repeat exposure leads to positive attitudes; familiarity; ex. advertisements
SSRI
selective serotonin reuptake inhibitor; works mechanically with serotonin; prozac, zoloft
Applied Behavior Analysis
shapes behavior through reinforcers (rewards)
Revisiting Robber's Cave
sheriff intervened with "frustration exercises", first experiment failed ( kids could not be persuaded to hate each other, suspicious of camp counselors); intervened more heavily in RC
symptoms
signs of disorders
HPA axis
slow, prolonged stress; releases cortisol (the stress hormone); repeated or prolonged activation leads to wear and tear on the body's stress regulatory systems, leads to illness
Berkman and Syme (1979)
social connections are beneficial regardless of stress -men v women, dying over 9 years -more socially integrated least likely to die in time frame
Persistent Depressive Disorder (Dysthymia)
Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months.
Thin-slice judgments
People can make surprisingly accurate judgments quickly and automatically; not without occasional error
Stanford Prison Experiment
Philip Zimbardo's study of the effect of roles on behavior. Participants were randomly assigned to play either prisoners or guards in a mock prison. study ended after only 5 days. prisoner went crazy.
General Adaptation Syndrome (GAS)
Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion.
disorganized speech and behavior
Severe tangentially in the conversation Loose associations between topics; Sudden derailment of thought; Unusual positions or actions
physical attractiveness stereotype
The presumption that physically attractive people possess other socially desirable traits as well: What is beautiful is good.
eating disorders
US/the west; concept is different
kitty genovese case 1964
stabbed repeatedly outside her apartment, observed by 38 neighbors, no one helped her, someone called 30 min after her first cry for help
Deindividuation
state of reduced individuality and self-awareness that leads to reduced attention to personal standards (ex. mob mentality, rioting)
behaviors are consistent with
strong attitudes
Asch study of conformity 1951
task: in a group of other "participants", pick which line matches the standard line (one person and a group full of researchers) -75% conformed on at least one trial (18) -30% conformed every time -compared to >1% in private condition -conformity increases with group size until about 4 members
Clifford and Walster (1973)
teachers given subjective information on a child's academic ability (the same throughout) and a picture of a child (attractive/unattractive based on social ideas of attractiveness); guess IQ, wellness of social relationships, parents attitudes towards school; teachers who are given a more attractive picture with the same academic information rate that student higher
social loafing
tendency for people to work less hard in a group than when working alone; you don't pull weight when you don't feel personally responsible for output
Montreal Cognitive Assessment (MoCA)
testing on memory and cognitive function
alarm
the first phase of the stress response, in which the person faces a challenge and starts paying attention to it; heightened sympathetic arousal; temporary drop in normal resistance
dopamine hypothesis
the idea that schizophrenia involves an excess of dopamine activity
Transference
the patient's transfer to the analyst of emotions linked with other relationships
Ringelmann Effect
the phenomenon by which individual performance decreases as the number of people in the group increases
social psychology
the scientific study of how we think about, influence, and relate to one another; individual behavior in a social context
bystander effect
the tendency for any given bystander to be less likely to give aid if other bystanders are present; assume someone else will step in
diffusion of responsibility
the tendency for individuals to feel diminished responsibility for their actions when they are surrounded by others who are acting the same way
outgroup homogeneity effect
the tendency to view outgroup members as less varied than ingroup members; "they're all the same"
realistic group conflict theory
the theory that prejudice arises from competition between groups for scarce resources; ingroup favoritism and outgroup derogation
Nalini Ambady
thin slice judgments and impression formation
psychotherapy
treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth
behavioral medicine
treatment of illness using behavioral and medical knowledge
fundamental attribution error
we tend to overestimate internal, and underestimate external, causes for other's negative behavior... while doing the opposite for ourselves
Diagnosis and Statistical Manual of Mental Disorders (DSM)
what people use to categorize various illnesses
counterconditioning
a behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning
Antidepressants
a class of psychotropic medications used for the treatment of depression; work to increase norepinephrine and/or serotonin; with or without psychotherapy; can also treat other disorders
halo effect
a cognitive bias in which our overall impression of a person influences how we think about their specific traits
major depression
a disorder characterized by severe negative moods or a lack of interest in normally pleasurable activities
bipolar depression
a disorder marked by alternating or intermixed periods of mania and depression
rational emotive behavior therapy
a form of cognitive behavioral therapy; Albert Ellis; client is confronted with irrational beliefs, develops a more realistic way of thinking
psychotic disorders
a group of psychological disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality (ex. schizophrenia)
fear hierarchy
a list of situations in which fear is aroused, in ascending order
stress
a pattern of responses (behavioral, psychological, biological) that arise when individuals perceive that they cannot adequately cope with the challenge or threat -variety of responses -perceived, subjective -perceived that challenge or threat exceeds ability or resources
locus of control
a person's tendency to perceive the control of rewards as internal to the self or external in the environment
just-world hypothesis
a strong need to believe the world is a just and predictable place; "we reap what we sow"; ex. assuming a homeless person did something to deserve their lot in life (lazy, drugs) and less likely to think about situational causes (lack of health care, unemployment)
cognitive restructuring
a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs
flooding
a treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless
phobia
abnormal fear; characterized by fear and avoidance (safety seeking); avoidance makes it worse
audience inhibition effect
acting cool and calm in front of others is valued; look to others for cues
compulsion
actions, irresistible urge to act on obsession (ex. drive back and check)
PTSD
an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience
OCD
an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)
panic disorder
an anxiety disorder that consists of sudden, overwhelming attacks of terror; fight or flight; fear of fear itself; symptoms mimic heart attack; derealization
stressor
an environmental event or stimulus that poses challenge or threat; disrupts equilibrium; varied and diverse; not only negative -objective -severity (major life events v daily hassles) -duration (chronic v acute)
cognitive dissonance
an uncomfortable mental state due to contradiction between two attitudes or between an attitude and a behavior
main effects model
asserts that social support contributes directly to well-being and positive health and that these beneficial effects occur even in the absence of stress
Finger Tapping Test
assess neuromuscular function; rate of how many finger taps in 60sec
Test of Variables of Attention (TOVA)
assesses impulsivity, inattention; kids with ADHD are very bad at this
natural killer cells (NK cells)
attack and destroy antigens
internal (personal) attribution
attributing cause to something about the person or the self
external (situational) attribution
attributing cause to something external to the person or the self (such as the situation)
Milgram (1963)
behavioral study of obedience; teacher is true participant, student controlled to zapper and said they have a heart condition, teacher teaching student to match, controlled voltage; when they objected the researcher told them to continue; went until teacher refused, finished or student was "unconscious"
delusion of persecution/paranoia
belief that others wish to persecute you; bizarre plots and ideas "They are out to get me"
delusion of grandeur
believe self to be overly powerful, important ; have special traits or abilities "I am an advisor to the president"
buffering effects model
beneficial effects of social support occur only in the presence of stress
Autism Spectrum Disorder
characterized by extreme difficulty communicating and forming relationships, difficulty using language and sensory disorder
Leon Festinger
cognitive dissonance theory
Latane and Darley (1968)
completing a questionnaire when room fills with smoke; 3 conditions (work alone, with one researcher, with 2 researchers) Did they tell experimenter about smoke? -more reported smoke when they were alone and that decreased as there were more people in the room
leading cause of death for adults in the developed world
coronary heart disease; accumulation of fatty deposits along artery walls and hypertension increase risk for heart attack
RC week 1
create ingroup; cooperative camp activities, develop identities (rattlers and eagles)
exhaustion
depletion of resources; susceptible to disease
common cold of mental illness
depression
Seligman's learned helplessness theory
depression occurs when people (and other animals) become resigned to the idea that they are helpless to escape from something painful; classical conditioning; not trying to get out of negative situation; "why try?"
unipolar depression
depression that alternates with normal emotional states
etiology
development of disorder
discrimination
differential action towards individual
diathesis-stress model
disorder develops when an underlying predisposition is coupled with a precipitating environmental event
bipolar disorders
disorders marked by alternating or intermixed periods of mania and depression
post-decision dissonance
dissonance aroused after making a decision, typically reduced by enhancing the attractiveness of the chosen alternative and devaluating the rejected alternatives; ie buyer's remorse
diagnosis
distinguish between disorders
Antipsychotics
drugs used in the treatment of psychotic disorders that help alleviate hallucinations and delusional thinking; decrease dopamine by blocking dopamine receptor sites -traditional: work on + symptoms -atypical: work on +/- symptoms
justification of effort
effort for the task/group causes dissonance, dissonance leads to anxiety and distress, people inflate the task/group's importance and their commitment; ex. hazing
RC week 3
encouraging intergroup cooperation; contact is not enough... must have super-ordinate (shared) goal, eased tensions, friendships formed
acute stress
enhanced natural immunity; suppression of specific immunity
attitudes
evaluations (feelings, opinions, beliefs) of people, events, objects, and ideas; formed through experience and socialization; can be conditioned
kitty genovese revisited
exaggerated witnesses and their responses in original; sensationalism (culture, media)
assessment
examination of a person's mental state to diagnose possible psychological disorders; ongoing- doesn't stop after one diagnoses
Robbers Cave Experiment
experiment which showed that even arbitrary group distinctions (camp teams) can cause a bitter rivalry and discrimination, thus demonstrating in-group/out-group biases
delusion
false belief -grandeur -persecution/paranoia -reference -control
hallucinations
false sensory perceptions -auditory- hearing voices -visual- seeing figures
specific phobia
fear of a specific object or situation -ex. claustrophobia, arachnophobia
social phobia (social anxiety disorder)
fear of interacting with others or being in social situations that might lead to a negative evaluation
prejudice
feelings and attitudes towards an individual based on group membership; leads to differential treatment
humanistic (client-centered) therapy
focus on the whole person; "client" and not "patient"; therapist has unconditional positive regard for the client (acceptance and support); Carl Rogers
problem-focused coping
focuses on task based approach to solving a problem
emil kraepelin
founder of modern psychology; A pioneer of diagnostic categorization in mental health who was one of the first to assign formal labels to particular clusters of symptoms
depressive disorders
general category of mood disorders in which people show extreme and persistent sadness, despair, and loss of interest in life's usual activities (ex. major depression)
Granulocytes
general white blood cells
stereotyping
generalized belief about other people based on their social group; not bad in and of themselves, we all have them
social influence
groups influence individual attitudes and behaviors
Payne (2001)
gun or tool (target object) white or black face (face prime) -participants were quicker to pair black faces with guns, slower to pair with tools -participants make more errors pairing black faces with guns (when its really tools)
cardiovascular system
heart and blood vessels
manic
high mood
emotion-focused coping
how you feel about it
attribution
identifying causes for an event or someone's behavior; impact how we feel and therefore how we behave
free association
in psychoanalysis, a method of exploring the unconscious in which the person relaxes and says whatever comes to mind, no matter how trivial or embarrassing
social striving
increased individual effort in group settings - more common in collectivist cultures
Schizophrenia
"splitting of the mind"; a break with reality, characterized by alterations in thoughts, perceptions, or consciousness; 1% prevalence rate; no sex difference; high genetic contributions
depression symptoms
(5 or more present in a 2-week period) -must include either -> depressed mood OR -> loss of interest/pleasure in activities -significant appetite or weight change (>5% body weight) -insomnia or hypersomnia -psychomotor agitation or retardation -fatigue or loss of energy -feelings of worthlessness or excessive guilt -difficulty thinking, concentrating, being indecisive -thoughts of death