Abnormal Psychology

Panic Disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.

Distress

can take the form of psychological or physical pain, or both concurrently. Simply put, distress refers to suffering. Alone though, distress is not sufficient enough to describe behavior as abnormal

Standardization

defining meaningful scores by comparison with the performance of a pretested group

Structure of Personality

id, ego, superego Freud's psychoanalysis was unique in the history of psychology because it did not arise within universities as most of the major school of thought in our history did, but from medicine and psychiatry, it dealt with psychopathology and examined the unconscious. Freud believed that consciousness had three levels

clinical diagnosis

identification of a disease by history, laboratory studies, and symptoms is the process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder set forth in an established classification system such as the DSM-5 or ICD-10 (both will be described shortly). Any diagnosis should have clinical utility, meaning it aids the mental health professional in determining the prognosis, the treatment plan, and possible outcomes of treatment (APA, 2013). Receiving a diagnosis does not necessarily mean the person requires treatment. This decision is made based upon how severe the symptoms are, the level of distress caused by the symptoms, symptom salience such as expressing suicidal ideation, risks and benefits of treatment, disability, and other factors (APA, 2013). Likewise, a patient may not meet full criteria for a diagnosis but require treatment nonetheless.

Impairment

impairment refers to when a person loses the capacity to function normally in daily life (e.g., can no longer maintain minimum standards of hygiene, pay bills, attend social functions, or go to work).

operant conditioning

a type of learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher

classical conditioning

a type of learning in which one learns to link two or more stimuli and anticipate events

What is Clinical Assessment?

the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

courtesy stigma

the tendency for individuals who are associated with stigmatized people to face negative evaluations from others

cognitive therapies

therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions

Psychodynamic Techniques

Free association Resistance Transference Dream analysis Manifest content Latent content

mesmerism

hypnotism; hypnotic appeal; intense fascination

Diagnosing: DSM-5

* 1844 - predecessor (APA) * 1954 - DSM 1st edition --- 4 subsequent revisions - used by psychiatrists, physicians, mental health professionals * 1999 - DSM-IV-TR * 2013 - DSM-5

Treatment: Psychotropic Medications

* Anti-anxiety medications - Controversial * Medications & CBT - No more effective than CBT alone - Long-term may be less effective ---- Exposure limited by medications

Treatment: Who?

* Anyone can seek mental health treatment -Significant distress or impairment * Stigma - Mental health professionals specially trained to work with mental health problems * Prevention - Proactive vs reactive * Psychotherapy - Many different approaches - Client-therapist relationship

Treatment: Psychotropic Medications

* Benzodiazepines --- Less addictive; calming --- Serious side effects including dependency * Selective Serotonin-Reuptake Inhibitors (SSRIs) * Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) * Somewhat effective

Classical conditioning

(also called response or Pavlovian conditioning) occurs when we link a previously neutral stimulus with a stimulus that is unlearned or inborn, called an unconditioned stimulus. In respondent conditioning, learning occurs in three phases: preconditioning, conditioning, and postconditioning. See Figure 2.1 for an overview of Pavlov's classic experiment.

Etiology: Psychological

* Cognitive -- Maladaptive assumptions -- Negative appraisals * Behavioral -- Classical conditioning * Modeling -- Stimulus generalization

Diagnosing: Elements

* Diagnostic Criteria & Descriptors - Guidelines for making a diagnosis * Subtypes & Specifiers Provide additional, useful info about the patient's sxs * Principle Diagnosis - Reason for admission/tx (primary disorder) * Provisional Diagnosis - Strong presumption that criteria will be met with additional info/time, but not at the present time

Treatment: Effectiveness

* Evidence based treatments *Many factors can influence the effectiveness of therapy * Termination -- Client dependent -- Collaboratively decide that tx goals have been addressed -- May also occur due to necessity

Specific Phobia

* Excessive and enduring fear/anxiety to a specific object/situation -- Impacts functioning * Can have multiple specific fears * Dx considerations -- What is the phobic stimulus? ---Important to identify all

Social Anxiety Disorder (SAD)

* Excessive and prolonged fear/worry/anxiety of social situations - Fear of evaluation - Significant distress/impairment

Generalized Anxiety Disorder (GAD)

* Excessive worry/fear related to a variety of events/activities - Greater intensity and duration than typical - Uncontrollable

Agoraphobia

* Excessive, prolonged fear/anxiety regarding public situations - Often report panic-like symptoms - Significant distress/impairment in functioning

Treatment: Psychotherapy

* Exposure - Systematic desensitization --- In vivo --- Imaginal - Flooding - Modeling

Treatment: Psychotherapy

* Exposure-based treatments * Highest effectiveness with exposure combined with CBT -- Particularly for those with comorbid panic sxs * Group and individual therapy may be effective

Etiology: Sociocultural

* Gender -- Higher rates among females than males ---- Influence of societal expectations ------ Emotion-focused coping vs. problem-focused coping * Discrimination -- Contribute to negative interactions ----- Result in negative affect and decline in mental health

Etiology: Biological

* Genetic predisposition -- Mutations of 5-HTTLPR * Neurobiological -- Brain structures/pathways responsible for anxiety response ------ Amygdala ------- HPA axis Hippocampus ---- Prefrontal cortex ---- Locus coeruleus ------- Corticostriatal-thalamocortical (CSTC) circuit

Panic Disorder (PD)

* Panic attack = sudden/abrupt surge of intense fear/discomfort -- Physical & cognitive sxs * Disorder -- Recurrent, unexpected panic attacks -- Fear of future panic attacks *Key features: Unexpected Recurrent

SAD:DSM - Epidemiology & Comorbidity

* Prevalence - 12-month = 7.1%% - Lifetime = 12.10% - Gender ---- More common among females than males - Age ---- Decrease in rates of dx among older adults * Comorbidity - Other anxiety related disorders - Major Depressive Disorder - Substance-related disorders

Agoraphobia - Epidemiology & Comorbidity

* Prevalence - 12-months = 1.7% - Lifetime = 2.6% * Comorbidity - Other anxiety disorders - Depressive disorders - Substance use disorders - PTSD

phobia - Epidemiology & Comorbidity

* Prevalence -- 12-month = 9.1% -- Lifetime = 12.5% -- Gender differences More common among females (but may be phobia dependent) * Onset -- Typically younger age than other anxiety disorders * Comorbidity ____ Other anxiety disorders ____ Depressive disorders ____ Substance-related disorders ____ Somatic disorders

Epidemiology & Comorbidity

* Prevalence of PD -- 12-month = 2.7% in adults -- Lifetime = 2.0-6.0% -- Racial/ethnic differences ----- Higher among American Indians; non-Hispanic Whites * Gender differences -- More common among females across the lifespan * Comorbidity of PD -- Other anxiety disorders -- Major Depressive Disorder -- Substance abuse -- Somatic symptoms

Mental Health History

***Prehistoric/ancient beliefs -Supernatural view of abnormal behavior -Trephination -Exorcism ***Greek/Roman beliefs -Mental disorders have natural causes ***Middle Ages -Mental disorders have supernatural causes -Mass madness *** Renaissance -Humanism -Asylums

Treatment: Psychotherapy

- Exposure - Social Skills Training - Cognitive Restructuring

Validity: = test is measuring what it is supposed to measure

-- Concurrent/descriptive validity -- Face validity -- Predictive validity

Reliability:= consistency of a measure

-- Interrater reliability -- Test-retest reliability

Psychopharmacology and Psychotropic Drugs

-Antidepressants - Anti-anxiety medications - Stimulants - Antipsychotics - Mood stabilizers

The definition of psychological disorders includes three components (3D's)

-Dysfunction -Distress or Impairment -Deviance

The Brain

-The central nervous system consists of the brain and spinal cord; the former we will discuss briefly and in terms of key structures which include: -Medulla - regulates breathing, heart rate, and blood pressure -Pons - acts as a bridge connecting the cerebellum and medulla and helps to transfer messages between different parts of the brain and spinal cord. -Reticular formation - responsible for alertness and attention -Cerebellum - involved in our sense of balance and for coordinating the body's muscles so that movement is smooth and precise. Involved in the learning of certain kinds of simple responses and acquired reflexes. Thalamus - major sensory relay center for all senses except smell. -Hypothalamus - involved in drives associated with the survival of both the individual and the species. It regulates temperature by triggering sweating or shivering and controls the complex operations of the autonomic nervous system -Amygdala - responsible for evaluating sensory information and quickly determining its emotional importance -Hippocampus - our "gateway" to memory. Allows us to form spatial memories so that we can accurately navigate through our environment and helps us to form new memories (involved in memory consolidation) -The cerebrum has four distinct regions in each cerebral hemisphere. First, the frontal lobe contains the motor cortex which issues orders to the muscles of the body that produce voluntary movement. The frontal lobe is also involved in emotion and in the ability to make plans, think creatively, and take initiative. The parietal lobe contains the somatosensory cortex and receives information about pressure, pain, touch, and temperature from sense receptors in the skin, muscles, joints, internal organs, and taste buds. The occipital lobe contains the visual cortex and receives and processes visual information. Finally, the temporal lobe is involved in memory, perception, and emotion. It contains the auditory cortex which processes sound.

Evaluating the Behavioral Model

-Used for phobias, anxiety disorders, sexual dysfunctions, and depression -Reinforcements used in schools, families, psychiatric hospitals -Critics comment that learning models don't address the complexity of human behavior -Critics also state that it does not incorporate genetic influences

multi-dimensional model

-the interaction between various factors is more important -Intervening on one level can influence another

Standardization: = careful use of norms, rules, and proceures

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Psychodynamic Techniques.

. Freud used three primary assessment techniques as part of psychoanalysis, or psychoanalytic therapy, to understand the personalities of his patients and to expose repressed material, which included free association, transference, and dream analysis. First, free association involves the patient describing whatever comes to mind during the session. The patient continues but always reaches a point when he/she cannot or will not proceed any further. The patient might change the subject, stop talking, or lose his/her train of thought. Freud said this was resistance and revealed where issues were. Second, transference is the process through which patients transfer to the therapist attitudes he/she held during childhood. They may be positive and include friendly, affectionate feelings, or negative, and include hostile and angry feelings. The goal of therapy is to wean patients from their childlike dependency on the therapist. Finally, Freud used dream analysis to understand a person's innermost wishes. The content of dreams include the person's actual retelling of the dreams called manifest content, and the hidden or symbolic meaning called latent content. In terms of the latter, some symbols are linked to the person specifically while others are common to all people.

Key Concepts in Assessment

1. Reliability 2. Validity 3. Standardization

glial cells

1. They act as a glue and hold the neuron in place. 2. They form the myelin sheath. 3. They provide nourishment for the cell. 4. They remove waste products. 5. They protect the neuron from harmful substances.

Diagnosing: ICD-10

1893 - International List of Causes of Death 1948 - ICD-6 (WHO) 1990 - ICD-10 2018 - ICD-11

Mental Health History Part III

20th - 21st Centuries -Biological/Somatogenic Perspective -- Emil Kraepelin Classified symptom clusters into syndromes -Identification of etiologies and treatments for some disorders with psychological sxs 1950s ---- Psychiatric medications --Deinstitutionalization Psychological/Psychogenic Perspective -- Emotional/psychological factors cause mental disorders --- Cathartic method (Josef Breuer)

suicide is the 10th leading cause of death in the U.S.

90% of those who die from suicide have an underlying mental illness. In relation to children and teens, 37% of students with a mental disorder age 14 and older drop out of school which is the highest dropout rate of any disability group, and 70% of youth in state and local juvenile justice systems have at least one mental disorder.

myelin sheath

A layer of fatty tissue segmentally encasing the fibers of many neurons; enables vastly greater transmission speed of neural impulses as the impulse hops from one node to the next. Also of importance to the neuron is the myelin sheath or the white, fatty covering which: 1) provides insulation so that signals from adjacent neurons do not affect one another and, 2) increases the speed at which signals are transmitted. The axon terminals are the end of the axon where the electrical impulse becomes a chemical message and is released into the synaptic cleft which is the space between neurons.

psychopathology

A more sensitive and less stigmatizing term that is used to refer to the scientific study of psychological disorders

Existential Perspective

A view that focuses on the cognitive, affective, and behavioral consequences of basic aspects of the human condition such as the knowledge of mortality, the desire for meaning, and the precarious nature of identity.

Maladaptive Cognitions

According to Cognitive Psychology, these types of cognitions lead to abnormal behavior or disturbed affect.

Cognitive Therapies

According to the National Alliance on Mental Illness (NAMI), cognitive behavioral therapy (CBT) "focuses on exploring relationships among a person's thoughts, feelings and behaviors. During CBT a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs." CBT attempts to identifying negative or false beliefs and restructure them. They add, "Oftentimes someone being treated with CBT will have homework in between sessions where they practice replacing negative thoughts with more realistic thoughts based on prior experiences or record their negative thoughts in a journal." For more on CBT, visit: https://www.nami.org/Learn-More/Treatment/Psychotherapy. Some commonly used strategies include cognitive restructuring, cognitive coping skills training, and acceptance techniques.

Anti-anxiety medications

Anti-anxiety medications help with the symptoms of anxiety and include the benzodiazepines such as Diazepam (Valium), Alprazolam (Xanax), and Lorazepam (Ativan). These medications are effective in reducing anxiety in the short-term and take less time to take effect than antidepressants which are also commonly prescribed for anxiety. However, benzodiazepines are rather addictive. As such, tolerance to these drugs can develop quickly and individuals may experience withdrawal symptoms (e.g., anxiety, panic, insomnia) when they cease taking the drugs. For this reason, benzodiazepines should not be used in the long-term. Side effects include drowsiness, dizziness, nausea, difficulty urinating, and irregular heartbeat, to name a few.

Antidepressants

Antidepressants are used to treat depression, but also anxiety, insomnia, or pain. The most common types of antidepressants are selective serotonin reuptake inhibitors (SSRIs) and include Citalopram (Celexa), Paroxetine, and Fluoxetine (Prozac). They can often take 2-6 weeks to take effect. Possible side effects include weight gain, sleepiness, nausea and vomiting, panic attacks, or thoughts about suicide or dying.

Antipsychotics

Antipsychotics are used to treat psychosis (i.e., hallucinations and delusions). They can also be used to treat eating disorders, severe depression, PTSD, OCD, ADHD, and Generalized Anxiety Disorder. Common antipsychotics include Chlorpromazine, Perphenazine, Quetiapine, and Lurasidone. Side effects include nausea, vomiting, blurred vision, weight gain, restlessness, tremors, and rigidity.

This process is called counterconditioning or extinction, or the reversal of previous learning.

As fears can be learned, so too they can be unlearned. Considered the follow-up to Watson and Rayner (1920), Jones (1924) wanted to see if a child (named Peter) who learned to be afraid of white rabbits could be conditioned to become unafraid of them. Simply, she placed Peter in one end of a room and then brought in the rabbit. The rabbit was far enough away so as to not cause distress. Then, Jones gave Peter some pleasant food (i.e., something sweet such as cookies; remember the response to the food is unlearned). She continued this procedure with the rabbit being brought in a bit closer each time until eventually, Peter did not respond with distress to the rabbit. This process is called counterconditioning or extinction, or the reversal of previous learning. Another way to unlearn a fear is called flooding or exposing the person to the maximum level of stimulus and as nothing aversive occurs, the link between CS and UCS producing the CR of fear should break, leaving the person unafraid. This type of treatment is rather extreme and is not typically practiced by psychologists.

Asclepiades (Greco-Roman Thought)

Asclepiades (124-40 BC) and philosopher Cicero (106-43 BC) rejected Hippocrates' idea of the four humors and instead stated that melancholy arises from grief, fear, and rage; not excess black bile. Roman physicians treated mental disorders with massage and warm baths, with the hope that their patients be as comfortable as possible. They practiced the concept of "contrariis contrarius", meaning opposite by opposite, and introduced contrasting stimuli to bring about balance in the physical and mental domains. An example would be consuming a cold drink while in a warm bath.

The Library of Congress uses classification to organize and arrange their book collections and includes such categories:

B - Philosophy, Psychology, and Religion; H - Social Sciences; N - Fine Arts; Q - Science; R - Medicine; T - Technology

- observational learning - model

Bandura said if all behaviors are learned by observing others and we model our behaviors on theirs, then undesirable behaviors can be altered or relearned in the same way. Modeling techniques are used to change behavior by having clients observe a model in a situation that usually causes them some anxiety. By seeing the model interact calmly with the fear-evoking stimulus, their fear should subside. This form of behavior therapy is widely used in clinical and classroom situations. In the classroom, we might use modeling to demonstrate to a student how to do a math problem. In fact, in many college classrooms, this is exactly what the instructor does. But keep in mind that we do not model everything we see. Why? First, we cannot pay attention to everything going on around us. We are more likely to model behaviors by someone who commands our attention. Second, we must remember what a model does in order to imitate it. If a behavior is not memorable, it will not be imitated. Finally, we must try to convert what we see into action. If we are not motivated to perform an observed behavior, we probably will not show what we have learned.

Deviance

Behavior that violates the standards of conduct or expectations of a group or society

Behaviorism is the school of thought

Behaviorism is the school of thought associated with learning that began in 1913 with the publication of John B. Watson's article, "Psychology as the Behaviorist Views It," in the journal, Psychological Review (Watson, 1913). It was Watson's belief that the subject matter of psychology was to be observable behavior and to that end said that psychology should focus on the prediction and control of behavior. Behaviorism was dominant from 1913 to 1990 before being absorbed into mainstream psychology. It went through three major stages - behaviorism proper under Watson and lasting from 1913-1930 (discussed as respondent conditioning), neobehaviorism under Skinner and lasting from 1930-1960 (discussed as operant conditioning), and sociobehaviorism under Bandura and Rotter and lasting from 1960-1990 (discussed as social learning theory).

So what are the models we will examine in this chapter?

Biological - Includes genetics, chemical imbalances in the brain, the functioning of the nervous system, etc. Psychological - includes learning, personality, stress, cognition, self-efficacy, and early life experiences. We will examine several perspectives that make up the psychological model to include psychodynamic, behavioral, cognitive, and humanistic-existential. Sociocultural - includes factors such as one's gender, religious orientation, race, ethnicity, and culture, for example.

Diagnosing Psychopathology

Clinical diagnosis: process of using assessment data to determine if a pattern of symptoms is consistent with the diagnostic criteria for a specific mental disorder ---- Syndromes ---- Classification systems -Diagnostic & Statistical Manual of Mental Disorders (5th ed) - International Statistical Classification of Diseases and Related Health Problems (11th ed; ICD; WHO)

Epidemiology

Branch of medical science concerned with the incidence, distribution, and control of diseases that affect large numbers of people. Prevalence rates for panic disorder are estimated at around 2-3% in adults and adolescents. Higher rates of panic disorder are found in American Indians and non-Latino whites. Females are more commonly diagnosed than males with a 2:1 diagnosis rate—this gender discrepancy is seen throughout the lifespan. Although panic disorder can occur in young children, it is generally not observed in individuals younger than 14 years of age.

Clinical Assessment

Collecting information and drawing conclusions through the use of: -- Observation --Psychological tests --Neurological tests --Interviews Determine: -- Presenting problems -- Symptoms Skills & resources Personality --Cognitive/emotional functioning -- -- Social context --Cultural factors

Classifying Mental Disorders

Common nomenclature Psychiatric/mental health epidemiology - Prevalence -Point Period - Lifetime -Incidence -Comorbidity Etiology Course Prognosis Treatment

gender issues - Consider this...

Consider this... In relation to men: "Men and women experience many of the same mental disorders but their willingness to talk about their feelings may be very different. This is one of the reasons that their symptoms may be very different as well. For example, some men with depression or an anxiety disorder hide their emotions and may appear to be angry or aggressive while many women will express sadness. Some men may turn to drugs or alcohol to try to cope with their emotional issues." In relation to women: "Some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression. When it comes to other mental disorders such as schizophrenia and bipolar disorder, research has not found differences in rates that men and women experience these illnesses. But, women may experience these illnesses differently - certain symptoms may be more common in women than in men, and the course of the illness can be affected by the sex of the individual."

Clinical Description Panic disorder

Clinical Description Panic disorder consists of a series of recurrent, unexpected panic attacks coupled with the fear of future panic attacks. A panic attack is defined as a sudden or abrupt surge or fear or impending doom along with at least four physical or cognitive symptoms (listed below). The symptoms generally peak within a few minutes, although it seems much longer for the individual experiencing the panic attack.

Methods of Assessment

Clinical Interview -- Unstructured vs. structured vs. semi-structured --Mental status exam - determine current mental state of patient --Limitations - lacks reliability Psychological tests -- Assess personality, skills, cognitive abilities, emotions, behavioral responses, interests -- Projective tests: ambiguous stimuli that can elicit a variety of responses ------Thematic Apperception Test; Rorschach; Sentence completion --Personality inventories: assess behavioral, emotional, and cognitive functioning ------ MMPI; NEO-PI-R -- Limitations - self-report Neurological Tests --Diagnose cognitive impairments due to tumors, infections, TBI ----- Positron Emission Tomography (PET) - studies brain's functioning ----- Magnetic Resonance Imaging (MRI) - studies brain's structure -----Computed tomography (CT) - studies brain's structure --Limitations - not every disorder has a specific neurological pattern Behavioral Assessment -- Measurement of a target behavior ----Identify and measure what behavior needs to be changed -----ABCs **Antecedents **Behaviors **Consequences *Self-monitoring --Limitation - observing behavior can change it; behavior may not occur in other situatons (cross-sectional validity) Physical Exam -- Physical disorders may have symptoms consistent with psychopathology -----Hyperthyroidism; hormone irregularities Intelligence Tests --Assess client's cognitive functioning -----Verbal and non-verbal Limitations - time consuming; expensive; require specialized training; may reflect cultural factors/biases

Biological Model: The Nervous System

Communication: -- Sensory receptor cells detect energy -- The energy is converted into electrical signals through transduction that are transmitted through the nervous system (PNS) -- Information is received by brain structures (CNS) where the information is perceived and integrated -- Commands are sent out in response to the information (PNS)

Psychodynamic Theory Evaluation

Criticisms --Non-scientific ---Not generalizable --Expensive & time consuming Positives --Raised awareness of unconscious ---Lasting impact on psychology --Useful therapeutic tools

many clinicians add a 4th D, Though not part of the DSM 5's conceptualization of what abnormal behavior is

Dangerousness

DSM Classification System

Diagnostic and Statistical Manual of Mental Disorders

Environmental Factors

Environmental factors also play a role in the development of mental illness. How so? In the case of borderline personality disorder, many people report experiencing traumatic life events such as abandonment, abuse, unstable relationships or hostility, and adversity during childhood. Cigarette smoking, alcohol use, and drug use during pregnancy are risk factors for ADHD. Divorce or the death of a spouse can increase the risk of developing an anxiety disorder. Trauma, stress, and other extreme stressors are predictive of depression. Malnutrition before birth, exposure to viruses, and other psychosocial factors are believed to contribute to the risk of developing schizophrenia. Seasonal Affective Disorder (SAD) occurs with greater frequency for those living far north or south of the equator (Melrose, 2015). Horowitz (2008) found that rates of SAD are just 1% for those living in Florida while 9% of Alaskans are diagnosed with the disorder. This is due to differences in exposure to sunlight in these regions.

Anxiety Disorders

Features of excessive * worry, anxiety, and fear as well as associated behavioral disturbances Worry = apprehensive expectation * Anxiety = anticipation of future threat * Fear = emotional response to real or perceived threat disorders = Panic Disorder Generalized Anxiety Disorder Specific Phobia Social Anxiety Disorder Agoraphobia

nerves

Finally, nerves are a group of axons bundled together like wires in an electrical cable.

Occurrence can be investigated in several ways.

First, prevalence is the percentage of people in a population that has a mental disorder. It can also be conceptualized as the number of cases of the disorder per some number of people (usually 100). For instance, if 1 person out of 100 has schizophrenia, then the prevalence rate is 1% (or 1 in 100).

The Development of Personality freud

Freud also proposed that personality develops over the course of five distinct stages (oral, anal, phallic, latency, genital), in which the libido is focused on different parts of the body. First, libido is the psychic energy that drives a person to pleasurable thoughts and behaviors. Our life instincts, or Eros, are manifested through it and are the creative forces that sustain life. They include hunger, thirst, self-preservation, and sex. In contrast, Thanatos, or our death instinct, is either directed inward as in the case of suicide and masochism or outward via hatred and aggression. Both types of instincts are sources of stimulation in the body and create a state of tension which is unpleasant, thereby motivating us to reduce them. Consider hunger, and the associated rumbling of our stomach, fatigue, lack of energy, etc., that motivates us to find and eat food. If we are angry at someone we may engage in physical or relational aggression to alleviate this stimulation.

Evaluating Psychodynamic Theory

Freud's psychodynamic theory has made a lasting impact on the field of psychology but also has been criticized heavily. First, most of Freud's observations were made in an unsystematic, uncontrolled way and he relied on the case study method. Second, the participants in his studies were not representative of the larger body of people whom he tried to generalize to and he really based his theory on a few patients. Third, he relied solely on the reports of his patients and sought out no observer reports. Fourth, it is difficult to empirically study psychodynamic principles since most operate unconsciously. This begs the question of how can we really know that they exist. Finally, psychoanalytic treatment is expensive and time-consuming and since Freud's time, drug therapies have become more popular and successful. Still, the work of Sigmund Freud raised awareness about the role the unconscious plays in both normal and abnormal behavior and he developed useful therapeutic tools for clinicians. By the end of the 19th century, it had become evident that mental disorders were caused by a combination of biological and psychological factors and the investigation of how they develop began. Today, rather than arguing for a purely biological or psychological approach to understanding mental disorders we focus on a more integrative multidimensional approach. This contemporary approach is the focus of Chapter 2.

psychodynamic theory

Freudian theory that unconscious forces determine behavior

Gender Factors

Gender plays an important, though at times, unclear role in mental illness. It is important to understand that gender is not the cause of mental illness, though differing demands placed on males and females by society and their culture can influence the development and course of a disorder. Consider the following: Rates of eating disorders are higher among women than, men, though both genders are affected. In the case of men, muscle dysphoria is of concern and is characterized by extreme concern over not be muscular enough. OCD has an earlier age of onset in boys than girls, with most people being diagnosed by age 19. Women are at greater risk for developing an anxiety disorder than men. ADHD is more common in males than females, though females are more likely to have inattention issues. Boys are more likely to be diagnosed with Autism Spectrum Disorder. Depression occurs with greater frequency in women than men. Women are more likely to develop PTSD compared to men. Rates of SAD (Seasonal Affective Disorder) are four times greater in women than men.

DSM-5 and ICD-11

Harmonization of DSM-5 and ICD-11 As noted earlier, the ICD-11 is currently in development with an expected publication date in 2018. According to the DSM-5, there is an effort to harmonize the two classification systems so that there can be a more accurate collection of national health statistics and design of clinical trials, increased ability to replicate scientific findings across national boundaries and to rectify the lack of agreement between the DSM-IV and ICD-10 diagnoses. (APA, 2013).

Psychological Tests and Inventories

Standardized tools that measure characteristics such as personality, social skills, intellectual abilities, or vocational interests

cathartic method

In Vienna, Josef Breuer (1842-1925) induced hypnosis and had patients speak freely about past events that upset them. Upon waking, he discovered that patients sometimes were free of their symptoms of hysteria. Success was even greater when patients not only recalled forgotten memories but also relieved them emotionally. He called this the cathartic method and our use of the word catharsis today indicates a purging or release, in this case, of pent-up emotion. Sigmund Freud's development of psychoanalysis followed on the heels of the work of Breuer, and others who came before him.

Clinical assessment refers

In order for a mental health professional to be able to effectively treat a client and know that the selected treatment actually worked (or is working), he/she first must engage in the clinical assessment of the client. Clinical assessment refers to collecting information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews to determine what the person's problem is and what symptoms he/she is presenting with. This collection of information involves learning about the client's skills, abilities, personality characteristics, cognitive and emotional functioning, social context (e.g., environmental stressors), and cultural factors particular to them such as their language or ethnicity. Clinical assessment is not just conducted at the beginning of the process of seeking help but all throughout the process. Why is that? Consider this. First, we need to determine if a treatment is even needed. By having a clear accounting of the person's symptoms and how they affect daily functioning we can determine to what extent the individual is adversely affected. Assuming treatment is needed, our second reason to engage in clinical assessment is to determine what treatment will work best. As you will see later in this chapter, there are numerous approaches to treatment. These include Behavior Therapy, Cognitive Therapy, Cognitive-Behavioral Therapy (CBT), Humanistic-Experiential Therapies, Psychodynamic Therapies, Couples and Family Therapy, and biological treatments (e.g., psychopharmacology). Of course, for any mental disorder, some of the aforementioned therapies will have greater efficacy than others. Even if several can work well, it does not mean a particular therapy will work well for that specific client. Assessment can help the clinician figure this out. Finally, we need to know if the treatment worked. This will involve measuring symptoms and behavior before any treatment is used and then measuring symptoms and behavior while the treatment is in place. We will even want to measure symptoms and behavior after the treatment ends to make sure symptoms do not return. Knowing what the person's baselines are for different aspects of psychological functioning will help us to see when improvement occurs. In recap, obtaining the baselines happens in the beginning, implementing the treatment plan happens more so in the middle, and then making sure the treatment produces the desired outcome occurs at the end. It should be clear from this discussion that clinical assessment is an ongoing process.

uni-dimensional model

In order to effectively treat a mental disorder, it is helpful to understand its cause. This could be a single factor such as a chemical imbalance in the brain, relationship with a parent, socioeconomic status (SES), a fearful event encountered during middle childhood, or the way in which the individual copes with life's stressors. This single factor explanation is called uni-dimensional model

Law of Effect (Operant Conditioning)

Influential on the development of Skinner's operant conditioning, Thorndike proposed the law of effect (Thorndike, 1905) or the idea that if our behavior produces a favorable consequence, in the future when the same stimulus is present, we will be more likely to make the response again, expecting the same favorable consequence. Likewise, if our action leads to dissatisfaction, then we will not repeat the same behavior in the future. Thorndike developed the law of effect thanks to his work with the Puzzle Box. Cats were food deprived the night before the experimental procedure was to occur. The next morning, they were placed in the puzzle box and a small amount of food was placed outside the box close enough to be smelled, but the cat could not reach the food. To get out, a series of switches, buttons, levers, etc. had to be manipulated and once done, the cat could escape the box and eat some of the food. But just some. The cat was then promptly placed back in the box to figure out how to get out again, the food being its reward for doing so. With each subsequent escape and re-insertion into the box, the cat became faster until he/she knew exactly what had to be done to escape. This is called trial and error learning, or making a response repeatedly if it leads to success. Thorndike also said that stimulus and responses were connected by the organism and this lead to learning. This approach to learning was called connectionism. trial and error learning/connectionism

Maladaptive Cognitions

Irrational or dysfunctional thought patterns can be the basis of psychopathology. Throughout this book, we will discuss several treatment strategies that are used to change unwanted, maladaptive cognitions, whether they are present as an excess such as with paranoia, suicidal ideation, or feelings of worthlessness; or as a deficit such as with self-confidence and self-efficacy. More specifically, cognitive distortions/maladaptive cognitions can take the following forms: Overgeneralizing - You see a larger pattern of negatives based on one event. What if? - Asking yourself what if something happens without being satisfied by any of the answers. Blaming - Focusing on someone else as the source of your negative feelings and not taking any responsibility for changing yourself. Personalizing - Blaming yourself for negative events rather than seeing the role that others play. Inability to disconfirm - Ignoring any evidence that may contradict your maladaptive cognition. Regret orientation - Focusing on what you could have done better in the past rather than on making an improvement now. Dichotomous thinking - Viewing people or events in all-or-nothing terms.

physical examination

Many mental health professionals recommend the patient see their family physician for a physical examination which is much like a check-up. Why is that? Some organic conditions, such as hyperthyroidism or hormonal irregularities, manifest behavioral symptoms that are similar to mental disorders and so ruling such conditions out can save costly therapy or surgery.

What might happen if mental illness is presented as a treatable condition?

McGinty, Goldman, Pescosolido, and Barry (2015) found that portraying schizophrenia, depression, and heroin addiction as untreated and symptomatic increased negative public attitudes towards people with these conditions but when the same people were portrayed as successfully treated, the desire for social distance was reduced, there was less willingness to discriminate against them, and belief in treatment's effectiveness increased.

Behavioral Assessment

Measuring, observing, and systematically evaluating (rather than inferring) the client's thoughts, feelings, and behavior in the actual problem situation or context. Within the realm of behavior modification and applied behavior analysis, is behavioral assessment which is simply the measurement of a target behavior. The target behavior is whatever behavior we want to change and it can be in excess (needing to be reduced), or in a deficit state (needing to be increased). During behavioral assessment we assess the ABCs of behavior: Antecedents are the environmental events or stimuli that trigger a behavior Behaviors are what the person does, says, thinks/feels; and Consequences are the outcome of a behavior that either encourages it to be made again in the future or discourages its future occurrence. Though we might try to change another person's behavior using behavior modification, we can also change our own behavior using self-monitoring which refers to measuring and recording one's own ABCs. In the context of psychopathology, behavior modification can be useful in treating phobias, reducing habit disorders, and ridding the person of maladaptive cognitions. A limitation of this method is that the process of observing and/or recording a behavior can cause the behavior to change, called reactivity. Have you ever noticed someone staring at you while you sat and ate your lunch? If you have, what did you do? Did you change your behavior? Did you become self-conscious? Likely yes and this is an example of reactivity. Another issue is that the behavior that is made in one situation may not be made in other situations, such as your significant other only acting out at their favorite team's football game and not at home. This form of validity is called cross-sectional validity.

Before introducing the main models subscribed to today, it is important to understand what a model is. In a general sense, a model is defined as a representation or imitation of an object (dictionary.com).

Models help mental health professionals understand mental illness since disorders such as depression cannot be touched or experienced firsthand. To be considered distinct from other conditions, a mental illness must have its own set of symptoms.

Models help

Models help mental health professionals understand mental illness since disorders such as depression cannot be touched or experienced firsthand. To be considered distinct from other conditions, a mental illness must have its own set of symptoms. But as you will see, the individual does not have to present with the entire range of symptoms to be diagnosed with major depressive disorder, schizophrenia, avoidant personality disorder, or illness anxiety disorder. Five out of nine symptoms may be enough to diagnose a disorder, for example. There will be some variability in terms of what symptoms the afflicted displays, but in general all people with a specific mental disorder have symptoms from that group. We can also ask the patient probing questions, seek information from family members, examine medical records, and in time, organize and process all of this information to better understand the person's condition and potential causes. Models aid us with doing all of this but we must be cautious to remember that the model is a starting point for the researcher, and due to this, determine what causes might be investigated, at the exclusion of other causes. Often times, proponents of a given model find themselves in disagreement with proponents of other models. All forget that there is no one model that completely explains human behavior, or in this case, abnormal behavior and so each model contributes in its own way.

Mood stabilizers

Mood stabilizers are used to treat bipolar disorder and at times depression, schizoaffective disorder, and disorders of impulse control. A common example is Lithium and side effects include loss of coordination, hallucinations, seizures, and frequent urination.

Prevention

More recently, medicine and science have taken a prevention stance which involves identifying the factors that cause specific mental health issues and implementing interventions to stop them from happening, or at least minimize their deleterious effects. Our focus has shifted from individuals to the population. Mental health promotion programs have been instituted with success in schools (Shoshani & Steinmetz, 2014; Weare & Nind, 2011; Berkowitz & Bier, 2007), in the workplace (Czabała, Charzyńska, & Mroziak, B., 2011), with undergraduate and graduate students (Conley et al., 2017; Bettis et al., 2017), in relation to bullying (Bradshaw, 2015), and with the elderly (Forsman et al., 2011). Many researchers believe the time is ripe to move from knowledge to action and to expand public mental health initiatives (Wahlbeck, 2015).

Mental Health Stigma

Negative stereotyping, labeling, rejection, and/or loss of status due to mental health label Public stigma Label avoidance Self-stigma Courtesy stigma Need for changes in stigma Services agenda Rights agenda

cognitive restructuring

Notice when you are having a maladaptive cognition such as making "negative predictions." They suggest you figure out what is the worst thing that could happen and what other outcomes are possible. Track the accuracy of the thought. For instance, if you believe ruminating on a problem generates a solution then write down each time you ruminate and then the result. You can generate a percentage of times you ruminated to the number of successful problem-solving strategies you generated. Behaviorally test your thought. As an example, if you think you don't have time to go to the gym then figure out if you really do not have time. Record what you do each day and then look at open times of the day. Explore if you can make some minor, or major, adjustments to your schedule to free up an hour to exercise. Examine the evidence both for and against your thought. If you do not believe you do anything right, list evidence of when you did not do something right and then evidence of when you did. Then write a few balanced statements such as the one the article suggests, "I've made some mistakes that I feel embarrassed about but a lot of the time, I make good choices."

Epidemiology & Comorbidity

Prevalence -- 12-month = 3.1% -- Lifetime = 6% -- Gender ------More common among females than males - Onset --- Tends to appear in childhood/early adolescence - Comorbidity ---- Other anxiety disorder ---- Major depressive disorders

Freud's psychosexual stages of personality development are listed below. Freud proposed that a person may become fixated at any stage, meaning they become stuck, thereby affecting later development and possibly leading to abnormal functioning, or psychopathology.

Oral Stage - Beginning at birth and lasting to 24 months, the libido is focused on the mouth and sexual tension is relieved by sucking and swallowing at first, and then later by chewing and biting as baby teeth come in. Fixation is linked to a lack of confidence, argumentativeness, and sarcasm. Anal Stage - Lasting from 2-3 years, the libido is focused on the anus as toilet training occurs. If parents are too lenient children may become messy or unorganized. If parents are too strict, children may become obstinate, stingy, or orderly. Phallic Stage - Occurring from about age 3 to 5-6 years, the libido is focused on the genitals. The Oedipus complex develops in boys and results in the son falling in love with his mother while fearing that his father will find out and castrate him. Meanwhile, girls fall in love with the father and fear that their mother will find out, called the Electra complex. A fixation at this stage may result in low self-esteem, feelings of worthlessness, and shyness. Latency Stage - From 6-12 years of age, children lose interest in sexual behavior and boys play with boys and girls with girls. Neither sex pays much attention to the opposite sex. Genital Stage - Beginning at puberty, sexual impulses reawaken and unfulfilled desires from infancy and childhood can be satisfied with sex.

The Sociocultural Model

Outside of biological and psychological factors on mental illness, race, ethnicity, gender, religious orientation, socioeconomic status, sexual orientation, etc. also play a role, and this is the basis of the sociocultural model. Next, we explore a few of these factors.

Prevalence can be measured in several ways:

Point prevalence indicates the percentage of a population that has the disorder at a specific point in time. In other words, it is the number of active cases at a given point in time. Period prevalence indicates the percentage of a population that has the disorder at any point during a given period of time, typically the past year (Note: when it is the past year it may also be referred to as the one-year prevalence). Lifetime prevalence indicates the percentage of a population that has had the disorder at any time during their lives.

Contingencies in Operant Conditioning

Positive Punishment (PP) - If something bad or aversive is given or added, then the behavior is less likely to occur in the future. If you talk back to your mother and she slaps your mouth, this is a PP. Your response of talking back led to the consequence of the aversive slap being delivered or given to your face. Ouch!!! Positive Reinforcement (PR) - If something good is given or added, then the behavior is more likely to occur in the future. If you study hard and earn an A on your exam, you will be more likely to study hard in the future. Similarly, your parents may give you money for your stellar performance. Cha Ching!!! Negative Reinforcement (NR) - This is a tough one for students to comprehend because the terms don't seem to go together and are counterintuitive. But it is really simple and you experience NR all the time. This is when you are more likely to engage in a behavior that has resulted in the removal of something aversive in the past. For instance, what do you do if you have a headache? You likely answered take Tylenol. If you do this and the headache goes away, you will take Tylenol in the future when you have a headache. Another example is continually smoking marijuana because it temporarily decreases feelings of anxiety. The behavior of smoking marijuana is being reinforced because it reduces a negative state. Negative Punishment (NP) - This is when something good is taken away or subtracted making a behavior less likely in the future. If you are late to class and your professor deducts 5 points from your final grade (the points are something good and the loss is negative), you will hopefully be on time in all subsequent classes. Another example is taking away a child's allowance when he misbehaves.

Psychological Disorders

Psychological dysfunction that causes distress or impairment in functioning Deviates from what is typical or expected Dysfunction Disturbance in cognition, emotion, and/or behavior Distress/Impairment Distress = suffering Impairment = harmful to different domains of life Deviance Atypical, abnormal, not the norm SOMETIMES: Dangerousness Threat to safety

adrenal glands

Rather, individuals with these conditions need to be treated with thyroid medications. Also of key importance to mental health professionals are the adrenal glands which are located on top of the kidneys, and release cortisol which helps the body deal with stress. However, chronically, elevated levels of cortisol can lead to increased weight gain, interfere with learning and memory, decrease the immune response, reduce bone density, increase cholesterol, and increase the risk of depression

Psychological Tests and Inventories

Psychological tests are used to assess the client's personality, social skills, cognitive abilities, emotions, behavioral responses, or interests and can be administered either individually or to groups. Projective tests consist of simple ambiguous stimuli that can elicit an unlimited number of responses. They include the Rorschach test or inkblot test and the Thematic Apperception Test which requires the individual to write a complete story about each of 20 cards shown to them and give details about what led up to the scene depicted, what the characters are thinking, what they are doing, and what the outcome will be. From these responses, the clinician gains perspective on the patient's worries, needs, emotions, conflicts. Another projective test is the sentence completion test and asks individuals to finish an incomplete sentence. Examples include 'My mother' .... or 'I hope.' Personality inventories ask clients to state whether each item in a long list of statements applies to them, and could ask about feelings, behaviors, or beliefs. Examples include the MMPI or Minnesota Multiphasic Personality Inventory and the NEO-PI-R which is a concise measure of the five major domains of personality - Neuroticism, Extroversion, Openness, Agreeableness, and Conscientiousness. Six facets define each of the five domains and the measure assess emotional, interpersonal, experimental, attitudinal, and motivational styles (Costa & McCrae, 1992). These inventories have the advantage of being easy to administer by either a professional or the individual taking it, are standardized, objectively scored, and are completed either on the computer or through paper and pencil. That said, personality cannot be directly assessed and so you can never completely know the individual on the basis of these inventories.

Biological Model of Psychopathology

Psychopathology arises due to malfunctions in the body -- Brain structure and chemistry --Genetics -- Hormonal Imbalances -- Viral Infections

Stigma often takes on three forms as described below:

Public stigma - when members of a society endorse negative stereotypes of people with a mental disorder and discriminate against them. They might avoid them altogether resulting in social isolation. An example is when an employer intentionally does not hire a person because their mental illness is discovered. Label avoidance - In order to avoid being labeled as "crazy" people needing care may avoid seeking it all together or stop care once started. Due to these labels, funding for mental health services could be restricted and instead, physical health services funded. Self-stigma - When people with mental illnesses internalize the negative stereotypes and prejudice, and in turn, discriminate against themselves. They may experience shame, reduced self-esteem, hopelessness, low self-efficacy, and a reduction in coping mechanisms. An obvious consequence of these potential outcomes is the why try effect, or the person saying, 'Why should I try and get that job? I am not unworthy of it' (Corrigan, Larson, & Rusch, 2009; Corrigan, et al., 2016).

Multicultural Factors

Racial, ethnic, and cultural factors are also relevant to understanding the development and course of mental disorders. Multicultural psychologists assert that both normal behavior and abnormal behavior need to be understood in relation to the individual's unique culture and the group's value system. Racial and ethnic minorities must contend with prejudice, discrimination, racism, economic hardships, etc. as part of their daily life and these stressors can increase vulnerability to a mental disorder (Lo & Cheng, 2014; Jones, Cross, & DeFour, 2007; Satcher, 2001), though some research suggests that ethnic identity can buffer against these stressors and protect mental health (Mossakowski, 2003). To address this unique factor, culture-sensitive therapies have been developed and include increasing the therapist's awareness of cultural values, hardships, stressors, and/or prejudices faced by their client; the identification of suppressed anger and pain; and raising the client's self-worth (Prochaska & Norcross, 2013).

Treatment: Psychotherapy

Rational-Emotive Therapy (Ellis) -- Developed from CBT -- People are unaware of the impact of thoughts on emotions/behaviors ---- Tx must identify, challenge, and replace irrational/maladaptive thoughts Cognitive Behavioral Therapy -- Combine cognitive and behavioral strategies to identify and replace maladaptive/harmful cognitions Biofeedback -- Visual representation of physiological arousal -----Electromyography -----Electroencephalography -----Heart rate variability -----Galvanic skin response

operant cond - What form do these consequences take? There are two main ways they can present themselves.

Reinforcement - Due to the consequence, a behavior/response is more likely to occur in the future. It is strengthened. Punishment - Due to the consequence, a behavior/response is less likely to occur in the future. It is weakened. Reinforcement and punishment can occur as two types - positive and negative. These words have no affective connotation to them meaning they do not imply good or bad. Positive means that you are giving something - good or bad. Negative means that something is being taken away - good or bad.

Treatment: CBT

Relabeling and reinterpreting bodily sensations based in reality -- Psychoeducation -- Self-monitoring -- Relaxation techniques -- Cognitive restructuring -- Exposure ------- In vivo ------- Interoceptive

Superego (Freud)

Represents the conscience, holds rules, values for socially acceptable behavior

Defense Mechanisms. The ego has a challenging job to fulfill, balancing both the will of the id and the superego, and the overwhelming anxiety and panic this creates. Defense mechanisms are in place to protect us from this pain but are considered maladaptive if they are misused and become our primary way of dealing with stress. They protect us from anxiety and operate unconsciously, also distorting reality. Defense mechanisms include the following:

Repression - when unacceptable ideas, wishes, desires, or memories are blocked from consciousness such as forgetting a horrific car accident that you caused. Eventually, though, it must be dealt with or else the repressed memory can cause problems later in life. Reaction formation - When an impulse is repressed and then expressed by its opposite. As an example, if we are angry with our boss but cannot lash out at him/her, we may be overly friendly instead. Another example is having lustful thoughts about a coworker that you cannot express because you are married, and so you are mean to this person. Displacement - When we satisfy an impulse with a different object because focusing on the primary object may get us in trouble. A classic example is taking out your frustration with your boss on your wife and/or kids when you get home. If we lash out at our boss we could be fired. The substitute target is less dangerous than the primary target. Projection - When we attribute threatening desires or unacceptable motives to others. An example is when we do not have the skills necessary to complete a task but we blame the other members of our group for being incompetent and unreliable. Another example is projecting your feelings of love toward your therapist onto your therapist, believing he/she is in love with you. Sublimation - When we find a socially acceptable way to express a desire. If we are stressed out or upset, we may go to the gym and box or lift weights. A person who desires to cut things may become a surgeon. Denial - Sometimes life is so hard all we can do is deny how bad it is. An example is denying a diagnosis of lung cancer given by your doctor. Identification - this is when we find someone who has found a socially acceptable way to satisfy their unconscious wishes and desires and we model that behavior. Regression - When we move from a mature behavior to one that is infantile in nature. If your significant other is nagging you, you might regress and point your hands over your ears and say, "La la la la la la la la..." Rationalization - When we offer well thought out reasons for why we did what we did but in reality, these are not the real reason. Students sometimes rationalize not doing well in a class by stating that they really are not interested in the subject or saying the instructor writes impossible to pass tests when in reality they are not putting enough effort into learning the material. Intellectualization- When we avoid emotion by focusing on intellectual aspects of a situation such as ignoring the sadness we are feeling after the death of our mother by focusing on planning the funeral.

Cost of Mental Illness to Society

SMI costs ~$193 billion in lost earnings per year Suicide 10th leading cause of death Mental illness can affect education, substance use, CJ involvement Mind-body connection

What is the Cost of Mental Illness to Society?

Serious mental illness costs the United States an estimated $193 billion in lost earnings each year

Evaluation Model

Technique that uses a common yardstick to measure and compare vendor ratings

Evaluation Model

Technique that uses a common yardstick to measure and compare vendor ratings The biological model is generally well respected today but suffers a few key issues. First, consider the list of side effects given for the psychotropic medications. You might make the case that some of the side effects are worse than the condition they are treating. Second, the viewpoint that all human behavior is explainable in biological terms, and therefore, when issues arise they can be treated using biological methods, overlooks factors that are not biological in nature. More on that over the next two sections.

Clinical Inteview

The Clinical Interview A clinical interview is a face-to-face encounter between a mental health professional and a patient in which the former observes the latter and gathers data about the person's behavior, attitudes, current situation, personality, and life history. The interview may be unstructured in which open-ended questions are asked, structured in which a specific set of questions according to an interview schedule are asked, or semi-structured, in which there is a pre-set list of questions but clinicians are able to follow up on specific issues that catch their attention.

Elements of a Diagnosis

The DSM 5 states that the following make up the key elements of a diagnosis (APA, 2013): Diagnostic Criteria and Descriptors - Diagnostic criteria are the guidelines for making a diagnosis. When the full criteria are met, mental health professionals can add severity and course specifiers to indicate the patient's current presentation. If the full criteria are not met, designators such as "other specified" or "unspecified" can be used. If applicable, an indication of severity (mild, moderate, severe, or extreme), descriptive features, and course (type of remission - partial or full - or recurrent) can be provided with the diagnosis. The final diagnosis is based on the clinical interview, text descriptions, criteria, and clinical judgment. Subtypes and Specifiers - Since the same disorder can be manifested in different ways in different individuals the DSM uses subtypes and specifiers to better characterize an individual's disorder. Subtypes denote "mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis" (APA, 2013). For example, non-rapid eye movement sleep arousal disorders can have either a sleepwalking or sleep terror type. Enuresis is nocturnal only, diurnal only, or both. Specifiers are not mutually exclusive or jointly exhaustive and so more than one specifier can be given. For instance, binge eating disorder has remission and severity specifiers. Major depressive disorder has a wide range of specifiers that can be used to characterize the severity, course, or symptom clusters. Again the fundamental distinction between subtypes and specifiers is that there can be only one subtype but multiple specifiers. Principle Diagnosis - A principal diagnosis is used when more than one diagnosis is given for an individual (when an individual has comorbid disorders). The principal diagnosis is the reason for the admission in an inpatient setting or the reason for a visit resulting in ambulatory care medical services in outpatient settings. The principal diagnosis is generally the main focus of treatment. Provisional Diagnosis - If not enough information is available for a mental health professional to make a definitive diagnosis, but there is a strong presumption that the full criteria will be met with additional information or time, then the provisional specifier can be used.

Sympathetic Nervous System (SNS)

The component of the autonomic nervous system that responds to stressful situations by initiating the fight-or-flight response. is involved when a person is intensely aroused. It provides the strength to fight back or to flee (fight-or-flight response).

Axon

The axon sends signals/information through the neuron while the dendrites receive information from neighboring neurons and look like little trees. Notice the s on the end of dendrite and that axon has no such letter. In other words, there are lots of dendrites but only one axon.

behavioral model

The behavioral model concerns the cognitive process of learning. Simply, learning is any relatively permanent change in behavior due to experience and practice and has two main forms - associative learning and observational learning. First, associative learning is the linking together of information sensed from our environment. Conditioning, a type of associative learning, occurs which two events are linked and has two forms - classical conditioning, or linking together two types of stimuli, and operant conditioning, or linking together a response with its consequence. Second, observational learning occurs when we learn by observing the world around us.

Evaluating the Humanistic and Existential Perspectives

The biggest criticism of these models is that the concepts are abstract and fuzzy and as such are very difficult to research. The exception to this was Rogers who did try to scientifically investigate his propositions, though most other humanistic-existential psychologists rejected the use of the scientific method. They also have not developed much in the way of theory and their perspectives tend to work best with people who have adjustment issues and not as well with severe mental illness. The perspectives do offer hope to people who have experienced tragedy by asserting that we control our own destiny and can make our own choices.

Hormonal imbalances

The body has two coordinating and integrating systems in the body. The nervous system is one and the endocrine system is the second. The main difference between these two systems is in terms of the speed with which they act. The nervous system moves quickly with nerve impulses moving in a few hundredths of a second. The endocrine system moves slowly with hormones, released by endocrine glands, taking seconds, or even minutes, to reach their target. Hormones are important to psychologists because they organize the nervous system and body tissues at certain stages of development and activate behaviors such as alertness or sleepiness, sexual behavior, concentration, aggressiveness, reaction to stress, a desire for companionship.

Evaluating the Cognitive Model

The cognitive model made up for an obvious deficit in the behavioral model - overlooking the importance of our thoughts and the role cognitive processes play in our feelings and behaviors. Right before his death, Skinner (1990) reminded psychologists that the only thing we can truly know and study is observable behavior. Cognitive processes cannot be empirically and reliably measured and so should be ignored.

panic disorder frequency

The frequency and intensity of these panic attacks vary widely among individuals. Some people report panic attacks occurring once a week for months on end, others report more frequent attacks multiple times a day, but then experience weeks or months without any attacks. The intensity of symptoms also varies among individuals, with some individuals reporting experiencing nearly all 14 symptoms and others only reporting the minimum 4 required for the diagnosis. Furthermore, individuals report variability within their own panic attack symptoms, with some panic attacks presenting with more symptoms than others. It should be noted that at this time, there is no identifying information (i.e. demographic information) to suggest why some individuals experience panic attacks more frequently or more severe than others.

The Humanistic and Existential Perspectives

The humanistic perspective, or third force psychology (psychoanalysis and behaviorism being the other two forces), emerged in the 1960s and 1970s as an alternative viewpoint to the largely deterministic view of personality espoused by psychoanalysis and the view of humans as machines advocated by behaviorism. Key features of the perspective include a belief in human perfectibility, personal fulfillment, valuing self-disclosure, placing feelings over intellect, an emphasis on the present, and hedonism. Its key figures were Abraham Maslow who proposed the hierarchy of needs and Carl Rogers who we will focus on here.

important note - classical conditioning

The important thing to understand is that not all behaviors occur due to reinforcement and punishment as operant conditioning says. In the case of classical conditioning, stimuli exert complete and automatic control over some behaviors. We see this in the case of reflexes. When a doctor strikes your knee with that little hammer it extends out automatically. You do not have to do anything but watch. Babies will root for a food source if the mother's breast is placed near their mouth. If a nipple is placed in their mouth, they will also automatically suck, as per the sucking reflex. Humans have several of these reflexes though not as many as other animals due to our more complicated nervous system.

The Renaissance - 14th to 16th Centuries

The most noteworthy development in the realm of philosophy during the Renaissance was the rise of humanism, or the worldview that emphasizes human welfare and the uniqueness of the individual.

Nucleus

The nucleus is the control center of the body and the soma is the cell body. In terms of structures that make it different, these focus on the ability of a neuron to send and receive information.

The Middle Ages - 500 AD to 1500 AD

The progress made during the time of the Greeks and Romans was quickly reversed during the Middle Ages with the increase in power of the Church and the fall of the Roman Empire. Mental illness was yet again explained as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of the Devil's influence. In extreme cases, the afflicted were confined, beat, and even executed. Scientific and medical explanations, such as those proposed by Hippocrates, were discarded at this time.

Psychological or Psychogenic Perspective

The psychological or psychogenic perspective states that emotional or psychological factors are the cause of mental disorders and represented a challenge to the biological perspective.

. Reform Movement - 18th to 19th Centuries

The rise of the moral treatment movement occurred in Europe in the late 18th century and then in the United States in the early 19th century. Its earliest proponent was Phillipe Pinel (1745-1826) who was assigned as the superintendent of la Bicetre, a hospital for mentally ill men in Paris. He emphasized the importance of affording the mentally ill respect, moral guidance, and humane treatment, all while considering their individual, social, and occupational needs. Arguing that the mentally ill were sick people, Pinel ordered that chains be removed, outside exercise be allowed, sunny and well-ventilated rooms replace dungeons, and patients be extended kindness and support. This approach led to considerable improvement for many of the patients, so much so, that several were released.

Polygenetic.

The same is true of most mental disorders. Indeed, it is presently believed that genetic factors contribute to all mental disorders but typically account for less than half of the explanation. Moreover, most mental disorders are linked to abnormalities in many genes, rather than just one; that is, most are polygenetic.

Evaluation of the Model

The sociocultural model has contributed greatly to our understanding of the nuances of diagnosis, prognosis, course, and treatment of mental disorders for other races, cultures, genders, ethnicities. In Chapter 3 we will discuss diagnosing and classifying abnormal behavior from the perspective of the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Important here is that specific culture- and gender-related diagnostic issues are discussed for each disorder, demonstrating increased awareness of the impact of these factors. Still, the sociocultural model suffers from issues with the findings being difficult to interpret and not allowing for the establishment of causal relationships due to a reliance on more qualitative data gathered from case studies and ethnographic analyses (one such example is Zafra, 2016).

- Observational Learning

There are times when we learn by simply watching others. This is called observational learning and is contrasted with enactive learning, which is learning by doing. There is no firsthand experience by the learner in observational learning. You can learn desirable behaviors such as exercising because your mother engaged in exercise every day and you can learn undesirable ones too. If your parents resort to alcohol consumption to deal with the stressors life presents, then you too might do the same. What is critical is what happens to the model in all of these cases. If my mother seems genuinely happy and pleased with herself after exercising, then I will be more likely to adopt this behavior. If my mother or father consumes alcohol to feel better when things are tough, and it works, then I might do the same. On the other hand, if we see a sibling constantly getting in trouble with the law then we may not model this behavior due to the negative consequences.

two key factors panic disorder

There are two key components to panic disorder—the attacks are unexpected meaning there is nothing that triggers them, and they are recurrent meaning they occur multiple times. Because these panic attacks occur frequently and essentially "out of the blue," they cause significant worry or anxiety in the individual as they are unsure of when the next attack will occur. In some individuals, significant behavioral changes such as fear of leaving their home or attending large events occur as the individual is fearful an attack will happen in one of these situations, causing embarrassment. Additionally, individuals report worry that other's will think they are "going crazy" or losing control if they were to observe an individual experiencing a panic attack. Occasionally, an additional diagnosis of agoraphobia is given to an individual with panic disorder if their behaviors meet diagnostic criteria for this disorder as well (see more below).

The History of Hypnosis

This perspective had a long history but did not gain favor until the work of Viennese physician Franz Anton Mesmer (1734-1815). Influenced heavily by Newton's theory of gravity, he believed that the planets also affected the human body through the force of animal magnetism and that all people had a universal magnetic fluid that determined how healthy they were. He demonstrated the usefulness of his approach when he cured Franzl Oesterline, a 27-year old woman experiencing what he described as a convulsive malady. Mesmer used a magnet to disrupt the gravitational tides that were affecting his patient and produced a sensation of the magnetic fluid draining from her body. This removed the illness from her body and produced a near instantaneous recovery. In reality, the patient was placed in a trancelike state which made her highly suggestible. With other patients, Mesmer would have them sit in a darkened room filled with soothing music, into which he would enter dressed in a colorful robe and passed from person to person touching the afflicted area of their body with his hand or a special rod/wand. He successfully cured deafness, paralysis, loss of bodily feeling, convulsions, menstrual difficulties, and blindness. His approach gained him celebrity status as he demonstrated it at the courts of English nobility. The medical community was hardly impressed. A royal commission was formed to investigate his technique but could not find any proof for his theory of animal magnetism. Though he was able to cure patients when they touched his "magnetized" tree, the result was the same when "non-magnetized" trees were touched. As such, Mesmer was deemed a charlatan and forced to leave Paris. His technique was called mesmerism, and today we know it as an early form of hypnosis.

Preconditioning

This stage of learning signifies is that some learning is already present. There is no need to learn it again as in the case of primary reinforcers and punishers in operant conditioning. In Panel A, food makes a dog salivate. This does not need to be learned and is the relationship of an unconditioned stimulus (UCS) yielding an unconditioned response (UCR). Unconditioned means unlearned. In Figure 2.1, we also see that a neutral stimulus (NS) yields nothing. Dogs do not enter the world knowing to respond to the ringing of a bell (which it hears).

A second major strategy is to use what is called cognitive coping skills training

This strategy involves teaching social skills, communication, and assertiveness through direct instruction, role-playing, and modeling. For social skills, therapists identify appropriate social behavior such as making eye contact, saying no to a request, or starting up a conversation with a stranger and examine whether the client is inhibited from engaging in the behavior due to anxiety. For communication, the therapist can help determine if the problem is with speaking, listening, or both and then develop a plan the client can use in various interpersonal situations. Finally, assertiveness training aids the client protect their rights and obtain what they want from others. Treatment starts with determining situations in which assertiveness is lacking and generating a hierarchy of assertiveness opportunities. Least difficult situations are handled first, followed by more difficult situations, all while rehearsing and mastering all the situations present in the hierarchy.

glial cells

Though not neurons, glial cells play an important part in helping the nervous system to be the efficient machine that it is. Glial cells are support cells in the nervous system that serve five main functions.

Brain Structure and Chemistry Communication in the Nervous System

To really understand brain structure and chemistry, it is a good idea to understand how communication occurs within the nervous system. Simply: -Receptor cells in each of the five sensory systems detect energy . -This information is passed to the nervous system due to the process of transduction and through sensory or afferent neurons, which are part of the peripheral nervous system. -The information is received by brain structures (central nervous system) and perception occurs. -Once the information has been interpreted, commands are sent out, telling the body how to respond, also via the peripheral nervous system. Please note that we will not cover this process in full, but just the parts relevant to our topic of psychopathology.

the existence of non-associative learning (behavioral model)

We should also note the existence of non-associative learning or when there is no linking of information or observing the actions of others around you. Types include habituation, or when we simply stop responding to repetitive and harmless stimuli in our environment such as a fan running in your laptop as you work on a paper, and sensitization, or when our reactions are increased due to a strong stimulus, such as an individual who experienced a mugging and now experiences panic when someone walks up behind him/her on the street.

Neurotransmitters

What exactly are some of the neurotransmitters which are so critical for neural transmission, and are important to our discussion of psychopathology? Dopamine - controls voluntary movements and is associated with the reward mechanism in the brain Serotonin - controls pain, sleep cycle, and digestion; leads to a stable mood and so low levels leads to depression Norepinephrine - increases the heart rate and blood pressure and regulates mood GABA - an inhibitory neurotransmitter responsible for blocking the signals of excitatory neurotransmitters responsible for anxiety and panic. Glutamate - an excitatory neurotransmitter associated with learning and memory

behavior modification

Within the context of abnormal behavior or psychopathology, the behavioral perspective is useful because it suggests that maladaptive behavior occurs when learning goes awry. The good thing is that what is learned can be unlearned or relearned using behavior modification which refers to the process of changing behavior. To begin, an applied behavior analyst will identify a target behavior, or behavior to be changed, define it, work with the client to develop goals, conduct a functional assessment to understand what the undesirable behavior is, what causes it, and what maintains it. Armed with this knowledge, a plan is developed and consists of numerous strategies to act on one or all of these elements - antecedent, behavior, and/or consequence.

electroconvulsive therapy (ECT)

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient According to Mental Health America, "Electroconvulsive therapy (ECT) is a procedure in which a brief application of electric stimulus is used to produce a generalized seizure." Patients are placed on a padded bed and administered a muscle relaxant to avoid injury during the seizures. Annually, approximately 100,000 are treated using ECT for conditions including severe depression, acute mania, and suicidality. The procedure is still the most controversial available to mental health professionals due to "its effectiveness vs. the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization" (http://www.mentalhealthamerica.net/ect). Its popularity has declined since the 1940s and 1950s.

diathesis-stress model

a diagnostic model that proposes that a disorder may develop when an underlying vulnerability is coupled with a precipitating event posits that people can inherit tendencies or vulnerabilities to express certain traits, behaviors, or disorders, which may then be activated under certain environmental conditions like stress (e.g., abuse, traumatic events). However, it is also important to note that certain protective factors (like being raised in a consistent, loving, supportive environment) may modify the response to stress and thereby help to protect individuals against mental disorders.

sociocultural model

a diagnostic model that views psychopathology as the result of the interaction between individuals and their cultures

client-centered therapy

a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth. (Also called person-centered therapy.)

Intelligence Tests

a method for assessing an individual's mental aptitudes and comparing them with those of others, using numerical scores Intelligence testing is occasionally used to determine the client's level of cognitive functioning. Intelligence testing consists of a series of tasks asking the patient to use both verbal and nonverbal skills. An example is the Stanford-Binet Intelligence test which is used to assess fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing and working memory. These tests are rather time-consuming and require specialized training to administer. As such, they are typically only used in cases where there is a suspected cognitive disorder or intellectual disability. Intelligence tests have been criticized for not predicting future behaviors such as achievement and reflecting social or cultural factors/biases and not actual intelligence.

Neuron

a nerve cell; the basic building block of the nervous system

The Action Potential

a neural impulse; a brief electrical charge that travels down an axon Recall that a neuron is normally at resting potential and polarized. The charge inside is -70mV at rest. If it receives sufficient stimulation meaning that the polarity inside the neuron rises from -70 mV to -55mV defined as the threshold of excitation, the neuron will fire or send an electrical impulse down the length of the axon (the action potential or depolarization). It should be noted that it either hits -55mV and fires or it does not. This is the all-or-nothing principle. The threshold must be reached. Once the electrical impulse has passed from one segment of the axon to the next, the neuron begins the process of resetting called repolarization. During repolarization, the neuron will not fire no matter how much stimulation it receives. This is called absolute refractory period. The neuron next moves into relative refractory period meaning it can fire, but needs greater than normal levels of stimulation. Notice how the line has dropped below -70mV. Hence, to reach -55mV and fire, it will need more than the normal gain of +15mV (-70 to -55 mV). And then it returns to resting potential, as you saw in Figure 2.3

prognosis

a prediction of the course of a disease key factor in determining the course is age, with some disorders presenting differently in childhood than adulthood.

Unconscious (Freud)

a reservoir of mostly unacceptable thoughts, wishes, feelings, and memories

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

cathartic method

a therapeutic use of verbal expression to release pent-up emotional conflicts

manifest content

according to Freud, the remembered story line of a dream

latent content

according to Freud, the underlying meaning of a dream

neural impulse

action potential; the firing of a nerve cell; the entire process of the electrical charge (message/impulse) traveling through inner on; can be as fast as 400 fps (with myelin) or 3 fps (no myelin) Step 1 - Neurons waiting to fire are said to be in resting potential and to be polarized (meaning they have a negative charge inside the neuron and a positive charge outside). Step 2 - If adequately stimulated, the neuron experiences an action potential and becomes depolarized. When this occurs, ion gated channels open allowing positively charged Sodium (Na) ions to enter. This shifts the polarity to positive on the inside and negative outside. Step 3 - Once the action potential passes from one segment of the axon to the next, the previous segment begins to repolarize. This occurs because the Na channels close and Potassium (K) channels open. K has a positive charge and so the neuron becomes negative again on the inside and positive on the outside. Step 4 - After the neuron fires, it will not fire again no matter how much stimulation it receives. This is called the absolute refractory period. Step 5 - After a short period of time, the neuron can fire again, but needs greater than normal levels of stimulation to do so. This is called the relative refractory period. Step 6 - Please note that the process is cyclical. Once the relative refractory period has passed the neuron returns to its resting potential.

culture-sensitive therapies

approaches that are designed to help address the unique issues faced by members of cultural minority groups

Group hysteria, or mass madness,

as also seen in which large numbers of people displayed similar symptoms and false beliefs. This included the belief that one was possessed by wolves or other animals and imitated their behavior, called lycanthropy, and a mania in which large numbers of people had an uncontrollable desire to dance and jump, called tarantism. The latter was believed to have been caused by the bite of the wolf spider, now called the tarantula, and spread quickly from Italy to Germany and other parts of Europe where it was called Saint Vitus's dance.

Finally, acceptance techniques

can be used to reduce a client's worry and anxiety. Life involves a degree of uncertainty and at times we need to just accept this uncertainty. However, many clients, especially those with anxiety, have difficulty tolerating uncertainty. Acceptance techniques might include weighing the pros of fighting uncertainty against the cons of doing so. The cons should outweigh the pros and help the client to end the struggle and accept what is unknown. Chances are the client is already accepting the unknown in some areas of life and identifying those can help them to see why it is helpful to accept uncertainty which may help them to do so in more difficult areas. Finally, the therapist may help the client to question whether uncertainty necessarily leads to a negative end. The client may think so, but reviewing the evidence for and against this statement will show them that uncertainty does not always lead to negative outcomes which can help to reduce how threatening uncertainty seems.

Etiology

cause of disease

Methods of assessment

clinical interview, behavioral assessment, psychological testing

Central Nervous System (CNS)

consists of the brain and spinal cord is the control center for the nervous system which receives, processes, interprets, and stores incoming sensory information.

Id

contains a reservoir of unconscious psychic energy that, according to Freud, strives to satisfy basic sexual and aggressive drives. The id operates on the pleasure principle, demanding immediate gratification

Preconscious (Freud)

contains thoughts, memories, feelings and images that are easily recallable

culture-sensitive therapies

culture-sensitive therapies have been developed and include increasing the therapist's awareness of cultural values, hardships, stressors, and/or prejudices faced by their client; the identification of suppressed anger and pain; and raising the client's self-worth (Prochaska & Norcross, 2013).

neurological tests

directly assess brain function by assessing brain structure and activity Neurological tests are also used to diagnose cognitive impairments caused by brain damage due to tumors, infections, or head injury; or changes in brain activity. Positron Emission Tomography or PET is used to study the brain's functioning and begins by injecting the patient with a radionuclide which collects in the brain. Patients then lie on a scanning table while a ring-shaped machine is positioned over their head. Images are produced that yield information about the functioning of the brain. Magnetic Resonance Imaging or MRI produces 3D images of the brain or other body structures using magnetic fields and computers. They are used to detect structural abnormalities such as brain and spinal cord tumors or nervous system disorders such as multiple sclerosis. Finally, computed tomography or the CT scan involves taking X-rays of the brain at different angles that are then combined. They are used to detect structural abnormalities such as brain tumors and brain damage caused by head injuries.

neural transmission

electrochemical communication within and between neurons and the final destination Transducers or receptor cells in the major organs of our five sensory systems - vision (the eyes), hearing (the ears), smell (the nose), touch (the skin), and taste (the tongue) - convert the physical energy that they detect or sense, and send it to the brain via the neural impulse. How so? We will cover this process in three parts.

The Behavioral Model

explanation of human behavior, including dysfunction, based on principles of learning and adaptation derived from experimental psychology

Asylums

facilities for treating the mentally ill in Europe during the Middle Ages and into the 19th century.

psychological disorders (aka mental disorders)

have been defined as a psychological dysfunction which causes distress or impaired functioning and deviates from typical or expected behavior according to societal or cultural standards.

According to the National Survey on Drug Use and Health (NSDUH), in 2015

in 2015 there was an estimated 9.8 million U.S. adults aged 18 years or older with a serious mental illness, or 4% of all U.S. adults, and 43.4 million adults aged 18 years or older with any mental illness, or 17.9% of all U.S. adults.

It may be surprising to you, but the concept of mental or psychological disorders has proven very difficult to define and even the American Psychiatric Association (APA, 2013)

in its publication, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5 for short), states that though "no definition can capture all aspects of all disorders in the range contained in the DSM-5" certain aspects are required.

Stimulants

increase one's alertness and attention and are frequently used to treat ADHD. They include Lisdexamfetamine, the combination of dextroamphetamine and amphetamine, and Methylphenidate (Ritalin). Stimulants are generally effective and produce a calming effect. Possible side effects include loss of appetite, headache, motor tics or verbal tics, and personality changes such as appearing emotionless.

Incidence

indicates the number of new cases in a population over a specific period of time. This measure is usually lower since it does not include existing cases as prevalence does.

client-centered therapy.

individual is accepted as they are they receive unconditional positive regard and become a fully functioning person. They are open to experience, live every moment to the fullest, are creative, accept responsibility for their decisions, do not derive their sense of self from others, strive to maximize their potential, and are self-actualized. Their family and friends may disapprove of some of their actions but overall, respect and love them. They then realize their worth as a person but also that they are not perfect. Of course most people do not experience this but instead are made to feel that they can only be loved and respected if they meet certain standards, called conditions of worth. Hence, they experience conditional positive regard. According to Rogers, their self-concept is now seen as having worth only when these significant others approve and so becomes distorted, leading to a disharmonious state and psychopathology. Individuals in this situation are unsure what they feel, value, or need leading to dysfunction and the need for therapy. Rogers stated that the humanistic therapist should be warm, understanding, supportive, respectful, and accepting of his/her clients. This approach came to be called client-centered therapy.

First, cognitive restructuring (also called rational restructuring)

involves replacing maladaptive cognitions with more adaptive ones. To do this, the client must be aware of the distressing thoughts, when they occur, and their effect on them. Next, the therapist works to help the client stop thinking these thoughts and to replace them with more rational ones. It's a simple strategy, but an important one. Psychology Today published a great article on January 21, 2013 which described 4 ways to change your thinking through cognitive restructuring.

operant conditioning

is a type of associate learning which focuses on consequences that follow a response or behavior that we make (anything we do, say, or think/feel) and whether it makes a behavior more or less likely to occur. This should sound much like what you just read about in terms of Thorndike's work. Skinner talked about contingencies or when one thing occurs due to another. Think of it as an If-Then statement. If I do X then Y will happen. For operant conditioning, this means that if I make a behavior, then a specific consequence will follow. The events (response and consequence) are linked in time.

treatment

is any procedure intended to modify abnormal behavior into normal behavior

The greatest strength or appeal of the behavioral model

is that its tenets are easily tested in the laboratory unlike those of the psychodynamic model. Also, a large number of treatment techniques have been developed and proven to be effective over the years. For example, desensitization (Wolpe, 1997) teaches clients to respond calmly to fear-producing stimuli. It begins with the individual learning a relaxation technique such as diaphragmatic breathing. Next, a fear hierarchy, or list of feared objects and situations, is constructed in which the individual moves from least to most feared. Finally, the individual either imagines (systematic) or experiences in real life (in-vivo) each object or scenario from the hierarchy and uses the relaxation technique while doing so. This represents individual pairings of feared object or situation and relaxation and so if there are 10 objects/situations in the list, the client will experience ten such pairings and eventually be able to face each without fear. Outside of phobias, desensitization has been shown to be effective in the treatment of Obsessive Compulsive Disorder symptoms (Hakimian and D'Souza, 2016) and limitedly with the treatment of depression that is co-morbid with OCD (Masoumeh and Lancy, 2016).

hormone - pituitary gland

is the "master gland" which regulates other endocrine glands. It influences blood pressure, thirst, contractions of the uterus during childbirth, milk production, sexual behavior and interest, body growth, the amount of water in the body's cells, and other functions as well.

Hypothalamic-Pituitary-Adrenal-Cortical Axis (HPA Axis)

is the connection between the hypothalamus, pituitary glands, and adrenal glands. Specifically, the hypothalamus releases corticotropin-releasing factor (CRF) which stimulates the anterior pituitary to release adrenocorticotrophic hormone (ACTH), which in turn stimulates the adrenal cortex to release cortisol (see Figure 2.4). Malfunctioning of this system is implicated in a wide range of mental disorders including, depression, anxiety, and post-traumatic stress disorder. Exposure to chronic, unpredictable stress during early development can sensitive this system, making it over-responsive to stress (meaning it activates too readily and does not shut down appropriately). Sensitization of the HPA axis leads to an overproduction of cortisol which once again can damage the body and brain when it remains at chronically high levels.

classification

is the way in which we organize or categorize things

mental status examination

is used to organize the information collected during the interview and to systematically evaluate the client through a series of observations and questions assessing appearance and behavior (e.g., grooming and body language), thought processes and content (e.g., disorganized speech or thought and false beliefs), mood and affect (e.g., hopelessness or elation), intellectual functioning (e.g., speech and memory), and awareness of surroundings (e.g., does the client know where he/she is, when it is, and who he/she is?). The exam covers areas not normally part of the interview and allows the mental health professional to determine which areas need to be examined further. The limitation of the interview is that it lacks reliability, especially in the case of the unstructured interview.

Conditioning

is when learning occurs. Through the pairing of a neutral stimulus and unconditioned stimulus (bell and food, respectively) the dog will learn that the bell ringing (NS) signals food coming (UCS) and salivate (UCR). The pairing must occur more than once so that needless pairings are not learned such as someone farting right before your food comes out and now you salivate whenever someone farts (...at least for a while. Eventually the fact that no food comes will extinguish this reaction but still, it will be weird for a bit).

observational learning

learning by observing others; also called social learning

Hippocrates classified mental disorders into three main categories (Greco-Roman Thought)-

melancholia, mania, and phrenitis (brain fever) and gave detailed clinical descriptions of each. He also described four main fluids or humors that directed normal functioning and personality - blood which arose in the heart, black bile arising in the spleen, yellow bile or choler from the liver, and phlegm from the brain. Mental disorders occurred when the humors were in a state of imbalance such as an excess of yellow bile causing frenzy/mania and too much black bile causing melancholia/depression. Hippocrates believed mental illnesses could be treated as any other disorder and focused on the underlying pathology.

course

of the disorder is its particular pattern. A disorder may be chronic, meaning it lasts a long period of time, episodic, meaning the disorder comes and goes (i.e., individuals tend to recover only to have later reoccurrences). Disorders can also be classified as time-limited, meaning that recovery will occur in a short period of time regardless of whether any treatment occurs.

Symptoms that cluster together

on a regular basis are called a syndrome. If they also follow the same, predictable course, we say that they are characteristic of a specific disorder. Classification systems for mental disorders provide mental health professionals with an agreed upon list of disorders falling in distinct categories for which there are clear descriptions and criteria for making a diagnosis. Distinct is the key word here. People experiencing delusions, hallucinations, disorganized speech, catatonia, and/or negative symptoms are different from people presenting with a primary clinical deficit in cognitive functioning that is not developmental in nature but has been acquired (i.e. they have shown a decline in cognitive functioning over time). The former would likely be diagnosed with a schizophrenia spectrum disorder while the latter likely has a neurocognitive disorder (NCD). The latter can be further distinguished from neurodevelopmental disorders which manifest early in development and involve developmental deficits that cause impairments in social, academic, or occupational functioning (APA, 2013). These three disorder groups or categories can be clearly distinguished from one another. Classification systems also permit the gathering of statistics for the purpose of determining incidence and prevalence rates, they facilitate research on the etiology and treatment of disorders, and they conform to the requirements of insurance companies for the payment of claims. The most widely used classification system in the United States is the Diagnostic and Statistical Manual of Mental Disorders currently in its 5th edition and produced by the American Psychiatric Association (APA, 2013). Alternatively, the World Health Organization (WHO) produces the International Statistical Classification of Diseases and Related Health Problems (ICD) currently in its 10th edition with an 11th edition expected to be published in 2018. We will begin by discussing the DSM and then move to the ICD.

Postconditioning

or after learning has occurred, establishes a new and not naturally occurring relationship of a conditioned stimulus (CS; previously the NS) and conditioned response (CR; the same response). So the dog now reliably salivates at the sound of the bell because he expects that food will follow, and it does.

nomenclature

or naming system, to structure our understanding of mental disorders in a meaningful way

culture

or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group - determines what is normal and so a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms.

Who Seeks Treatment?

ould you describe the people who seek treatment as being on the brink, crazy, or desperate? Or can the ordinary Joe in need of advice seek out mental health counseling? The answer is that anyone can. David Sack, M.D. (2013) writes in an article entitled, 5 Signs Its Time to Seek Therapy, published in Psychology Today, that "most people can benefit from therapy at some point in their lives" and that though the signs one needs to seek help are obvious at times, people often try "to sustain [their] busy life until it sets in that life has become unmanageable." So when should we seek help? First, if we feel sad, angry, or not like ourselves. We might be withdrawing from friends and families or sleeping more or less than we usually do. Second, if we are abusing drugs, alcohol, food, or sex to deal with life's problems. In this case, our coping skills may need some work. Third, in instances when we have lost a loved one or something else important to us, whether due to a death or divorce, the grief may be too much to process. Fourth, a traumatic event may have occurred such as abuse, a crime, an accident, chronic illness, or rape. Finally, if we have stopped doing the things we enjoy the most. Sack (2013) says, "If you decide that therapy is worth a try, it doesn't mean you're in for a lifetime of "head shrinking." In fact, a 2001 study in the Journal of Counseling Psychology found that most people feel better within seven to 10 visits. In another study, published in 2006 in the Journal of Consulting and Clinical Psychology, 88 percent of therapy-goers reported improvements after just one session."

pineal gland

produces melatonin which helps regulate the sleep-wake cycle and other circadian rhythms. Overproduction of the hormone melatonin can lead to Seasonal Affective Disorder (a specific type of Major Depressive Disorder).

thyroid gland

produces thyroxin which facilitates energy, metabolism, and growth. Hypothyroidism is a condition in which the thyroid glands become underactive and this condition can produce symptoms of depression. In contrast, hyperthyroidism is a condition in which the thyroid glands becomes overactive and this condition can produce symptoms of mania. Therefore it is important for individuals experiencing these symptoms to have their thyroid checked, because conventional treatments for depression and mania will not correct the problem with the thyroid, and will therefore not resolve the symptoms.

Anxiety Disorders

psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety In Chapter 4, we will discuss matters related to anxiety disorders including their clinical presentation, epidemiology, comorbidity, treatment options, and etiology. Our discussion will include Panic Disorder, Generalized Anxiety Disorder, Specific Phobias, Social Anxiety Disorder, and Agoraphobia. Be sure you refer to Chapters 1-3 for explanations of key terms (Chapter 1), an overview of the various models to explain psychopathology (Chapter 2), and descriptions of the various therapies (Chapter 3).

abnormal psychology

refers to the scientific study of people who are atypical or unusual, with the intent to be able to reliably predict, explain, diagnose, identify the causes of, and treat maladaptive behavior.

Psychiatric or mental health epidemiology

refers to the study of the frequency of occurrence of mental disorders in a population. In mental health facilities, we say that a patient presents with a specific problem, or the presenting problem, and we give a clinical description of it which includes information about the thoughts, feelings, and behaviors that constitute that mental disorder. We also seek to gain information about the occurrence of the disorder, its cause, course, and treatment possibilities.

Dangerousness

refers to when behavior represents a threat to the safety of the person or others. Individuals expressing suicidal intent, those experiencing acute paranoid ideation combined with aggressive impulses (e.g., wanting to harm people who are perceived as "being out to get them"), and many individuals with antisocial personality disorder may be considered dangerous.

Stigma

refers to when negative stereotyping, labeling, rejection, and loss of status occur.

Impairment

refers to when the person experiences a disabling condition "in social, occupational, or other important activities"

Abnormal psychology:

scientific study of people who are atypical or unusual Purpose to be able to reliably predict, explain, diagnose, identify the causes of and treat maladaptive behavior

Social desirability

states that sometimes people do not tell us the truth about what they are thinking, feeling or doing (or have done) because they do not want us to think less of them or to judge them harshly if they are outside the social norm. In other words, they present themselves in a favorable light. If this is true, how can we really know what they are thinking? The person's true intentions or thoughts and feelings are not readily available to us or are covert, and so do not make for good empirical data. Still, cognitive-behavioral therapies have proven their efficacy for the treatment of OCD (McKay et al., 2015); perinatal depression (Sockol, 2015); insomnia (de Bruin et al., 2015), bulimia nervosa (Poulsen et al., 2014), hypochondriasis (Olatunji et al., 2014), and social anxiety disorder (Leichsenring et al., 2014) to name a few. Other examples will be discussed throughout this book.

psychosurgery

surgery that removes or destroys brain tissue in an effort to change behavior Another option to treat mental disorders is to perform brain surgeries. In the past, we have conducted trephining and lobotomies, neither of which are used today. Today's techniques are much more sophisticated and have been used to treat schizophrenia, depression, and obsessive-compulsive disorder, though critics cite obvious ethical issues with conducting such surgeries as well as scientific issues. Due to these issues, psychosurgery is only used as a radical last resort when all other treatment options have failed to resolve a serious mental illness.

multi-dimensional model

that integrates multiple causes of psychopathology and affirms that each cause comes to affect other causes over time. Uni-dimensional models alone are too simplistic to fully understand the etiology of something as complex as mental disorders.

Critics of the behavioral perspective point out

that it oversimplifies behavior and often ignores inner determinants of behavior. Behaviorism has also been accused of being mechanistic and seeing people as machines. Watson and Skinner defined behavior as what we do or say, but later, behaviorists added what we think or feel. In terms of the latter, cognitive behavior modification procedures arose after the 1960s along with the rise of cognitive psychology. This lead to a cognitive-behavioral perspective which combines concepts from the behavioral and cognitive models, the latter is discussed in the next section.

The nervous system consists of two main parts -

the central and peripheral nervous systems

Comorbidity

the co-occurrence of two or more disorders in a single individual

Comorbidity

the co-occurrence of two or more disorders in a single individual Panic disorder rarely occurs in isolation, as many individuals also report symptoms of other anxiety disorders, major depression, and substance abuse. There is mixed evidence as to whether panic disorder precedes other comorbid psychological disorders—estimates suggest that 1/3 of individuals with panic disorder will experience depressive symptoms prior to panic symptoms whereas the remaining 2/3 will experience depressive symptoms concurrently or after the onset of panic disorder (APA, 2013). Unlike some of the other anxiety disorders, there is a high comorbid diagnosis with general medical symptoms. More specifically, individuals with panic disorder are more likely to report somatic symptoms such as dizziness, cardiac arrhythmias, asthma, irritable bowel syndrome, and hyperthyroidism (APA, 2013). The relationship between panic symptoms and somatic symptoms is unclear; however, there does not appear to be a direct medical cause between the two.

Consciousness (Freud)

the current me

Valitidy

the degree to which a test measures what it is intended to measure

parasympathetic nervous system

the division of the autonomic nervous system that calms the body, conserving its energy Eventually, the response brought about by the sympathetic nervous system must end so the parasympathetic nervous system kicks in to calm the body.

Reliability

the extent to which a test yields consistent results, as assessed by the consistency of scores on two halves of the test, on alternate forms of the test, or on retesting

Synapse

the junction between the axon tip of the sending neuron and the dendrite or cell body of the receiving neuron The electrical portion of the neural impulse is just the start. The actual code passes from one neuron to another in a chemical form called a neurotransmitter. The point where this occurs is called the synapse. The synapse consists of three parts - the axon terminals of the sending neuron (presynaptic neuron); the space in between called the synaptic cleft, space, or gap; and the dendrite of the receiving neuron (postsynaptic neuron). Once the electrical impulse reaches the end of the axon, called the axon terminal, it stimulates synaptic vesicles or neurotransmitter sacs to release the neurotransmitter. Neurotransmitters will only bind to their specific receptor sites, much like a key will only fit into the lock it was designed for. You might say neurotransmitters are part of a lock-and-key system. What happens to the neurotransmitters that do not bind to a receptor site? They might go through reuptake which is a process in which the presynaptic neuron takes back excess neurotransmitters in the synaptic space for future use or enzymatic degradation when enzymes destroy excess neurotransmitters in the synaptic space.

ego

the largely conscious, "executive" part of personality that, according to Freud, mediates among the demands of the id, superego, and reality. The ego operates on the reality principle, satisfying the id's desires in ways that will realistically bring pleasure rather than pain.

autonomic nervous system (ANS)

the part of the peripheral nervous system that controls the glands and the muscles of the internal organs (such as the heart). Its sympathetic division arouses; its parasympathetic division calms. regulates the functioning of blood vessels, glands, and internal organs such as the bladder, stomach, and heart. It consists of sympathetic and parasympathetic nervous systems.

Somatic Nervous System (SNS)

the part of the peripheral nervous system that controls voluntary movement of skeletal muscles allows for voluntary movement by controlling the skeletal muscles and it carries sensory information to the CNS.

Psychopathology:

the scientific study of psychological disorders

Peripheral Nervous System (PNS)

the sensory and motor neurons that connect the central nervous system (CNS) to the rest of the body. It handles the CNS's input and output and divides into the somatic and autonomic nervous systems.

dream analysis

the therapist interprets the symbolic meaning of the client's dreams

Cognitive Model

the view that emphasizes thinking as the key element in causing psychological disorders

Psychotherapy

treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth Several different approaches can be utilized to include behavior, cognitive and cognitive-behavior, humanistic-experiential, psychodynamic, couples and family, and biological therapies/treatments.

ions

vIons are charged particles found both inside and outside the neuron. It is positively charged Sodium (Na) ions that cause the neuron to depolarize and fire and positively charged Potassium (K) ions that exit and return the neuron to a polarized state.

plato Plato (429-347 B.C.), Greco-Roman Thought)

who said that the mentally ill were not responsible for their own actions and so should not be punished. He emphasized the role of social environment and early learning in the development of mental disorders and believed it was the responsibility of the community and their families to care for them in a humane manner using rational discussions.

uni-dimensional model- The problem

with this approach is that mental disorders are not typically caused by a solitary factor, but instead, they are caused by multiple factors. Admittedly, single factors do emerge during the course of the person's life, but as they arise they become part of the individual and in time, the cause of the person's disorder is due to all of these individual factors.