PSC 168

Diagnostic & Statistical Manual Definition of Abnormal Behavior

"A behavioral or psychological syndrome or pattern that reflects an underlying psychobiological dysfunction, that is associated with distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) and is not merely an expectable response to common stressors or losses." (www.dsm5.org)

hypomania:

"high" mood and overactive behavior; poor judgment, delusions (rare), start many projects but complete few, dominate conversations, often grandiose

what is a major obstacle in the progress?

"stigma"

Prevalence:

% of people in a population (number of current cases) with a disorder at a given time.

Four problems are commonly used as the foci of therapy:

(a) Grief - usually prolonged grief following the loss of a loved one; (b) interpersonal disputes often caused by a change in roles; (c) role transitions (e.g., changing jobs, moving, retirement); and (d) interpersonal deficits -- lack of the skills or knowledge required to stay free of psychopathology. Insight is viewed as the mechanism for change. The client's assumptions are questioned, expression of affect is encouraged, communication patterns are analyzed, and the therapeutic relationship is used to encourage transference.

DSM-5 criteria:

(a) Temporal relationship between psychological factors and onset of, or recovery from medical condition, (b) psychological factor interferes with treatment, (c) psychological factors are added health-risk factor for the person, or (d) psychological factors influence physiology and thus precipitate or aggravate the condition.

Common features among suicide:

(a) intense and prolonged psychological pain - underestimated by others; (b) solution is to end pain and escape with no alternative in sight (tunnel vision; (c) associated with hopelessness/helplessness and depression; (d) ambivalence; (e) interpersonal act involves communication of intent - 80% are preceded by behavioral cues indicating intentions.

Errors:

(a) working relationship - information exchange blocked if relationship problematic, (b) faulty information from interviewee, (c) faulty interpretation from interviewer due to theoretical, professional, or cultural orientation.

Treatment: Identifying Triggers and high risk situations and using alternative activities to manage urge.

(ex: depression, stress, conflict)) (ex: billboard, televised game)

Magnetic resonance imaging (MRI):

- A magnetic field is induced around the patient and assessment is made with the use of radio waves. A computer processes and maps out a very clear picture of the brain's structure.

Positron emission tomography (PET) scan:

- A radioactive substance is injected into bloodstream and is detected as it metabolizes in the brain.

Electroencephalograph (EEG):

- Assesses electrical activity as marker of brain processing.

CBTs: (Treatments):

- Coping strategies - Identifying triggers (ex: depression, stress, conflict), and high risk situations (ex: billboard, televised game), and using alternative activities to manage urge. - Stress Management - Coping with slips and relapse experiences - Replacing these distortions with realistic thinking about gambling - Identifying and challenging cognitive distortions such as the Gambler's Fallacy, illusions of control, and irrational beliefs. - Getting people out of denial by Monitoring gambling wins and losses and assessing financial debts. - a sobering experience. - Assessments of gambling patterns and money spent of gambling. SOGS and NODS used to assess gambling problems. - Dealing with debts to family and friends, creditors, loan sharks and bookies, and the IRS. - this is easier for their community to support them because they wont feel angry toward them.

Cognitive factors in substance abuse:

- Different types of stress produce different results: Marlatt(1978) - social (women evaluate attractiveness) but not physical (shock) stress associated with more drinking.

Eisenberg

- Disease is basic dysfunction in biological systems or psychological systems. Illness is a person's reaction to this dysfunction in terms of experienced states of discontinuity and role performance

Distress(physical or psychological stress)

- Experienced pain and suffering usually motivating person to seek help. Even here there can be important individual and cultural differences.

Impulsive Control Disorders: notable that there is very little gain to these disorders -all have to do with pleasure

- Intermittent explosive disorder - Kleptomania - Pyromania - Pathological Gambling - Trichotillomania

New in DSM-5: Disorders for Further Study: these are all fairly consistent, but differ as they do not directly harm others like some of the other ones.

- Internet gaming disorder - fixation on Internet games at the expense of school, work, and/or social interactions. (Big in East Asia and among adolescent males) - Caffeine use disorder - excessive caffeine use and an inability to control use. - Non-suicidal self-injury - repeated, self-inflicted bodily damage due to interpersonal problems, negative feelings, or uncontrollable and/or intense thoughts about the act of injury -Impulsive shopping - is also in the works of being studied.

Cluster A: Disorder characterized by odd or eccentric behaviors:

- Paranoid personality disorder. -Schizoid personality disorder -Schizotypal personality disorder

Impulse Control Disorders: Characteristics:

- Problems in emotional and behavioral self control - Failure to resist temptations resulting in harm - Tension before committing act - Release after committing act - Guilt may or may not be felt

Operational Definitions

- Researchers are accountable for how they define a variable in terms of how it is measured and assessed (i.e., the operations used to define a variable). Special challenges in operationalizing and classifying mental health disorders.

What are the conceptional definitions of abnormal behavior?

- Statistical deviation: based on relative frequency abnormality defined as deviation from normative or average frequency. - Deviations from ideal mental health as defined by some theory or school of thought

Computerized axial tomography (CT scan)

- X-rays and computer used to map out brain structure.

• Essentially, effective psychological treatment involves 3 essential processes:

- applying the best available research evidence in the selection and application of treatments - using clinical expertise that encompasses a number of competencies that have been found to promote positive therapeutic outcomes - being responsive to the patient's characteristics, culture, and personal preferences

Inferiority Model

- basic inadequacies

Multicultural Model

- contextualizing behavior

Deficit Model

- cultural deprivation

Rational Method:

- develop measure to assess individual variation on a specific trait or attribute vs. the empirical approach in which scores on measure distinguish individuals who share a particular attribute or characteristic from those who do not share this characteristic.

Manifestations of Anxiety:

- feelings of fear, apprehension, and tenseness.

Altruistic suicide -

- for group's greater good, higher cause.

Exposure therapy

- gradually introduce contact with feared situation; extinction

Dangerous - not true?

- large majority of mental patients not violent or out of control.

Extinction through flooding (prolonged exposure) procedures

- often difficult for patients to comply because need to generate a clear and vivid experience of traumatic event.

fMRI:

- provides images of brain structures combined with physiological activity in brain regions

Shaping:

- reinforcement of successive approximation to desired behavior. Shaping needed to learn complex tasks in which the acquisition of the basic components of the task are reinforced. This is followed by reinforcement of the acquisition of more complex behaviors as more components are added

Systematic desensitization

- relaxation (incompatible response to anxiety) while imagining increasingly anxiety- provoking situations in stimulus hierarchy.

Gender Factors

- sex differences in life stress, certain mental health disorders, and response to treatment

• Strupp & Hadley's (1977) three vantage points for judging mental health:

- society - the individual - the mental health professional

Schizotypal personality disorder:

- ultimate odd or strange disorder -- odd, eccentric, or peculiar thinking and behavior without loss of contact with reality; hypersensitivity and inappropriate affect; poor interpersonal relatonships; social isolation is a secondary symptom; genetic link between schizophrenia and schizotypal personality - higher risk of schizotypal personality disorder among relatives of schizophrenics.

Cyclothymic disorder

-- chronic mood swings but less than hypomania or depression, continual in nature with depressed and manic moods that do not meet criteria for major depression. It lasts more than two months and is continual for ≥ 2 years.

Ethnic and cultural variables

-- highest among American Indians, lowest among Asian Americans.

Egoistic suicide

-- inability to integrate with society; sense of belonging and community.

Suicide and Gender

-- men succeed 4 times more often than women; women attempt three times more often than men.

Cluster B: Disorders characterized by dramatic, emotional, or erratic behaviors.

--- histrionic personality disorder: --- borderline personality disorder --- Narcissistic personality disorder --- Antisocial personality disorder

Characteristics of personality disorders:

--- impairment and traits cross-situationally consistent and stable across time. - they often are rigid and cannot be flexible enough to change their response over time. (they don't vary too much regardless of age.) ---Impairment and traits NOT explainable by normal development or socio-cultural processes. --- Impairment and traits NOT due to substance abuse or medical condition.(concussion from football causing behavior change) - this would not fit the criteria. --- Account for 5 to 15 percent of admissions to hospitals ad outpatient clinics; overall lifetime prevalence between 9 to 13 percent. --- Gender distribution: more men have schizotypal, narcissistic, obsessive compulsion, and antisocial - more woman have borderline disorders.

Contemporary Trends & Future Directions

---Increased reliance on the biological model DSM-5 is inadequate NIMH launched Research Domain Criteria (RDoc) in 2010 to identify biomarkers associated with DSM disorders ---Increased and more careful consideration of psychological, social, and sociocultural factors Loss, discrimination, abuse, trauma, poverty Negative thinking patterns

Hereditiy in Schizophrenia studies involving blood relatives

---based on 1 % risk in general population and comparison with risk and degree of genetic similarity in relatives general finding: the closer the blood relationship, the higher risk among relatives of schizophrenics.

What Are Some Contemporary Trends in Abnormal Psychology? (cont'd)

--Advances in research -Neuroanatomy, neurotransmitters, genetics -Combining drug therapy with psychotherapy --Diversity/multicultural psychology -Culture, race, ethnicity, gender, age, SES relevant to understand/treat abnormality - Cultural sensitivity, knowledge of diversity, culturally relevant therapy -Social conditioning, cultural values and influences, sociopolitical influences, and bias (research & diagnosis)

Treatment of BPD:

--CBT: challenge distorted cognitions and correct faulty assumptions about self and others. --Dialectical Behavior Therapy(Linchan, 1993) - treatment focuses on reducing (a) self-destructive (e.g. cutting) and suicidal behaviors and counter-therapeutic behaviors before (b) enhancing emotional regulation, distress tolerance, and interpersonal effectiveness. Dialectical - back and forth process leading to reconciliation of opposite tendencies. -- this has been the most effective!!!

asian americans

-60% of asian americans do not have the gene to turn on the enzyme that metabolizes acid aldehyde so it is not a toxic substance when you consume alcohol. If this acid stays in your system, then you have a higher chance of stomach cancer, gastric cancer or other cancers. -- it also though may protect them from ultra high use of alcohol. - asian glow?

Stereotypes of the mentally disturbed

-Easily recognized as deviant -Disorder due to inheritance - Incurable -Never contribute to society because they cannot be cured notion of cure is itself a myth. - Weak willed - Dangerous

Dimension Four: Sociocultural Factors

-Gender Factors -Socioeconomic Class -Immigration and Acculturative Stress -Race/Ethnicity

DSM-5 Personality Disorder Trait Domains Existence of one or more of these domain traits that impair self and interpersonal functioning: they can define people by these categories.

-Negative affectivity - anxiousness, hostility -Detachment - depressivity, withdrawal. -Antagonism - manipulativeness, deceitfulness -Disinhibition - impulsivity, risk taking. -Psychoticism - unusual beliefs, eccentricity

what % of Americans are affected with schizophrenia

1%

Cognitive content is organized along three levels:

1) Most accessible and least stable cognitions; voluntary thoughts 2) Automatic thoughts that occur spontaneously; triggered by circumstances 3) Underlying assumptions about oneself and one's world

Post-traumatic stress disorder:

1-2 symptoms from each symptom cluster; symptoms last more than one month. Lifetime prevalence: PTSD 8.7%, higher among AfAm, lower among AsAm

The process of Diathesis Stress Theory:

1. Precursors (genetic factors; brain disease; early learning experiences; bad family dynamic) then.. 2. Diathesis: (vulnerability) then.. (or go straight from diathesis to disorder - if no stress occurs) 3. Stress (poor self-understanding; stressful family dynamics; social stresses) then... 4. Outcome - Disorder (i.e. schizophrenia)

3 factors of APD:

1. arrogant and deceitful interpersonal style - very charming - they will say anything to get you to like you. 2. Deficient and affective experience 3. impulsive and irresponsible behavioral style. they externalize - those people knew what they were getting into.

There are typically 3 phases or stages in the career of the pathological gambler:

1.Winning, 2.losing, 3.desperation with hopelessness. In the early stages of the disorder, the gambler tends to win and often continues to win because initial luck is replaced by skillful playing and astute betting strategies.

Role of Bullying with suicide:

1/3 of teens report being bullied at school Bully victims are 2-9 times more likely to consider suicide Nearly 50% of youth who commit suicide have experienced bullying

Found relationship between LCU level and likelihood of illness:

150 -199: 37% ill 200 - 299: 51% ill >300: 79% ill Only undesirable changes had negative effects. Research tends to be correlational and retrospective in nature.

data:

2/10 students in college classes score in range 8 - 15 5% score in a high level when you add these up, you find that about 27% - 26.9% of students in college classes having moderate alcoholism - data from 4 to 5 classes.

for question 5:

27% say they fail to function because of alcohol

According to NIMH study, how many people have had a disorder?

29-38% of sample have had at least one disorder.

Incurable - not true? -Never contribute to society because they cannot be cured notion of cure is itself a myth.

3/4s of those hospitalized for mental disorders recover sufficiently to lead productive lives

What % of adult americans and children have suffered from mental illness

30% adults 20% children

Etiology of ADP Genetic perspective FINISH WITH SLIDE

5 and 10 times more common among first-degree biological relatives of male and female, respectively. MZ twins' concordance rate higher than that of DZ twins. Environment - shared environment is a confounding factor which may provide dysfunctional learning experiences.

College student gambling problesm

5% - another study says 8%

Suicide in College:2009 Study on 70 college campuses

50%+ report suicidal thoughts 18% undergraduates and 15% graduate students seriously considered attempting suicide Most common plan is drug/alcohol overdose Contributing factors: (1) relief from emotional/physical pain; (2) problems with romantic relationships; (3) desire to end one's life; (4) school problems; (5) friend problems; (6) family problems; (7) financial problems

UC Davis problem gambling:

6.2% of students are at risk that they are gambling beyond their means.

Acute Stress Disorder

9 or more symptoms associated with stress disorders that last more than two days but less than one month occurring within four weeks of the event.

Somatic Manifestation

: Changes in perspiration, shallow breathing, frequent urination, heart pounding, muscular tension, indigestion, etc.

Objections to Classification and Labeling

A label can lead to overgeneralizations, stigmas, and stereotypes: Rosenhan's study (1973), "Sane in Insane Places" A label may lead others to treat a person differently. Rosenthal & Jacobson's (1968) study. A label may lead those who are labeled to believe that they do indeed possess such characteristics: Affects one's identity and self-perception. Social anxiety research. A label may not provide the precise, functional information that is needed: DSM symptom-oriented

Maddi (2002):

A longitudinal study of employees after massive layoffs; 2/3 developed health problems; 1/3 appeared to thrive. The individuals who did well had three characteristics: (1) commitment - they were involved in ongoing changes rather than giving up and feeling isolated; (2) control - they made attempts to influence decisions and refused to feel powerless; and (3) challenge - changes were viewed as opportunities.

Diathesis-Stress Theory:

A predisposition to develop illness (diathesis) is inherited and may or may not be activated by environmental factors

Regression:

A retreat to an earlier developmental level - according to Freud, the person's most fixated stage - that demands less mature responses and aspirations. Example: a dignified college president drinks too much and sings old school songs at a reunion with college classmates. - or when you act like a baby and you're really upset about a break up.

Undoing:

A symbolic, often ritualistic or repetitive, to right a wrong or negate some disapproved thought, impulse, or act. Example: In Shakespeare's play, Lady Macbeth goads her husband into slaying the king and then tries to cleanse herself of sin by constantly going through the motions of washing her hands. Another example from class: a bully pushes another kid down on the playground. he feels bad and so picks him up, dusts him off, and continues to play, as if it never happened - very common for young children.

Operant Behavior:

A voluntary and controllable behavior that "operates" on an individual's environment

Siegal (1978):

APDs learn as well as normals when the punishment is certain but not when there are only threats or a possibility of punishment. they respond to for sure punishment rather than threats (the law is a threat)

Schmauk (1970):

APDs show learning deficits relative to normals when punishment is physical or social but not when it is monetary in nature.

Schachter & Latane (1964):

APDs with adrenaline > non-APDs with placebo on avoidance learning task with shock.

Surgeon General

Abnormal behavior departs from some norm and harms the affected individual or others

Etiology of ADP Biological

Abnormal brain structure and activity in the prefrontal portion and limbic amygdala circuitry. Poor fear conditioning Autonomic nervous system abnormalties. - ANS deficits makes ASPs less likely to expereince anxiety and, thus, less liekly to benefit from avoidance learning. - ANS abnormalities result in under-arousal, which results in ASPs tendency for thrill seeking and drfying docial standards, Such experiences reduce boredom and enhance arousal states.

Etiology: Biological Perspective (mostly on DID):

Activation or inhibition of certain brain regions (i.e., hippocampus region - involves memory) Differences in temporal lobe activity - seizures often alter consciousness Decreased brain volume in amygdala and hippocampus - may affect coding of information

Rights of Mental Patients

Addington v. Texas - must provide "clear and convincing evidence" (~75% certainty) that a person is mentally ill and potentially dangerous before they can be committed States must provide the least restrictive environment (alternative to freedom) Right to treatment - right to receive therapy that would improve their emotional state Right to refuse treatment - under certain conditions; extend the least intrusive form of treatment

Psychodynamic models:

Adult disorders arise from childhood traumas or anxieties. Childhood-based anxieties are unconscious and are repressed through defense mechanisms because they are too threatening to face.

Pedophilic Disorder:

Adult obtains erotic gratification through urges, acts, or fantasies involving sexual contact with a prepubescent child; 20-30% of women report childhood sexual encounters with a man; most likely a relative, friend, or casual acquaintance.

The Symptoms of Depression

Affective: Depressed mood, dejection, excessive and prolonged mourning, worthlessness, lack of joy Cognitive: Pessimism, extreme feelings of incompetence, self-denigration, concentration difficulties, faulty thinking and irrational beliefs, difficulties in planning and making decisions, disinterest, rumination Beck's Cognitive triad: Negative views of self, outside world, and the future

Treatment for Alcohol Use Disorder

Alcoholics Anonymous (AA) Self-efficacy, active coping, motivation Medications (only modest effects) Antabuse: Prevents breakdown of alcohol Acamprosate: Reduce relapse; increase abstinence Naltrexone: Reduce craving for and pleasure in alcohol use Nalmefene: Harm-control measure

Sexual Dysfunction:

All DSM-5 sexual dysfunctions (except substance- or medication-induced sexual dysfunction) require a minimum duration of approximately 6 months and more of precise severity criteria.

Life change model (Holmes & Holmes):

All life events (large or small, positive or negative) can cause stress in a person; cumulative impact of life changes.

Depersonalization disorder (slower spontaneous remission) treatments:

Alleviate feelings of anxiety, depression, fear of going insane Occasionally behavioral therapy (reinforcement of appropriate responses)

Freud:

Although most impulses are hidden from consciousness, they determine human actions.

Projective Personality Tests:

Ambiguous stimulus such that person projects personal motives, needs, and conflicts into stimulus.

Insanity Defense: Legal Precedents

American Law Institute (ALI) Code (United States, 1962): "as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law" Does not include antisocial personality as mental disease or defect. No others must be involved - suggests sane enough to collaborate

Etiology of Gender Dysphoria Biological factors are major determinants:

Animal studies support role of sex hormones - excess or deficiency in hormones such as testosterone.

Treatment for Bulimia:

Antidepressant mds combined with theraoy in which clients eat regularly, try to anticipate stressors the precepotate bingeing, delay purging as long as possible, and treat each binge as an isolated incident rather than a pattern. CBT approaches emphasize balanced eating, challenging rigid beliefs about eating, and using coping strategies such as exercise and relaxation to control urges. Best treatment for bulimia appears to be antidepressant medications and CBT. Some evidence for effectiveness of cue exposure treatment which involves prolonged exposure to attractive foods without consuming them.

Treatment: Somatic Symptom Disorders Biological:

Antidepressants (SSRIs) effective, opioids, and increases in physical activity (conversion disorder)

Treatment of panic disorder and generalized anxiety disorder Biochemical Treatment:

Antidepressants (tricyclic antidepressants and Selective Serotonin Reuptake Inhibitors (SSRIs)) and antianxiety medications (e.g., benzodiazepines); relapse after stopping drug therapy quite common; unclear if due to placebo effects which can approach 75% success rate in clinical trials. Benzodiazepines (Valium and Librium) useful in GAD but can cause tolerance and dependence

Treatment of Schizophrenia

Antipsychotic (neuroleptics) medications include phenothiazines such as Thorazine (and its variations) and the newer atypical antipsychotics (e.g., clozapine, risperidone, and olanzapine) introduced in the 1990s. Highly effective with positive symptoms, not very effective for negative symptoms, and not a cure; must be monitored closely because serious side effects (e.g., Clozapine overdose can cause fatal lesions in mucous membranes and gastrointestinal system). Side effects (tremors, motor restlessness, anxiety, agitation, extreme terror, tardive dyskinesia, and suicidal behavior) may seem like neurological disorders. Relatively large group (25%) does not benefit from phenothiazine medication. 50% of the non-responsive group can benefit from the atypical antipsychotics.

agoraphobia:

Anxiety about leaving one's home Panic disorder and agoraphobia are unlinked in DSM-5 Lifetime prevalence: 3.5%; twice as common in women as in men

Anxiety disorders meet one of these criteria

Anxiety itself is a major disturbance Anxiety is manifested only in particular situation Anxiety results from attempt to master other symptoms

Etiology of panic disorder and generalized anxiety disorder Psychodynamic:

Anxiety over sexual and aggressive impulses that cannot be controlled by defense mechanisms

symptoms of depression physiological

Appetite/weight changes, constipation, sleep disturbance, disruption of menstrual cycle, aversion to sexual activity, unexplained aches/pain

Positive Punishment:

Apply Stimulus and Behavior/response decreases

Positive Reinforcement:

Apply Stimulus and Behavior/response increases

Cognitive Explanation Distortions of thought processes - Beck has focused on types of maladaptive or faulty thinking invoked by schemas or cognitive sets that influence how one interprets and responds to events.

Arbitrary inference Selective abstraction Overgeneralization Magnification/minimization

Recovery Movement

Arose in response to pessimistic views held by the public and mental health processionals regarding life prospects Perspective that those with mental illness can recover and live satisfying, hopeful, and contributing lives even with limitations caused by illness

Cultural Competence in Mental Health Care

Aspects of cultural competence Cognitive competence Affective competence Role competence.

Preventing Suicide

Assessing lethality Know factors correlated with suicide Determine probability of person acting on wish Implement appropriate actions

Behavioral explanations: anxiety reduction:

Assumes alcohol reduces anxiety of approach-avoidance conflict - reducing fear of unpleasant or aversive consequences. Anxiety reduction is reinforcing.

Abnormal Psych uses psychodiagnosis - what is that?

Attempts to describe, assess and systematically draw inferences about psychological disorders.

Etiology: Psychodynamic:

Attempts to fend off anal sadistic (antisocial), anal libidinous (pleasurable soiling) and genital (masturbatory) impulses. The obsession is a less threatening substitute or replacement for the original conflict.

Cognitive and Behavioral Interventions and Treatment

Aversion therapy: Response to a stimulus is decreased by pairing the stimulus with an aversive stimulus Covert sensitization: Imagine a disgusting scene or event occurring in the presence of a behavior Skills training: Learn to resist peer pressure or temptation; resolve emotional conflicts or problems; more effective communication Reinforcing abstinence: Behavioral reinforcements for abstinence; effective for opioid dependence Relaxation and systematic desensitization Motivational: Important and realistic goal setting Stress management and cognitive restructuring; coping with negative emotions and stress Response prevention Controlled drinking: Controversial approach

Behavioral Manifestations

Avoidance of fear-inducing situations

Cluster C: Disorders chaacterized by Anxious or fearful behaviors

Avoidant Personality Disorder. Obsessive- compulsive personality disorders: Dependent Personality Disorder.

Etiology of Impulse Control Disorders Behavioral:

Behaviorists stress variable reinforcement schedule - most resistant to extinction.

The Observational Learning Model

Behaviors are acquired by watching someone else perform those behaviors.

Bulimia Nervosa (BN)

Binge eating of high-caloric food at least once a week for 3 months, loss of control over eating. Followed by compensatory behaviors involving purging (e.g., vomiting, laxatives). Overestimate body size, show greater psychopathology in terms of poor self-concept, external locus of control, low self-esteem, and overestimates of perceived stress associated with life events compared to normals. Frustrated by eating pattern - know that it is abnormal; loss of control over eating is discriminating feature from AN. Lifetime prevalence -- much greater than anorexia (2% general population; 2.6% women; 0.5% men) Side effects: Tooth erosion, esophagitis, stomach irritation, dehydration, loss of potassium, and swollen salivary glands Stress related to bingeing - way of coping Later onset than anorexia - late adolescence or early adulthood

Dimension One:

Biological Factors and Biochemical Theories

The Endophenotype Concept:

Biological indicators that provide information on the genes involved in the disorder. Associated with the disorder Heritable Manifested in an individual regardless of whether the disorder is present Found in a higher rate among nonaffected family members than gen. pop.

Comparison Between Depressive and Bipolar Disorders

Bipolar more genetically based Bipolar much less common - 1-2% vs. 8-19% of general population has experienced BP vs. UP Onset of bipolar earlier (late teens/early twenties) than unipolar (late twenties) Bipolar displays psychomotor retardation and more suicide ideation and attempts. Bipolar responds to Lithium

Etiology Psychodynamic

Bodily symptoms driven by repression mechanisms coupled with secondary gain to serve dependency needs.

Obesity

Body mass index (BMI) > 30 35% of American adults Higher rates: African American, Mexican Americans, American Indians, and women Not recognized in the DSM-5 as a disorder Second only to tobacco as a preventable cause of disease and death

Somatic Symptoms of Panic Disorder

Breathlessness, sweating, choking, nausea, heart palpitations- May lead to agoraphobia

other psychotic disorders

Brief Psychotic Disorder - Schizophrenic-like episodes that last fewer than one month Schizophreniform Disorder - Schizophrenic-like episodes that last at least one month, but less than six months Delusional Disorder - persistent delusions not accompanied by other unusual or odd behaviors Schizoaffective Disorder - abnormal thought and de-regulated emotions; features of both schizophrenia and a mood disorder (MDD or bipolar); a major mood episode is required DSM-5 condition requiring further research: Attenuated Psychosis Syndrome - distressing or disabling delusions, hallucinations, or disorganized speech in combination with intact reality testing ("milder" psychosis); symptoms must have emerged or gotten worse over the previous year; symptoms less severe and more transient

Treatment: Cognitive-Behavioral:

CBT is most promising intervention. Focus on (a) relaxation training to reduce arousal and anxiety, (b) connecting stress to bodily sensations, (c) correcting cognitive distortions, catastrophic thinking, and misinterpretations, (d) reinforcing social contact, and (e) confirming non-physical nature of problems.

stimulants:

CNS energizer producing elation, grandiosity, hyperactivity, appetite supression, and perception of clear thinking.

Etiology of Dissociative Disorders Psychodynamic:

Capacity to dissociate needed when repression not totally effective, need to split off the disturbing experience. Exposure to severe long-term, stress that usually is inescapable such as physical or sexual abuse Walling off experience essentially is a protective mechanism - allows person to function under very difficult conditions

Biological Perspectives on Mood Disorders Neurotransmitters and Depressive Disorders

Catecholamines (norepinephrine, serotonin, dopamine) insufficient due to excessive neurotransmitter breakdown due to enzyme, Monoamine Oxidase (MAO) or excessive re-uptake. May be problem in reception of neurotransmitter resulting in deficit of neurotransmitters at synaptic sites. MAO inhibitors or tricyclics that inhibit re-uptake alleviate depression. Deficiencies in catecholamines also may be due in part to membrane responses to the neurotransmitters or to lack of transporter proteins which affect the level of neurotransmitters at the synaptic sites.

New DSM-5 System

Categorical Model Subtypes: subgroups within a diagnostic category Specifiers: characteristics associated with a diagnostic category (not mutually exclusive) Severity measures: mild, moderate, severe Includes client-rated and clinician-rated symptom measures (cross-cutting measures) Consideration of cultural factors in assessment and diagnosis

Preparedness:

Certain phobias may develop because people are evolutionarily predisposed to develop certain fears because certain stimuli were dangerous to pre-modern humans.

what underlie mental disorders?

Chemical imbalances

Neurotransmitters:

Chemicals involved in transmission of neural impulses

Etiology of Psychophysiological Disorders Biological:

Chronic activation of sympathetic nervous system, genetic influences

Therapist-Client Relationship Privileged communication exemptions:

Civil or criminal commitment or competency to stand trial Mental condition is introduced as a claim or defense in a civil action Client is younger than 16 or is a dependent elderly person who was the victim of a crime Client presents danger to self or others

Classical Conditioning in Psychopathology:

Classical conditioning helps explain acquisition of phobias, unusual sexual attractions, and other extreme emotional reactions. Classical conditioning serves as a basis for effective treatment techniques, although most human behaviors are more active and voluntary.

Criteria for commitment

Clear and imminent danger to self or others Unable to care for self and without communal support (most common reason) Unable to make responsible decisions about appropriate treatment and care In unmanageable state of panic -- often due to drug-induced psychosis

Antisocial Personality disorder:

Cleckley's checklist of characteristics: - Superficial charm and seemingly intelligent. - shallow emotions, lack of empathy, guilt, or remorse. -Little life plans or oder, very impulsive and present oriented, cannot delay gratification; they are thrill seekers. -Failure to learn from experience, lack of anxiety - no inhibitory anxiety or apprehension anxiety - failure to learn from a negative consequence from experience specifically. - unreliable and dishonesty - will lie and fake emotions to manipulate others. they treat people as objects they do not relate to you like other people relate to you - they only see you as an object in your life. even though they know its wrong, it wouldn't stop them. lack of morale.

Case Study:

Clinical data on one person or small number of people.

Assessment difficulties in determining dangerousness:

Clinicians usually overpredict dangerousness (false positive) because violent behavior is very rare. However, since cost of not detecting violence is very high society willing to commit false positives versus false negatives. Mistakes due to rarity of the event (fewer than 10 percent of psychotic patients are assaultive). Dangerousness is often situation-specific; best predictor is past conduct or history of violence. Most definitions of dangerousness pertain to physical harm and exclude psychological harm and torture.

Integrated Psychological Therapy (IPT)

Cognitive differentiation (perceptual tasks to form concepts and retrieve accurate information) Social perception (understand and respond appropriately to social cues by means of analyzing slides) Verbal communication skills Social-skills training

Relapse prevention treatments used:

Cognitive restructuring applied to de-catastrophize the slip and substitute those maladaptive thoughts with recovery-oriented ones.

M'Naghten rule (the "right-wrong test"):

Cognitive test of legal insanity. A person can be acquitted of a crime if it can be shown that, at the time of the act: Defendant's reasoning was so defective that he/she did not know what he/she was doing (nature of the act) The defendant was unable to comprehend that the act was wrong (quality of the act)

Treatment of OCD: Behavioral treatments

Combination of exposure (flooding or gradual exposure) and response prevention is the treatment of choice

Mental health issues become legal when...

Competence to stand trial is in doubt An accused person bases his or her criminal defense on insanity or diminished mental capacity Decisions must be made about involuntary commitment to mental hospitals The rights of mental patients are legally tested

Addiction:

Compulsive Drug Seeking Behavior Loss of control over drug usage Men twice as likely to develop and alcohol use disorder Alcoholism in women progresses more rapidly

Dopamine

Concentrated in small areas of the brain, one of which is involved in the control of the muscles. in excess, dopamine can cause hallucinations. associated with schizophrenia.

Behavioral perspective Classical Conditioning:

Conditioned emotional responses; some research and clinical support for conditioned learning in that most phobic patients report conditioning experiences as perceived cause

The Therapist-Client Relationship

Confidentiality and privileged communication Confidentiality an ethical standard to protect clients from disclosure without their consent. Therapists will disclose only as required by law. Important in therapeutic relationship. Privileged communication is a narrower legal concept; client holds the privilege of confidential communication and can waive this privilege.

Cognitive Models:

Conscious thought mediates or modifies a person's emotional state and/or behavior in response to a stimulus

Construct validation

Construct validation involves assembling evidence about what a test really means. This is done by showing the relationship between a test and other tests and measures.

Laudenslager and associates:

Control-over-shock rats rejected cancer cells (65%) more than either yoked control (27%) or no-shock control group.

A placebo group:

Controls for expectations that treatment will work. In drug trials, the placebo is a sugar pill (inert drug). In psychotherapy research, the placebo condition is an intervention in which minimal behavior change is expected.

Dissociative identity disorder (DID): treatments:

Controversial treatments, not always successful Hypnosis Personalities introduce selves to patient and recall traumatic experiences/memories Therapist suggests personalities served a purpose but now alternative coping strategies will be more effective Integrate personalities

Procedures in involuntary civil commitment (temporary action or longer detention after court hearing)

Court hears testimony of two independent professionals as well as others Length of treatment is finite (six to twelve months): California has a 5150 (72 hrs. hold) and 5250 (up to six months) holds.

Characteristics of rapists:

Create situations for sexual encounters Interpret friendliness as provocation, protest as insincerity Manipulate women with alcohol/other drugs Attribute failed attempts at sexual encounters to perceived negative features of the woman Childhood background of parental neglect/physical or sexual abuse Initiate coitus earlier and have more sexual partners than non-sexually aggressive men

Criminal Commitment

Criminal commitment: Incarceration of an individual for having committed a crime. Criminal law recognizes that some people lack the ability to discern the ramifications of their actions because they are mentally disturbed.

Criticisms for DSM-5:

Criticisms: not all diagnostic categories have good validity and reliability (e.g., poor agreement between clinicians of major depressive disorder and generalized anxiety disorder)

Criticisms to this:

Criticisms: subjective interpretation, cultural influences

Multicultural Perspectives

Culture is shared learned behaviors which is transmitted from generation to generation for the purposes of individual and societal growth, adjustment, and adaptation.

symptoms of mania physiological:

Decreased need for sleep, plus high levels of arousal

Irresistible impulse test:

Defendant is not criminally responsible if he/she lacked the will power to control his/her behavior

Competency to stand trial:

Defendant knows (the factual and rational understanding of the) nature of proceedings and can assist in own defense. Much more common than insanity issue

Penetrance:

Degree to which genetic characteristic is seen in people carrying a gene associated with it. Usually partial or incomplete penetrance.

Pathognomonic:

Degree to which symptom is specific to a disorder. Most people with mental disorders have poor family relations, low self-esteem, and poor social skills. These are not pathognomonic symptoms but indeterminate conditions. Problem of "fallacy of etiological specificity."

Pyromania:

Deliberate and purposeful fire setting on more than one occasion Intense pleasure or relief from setting ires, watching things burn, or observing firefighters and their efforts to put out the fires Driven by fascination rather than motives involving revenge, sabotage, or financial gains. High rates of mood and substance-use disorders.

John B. Watson:

Demonstrated acquisition of a phobia (exaggerated, seemingly illogical fear) using Classical conditioning paradigm

prevalence of suacide in these occupations is higher than others

Dentists - nobody is happy about going to the dentist. physicians lawyers law enforcement

Behavioral Activation Therapy

Depression results from diminished reinforcement

Learned Helplessness and Attributional Style

Depression results from learned helplessness: Belief that no relationship between behavior and consequences. Attribute outcomes to external, stable, and global causes. Seminal research induced depression in animals with uncontrollable shock. Dogs or rats that that were yoked to the ones with control so that they could not control the shock experienced learned helplessness whereas those with control did not experience learned helplessness.

Lecture 15

Depressive and Bipolar Disorders

Tests for Cognitive Impairment

Detect and assess organicity (damage or deterioration in the central nervous system) based on one's performance on mental tasks Bender-Gestalt Visual-Motor Test Halstead-Reitan Neuropsychological Test Battery

Genetic Linkage Studies:

Determine whether a disorder follows a genetic pattern.

Diagnosis of acute and post-traumatic stress disorder

Develops in response to specific traumatic event: experienced directly, witnessed, or experienced indirectly.

DSM-5 Alternative Personality Model

Diagnosis can be made via two routes: 1. Evidence of characteristics from one of six specific PD types (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, or schizotypal). 2. Evidence of moderate impairment in two key domains of personality functioning (identity, self-direction, empathy, or intimacy) combined with specific pathological personality traits.

Stress and depression

Diathesis (vulnerability) triggered by stress; one severe stressor more likely to cause depression than several minor stressors; stress and depression may have bi-directional relationship.

The Operant Conditioning model

Differs from classical conditioning: Operant conditioning is linked to voluntary, not involuntary, behaviors. In operant conditioning, behaviors are controlled by consequences that follow behavior, rather than precede it.

Displacement:

Directing an emotion, such as hostility or anxiety, toward a substitute target. Example: a meek clerk who is constantly belittled by her boss, builds up tremendous resentment and snaps at her family members instead of at her boss, who might fire her. Displacement is often used and directed toward people who are in an inferior or equal position, but not really superior to you.

Sociocultural:

Discrimination (actual and perceived), cultural roles

Dissociative Disorders:

Disorders in which person's identity, consciousness, or memory are significantly altered. Most are rare, but reports of dissociative identity disorder in United States have increased (now estimated that 5 percent of adult psychiatric unit patients have dissociative identity disorder)

Etiology of phobias Psychodynamic perspective:

Displaced sexual or aggressive conflict; phobic stimulus or situation has symbolic significance of real conflict that is threatening the person. Little Hans's fear that a horse would bite him represents his castration anxiety over Oedipal conflict with his father.

Practical Definitions

Distress Deviance Dysfunction Dangerousness

Withdrawal:

Distress/impairment in social occupational, other areas of functioning or physical or emotional symptoms (e.g. shaking, irritability, inability to concentrate) after reducing or ceasing intake.

Mood Disorders

Disturbances in emotions, thoughts, and behaviors that cause subjective discomfort, hinder a person's ability to function, or both 1. Depression 2. Mania

Criticisms of Biological Models

Do not account for abnormal behavior if biological causes are not found (e.g., phobias) Ignore environmental/societal/cultural influence Diathesis -Stress theory. Biochemical changes may occur because of environmental forces May foster helplessness by eliminating personal responsibility for well-being

Etiology and Treatment of Obesity

Dopaminergic activity - pleasure in eating Hormonal activity in hypothalamus - leptin Negative mood states and poor self-esteem Family environment: Social contagion theory - family member attitudes affect eating patterns; teasing and meal-time situations Treatments include dieting (relatively ineffective), lifestyle changes (calorie monitoring & exercise), medications (Orlistat), and gastric bypass surgery

Etiology and Treatment of Paraphilic Disorders Behavioral:

Early conditioning experiences of sexually deviant behaviors; treatment includes the use of extinction or aversive conditioning and developing appropriate behaviors

Lecture 19

Eating Disorders

Cognitive-behavioral treatment of panic disorder:

Educate about panic symptoms, restructure catastrophic thinking, self-induce physiological symptoms, self-controlled exposure, substitute coping statements, identify high-risk situations. Higher success rates in behavioral treatment than medication; 80 percent treated with cognitive behavioral treatments were panic free

Law of Effect:

Edward Thorndike noticed that behaviors followed by positive consequences are repeated. B. F. Skinner called this "reinforcement."

Effectiveness of Treatment:

Effective, but some studies suggest outcomes have been modest Most heroin and opiate addicts are using within one year Relapse rates for alcoholics and smokers are 67% and >50%, respectively. Problem of treatment adherence and persistence No single "best" treatment: Find the best combination of treatments for particular individuals with substance use disorders

Early (Premature) Ejaculation:

Ejaculation with minimal stimulation; ejaculation within 1 minute after coital entry.

Unconditioned Stimulus:

Elicits an unconditioned response

Mania:

Emotional state characterized by elevated mood, expansiveness, or irritability, often resulting in hyperactivity Risk of another depressive episode increases with each episode: 50% after one episode, 70% after second, 90% after third.

Depression:

Emotional state characterized by intense sadness, feelings of futility and worthlessness, and withdrawal from others

Recovery Model

Emphasizes optimism and collaborative support Views schizophrenia as a chronic medical condition like diabetes or heart disease Recovery or improvement is possible Healing involves separating one's identity from the illness and developing the ability to cope with psychiatric symptoms Empowerment helps correct the sense of powerlessness and dependence from traditional mental health care Establishing or strengthening social connections can facilitate healing

Cognitive-behavioral therapy:

Engagement and assessment: Problem conceptualization of how symptoms are developed. Very important in establishing therapeutic relationship and basis for change. Identifying negative or distorted beliefs and substituting more adaptive ones. Normalization Challenging false beliefs and correcting misattributions Developing new explanations and realistic beliefs Social skills training

Social:

Environmental stressors vs. strong support networks

Binge Eating Disorder

Essentially, BN without compensatory behaviors and bingeing at least once a week for 3 months 3+: Eat more rapidly than normal; uncomfortable feeling of fullness; eating large amounts of food even when not hungry; eating alone due to embarrassment; feeling depressed or guilty Lifetime prevalence is 3.5% (women) and 2% (men) of the general population Major problem involves being overweight Complications include high blood pressure, high cholesterol, and type 2 diabetes

Cognitive factors:

Etiology: Guilt, self-blame, cognitive set CBT Intervention: Psychoeducation, exposure, identify faulty thinking, replace with realistic cognitions, stress management/muscle relaxation

• Currently, in the mental health field, there has been a major movement toward emphasizing and prioritizing "evidence based practices."

Evidence-based practices (EBPs) in mental health refer to the development and use of only those psychological and medical interventions that have garnered some scientific basis or evidence that they are effective in treating a particular disorder

Rationalization:

Explaining your behavior by giving a well-thought-out and socially acceptable reasons that do not happen to be the real ones. Example: a student may explain flunking a test as follows: "I'm not interested in the course and so not really need it to graduate. Besides, i find the teacher extremely dull."

Behavioral treatments - most effective approaches usually involves combination of the following:

Exposure therapy Systematic desensitization Cognitive restructuring Modeling therapy

Expressed Emotion Index:

Expressed emotion index -- critical comments (criticism), dislike or resentment (hostility), and overconcern or overprotectiveness (emotional overinvolvement). EE associated with higher relapse rates in SZ. May be effect rather than cause of disorder (bidirectional) - SZ cause high EE which causes more stress and more severe symptoms of SZ. Not pathognomonic for schizophrenia, found in families of depressed, eating disorders patients - may be result of chronic illness and stress of caring for ill person; most evident in White American families.

Correlation

Extent to which change in one variable is accompanied by change in second variable Variables are not manipulated Is increase in one variable accompanied by increase or decrease in another variable? Shows degree of relationship, not the reason for the relationship

Stressor:

External event or situation that places a physical or psychological demand on a person.

Positive symptoms Disorganized motoric disturbances

Extreme activity levels, peculiar body movements or postures (catatonia), strange gestures or grimaces, or a combination Excited catatonia - agitated and hyperactive Withdrawn catatonia - unresponsive

antisocial personality disorder (APD): (sociopath)

Failure to conform to social and legal codes;lack of anxiety and guilt; irresponsible behaviors; arrogance; seek power over, manipulate, deceive, and exploit others. they see people simply as objects. after they go to prison, they will not change their behaviors.

Fearless or lack of anxiety (Lykken, 1982):

Failure to learn avoidance because of under-arousal (a genetic predisposition in ANS) which leads to less anxiety reactivity such that cannot learn from consequences. Avoidence learning task with shock - sociopaths made more erros than non-psychopathic prisoners who made more errors than students. All models point to dampened or less reactivity to aversive stimuli, which, in turn, results in less consequence-oriented anixety expericnes that hamper avoidance learing.

Effectiveness of family approaches:

Family approaches tend to be more effective in preventing relapse than drugs alone. One program placed high-EE family members with low-EE members in supportive group therapy format. This resulted in reduction in EE and in relapse. Combination of psychotherapy and medications constitute a very effective and promising intervention for SZ patients and their families.

Family Therapy:

Family system is dysfunctional and the actual client, the "identified patient" (IP) manifests the family's symptoms. The IP problems allow family members to avoid dealing with maladaptive relationships. Change in IP threatens equilibrium of system such that there is resistance to change. Therapist must modify family relationships.

Etiology of ADP Psychodynamic:

Faulty superego development; dominated by id impulses.

Agoraphobia:

Fear of being in public places without help; fear of panic symptoms; anxiety over symptoms can result in people being house-bound. DSM-5: Endorsement of fears from 2+ situations now required; 6-month duration of symptoms Lifetime prevalence: 3.5 percent for males, 7.0 percent for females Panic attacks precede agoraphobia, but relationship unclear; clear precipitating event in 75 percent of those surveyed in one nationwide survey Catastrophic thoughts of losing control, becoming ill, and other extreme outcomes often associated with agoraphobia.

Social anxiety disorder:

Fear of being scrutinized; fear of negative evaluation from others. One subcategory: Performance (i.e., public speaking). Lifetime prevalence: 11.1 percent for males, 15.5 percent for females; 8.7 percent annually Women twice as likely to have social phobia, but men are more likely to seek treatment

Depersonalization/derealization disorder:

Feelings of unreality and perceptual distortion of self or environment. Things feel strange or surreal. Most common form of dissociative disorder and is often precipitated by physical or psychological stress.

Orgasmic Disorders

Female Orgasmic Disorder Delayed Ejaculation Early(premature) ejaculation Genito-Pelvic Pain/Penetration Disorder

Treatment: Psychological:

Focus on developing better social relationships to counter reliance on "sick role."

Gender Dysphoria:

Formerly gender identity disorder -- controversy over whether these are true disorders and should be treated. DSM-5: Distress and impairment in functioning due to gender incongruence (mismatch) between one's experienced or expressed gender and one's assigned gender as a male or female

Illness Anxiety Disorder

Formerly known as hypochondriasis in DSM-IV High health anxiety about, preoccupation with, and oversensitivity to normal variations in bodily functions or sensations for at least six months Minimal or no somatic symptoms Cognitive disorder - believe they have a serious illness or are dying

Somatic Symptom Disorder

Formerly somatization disorder and pain disorders in the DSM-IV Characterized by excessive distress over somatic symptoms, accompanied by high levels of health related anxiety, maladaptive thoughts, feelings, and behaviors present for six months Two subtypes: Somatization or Pain features

Pathological Gambling:

From 1974-1992, the rate of gambling has increased by 19 fold. Gambling is now legal in some form in 48 of he 50 states. Current estimates are that the large majority of the United States population gambles. A 1989 Gallup poll found that 81% of the general population had gambled with 71% doing so in the past year and 31% doing it weekly. About 2 to 3 percent of adults are pathological gamblers. Seems to be an increasing problem. UCD study found 6 percent prevalence. Pathological gamblers often encounter family, job, financial, and legal difficulties as a result of their addiction.

Pathological Gambling

Gambling Disorder

Synapse:

Gap between axon of sending neuron and dendrites of receiving neuron

Genetic Explanation:

Genetic makeup plays an important role in developing abnormal conditions. Autonomic nervous system reactivity may be inherited. Hereditary factors are implicated in alcoholism, schizophrenia, and depression Genotype: Genetic makeup Phenotype: Observable physical and behavioral characteristics

Biological perspective:

Genetic predisposition for fear reactions but depends on the type of phobia with specific phobias having less of a genetic contribution than either agoraphobia or social phobias. Some evidence that individuals may inherit the disposition to develop phobias due to having usually high autonomic nervous system (ANS) reactivity - more likely to respond more intensively to external and internal stimuli, more easily aroused and more difficulty in habituating to stimuli

Etiology and treatment considerations for personality disorder:

Genetics - Tellegen et. al. (1998) concordance rate higher among identical twins (100% shared genetic material) than dizygotic twins. Family envorment: genetic characterisitcs may be reinforced by the environement. Environment niches may "protect" or perpetuate such adaptations. Treatment - stable personalities so there is no break with reality; thse people can function and are not in distress most of the time even thouh they can expereince great distress from interaction with others.

Diagnostic controversy

Great increases in diagnosis (one clinician reported 130 cases) Rare outside United States and Canada. Base rate for dissociation experiences may be high which clinicians misinterpret as dissociative identity disorder. Hard to separate faking from real behavior.

Narcissistic Personality Disorder:

Great sense of self-importance and entitlement, lack empathy, self-centered, and fantasies of power and control. so self centered - cant put yourself in other peoples shoes overly controlling because they are so into themselves.

Social-Relational Treatment Approaches

Group Therapy Family Therapy

Somatic Symptoms of GAD:

Heart palpitations, muscle tension, restlessness, trembling, sleep difficulties, poor concentration, persistent apprehension/nervousness

Mediating the effects of stressors

Helplessness or control - belief that no relationship exists between your behavior and consequences.

Etiology of Substance-use disorders: Biological:

Heredity and congenital factors: modeling occurs in non-familial.

Hopelessness and depression

High correlation between suicide and depression, but not at depths of depression when too low in energy. Hopelessness may be more a catalyst than depression. Beck, Emery, & Greenberg (1985) - 10 year study of psychiatric patients who had suicidal ideation; 14 of 207 eventually committed suicide, no differences between them and other patients on depression and suicidal ideation but higher levels of hopelessnessq

Determining Lethality in suicide prevention:

High: Many risk factors present plan well thought out and method extremely lethal Imminent danger Moderate: some risk factors present suicide ideation, but not specific less lethal method considered Low: minimal risk factors present vague reference to suicide but no real intent verbalized

Cognitive Approaches to Therapy

Highly specific learning experiences to teach clients to: Monitor negative, automatic thoughts Recognize connections between cognition, affect, and behavior Examine evidence for or against distorted automatic thoughts Substitute reality-oriented interpretations Identify and alter beliefs that predispose them to distort their experiences

Dysfunction(gap between function and performance)

How person functions in critical and important roles.

Genetics and Epigenetics:

How the environment affects or "programs" gene expression. Identifying the impact of environmental stressors during certain critical periods in child development. Epigenetics is a change in phenotype without a change in genotype.

Relapse Prevention:

Identify high-risk situations and seemingly irrelevant decisions (SIDs). Challenging Abstinence Violation Effect and using coping skills, rewarding self for coping. Develop effective coping: Problem-solving (fulfilling expectations and roles), interpersonal effectiveness (social skills, assertion, communication skills), emotion regulation, relaxation, and increasing self-efficacy. Building recovery support system.

Cognitive-behavioral therapy

Identify negative thoughts Link to depression Examine negative thoughts and decide if these can be supported. Replace distorted negative thoughts with realistic ones Steps: Monitor thoughts and substitute logical interpretations; increase activity level; and improve social skills.

Therapeutically for treatment:

Identifying and challenging cognitive distortions such as the Gambler's Fallacy, illusions of control, and irrational beliefs.

Treatment for Incest Offenders and Rapists Conventional treatments:

Imprisonment is the main form of social control but not treatment. Behavior therapies: (a) assess sexual preferences for stimuli, (b) aversion therapy for deviant responses, (c) orgasmic reconditioning or masturbation training to associate arousal to appropriate stimuli, (d) social skills and assertion training to empower person so does not victimize the powerless, and (e) assessment of impact. Effective with child molesters and exhibitionists; ineffective with rapists. Probably due to fact that rape involves violence and aggression as cues other than sex.

Lecture 12

Impulse Control Disorders

Obsessive-Compulsive Disorder (OCD)

In a given year, ~1% of U.S. adult population has OCD; no gender differences, but less common in AfAm and MexAm

Idiographic approach:

In-depth study of one person; valuable for clinical work. Idiographic approach emphasizes the uniqueness of individuals and their unique qualities such that an in-depth examination can only do justice to describing that person.

Male Erectile Disorder:

Inability to attain or maintain an erection sufficient for sexual intercourse and/or psychological arousal during sexual activity. Primary vs. secondary erectile dysfunction: Never able to successfully engage in sexual intercourse vs. cannot achieve an erection or penetration in 25%+ of attempts

Female sexual interest/arousal disorder:

Inability to attain or maintain physiological response and/or psychological arousal during sexual activity May be lifelong or acquired Often related to negative attitudes about sex or early sexual experiences Prevalence: Estimates vary from 10-50% of female population

Gambling Disorder:

Inability to resist gambling urges. Pathological gambling is defined as a problem of impulse control characterized by "persistent and recurrent maladaptive gambling behavior that disrupts personal, family, and vocational pursuits."

Incest

Incest - sexual relations between blood-related individuals too close to be married. Wide range of incidence estimates (48,000 to 250,000 cases per year); 75 percent of sibling incest is consensual. Most common is sibling incest not parent-child incest. Father-daughter incest: Daughter victims seriously affected - guilty and powerless in relationship, adversely affects future relationships with partners, related to drug abuse, sexual dysfunctions, and mental health problems. According to Herman & Hirschman (1981) 3 incest types: Socially isolated -- dependent on family for interpersonal needs and relationships, dependency needs expands into relations with daughter; sociopathic personality; pedophile -- pedophilic urges that involve most children in family, including daughter.

Etiology of OCD: Biological:

Increased metabolic activity in the frontal lobe of left hemisphere suggests dysregulation of the orbital frontal-caudate circuit (alerts rest of brain when something is wrong). In OCD, it is weakened, and disturbing thoughts may leak through. Response to medication also suggests serotonin deficiency. Heredity may also be involved.

Tolerance:

Increasing doses are necessary to achieve desired effect.

Etiology: Behavioral perspective:

Indirect avoidance of stress Socio-cognitive model: Rule-governed/goal-directed experiences and displays created, legitimized, and maintained by social reinforcement Iatrogenic: Created by the therapeutic situation (hypnotic suggestibility)

Environmental Factors in Schizophrenia

Infections or birth complications during fetal period a possibility - disrupts normal development. Negative family environments: Prospective studies found that high-risk children with negative family relations more likely to develop SZ than those with positive relations or positive parenting experiences. Environment a contributor to development in SZ but only for high-risk individuals.

Multicultural Models:

Inferiority Model - basic inadequacies Deficit Model - cultural deprivation Multicultural Model - contextualizing behavior

Part of the personality structure:

Instincts give rise to thoughts and actions and fuel their expression.

Panic Attacks:

Intense fear, fear of losing control, with somatic symptoms (e.g., intense heart pounding); can occur in all anxiety disorders

Stress:

Internal response to a stressor

Thematic Apperception Test (pictures):

Interpersonal conflicts and needs.

Psychotherapy and behavioral treatments for depressive disorders

Interpersonal psychotherapy -- short-term, psychodynamic treatment. Focus on conflicts in current relationships Linked to past life experiences and traumas The depression is treated like a terminal "disease" with the view that the goal of therapy then, is to make the disease end as soon as possible and to prevent future relapse.

Treatment of Mood Disorders

Interpersonal psychotherapy and cognitive-behavioral therapy are both effective for treating depression. Combination of psychotherapy and medication (imipramine) may be best Effects of treatment diminish over time, although cognitive therapy has better long-term outcomes CBT more effective in preventing relapse following treatment compared to antidepressants (Dobson et al., 2008)

Social perspectives (Joiner, 2005)

Interpersonal-psychological theory Two social dimensions must be experienced before suicide attempts are made: Perceived burdensomeness Thwarted belongingness Acquired capacity for suicide Reduction in fear of taking one's own life Repeated exposure to painful live events (habituation)

Major symptom clusters:

Intrusion symptoms - Re-experiencing terror of event, intrusive dreams, and memories Avoidance - Avoiding stimuli associated with trauma (e.g., thoughts, sensations, events, situations) Negative alterations in mood or cognition - associated with the event (e.g., emotional numbing, self-blame, anhedonia) Arousal and changes in reactivity - Heightened autonomic arousal - hypervigilance, startle reactions, concentration problems, sleep disturbance, irritable & aggressive behavior

Obsessions:

Intrusive, repetitive thoughts or images that produce anxiety. Most common obsessions: Children and adolescents - dirt, germs, disease, death, danger to oneself or loved ones. Adults - bodily wastes, secretions, dirt, germs, environmental contamination.

Civil Commitment

Involuntary commitment for protective confinement. When person is dangerous (to self or others), very bizarre, or likely to destroy property. Appears to involve a conflict between public good vs. individual rights

Somatic Symptom and Related Disorders

Involve (positive) physical or bodily symptoms associated with significant impairment or distress DSM-5: Physical illness may or may not be present

Ellis's ABC Theory of Personality:

Irrational Cognitive Process: A: Activating Event - "lost your job" B: Belief - "so terrible that this happened" C: Emotional and behavioral consequence - "depression" Rational intervention occurs at B - Belief - D: Disputing intervention - "this does not define you" E: New Effective Philosophy - "It's okay, I won't give up" F: New Feelings: - "It's okay to be frustrated, I won't give up"

Specific phobias:

Irrational fear to object or situation

Etiology and Treatment of ASD and PTSD Classical conditioning:

Lack of extinction due to avoidance; model cannot explain why most people who have been traumatized do not develop PTSD; perception of event very important.

Lecture 20

Law and Ethics in Abnormal Psychology

Modeling:

Learning by observing models and later imitating them (also called vicarious conditioning)

Classical Conditioning:

Learning principle in which involuntary responses to stimuli are learned through association

Treatment of impulse control Disorders:

Leisure (1989 notes two explanatory camps: - Impulse control problems on a continuum from problem-free to maladaptive (behavioral, cognitive, and sociological perspectives) - Impulse control disorders are a disease similar to alcoholism (psychodynamic and physiological perspectives).

Three type of life stressors:

Life event stress Daily hassles Traumatic stress

Etiology of Impulse Control Disorders:

Little information on these disorders. In some ways, they are like obsessive - compulsive disorders (compulsion), substance abuse disorders (addictive), or sexual deviance problems (intense, pleasurable release and experience). This makes them sort of difficult to treat. Question for clinician: how am i going to replace this behavior that is so pleasurable for this person.

Male hypoactive sexual desire disorder:

Little or no interest in sexual activities; recurrent lack of sexual interest

DSM-5 specifiers:

Living creatures, environmental conditions (such as thunder), blood/injections or injury (e.g., needle phobics) - usually associated with fainting, and situational factors (such as elevators, flying). Most common are small animals, heights, the dark, and being teased Two times more prevalent in women than in men; men may not admit to their fears more than women

Positive symptoms Disorganized thought and speech:

Loosening of associations (cognitive slippage): continual shifting from topic to topic without any apparent logical or meaningful connection between thoughts.

Biological explanations suicide:

Low-5HIAA (5-hydroxyindoleacetic acid - indicating low serotonin activity) related to violent suicide but also to depression. Low-5HIAA in suicidal individuals without history of depression; may predispose people to suicide - cannot account for psychological pain.

Etiology: Somatic Symptom Disorders Biological vulnerabilities

Lower pain threshold Heightened sensitivity to pain and somatic cues Chronic exposure to stressors

Stress and the Immune System Components

Lymphocytes (B-cells - produce antibodies, T-cells - detect and destroy foreign cells, and Natural Killer (NK) cells - kill tumor or virus-infected cells) Phagocytes - also destroy invasive agents Stress response causes release of neurohormones, some of which impair or inhibit immune system functioning.

Marriage and Family counseling

M.A. - Marital and Family therapy - works at private practice, or mental health centers

psychiatric social worker

M.S.W. - therapy; family and community advocacy - works at private hospitals and mental health centers.

magnification/minimization example

Magnifications and minimizations means a person distorts his or her reality by being far more negative than what others would perceive. A person's problems become larger than life, while the positive aspects of their life are ignored.

Operant Conditioning in Psychopathology

Maladaptive behaviors linked to environmental reinforcers Positive: Pleasurable, peak feelings (e.g., drug use) Negative: Escape/ avoidance (e.g., procrastination) Early behaviorists saw "inner life" as unscientific. Today, behavioral therapists acknowledge that internal mental life affects acquisition and treatment of disorders

Substance Use disorder:

Maladaptive pattern of use over 12-month period, characterized by (2+ symptoms): Notable impairment or distress Unsuccessful efforts to control use, despite knowledge of harmful effects as well as social, occupational, psychological, physical or safety problems Takes more of substance than intended Devotes considerable time to activities necessary to obtain the substance

Other Etiological Factors

Maladaptive perfectionism: (1) inflexible high standards (2) negative self-evaluations involving mistakes Anorexia: Perfectionism, obedience, academic and athletic success, model children Bulimia: Perfectionism, seasonal affective disorder Genetic factors: First-degree relatives and twin studies Levels of dopamine - desire to consume more/less food

Sexual Interest/Arousal Disorders

Male hypoactive sexual desire disorder Female sexual interest/arousal disorder Male Erectile Disorder

Treatment of phobias Biochemical treatments:

Many new drugs; benzodiazepines, SSRIs most commonly used drugs to treat phobias. Effective but effects confounded with exposure effects with the feared stimulus.

Other psychological factors with suicide:

Many who commit suicide have a mental disorder; 15% of those with mood disorders, schizophrenia, or substance abuse attempt to kill themselves; 50-67% of all suicides related to mood disorders.

learning expectations:

Marlatt, Deming, and Reid (1973): tested effects of expectations about alcohol vs. disease model of loss of control. Varied alcohol intake vs. expectation of alcohol. Told alcohol/tonic crossed with Given alcohol/tonic.

Etiology of Eating Disorders Societal influences:

Mass media portray ideal female body as 5'7" 110 lbs; actual average is 5'4" 166 lbs Sociocultural demand for thinness Peer influences Criticisms by family members about weight Dating Abnormal attitudes stronger when exposed to Western culture among college women. Huang's (2000) study of cultural values and eating disordered behaviors. Assessed ethnicity, ethnic identity, and self-construals and their relationship to disordered eating habits. Ethnicity (White), identification with WA culture and independent SC positively associated with compensatory behaviors (e.g., fasting, laxative use, vomiting, exercise). No ethnic differences in weight concern or bingeing. Family systems: Problematic family communication patterns result in anorexia; may be effect rather than cause (e.g., EE research). Sexual abuse: Assumed to be causal factor but little evidence supporting this relationship. Low self-esteem and feelings of helplessness Passivity, dependence, nonassertivness

Hypothesized that greater life change units produce greater chance of illness:

Measured stress with the Social Readjustment Rating Scale, and stress potential values are called life change units (LCUS).

Treatment of Dissociative Disorders

Medications treat accompanying anxiety or depression. Survivors of childhood sexual abuse who have dissociated are often treated with psychoeducation, use of group resources, and cognitive/social skills training.

Memorize Table of Phobias

Memorize Phobias

Choice of weapon

Men choose firearms Women choose barbiturate overdose and asphyxiation but increasingly use firearms and explosives Children jump from buildings or run into traffic Adolescents use hanging and drug overdoses

Biological challenge tests:

Monitor behavior change after presentation of a specific chemical or nutrient.

SuperEgo:

Moral judgments/moralistic considerations involve conscience & ego ideal

Reform movement (eighteenth and nineteenth centuries

Moral treatment movement which emphasized humane treatment of mental patients involving hygienic conditions, humanitarian care by staff, and rest and non-stressful living environments. 1st half of 19th century (1800-1860) moral treatment was preferred approach - involved emphasizing regular habits and activities and conducting self in moral and proper manner.

Frequency of Suicide:

More than 34,000 (~38,000) in United States yearly (an underestimate by some 25 to 30% - some suicides disguised as accidental deaths); 25 attempts for each completion.

• Role of spirituality and religion

More than 80% of Americans say religion is important Racial/ethnic minorities believe spiritual issues are tied to cultural identities Positive association between spirituality/religion and optimal health outcomes, longevity, and mental health

Sexual relationships with clients

Most common malpractice claim; considered to be one of the most serious of all ethical violations Therapists need to be objective and removed from their clients Therapist must terminate with the client and wait for 2 years or more before initiating a relationship of a sexual nature

Interviews:

Most commonly used technique of assessment in clinical psychology. Affected by professional discipline and theoretical orientation: Psychoanalysts emphasize early childhood experiences but Cognitive Behaviorists emphasize current thinking processes

Treatments of Pathological Gambling:

Most treatments are variants of CBT for PD Assessments of gambling patterns and money spent of gambling. SOGS and NODS used to assess gambling problems. Gamblers usually underestimate the amount they have gambled and the amount of money they have lost. Monitoring gambling wins and losses and assessing financial debts. - a sobering experience. Dealing with debts to family and friends, creditors, loan sharks and bookies, and the IRS. - this is easier for their community to support them because they wont feel angry toward them.

Behavioral Medicine:

Multi-disciplinary approach to health problems and medical conditions (e.g., cardiovascular disease, headaches, hypertension, and asthma).

Race/Ethnicity:

Multicultural Models

Observational learning:

Negative information and modeling are major factors accounting for childhood fears. Probably depends on if the model and observed situation can elicit a strong vicarious emotional response. Ollendick and King (1991) found that modeling (56%) accounted for childhood fears more than direct conditioning experiences (36%).

Cognitive behavioral:

Negative thoughts and overestimates of unpleasant future events in those with phobias; may be consequence of phobias rather than cause.

Etiology of panic disorder and generalized anxiety disorder Cognitive behavioral:

Negative thoughts or overattention to bodily sensations serve as internal triggers for panic attacks.

Double Blind Design

Neither subjects nor the researchers know which experimental conditions the participants are in. Controls for experimenter and participant bias

Neurons:

Nerve cells that transmit messages throughout the body

Physiological Factors in Schizophrenia tied more to the negative symptoms

Neurological findings: 20-75% of schizophrenics show neurological abnormalities (depends on study) Ventricular enleragement, smaller cortical structures (e.g. hippocampal and medial temporal lobes), decreases size of thalamus, abnormalites in prefrontla cortex Rapid loss of gray brain matter over time for early onset schizophrenia Structual characteristics of SZs may involve problems in connectivity among brain regions resulting in dysfunctional information processing.

Conditioned stimulus:

Neutral stimulus acquires some properties of another stimulus with which it is paired

Four effects of observational learning:

New behaviors may be acquired by watching a model. A model may elicit behaviors in an observer by providing cues. Behaviors formerly inhibited due to negative reactions may occur after observing a model. If observer sees a behavior by a model result in aversive consequences, the behavior may become inhibited.

With anxiety -

No loss of contact with reality; not a psychotic disorder However, cannot control the anxiety reactions or panic attacks.

Family communication and education:

Normalize family experience Educate family members about schizophrenia Identify strengths and competencies of pt. and family Develop problem solving, communication, and stress management skills Learn to cope with symptoms Recognize early signs of relapse Create supportive family environment - avoid blame and pathologizing and encourage concern and support for all

Lewinsohn's model:

Number of reinforcing events, availability of reinforcers, low social skills, and stress - factors that can reduce rate and availability of reinforcers.

Clues to suicidal intent

Number of risk factors that are present. Details about threat -- details, method, access to means for the suicide, type of method in terms of lethality. Verbal signals can be subtle cues reflecting intent or results of suicide and pain of living. Behavioral clues -- rehearsing act, making arrangements, time perspective.

Etiology: Cognitive and behavioral:

Obsessive-compulsive behaviors develop to reduce anxiety. The individual does not trust own memories and judgment and make attempts to determine if they did something "correctly." The uncertainty leads to rituals. Person is subject to disconfirmatory bias, probability bias, and morality bias.

Intelligence Tests Primary functions:

Obtain intelligence quotient (IQ), or estimate of current level of cognitive functioning Assess intellectual deterioration in psychotic disorders

Serotonin:

Occurs in the brain. works more or less in opposition to norepinephrine, suppressing activity and causing sleep. linked with anxiety disorders, mood disorders, and eating disorders.

Acetylcholine (ACh):

One of the most widespread neurotransmitters. Occurs in systems that control the muscles and in circuits related to attention and memory. Reduction in levels associated with Alzheimers Disease.

Bipolar Disorders

One or more manic or hypomanic episodes Mania for one week (Bipolar I); depression for 2 weeks and hypomania for at least four days (Bipolar II)

Incidence:

Onset(number of new cases) of a disorder over a period of time.

Theories of the addiction process Solomon (1980):

Opponent-process theory of acquired motivation: Occasional users have a different pattern of use than that of the chronic user (i.e., resting state-peak state-coming down state vs. craving-contentment-withdrawal)

Etiology: Social and sociocultural:

Overly critical parenting and adverse environments may be related to development of OCD. More common among the young and those who are divorced, separated, or unemployed. Less likely to be diagnosed in AfAm and HisAm than Whites.

Biological perspective

Panic disorder associated with oxygen misregulation resulting from dysfunction in the brain; erroneous messages that oxygen is insufficient that elicits hyperventilation and fears of suffocation. Disturbances in or lack of serotonin 5-HT1A receptors Genetic studies: Higher concordance rates for MZ than for DZ twins for panic disorder; less support for genetics in GAD

Etiology of Gender Dysphoria Behavioral perspective:

Parental encouragement of feminine behavior, lack of autonomy, overprotective/attentive mother, and lack of male model or playmates, peer ostracism.

Etiology Social/Sociocultural

Parental modeling and history of rejection Evidence of cultural variations in somatic symptoms in depression and other disorders. Psychosomatic vs. somatopsychic perspectives.

A significant correlation does not imply causation. Relationship can be bi-directional or caused by a third variable.

Parents Television Council (2007) correlational study: Relationship between violent TV programs and aggressive behavior Sanders and Giolas (1991) correlational study: Relationship between childhood abuse and dissociation

Family therapy:

Parents involved in meal planning, reduce criticism (understanding seriousness of anorexia), negotiate new relationship patterns, move toward separation and individuation. Prognosis is good for treatment of AN: 45-50% fully recovered, 30-40% had weight gain but still underweight

Dissociative amnesia:

Partial or total loss of personal information (due to traumatic event). Types of amnesia: localized - memory loss for a short time (most common type), dissociative fugue - amnesia plus travel; usually incomplete change of identity; recovery usually abrupt and complete (new DSM-5 specifier).

the control group

Participants are treated in ways that are very similar to the experimental group, but they do not receive an intervention or receive less of independent variable.

the experimental group

Participants exposed to the treatment or intervention.

how is time orientation related to how people feel in terms of depression

Past oriented people tend to be more depressed and high thoughts of suicide future oriented people have less thoughts of killing themselves present oriented people - 100% have no thoughts of killing themselves or wouldn't do it.

Gambler's Fallacy:

People are notoriously bad statisticians, especially young adults. -- past results affect future results. - this is the fallacy... ...because they don't!! "Oh i have been losing, therefore I have a win waiting for me."

Irrational/Maladaptive Assumptions and Thoughts Aaron Beck:

People engage in rigid, inflexible, and automatic interpretations of events.

Delayed Ejaculation:

Persistent delay or inability of man to ejaculate during partnered sexual activity, even with full arousal

Female orgasmic disorder (inhibited female orgasm):

Persistent delay or inability of woman to achieve orgasm with adequate clitoral stimulation. 10% of females have never achieved an orgasm.

Generalized Anxiety Disorder (GAD)

Persistent high levels of anxiety and excessive worry over major and minor life circumstances (more persistent, less intense than Panic Disorder) DSM-5: Symptoms present at least six months Most have co-morbid disorders: 2/3 of people with GAD have depression, substance abuse, or phobia. World-wide: Most frequently diagnosed anxiety disorder Lifetime Prevalence: 5%; twice as common in women as in men

Single-participant experiment:

Person's own behavior acts as own control condition. Person subjected to intervention and then no-intervention condition.

psychological:

Personality - positive vs. negative affect, hostility, depression

Lecture 11(start of final exam material)

Personality Psychopathology

Rorschach technique (inkblots):

Personality dispositions, conflicts, and needs.

Hardiness:

Personality style that tends to be resistant to stress.

Clinical psychologist

Ph.D. or Psych.D. - can do assessment, research, therapy, prevention, - works at private hospitals, mental health centers, universities

Etiology of ADP Learning:

Poor role models; neurobiological delays

Dangerousness

Potential for doing harm to self or others. More and more MH care providers are being asked to predict and act on dangerousness. Important issue because therapists now can be held legally accountable for failing to diagnose or predict dangerousness and for failing to protect public against dangerous individuals.

Etiology and Treatment of Sexual Dysfunctions Psychological factors and behavioral therapy:

Predisposing factors: Negative parental attitudes, strict religious upbringing, and trauma associated with molestation, rape, and incest. Current factors can include relationship stress, performance anxiety, self-focus, lack of accurate information about sexuality and sexual behavior/techniques, and guilt. Treatment usually includes education, anxiety reduction, identifying maladaptive thoughts and beliefs, structured behavioral exercises (i.e., graded progressive steps - non-genital fondling, genital fondling, intercourse, and lastly, orgasm) and communication training. Specific techniques for specific disorders: Masturbation for female orgasmic dysfunction, start-stop and squeeze techniques for early (premature) ejaculation, relaxation and successively larger dilators for vaginismus. Evaluation of behavior therapy: Questions about high success rate; relapse a concern - 75% had relapses.

Id:

Present from birth, it operates on the pleasure principle: Impulsive, pleasure-seeking aspect of being; immediate gratification of instinctual needs

Common Addictive Process?

Previous studies limited by only examining one addictive behavior resulting in the "fallacy of etiological specificity." It is unclear whether these factors are common (non-specific) risks for addictive behaviors, in general, or specific risks for a certain addictive behavior. The research has not differentiated between factors that place a person at risk for engagement in an addictive behavior as opposed to risk for developing problems in that behavior. Chan and Zane (under review) found that for both gambling and drinking the risk factor for engagement was sensation seeking whereas the risk factors for problems with gambling and drinking were anxiety and an impulsive coping style.

The assessment of Abnormal Behavior:

Primarily used to assess one's personality and psychological problems. Personality = stable, consistent organization of person's behavioral dispositions, attitudes, and values that determine how the person adapts and reacts to the environment.

Cognitive Explanations:

Primary disturbance in depression is negative thinking and low self-esteem. Beck -- schema (cognitive set) predisposes one for major depression.

Relaxation training:

Progressive muscle relaxation - tense and relax each muscle group.

Psychological tests and inventories

Projective Personality tests Rorschach technique (inkblots) Thematic Apperception Test (pictures)

Duty-to-warn principle (Tarasoff v. Board of Regents, 1976)

Prosenjit Poddar seen by therapist at Cowell Health Center (UCB) as dangerous. Therapist warned center director and police. Police temporarily detained him when he promised to stay away from Tatiana Tarasoff but later wounded her with a gun and stabbed her to death. Court ruled therapist must warn potential victim and others with victim. Privilege ends where harm to public begins.

Defense Mechanisms:

Protect the individual from anxiety Operate unconsciously Distort reality It's normal to use some strategies to reduce anxiety, but maladaptive when overused.

Jackson v. Indiana (1972):

Protects due process - must after reasonable time determine if person is competent; if not, must release person or begin civil commitment; seems to be still biased towards keeping person incarcerated, this time in the MH system. Double-bind: If person gets better s/he will be charged with crime; if not, will stay incarcerated.

Intelligence Tests Secondary function:

Provide clinical data Wechsler Scales and Stanford-Binet Scales

Etiology of Impulse Control Disorders Psychoanalytical:

Psychoanalytical theory stresses sexual symbolism and sexual gratification - release of tension thorugh certain acts such as gabling money or stealing

Dimension Two: Psychological Factors:

Psychodynamic Models Behavioral Models Cognitive Models Humanistic and Existential Models

Problems in interpreting genetic studies

Psychological disorder in nonschizophrenic parent often not considered such that the genetic contribution of SZ parent is overestimated. Varying definitions of concordance; schizophrenia spectrum includes schizoid, borderline, schizophreniform disorders. Bias in interviewers of relatives - non-blind studies Studies based on patients with severe and chronic conditions may inflate estimates of genetic influences.

Irrational/Maladaptive Assumptions and Thoughts Albert Ellis:

Psychological problems produced by irrational thought patterns stemming individual's belief system Unpleasant emotional responses result from one's unrealistic and irrational thoughts about an event, not the event itself. Irrational thinking operates from dogmatic, absolutist "shoulds," "musts," and "oughts" that cause human misery as "musturbatory activities."

Positive psychology

Psychologists should consider assets, strengths, and optimal human functioning Seeks balance - study, develop, and understand positive human qualities that build thriving individuals, families, and communities Focus on prevention rather than remediation

Psychosocial Therapy

Psychosocial therapy - involves using both medication and therapy. Institutional approaches: Milieu therapy -- patients involved in ward decision-making; programs to increase social skills, communication skills, self-care, and occupational skills through social learning-based treatments (differential reinforcement and modeling). Helps patients transition to community and decentralized services.

Empirically supported treatments

Psychotherapies and treatments that satisfy rigorous research criteria such as those involved in randomized clinical trials (RCTs) are referred to as empirically supported treatments (ESTs) or empirically validated treatments (EVTs).

Treatment of Gender Dysphoria

Psychotherapy with adults: Focused on accepting transgender status or decision to pursue more sex-consistent behavior. Gender reassignment surgery: Must pass "real-life" test in which clients change their whole life to desired gender status including dealing with relatives, friends, and co-workers. Many transsexuals become depressed or suicidal after surgery. Works for some but not for others; seems more effective for female conversion than male conversions.

Major changes and shift in psychiatric care in 1950s and 1960s due to 3 developments:

Psychotropic medication controlled symptoms; patients could function in their communities Maxwell Jones introduced concept of therapeutic community in England and Scotland. Assumed therapeutic potential rests with patients and staff Decentralization (and localization) of services in which patients would be assigned to wards for a particular city or region. Staff could network with community in providing aftercare and residents would be with their neighbors.

Effects of Rape

Rape trauma syndrome Psychological distress Phobic reactions Sexual dysfunction Consistent with PTSD Acute Phase: Disorganization - feelings of self-blame, fear, and depression Long Term Phase: Reorganization - deal with feelings and attempt to reorganize life

Rape:

Rape: An act of intercourse accomplished through force or threat of force Statutory rape: Sexual intercourse with a child younger than the age of consent Date rape: Majority of all rapes (8-25% of female college students report having "unwanted sexual intercourse") Sexual aggression by men is common

Development of measures:

Rational Method Using an Empirical Approach

Ego:

Realistic, rational part of mind, it operates on reality principle: Awareness of environmental demands, plus need to adjust behavior to meet these demands

Dendrites

Receive signals from other neurons

Kleptomania:

Recurrent failure to resist impulses to steal objects Do not need the objects for personal us and do not steal them for monetary value (usually have the money and typically discard, give away, or return the items). Irresistible urges/tension before stealing or shoplifting; relief/gratification after the theft. More common among females than males.

Behavioral Explanations:

Reduced reinforcement due to loss reduces availability of reinforcers and activity. Sympathy reinforces depression (secondary gain) Individual drives others away and loses social reinforcements In bipolar disorder, biogenic factors dominant but rewards for euphoria continue until negative reactions caused by decreasing tolerance of manic behavior bring on depression.

Anorexia Nervosa

Refusal to maintain normal weight, obsessive fear of becoming fat, body image distortion (denial and not recognizing thinness), and persistent behavior that interferes with weight gain; essentially self-starvation. Complications: Heart arrhythmias, low blood pressure, slow heart rate Mortality: Rate 6X higher than general population due to suicide, substance abuse, and effects of starvation Two subtypes Restricting - extreme dieting, constant fasting, and excessive exercising. Individuals tend to be introverted, little distress or dysphoria over fasting. Binge eating/purging - lose weight by self-induced vomiting, laxatives, or diuretics used often after binge eating episodes. Individuals tend to be extroverted, anxious, depressed, guilty, and older Lifetime prevalence: 0.9% females; 0.3% males Peak years 15 to 17 Primarily in adolescent girls and young women

Etiology Cognitive-Behavioral

Reinforcement and modeling of the (a) sick role, (b) preoccupation with bodily sensations, (c) misinterpreting physical symptoms as disease indicators.

Cognitive-behavioral interventions - used in anger and stress management.

Relaxation Skills Self-instruction - alter self statements; focus on task rather than on demands and expectations. Cognitive restructuring - identify, challenge, and modify irrational, distorted thinking and replace such cognitions with rational, task-oriented thoughts; use of "shoulds," ego-centric orientation. Assertion training

Negative Punishment:

Remove Stimulus and Behavior/response decreases.

Negative Reinforcement:

Remove Stimulus and Behavior/response increases

Types of Defense Mechanisms:

Repression Reaction Formation Projection Rationalization Displacement Undoing Regression

Reaction Formation

Repression of dangerous impulses, followed by converting them to their direct opposite. Example: a woman who gives birth to an unwanted child may become an extremely overprotective mother who is afraid to let her child out of sight and who showers the child with superficial attention.

Blind Design:

Researchers do not know purpose of research study. Controls for experimenter bias

Dangerousness

Responsible for assessing dangerousness (harm to self and others) and for protecting intended victims. Difficult to predict violence; use past behavior

Projection:

Ridding oneself of threatening desires or thoughts by attributing them to others. Example: a worker may mask unpleasant feelings of inadequacy by blaming his poor performance on the incompetence of fellow workers or on a conspiracy in which enemies are disrupting his life.

Treatment of OCD: Biochemical treatments

SSRIs to increase available serotonin (only 60-80% respond to these) Benzodiazepines less effective with OCD than other anxiety disorders Clomipramine (tricyclic antidepressant) in small dosages are taken by some AsAm and Whites due to metabolic differences

Treatment for Bipolar Disorders

Same forms of psychotherapy and behavior therapy used for unipolar disorder are used for bipolar disorder (particularly family therapy) Social Rhythm Therapy: Establish regular, daily routines to minimize or prevent swings in mood. Typical treatment for bipolar patient involves lithium carbonate, which is 60-80% effective. Negative physical side effects contribute to lack of compliance or self-regulation of dosage

Criticisms of Psychodynamic Models

Samples that Freud used were narrow in scope and types of individuals examined. The methods that he used to formulate his theory relied too heavily on anecdotal or case study approaches. Theories on female sexuality and personality seen as grounded in sexist and biased interpretations of female behavior. Such theories have little support empirically and neglect the important impact of sociocultural factors. Psychoanalytic therapy has limited application in that it seems most appropriate for well-educated, verbal, clients from middle class or upper class backgrounds.

Lecture 17

Schizophrenia Spectrum Disorders Diagnosis and Symptoms

Lecture 18

Schizophrenia Spectrum Disorders: Etiology and Treatment

Effects of social class:

Schizophrenia is disproportionately concentrated in poor areas of large cities and low-status occupations Breeder hypothesis Downward drift theory Migration/immigration and experiences of discrimination as a visible minority are additional stressors for predisposed individuals

Axons

Send signals to other neurons

Intermittent explosive disorder:

Separate and discrete episodes of loss of control over aggressive impulses, resulting in serious assaults on others or destruction of property. Aggressiveness is out of proportion to any stress. No signs of general aggressiveness between episodes; may feel remorse. Rare; more common among males than females.

Panic Disorder:

Severe and frightening episodes of apprehension and feelings of impending doom DSM-5: Recurrent unexpected panic attacks, plus at least one month of apprehension over having another attack

Dominant human instincts:

Sex and Aggression

Etiology and Treatment of Sexual Dysfunctions Biological factors and treatment:

Sex hormones - testosterone therapy for men and prolactin therapy for women now used. Insufficient blood flow in genitals - Vaginal (Kegel) exercises and masturbation to increase flow for women. Vascular surgery to increase blood flow, injections of vasodialating drugs into penis; and Viagra which increases vascular response by blocking the enzyme that breaks down the substance that expands arteries and relaxes the smooth muscle.

Lecture 14

Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders

Fetishistic Disorder:

Sexual arousal and attraction to non-animate objects or non-genital body parts. A problem because it may displace normal sexual relations.

Etiology and Treatment of Paraphilic Disorders Psychological:

Sexual deviations represent unconscious conflicts from childhood; castration anxiety; treatment involves helping the patient understand relationship between deviation and unconscious conflict

Paraphilic Disorders

Sexual urges and fantasies about situations, objects, or non-consenting people not part of the usual sexual arousal pattern associated with relationship-based sexual activity; must cause the individual or others significant distress.

Deinstitutionalization

Shifting of responsibility for the care of mental patients from large central institutions to agencies within local communities Mainstreaming - integrating mental patients back into the community - could be accomplished by providing local outpatient or transitory services May be responsible for placing on the streets many former patients who should remain institutionalized; many not receiving treatment Communities are ill-prepared and lack resources

Analogue studies

Simulate real situation under controlled conditions, usually done because real-life conditions difficult to study or difficult to control conditions in real life. Give insight into behavior but only an approximation of real life. Simulations often test people's capacities and not actual behavior or performance (e.g., practice vs. real game).

Criticisms of Cognitive Models

Skinner: Cognitions are not observable, so they cannot form the foundation of empiricism. Human behavior is more than thoughts and beliefs. Therapist, as teacher, expert, authority figure is direct and confrontational and may intimidate client and misidentify the disorder.

Dimension Three: Social Factors

Social Relational Models - Social isolation, poor social support, and lack of intimacy related to pathology Social-Relational Issues - Focus of Positive Psychology

-Schizoid personality disorder:

Social isolation, reclusive, withdrawn, and indifferent to others. Not motivated for social contact or intimacy. - they don't get lonely. they feel fine - they are indifferent to the presence of others - they dont really like to be around other people.

Commonalities of Group Therapy:

Social situation and social support - reduces isolation; interpersonal response in real-life context; and the development of new communication and social skills. Little research on effectiveness

Theoretical Perspectives

Sociocultural (Durkheim) suggests three categories; social conditions and changes can alienate people, thereby, increasing the risk for suicide.

Etiology and Treatment of Paraphilic Disorders Biological:

Some men predisposed - deficits in brain activation and less white matter

Direct effects:

Spouses of dementia victims, divorced or bereaving individuals, members of conflicted marriages all show weaker immune systems.

Decreased immunological functioning as a function of stress.

Stress triggers expression of existing pathogen - Cohen and associates (1998) found that 84% became infected with cold virus but only 40% developed cold symptoms; those with chronic stressors lasting > 1 month more likely to develop colds.

Indirect effects:

Stressed person eats poorly, gets less sleep; unhealthy life style may contribute to weaker immune system.

Etiology of panic disorder and generalized anxiety disorder Social/sociocultural:

Stressful childhood involving separation anxiety, family conflict, poverty, prejudice, trauma, and other environmental stressors

Lecture 13

Substance Related and Other Addictive Disorders

Treatment: Coping strategies:

Substituting alternative images, limiting access to gambling, limiting access to money, postpone gambling, imaging typical gambling outing, aversive conditioning using covert sensitization, and social support.

Alcohol consumption

Successful suicide without alcohol consumption is rare; 70% drink alcohol before act and 25% legally intoxicated. Alcohol foreshortens thinking and makes solution seem all-or-none - alcohol-induced myopia (limits one's perceptual field and analytical thinking) constricts problem-solving in already suicidal person (Steele & Josephs, 1990). Exacerbating factor, not causal one.

Lecture 16

Suicide

The Right to Suicide -- Moral, Ethical and Legal Implications

Suicide illegal and a sin (against Catholic canonical law) Prolongation of life leads to prolonged dying and suffering Ethics of life quality versus preservation of life Therapist confronted with suicidal client must think through conditions. Werth (1996): Hopeless condition, no interpersonal coercion, rational decision, consistent with values. These considerations not always independent of each other - is shame and obligation to family coercive? Therapist has responsibility to prevent suicide if possible; failure to do so can result in legal liability

Crisis Intervention

Suicide prevention centers: Many people in acute distress are not being treated for psychological problems and may be unaware of available services. Mixed results about effectiveness of centers Most contacts (99%) are by phone: Maintain contact/establish relationship Obtain necessary information Evaluate suicidal potential Clarify nature of stress and focal point Assess strengths and resources Recommend and initiate action plan

Amnesia and fugue (usually spontaneously remit): treatments:

Supportive counseling Treat depression and stress

Treatment for Incest Offenders and Rapists Controversial treatments:

Surgical castration - effectiveness is questionable. Chemical therapy -- the hormone, Depo-Provera, used to reduce sexual desire and urges.

Other Forms of Research:

Survey Research (including epidemiological research) Longitudinal vs. Cross-sectional Research Historical (Archival) Research Twin Studies (Genetic Linkage) Treatment Outcome Studies - Effectiveness vs. Change Mechanism Research Treatment Process Studies - Examine processes between therapist and client that result in certain outcomes Program Evaluation - Accountability of social change programs

3 processes are involved in clinical depression:

Symptom function; social and interpersonal relations; and personality and character problems. IPT is used to intervene in the first two

Scientific Method

Systematic method for describing and explaining phenomena incorporating the following principles: Empirical Verification Operational Definition Controlled Observation Statistical Generalization Empirical Confirmation

Observations:

Systematic monitoring and documentation of how the person behaves. Varies in terms of specificity of behavior from molecular to global which is associated with the level of inference required from the observer.

Etiology of Rape

Tends to do with aggression, power, and violence rather than sex. Power rapists -- to compensate for personal inadequacy and use intimidation. Anger rapists - anger and hostility at women in general. Sadistic rapists -- satisfaction from torture and pain Men with more sexually aggressive tendencies (sadistic, more likely to commit rape) are more sexually responsive to aggressive cues (e.g., non-consenting adults, pain and distress in women). Hall and associates (2000) - Loss of Face, Rape Myth acceptance, Hostility toward women, Alcohol use related to sexual aggression for AAs; for Whites, only Rape Myth acceptance and Hostility toward women related to aggression.

Self-Report Inventories

Test taker answers specific written questions or selects specific responses from a list of alternatives. Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2) Beck Depression Inventory

Losing:

The big win typically introduces this phase of losing: you start to lose because that's just the odds. gamblers start "chasing" they start betting more and more heavily to try to recuperate their losses. they develop compulsions and chasing.

What Are Some Contemporary Trends in Abnormal Psychology?

The drug revolution: 1950s: --Rapidly and dramatically decreased or eliminated symptoms --Deinstitutionalization --Prescription privileges for psychologists --Managed health care: Industrialization of health care has created major changes in mental health professions

DSM-5 Criteria for Schizophrenia:

The individual must have 1 of these core positive symptoms: 1. Delusions 2. Hallucinations 3. Disorganized speech(incoherence or frequent derailment)

Suicide:

The intentional, direct, and conscious taking of one's own life As the 10th leading cause of death in the U.S., it is considered a serious threat to public health. 2nd leading cause of death among college students Most therapists encounter a suicidal client; 1 of 4 will have an actual client suicide

Conditioned Response:

The learned response made to a previously neutral stimulus that has acquired some properties of another stimulus with which it was paired

Statistical Significance

The likelihood that a relationship could be due to chance alone

Compulsions:

The need to perform acts or to dwell on thoughts to reduce anxiety. Most common compulsions: Children and adolescents - excessive or ritualized washing, repeating rituals, checking behaviors.

Durham standard:

The products test -- Accused is not responsible if the unlawful act was the product of mental disease or defect

Base Rates:

The rates of natural occurrence of phenomena in the population studies

Unconditioned response:

The unlearned response made to an unconditioned stimulus

Weak willed - not true?

This stereotype ignores the fact that mental health problems are the result of major traumas, disordered learning histories, and biological vulnerabilities that are difficult to change or control without formal treatment.

Longitudinal study of adolescent drinking:

Those who expect social benefits drink more and endorse more positive social benefits to alcohol.

Cognitive manifestation:

Thoughts ranging from worry to panic; fears of losing control

Desperation of hopelessness:

To cope with the losses, the gambler starts borrowing money frequently and in large amounts. Most compulsive gamblers report that the initial experience of borrowing brings a feeling akin to that of the big win . The gambler conceals losses and manipulates family members and friends as she or he tries to pay off pressing debts. Borrowing upon borrowing upon borrowing. After numerous bailouts and repeated failures to keep promises to stop gambling, desperation, the third and final phase, sets in. Gambling continues with an all-consuming intensity and apparent disregard for family, friends, and employment.

Results of experiment:

Told alcohol conditions drank more than told tonic conditions and alcohol conditions drank as much as tonic condition. Demonstrates the effects of expectations about drugs on behavior.

Trauma Model`

Trauma model includes individual characteristics (e.g., cognitive processing abilities, anxiety, and depression), nature of the traumatic experience (e.g. life threat, survivor), cognitive processing and interpretation (coping response), and the recovery environment (e.g., social support, immediate stressors, cultural/societal attitudes) that determine if PTSD will occur. Individuals with a sensitized autonomic system & specific genetic factors are more likely to develop PTSD.

Treatment for Binge Eating Disorders -

Trearment is similar to that for BN, but weight control program usually supplements psychotherapy because many patients are overweight. CBT focuses on identifying beliefs and thoughts that trigger the binges, stress management, challenging distorted beliefs about eating, and acceptance of one's own body (critical issue). Weight monitoring and regular eating habits are also established. CBT effective in reducing bingeing but less effective in weight control. Weight control programs involve monitoring, reducing caloric intake, exercise, and controlled intake (delay and small portions). The last component involves cue exposure.

Treatment of APD:

Treatments are not very effective because ASPs do not experience distress or anxiety over behavior and cannot learn from experiences. Also their low level of arousal may affect attention to important cues associate with learning experience.

Treatment of Mood Disorders Biomedical treatments for depressive disorders: Types of medication:

Tricyclic antidepressants (TCAs) Heterocyclic antidepressants (HCAs) Monoamine Oxidase Inhibitors (MAOIs) Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) Abrupt cessation of some antidepressants can result in a discontinuation syndrome (flu-like) Increased risk for suicide among <25 year-olds

Environment confounded with genetics - shared genes and environment

Twin studies -- concordance rate for MZ twins should be higher than that for DZ twins. Generally, concordance rates for schizophrenia are two to four times higher in MZ than DZ twins. MZ concordance ranges from 0 to 86 percent because definitions of schizophrenia spectrum can vary.

Dissociative identity disorder (formerly multiple personality disorder) Characteristics:

Two or more independent personalities exist in one person; core set of symptoms (Gleaves, 1996) - amnesia, lack of personal memory of childhood and/or daily events; chronic depersonalization; alteration of identity; experience of possession with a new identity; and may be observable by others or self-reported. One personality evident at a time; usually there is amnesia in personality that is not present, but one personality may have awareness of other personalities Often opposite personalities that reflect different mood and attentional states that are often in conflict or unacceptable to the person.

Iatrogenic effects:

Unintended changes in behavior due to treatment. For example, hypnosis by therapist may create memories among patients.

Etiology of Gender Dysphoria Psychodynamic perspective:

Unresolved Oedipal complex, unsuccessful separation and individuation results from inability to resolve conflict.

Deviance

Unusual or rare experiences which usually are distressing. At times, not distressing as with paranoia

Empirical Approach:

Using empirical approach the only criteria for item inclusion is that it can distinguish the criterion group from the control group. Used to identify individuals who are likely to be sociopaths, juvenile delinquents, actors, professional sports athletes, good sales people, sorority members.

Genito-Pelvic Pain/Penetration Disorder:

Vaginismus: An involuntary spasm of the outer third of the vaginal wall, preventing or interfering with sexual intercourse. Relatively rare. Dyspareunia: Recurrent or persistent pain in the genitals in the process of sexual intercourse. Prevalence: 17-19% lifetime.

Problems:

Validity of observations when patient is from another culture. Reactivity - knowledge or awareness of being observed affects person's behavior.

Operant Conditioning:

Voluntary behaviors are controlled by the consequences that follow them.

Substance Related Disorders:

When the use of psychoactive substances causes social, occupational, or physical problems. Use of legal or illegal psychoactive substances that directly affect the central nervous system (CNS) to alter physical and psychological states. 23.9 million adolescents and adults (9.2% of population) use illicit drugs (SAMHSA, 2012)

Clinical Significance

Whether a statistically significant finding has any practical relevance in a clinical setting.

Group therapy:

Wide range of formats, theoretical perspectives, and purposes.

Gender and depression:

Women twice as likely as men to become depressed; gender differences may reflect differences in illness behavior; Nolen-Hoeksema (1991) concludes women ruminate over moods while men tend to minimize dysphoria. Gender differences in emotion regulation may account for differences in rate of depression.

Psychotherapy

Work on safety issues, stabilization, symptom reduction Identifying and working through traumatic memories and experiences Integrate personalities

Schemas:

a cognitive model - Sets of underlying assumptions influenced by experiences, values, and perceived capabilities

Selective abstraction example

a detail is taken out of context and believed whilst everything else in the context is ignored

Relapse:

a full return to addictive patterns. It is important to stress the likelihood of relapse to the patient ahead of time to inform them of it because the possibility is very likely. - and what to do when they feel like they are about to relapse or slip up. - what do they do? they don't inhibit the possibility of gambling but rather a behavior that is incompatible with gambling and then reward themselves.

therapeutic community:

a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach was usually residential, with the clients and therapists living together, but increasingly residential units have been superseded by day units.

Arbitrary Inference Example

a person quickly draws a conclusion without the requisite evidence

Two types of alcoholism:

a) Familial -- Family history of alcoholism, suggesting genetic predisposition (Codoret and Wesner, 1990) and b) non-familial: environmental factors

Cultural Relativism

abnormality and abnormal behavior defined and determined by culture and worldviews

Guilty, but mentally ill --

adopted after John Hinkley verdict; Insanity Reform Act (1984) bases insanity solely on ability to understand what one did. Based on recognition that MI people are not always psychotic.

Conversion Disorder

aka: Functional Neurological Symptom Disorder Motor, sensory, or seizure-like symptoms incongruent with recognized neurological or medical disorder Onset of symptoms often related to traumas or other stressors

8 - 15:

already expereincing moderate alcoholism

Psychiatrist

an MD, can prescribe medication, does therapy - located in private practice, hospitals, or mental health facilities. - have to go to med school

overgeneralization example

an error that involves coming to a conclusion based on information that is too general and/or not specific enough. This is like looking at a whale and concluding that "since it lives in water and has fins it must be a fish."

Correlation between prevalence and people who:

are financially dependent Men ages 30-44 unemployed not white urban unmarried and cohabited not completed high school

Treatments often include:

behavioral and cognitive methods; can include family and self-help groups (such as Gamblers Anonymous).

most of research on:

borderline personality disorder and antosocial personality disorder because they are thought to have the most dangerous impact on society which is not necessarily true - the media has exxaggerated and sometimes stereotypical protrayals of these disorders.

long-term physiological effects:

brain damage, physical deterioration and malnutrition, liver disease such as cirrhosis, heart failure, and cancers of mouth and throat.

Neurological tests -

brain dysfunctions due to structural damage or biochemical/physiological processes or functioning.

Nicotine effects

cessation leads to withdrawal; use leads to lung cancer, emphysema smoking is single most preventable casue of death in the US; accounts for 1/6 deaths in US.

Cognitive restructuring

challenges catastrophic thinking and self-focus

heavy drinking:

chronic drinking, average 2+ drinks per day for men and 1+ for women.

describe the impact of civil commitment or involuntary confinement on the world and mental health:

civil commitment infringes on our rights in America of being innocent until proven guilty - we cant lock anyone up forcefully without evidence and in many cases there is no evidence until after a mental break and people get hurt - until then all we have it warning, worry, and waiting.

How Powerful Are Thoughts in Causing Mental Disorders?

cognitive models

Negative Symptoms

deficiencies in aspects of normal functioning negative symptoms: flat affect (little or no emotion in situations in which strong reactions are expected), alogia(poverty of speech), apathy, anhedonia, and avolition (inability to take action or to become goal oriented) primary (arise from schizophrenia itself) secondary (response to medication or hospitilzation) - flat affect could be moslty a secondary symptom associated with poor prognosis and may be related to structural abnormality in brain;less responsive to medication, somewhat respinsive to therapy.

Standardization:

degree of structure determined by the relative presence (structured) or absence of specific data and information procedures (e.g., questions, probes) that must be followed.

Current treatments focus on...

different personalities as symptoms and addressing the stress and/or trauma that created these symptoms rather than working for personality integration. Common feature of most therapies is emphasis on having client work through or cope with stressful or trauma that precipitated the dissociative experience

Cultural Universality

disorders and their manifestation same regardless of culture, similar etiology, symptomatology, and course of illness for specific disorders

Schizophrenia

disorders of thought or cognition; severe dysfunctions in the processes of thinking, perception, judgment, and recognition. Lifetime prevalence in United States is 1 percent (males and females equally). Onset later in females

Etiology of borderline cognitive

distorted or inaccurate attributions about others; behaviors or beliefs about the self. Faulty beliefs: dangerous world, powerless self, and unacceptable person (Beck et. al 1990).

Posisitve symptoms of schizophrenia

distortions or excesses in aspects of normal functioning delusions: false beliefs firmly and consistently held despite disconfirming evidence or logic delusions of grandeur - Grandiose delusions involve the belief that he/she has exceptional power, talent or worth, or is someone famous. He/she may believe he/she is God or some other type of deity. delusions of control - someone is controlling you (behavior) delusions of persecution - The schizophrenic believes that he/she is being followed or is under surveillance, or that he/she is being made fun of, tricked, or treated very unfairly by others delusions of thought broadcasting - broadcasting their thoughts so that others can hear them, usually against his/her will. delusions of reference - This is when the person believes, for example, that things written in a newspaper or stated in a newscast, passages found in a book, or the words in a song are about him/her. thought withdrawal - someone is taking your thoughts out of your brain Capgras's syndrome - the irrational belief that a familiar person or place has been replaced with an exact duplicate — an imposter --look all of these up - which three are the most common? - persecutory is most common.

what is the main difference between anxiety and personality disorder criteria?

distress is not a criteria for personality disorder beause the person is not sometimes aware or distressed.

Biochemistry

dopamine hypothesis (excessive dopamine activity at the synpatic sites - pridcues posisitve symptoms Effective drugs (Phenothiazines) reduce dopamine activity by blocking receptor sites on dendrites L-dopa (trwats Parkinsons disease) -- body converts it to dopamine, and this can produce schizophrenia-like symptoms. - can increase potitive symptoms Extensive amphetamine use (which increases dopmine and norepinephrine levels) - mimic paranoid SZ symptoms Problems: Sizable minority (25%) of schizophrenics unrespinsive to drugs ; effectiveness of 2nd generation anitpsychotics (works on serotonin system) implicates other neurotransmitters in etiology of SZ

Chronic substance abuse alters

dopamine reward pathways and parts of brain associated with decision-making

Symptoms of Mania Affective:

elevated, expansive, grandiose(deluded)ex: i am going to get 4 degrees, my law, doctoate and masters in one month) , irritable mood; if frustrated, may become beligerent. impaired social and occupational functioing boundless energy, enthusiasm, self-assertion

Adoption studies

eliminates environmental influence in twin studies; includes controls that had non-SZ mothers but same adoption procedures. In Heston (1966) study, 0 of 50 controls become schizophrenic, versus 5 of 47 in at-risk group. confounds in results: Mother's status known to adoptable parents that may have affected behavior toward the child and antipsychotic drug use by mother during pregnancy could have contributed to disorder. families of adoptive parents whose children developed schizophrenia show no schizophrenia; only biological relatives of adoptive child who became schizophrenic show the disorder - 4.7% SZ and 8.2% spectrum. no increase in rate o disorder when adoptive family shows schizophrenic symptoms but child had normal biological parents.

binge drinking:

episodic drinking; 5+ drinks for men (4+ drinks for women) in a single episode.

5% of people who use alcohol are physiological deoendance (1/20 people)

even though you become an addict, you dont always ebcome physilogical dependent - it mostly comes from psychologicial dependence.

Disorder due to inheritance - not true?

evidence for schizophrenia, mental retardation, bipolar disorders; heredity may make certain people more vulnerable, but environmental factors are very important.

Treatment: Replacing these distortions with realistic thinking about gambling:

ex: I can relax in other ways, odds of winning or losing do not change depending on the circumstances.

Social and sociocultural factors

ex: peer pressure, marketing - pathonogmonic?

Bailouts:

experienced as a big win - when they get loans or successfully borrow money to pay off debts.

above 15:

experiencing high levels of alcoholism

borderline personality disorder:

extreme fluctuations in mood and behabior; unstable and intsnes erelationshps; feelings of emptimnss; impulsive and capricious behaviors. PErson has problems in identity and relationshiops and in regulating emotions. biggest problem: emotion regulation - makes it difficult to have relationships. most commonly diagnosed personality disorder in inpatient and out patient.

Etiology of borderline social learning:

faulty self-identity affecting development of goals and coping with emotions; conflict between attachment needs and fear of engagement or engulfment.

Avoidant personality disorder:

fears rejection, humiliation, and reluctance to enter relationships; negative sense of self; low self-esteem; avoid social situations; overly sensitive of criticism; crave affection and an active social life. doesn't make eye contact, drive people away by making them uncomfortable so that they do not have to interact with them. they will often times anticipate such a negative reaction to other people that they will often avoid other people because they feel this sense of rejection and that it will be the outcome of any social situation they have. so they want to interract with people but they feel so negative about the outcome that they avod people.

shorttt-term

few months to few days

symptoms of mania cognitive

flightiness, pressured thoughts, lack of focus and attention, poor judgment

Cognitive-behavioral treatment of GAD:

focus on worrisome thoughts, discriminate between realistic and irrational worries, challenge irrational and catastrophic beliefs underlying worry, substitute coping and problem-solving thoughts, and use relaxation to counter somatic symptoms.

Endorphines:

found in the brain and spinal cords - suppresses pain

Prevalence of major disorders

from highest prevalence to lowest prevalence: Phobias - around 14% of population. alcohol abuse/dependence major depressive episode drug abuse/dependence antisocial personality OCD Panic Schizophrenia Manic episode.

Whales:

gamble over 1 million dollars in one week.

Illusions of control:

gamblers feel that they can control certain things with their rituals or superstitions or systems.

First to get them out of denial:

get them to keep track and monitor their gambling: to see how much they spend and lose.

Winning:

gets lucky or has a strategy that they think makes them the exception, that they're special. this feeling persists and furthers their gambling. they develop gambling tendencies.

Dependent personality disorder:

great reliance on others and unwilling to accept personal responsibility. they are like a human barnacle, they latch on and externalize. impairment in interpersonal relationships.

short-term psychological effects-

happiness, poor judgement, lose concentration, loss of inhibitions including inhibitory anxiety, Newcomb, Chou, Bentler, and Huba, C.J. (1988): Different motives for use: Reduce negative affect, enhance positive affect, addiction, enhance social afilliation, enhance sexual performance.

Prop bets:

has to do with the game, but not with the outcome.

loss of contact with reality:

having experiences that most people wouldnt have with every day interactions - for example, thinking the milk is poisoned. - delusions, hallucinations.

this guy example:

he suspected his wife was cheating on him so he went into his drawer and pulled out all of his condoms. he wrote down all the serial numbers to see if she used any of them. why? because i don't want her to use my condoms - but she's cheating on you, but i don't want her to use my supply i don't care.

example:

he thought he was not from this earth - that he was an alien, so he didnt think that the law applied to him so he got in trouble alot. - this odd thinking would get him in trouble. - he wasnt doing it to manipulateother people or further his own needs - he was doing it because he truly thought that he was alien. He has conact with reality, he has these starnge set of ideas.

Suicide and Occupation --

high rates among physicians, lawyers, law-enforcement personnel, and dentists

cultural issues

highly stigmatized in certain cultures may be diagnosed more often in individuals who are african american than other ethnic groups (in U.S.) Hispnaic Americans may have lower prevalence, but this may be due to underreporting no gender differences in prevalence

By second half of 19th century ...

hospitals had become overcrowded, treatment was inadequate. Mentally disturbed seen as organically caused and incurable For example, Worcester State Hospital: 1830-1870 avg. stay = 1 year. By 1950 average stay = 5 years.

Treatment involves:

identifying and rating different activities in terms of pleasure and mastery performing some of the selected activities Identifying problems and using behavior techniques to deal with them Improving social and assertiveness skills

Personality Disorder:

impairment in identity or sense of self and interpersonal functioning. Level of impairment: 0 = no impairment to 4 = extreme impairment. Must have mild impairment in both domains. one or more pathological personality types or traits.

Etiology of APD Social environemtn:

impoverished backgrounds, poor parental supervision and involvement; neglect, maltreatment, and abuse; rejection or deprivation by parents.

why is mental illness a cost and burden to society?

inadequate knowledge about causes, treatment, and prevention Mental disorders account for more than 15% of the overall burden of disease from all causes. Mental illness/health must become part of public policy

Psychodynamic explanations focus on introjected anger

incorporated love object so that suicide is anger directed toward this person the object of overidentification; little research support for this model.

long-term psychological effects

increased drinking in all occasions, increased tolerance, preoccupied with supply, drink only until intoxicated, impaired functioning.

Helplessness

increases epinephrine levels and feelings of tension and depression.

if you score above an 8:

indicates either hazardous use or harmful alcohol - you may be becoming dependent on alcohol

Biofeedback:

information (feedback) on internal changes gives patient a means of altering physiological response. An operant technique - feedback serves as reinforcer. Used for high blood pressure, tension and migraine headaches, muscle tensions, blood flow control.

Treatment of Eating Disorders Anorexia Nervosa:

inpatient/outpatient deoends on weight and health of individual initial goal: restore weight with psychological support nutritional/physical rehabilitation identify/understand dysfunctional attitudes improve interpersonal/social functioning adress comorbid psychopathology/psychological conflicts

the lillustrate=or is always involved in making comuication and adapter is for managing anxiety also got her into a social group best way to prevent somehting is to get a person to engage in a behavior that incompatible with the behavior that they want to do ex: socialize when you want to restrict and withdraw. gain two pounds a week for phsycial goals and nutritional goals.

interpersonal skills

Jim example:

jim said i dont kwant to say anything to you and you need to turn off the tape recorder "theres no tape recorder jim" "thats what they all say" "he said if i go through your drawer, then i'll find a tape recroder" "but its not on!" the exapmle form this show that they will find anuythign to interpreyt and confirm their paranoia, engaging in this only enavles the paranoia.

example for dependent disorder:

lawyer who was a clerk - someone said youre the best clerk ive ever had, now she went into sepression , because now she thought she could fail, because now she cant overachieve. the bar is now set too high.

moderate drinking:

low-risk pattern of drinking 1-2 drinks per day occasionally

prevalence of men and women differences

men have higher prevalence in substance abuse than women women have higher prevalence in anxiety and affective mood disorder than men

Modeling therapy -

model should be similar to patient in characteristics

Persistent Depressive Disorder (formerly: Dysthymia):

mood is chronic and continual Ongoing presence of 2+ symptoms: feelings of hopelessness, low self-esteem, poor appetite or overeating, low energy or fatigue, difficulty concentrating or making decisions, sleeping too much/little

Easily recognized as deviant - not true?

most of time the MD do not have symptoms, no clear distinction between normal and abnormal.

Major Depression(Major Depressive Disorder;MDD;unipolar depressive disorder; unipolar illness;

no history of mania severe depression symptoms lasting two weeks or more and represents change from earlier functioning consistent pattern of (a) depressed mood, feelings of sadness or emptiness and/or (b) loss of interest or pleasure in previously enjoyed activities Four additional changes in functioning: significant alteration in weight or appetite, atypical sleep patterns; restlessness or sluggishness; low energy; feelings of guilt or worthlessness, difficulty concentrating or making decisions, preoccupation with death or suicide.

Insanity defense --

not responsible for criminal actions; mentally disturbed at time committed the crime.

Etiology of borderline: psychodynamic:

object splitting results in emotional fluctuations; no sense of boundaries so extreme ambivalence over dependency and terror over losing one's self to another. (Kerberg, 1976).

Norepinephrine:

occurs widely in the central nervous system. regulates moods and may increase arousal and alertness. often associated with mood disorders and eating disorders.

what do you do?

open the door roll your chair out form your desk - but dont do too much or youll feed into the idea that you are suspicious

in the study of the 70 colleges

over half had thoughts of suacide

long term:

over severl years

Four types of anxiety disorders:

panic disorder, generalized anxiety disorder , phobias, and agoraphobia

time orientation

past oriented present oriented or future oriented

alot of personality tyoes have less data because:

people are not in distress so they are not motivated to go seek help.

Obsessive- compulsive personality disorders:

perfectionism, tendecny to be interpersonally controlling, devotion to details, and rigidity. Differs from OCD: involves traits (e.g. perfectionsism, inflexibility) rather than recurrent thoughts and repetitive behaviors. they dont have obsessions and compulsions, but they do have perfectionsim qualities and are controlling. when you talk to them - this is their mantra: maybe I'm rigid of judgmental, but i just have really high standards.

Are Early Childhood Experiences and Unconscious Motivations Important in Determining Mental Health?

perhaps... Psychodynamic models:

Psychophysiological disorders -

physical illnesses that have a strong psychological basis or component, which are distinguished from illnesses that are strictly organic problems. Distinct from conversion disorder: Actual tissue damage in psychophysiological disorders.

the course of schizophrenia

premorbid personality usually impaired with respect to negative symptoms. prodromal phase: progressive development of SZ symptoms; withdrawal ad peculiar actions or talk. Active phase - manifestation of full blown symptoms. Residual phase -- symptoms no longer prominent although full recovery is rare; still can be productive; seen as a chronic illness similar to hypertension, diabetes, cancer Long term outcome studies: chronic condition but majority of patients have significant recovery and can lead productive lives. prognosis favorable in over 50% of cases in one study (Rabinowitz et al., 2007) even when stringent DSM criteria applied.

cognitive symptoms:

problems with attention and memory poor "executive functioning" difficulty developing a plan of action Often present prior to the onset of the first psychotic episode, persist even with treatment, and are found to a lesser degree among nonpsychotic relatives of patients with schizophrenia

Limitations of tension-reduction:

prolonged drinking associated with anxiety and depression.

symptoms of mania behavioral:

pronounced overactivity, grandiosity, irritability; incoherent speech, no tolerance for criticism or restraint, uninhibited, impulsive sexual activity, abusive discourse.

Immigration and Acculturative Stress

psychological, physical, and social pressures associated with moving to a new country

cocaine: effects:

reduces fatigue, produces euphoria and feelings of confidence; when smoked (crack), prodcued quicker effects; physical as well as pychological addiction can develop, sometimes after short period use; depression when high wears off.

Psychological dependence is the cause of

relapse

Self-efficacy

related to better response to treatment.

how does this develop?

research shows it sort of fluctuates or "develops as a young adult and once you hit mid adulthood people become very set in their ways.

MZ twins have highest morbidity risk - close to 50% child of two affected parents - a little more than 45% DZ twins 17% child of one affected parent 16% siblings 8% parents 6% half-sibling 5.5% grand-child 5% niece and nephew 4% cousin 3% uncle and aunt 2.5% grand-parent 2% Spouse 1% No relationship - 1% or lower

risk of heredity in schizophrenia

main difference between schizotypal and schizoid:

schizoid: totally isolated schizotypal: just has really strange ideas about the world.

What is Abnormal Psychology?

scientific study aimed at describing, explaining, predicting, and treating strange or unusual behavior.

histrionic personality disorder:

self-dramatizing, attention seeking, and exxaggerated emotions; originally this was the hysterical personality. Person is extroverted, talkative, very superficial in relationships, tends to have physical symptoms under conditions of emotional stress. they have a lot of friends, but they aren't close to any of them. secondary gain of somatic symptoms pays off for them because they get more attention. they have a lot of problems with relationships.

Positive symptoms Perceptive dysfunction: Hallucination:

sensory perceptions not directly ttributable to environmental stimuli (appear real to the schizophrenic): -Auditory (hearing) -Visual (seeing) -Olfactory (smelling) - Schintushitzu? in japan? -taxtile (feelings) -gustatory (tasting)

Margarette example:

she has borderline personality disorder they are very difficult to treat because of the extreme fluctuation first session with Margarette - she asked if he could tell if anything was different about her. she said she was wearing a wig because she pulled out all of her hair last night. she ended the session by saying: you are the best therapist i have ever had! next week she comes in and says that she is very angry with him because he didnt allow her enough time to explain herself, she says, youre a terrible therapist! you dont know how to connect with people!

Effects of alcohol:

short-term physiological effects - blood alcohol level of 0.1: muscular coordination and speech impaired: .3: lose consciousness or die.

symptoms of depression psychomotor retardation:

slowing of bodily movements, expressive gestures, and spontaneous respinses

this is a categorical system:

so the degree of antisocial disorder is categorical - if you fit the criteria, you are a sociopath.

Socioeconomic Class

social class differences in life stress, vulnerability to pathology, and treatment experience

symptoms of depression behavioral

social withdrawal, lowered work productivity, lack of personal cleanliness, slow speech, anhedonia

Biological Treatment

some evidence that PTSD is associated with an alteration in the neural and biological systems resulting in a hypersensitivity to stimuli similar to or related to the traumatic event. Tricyclic antidepressants and SSRIs have been effective in treating ASD and PTSD with SSRIs as the current treatment of choice.

example of whale family:

spent over 10 million on staying in Tahoe, and a lot of money in gambling: shows a lot of enabling from society for gambling disorders.

Personality :

stable consistent organization of individuals behavioral dispositions, attitudes, and values that determine how the person adapts and reacts to the environment.

Etiology of borderline Biological Factors:

structural abnormalities in the prefrontal cortex and different patterns of activation in amygdala; these structures are involved in emotional processing and regulation.

Alcohol use: Depressants or sedatives:

substances depress central nervous system, increase relaxation, lower inhibitions and anxiety.

Anomic suicide --

sudden change in individual's lifestyle or status, cannot cope with this disequilibrium.

Therapy:

systematic intervention aimed at modifying client's behavioral, emotional, and/or cognitive state.

study on asian children:

teachers characterize asian childtren as overly shy, but this can be explained by sociocultural factors - not an avoidance disorder

present oriented people

tend to be more impulsive more into living in the moment they are more expreriences in general

Tolerance or withdrawal indicates what?

that the person has a physiological dependence now along with a psychological dependence.

- Recovery involves:

the "development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness"

AUIT:

the alcohol use indentification test

Repression:

the blocking of forbidden or dangerous desires or thoughts to keep them from entering one's consciousness. according to freud, the most basic defense mechanism. Example: a soldier who witnesses the horrible death of his friend in combat may repress the event because it symbolizes his own mortality.

Mental Status Examination:

the use of questions, observations, and tasks to briefly evaluate a client's cognitive, psychological, and behavioral functioning Appearance Mood Affect Speech Thought process Thought content Memory Abstract thought General knowledge

if they have two alleles that keep you from turning on the enzyme that metabolizes acid aldehyde.

then you are allergic to alcohol, meaning to you get sick pretty much immediately .

Theories of the addiction process: Tiffany (1990):

theory of automatic processes (rather than conscious) and change-resistant processes - emphasizes chronic, automatic drug-using habits of addict.

There is preliminary research on biological basis:

there may be a genetic perspective that makes people have a predisposition for addiction in general.

another study:

they hooked up a machine to measure arousal from perpiration on the skin. socciopaths has less of a skin reaction than prisoners - they were less aroused - they used the same control group - prisoners.

adoption study:

they looked at children who were adopted from non alcoholic compared wot alcoholic families. they found that chiuldren with more alcoholic parents (biological parents) were mre likely to devlop alcoholism later in their lives than children with non-alcholic biologicla paretns.

Future oriented people:

they tend to be oritented toward the future planful high achieveing

Life-time prevalence:

total proportion of people in a population who have ever had a disorder.

past oriented people:

traditional - like traditions like thinking about the past

Theories of the addiction process: Wise (1988):

two-factor model involves positive reinforcement (high) and negative reinforcement (avoid craving and distress)

Communication of intent --

two-thirds of those who commit suicide signal intent within three months of act; fewer than 5 percent unequivocally wish to die.

Paranoid personality disorder:

unwarranted suspiciousness, lack of emotion, (they spend so much time on looking for evil, they cant really feel anything else), hypersensitivity.

Optimism -

very positive beliefs about the future, has been linked to longer survival among AIDS patients (Taylor et al., 2000).

double bind communication

whatever they do is wrong - i love you so much that i cant stand being with you. are you going to clean your room - and dont just say yes

Slip:

when a person gambles again

we mostly diagnose people with depresion

when they show all of these symptoms, if they only show one or two, then it might not be depression, leearn to trust your emotional insticts, are you depressed when you are around them

ethinic differences:

white students are drinkning at more problematic levels than asian american students.

GABA:

widely distributed in the brain - works against other neurotransmitters, particularly dopamine.

Irrational beliefs:

you have this system or idea that you can beat the system - this is irrational however, because the system is in fact set up, like in the casinos and stuff, for the odds to be against you - you have a higher chance of losing, in reality.

If you spend over 2% of your gross income on gambling,

you may be at risk for a gambling problem - people use this as an indicator or a warning sign.