psych exam 3

cognitive behavioral therapy

-focus on directly changing maladaptive cognitions and behaviors -skills based (not insight focused) -active and collaborative -involves homework, assignments, collecting data -time limited -the most well researched and supported

biological cause of anxiety disorders

-genetic vulnerability for being shy, inhibited -genetic vulnerability for high trait neuroticism

biological factors of mental illness

-genetics (twin studies, adoptee studies) -prenatal development (malnutrition, maternal illness) -neural dysfunction (neurotransmitters, brain regions)

biological causes of schizophrenia

-high genetic contribution -> the closer someone is genetically related to someone with this mental disorder, they are at a greater risk of developing it -structural abnormalities in the brain -dopamine hypothesis -.... interacting w dysfunctional family environment

social factors of mental illness

-interpersonal (from relational contexts, someone dealing with a death, divorce, bully, etc) -cultural, demographic (age, gender, race, etc)

social causes of depression

-interpersonal events (ex. death, divorce) -demographic; cultural differences

assessment techniques

-interviews -behavioral techniques (overly familiar, pressure to speak) -instruments (questionnaires, testing)

lifetime prevalence of major psychological disorders

-more females have social or specific phobias -more females have major depression -more males have alcohol dependance

how do we treat psychological disorders?

-need to be managed over time with treatment -most can be treated in more than one way, require a team approach

Natural (innate) immunity

-non specific defenses -created by the body's natural barriers (skin, mucus, stomach acid) -rid the body of pathogens (elimination, fever, vomiting) -present at birth

degree of bias on IAT predicts

-nonverbal behavior in subsequent interracial interaction -doctor's medical decision-making about white v black patients -employer's response to job applicants

variability of ringelmann

-not culturally universal -less among friends v strangers -less among women v men -less when its a complex task (v simple task) -more intrinsically rewarding

what moderates stress?

-personality -predictability and control -coping -social support

cognitive behavioral factors of mental illness

-principles of learning (conditioning, tied into how people come to fear things through learning) -distorted thinking (large emphasis on thought patterns)

humanistic therapy techniques

-show empathy -emphasis on emotions/feelings -non directive, open ended statements -reflective listening, paraphrasing

behavioral (vegetative) symptoms

-significant appetite or weight change (>5% body weight) -insomnia or hypersomnia -psychomotor agitation or retardation -fatigue or loss of energy

two pathways from hypothalamus to adrenal glands

-sympathetic nervous system -HPA axis

deindividuation is most likely to occur when

-tense, highly emotional situations -feeling anonymous -diffusion of responsibility -victims are dehumanized

behavior therapies

-views the problem as one due to learning -uses conditioning principles in treatment

Generalized Anxiety Disorder (GAD)

-what if? -free floating, incessant worry (across multiple domains-work, health, relationships) -common symptoms -->hyper vigilance, distractibility --> disrupted sleep -->somatic symptoms (headaches, pain, tension in body)

increased risk of depression

-women -unemployed -low SES/poverty

proportion of Americans who have a mental illness in any given year

1 in 4

proportion of Americans who receive treatment over any 2 year period

1 in 5

humans try to reduce cognitive dissonance by...

1. changing behavior 2. changing attitude 3. changing cognition (add another thought, thinking differently, rationalize, make sense of it)

implicit association test (IAT)

1. classify word as good or bad 2. classify face as white or black 3. intermixed reaction time-> most people are faster at good/white and bad/black

slopen et al (2012)

10 year prospective study of 22,000+ women healthcare professionals ; chronic job stress (high demand, low control) -women with high job strain were 38% more likely to experience a cardiac event than women with less job strain

amount of people in US affected by depression

13-14 million

Carl Rogers

1902-1987; Field: humanistic; Contributions: founded person-centered therapy, theory that emphasizes the unique quality of humans especially their freedom and potential for personal growth, unconditional positive regard, fully functioning person

prevalence rate of bipolar depression

2-3% rate for US adults; no gender difference

gender depression difference

2:1; largely applies across the world; differences emerge at puberty

rosengren et al (2003)

50+ Swedish men with numbers of life events -high emotional support- lower mortality -social support is protective (buffers) the stress-mortality link

rosenman et al 1964

8.5 year prospective study on 3,500 middle aged men (free of cardiovascular disease at beginning of study) -assessed type a personality and behavior -assessed CVD risk factors -risk of heart attack was 2X greater for type a men (hyper reactive, high arousal)

Tricyclics

A class of antidepressant drugs that increase the level of norepinephrine and serotonin; elavil

psychoanalytic (psychodynamic) therapy

Focus on bringing unconscious struggles into consciousness (free association, dream analysis); Insight: Increase patient's understanding of their own psychological processes; Freudian (drives, conflicts (id-ego-superego), defenses); focuses on early childhood experiences and emotions

Musturbation

A term coined by Ellis to refer to behavior that is absolutist and rigid. We tell ourselves that we must, should, or ought to do or be something. 1. Everyone must think that I'm perfect or I will be worthless 2. Everybody has to act the way I want them to act 3. The universe has to give me what I want and the way I want it

systematic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

conformity

Adjusting one's behavior or thinking to coincide with a group standard.

exposure therapy

An approach to treatment that involves confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response

perfectionism

An unhealthy compulsion to do things perfectly.

trepanning

Ancient practice where holes were cut into ill person's head ; Release evil spirits causing mental illness

Countertransference

Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life.

Hikikomori

Common among young adults in Japan; Victims isolate themselves for months or years; epidemic

cognitive therapy

Distorted thoughts produce maladaptive behaviors and emotions; treatment strategies attempt to modify these thought patterns

center for epidemiological studies depression scale (CESD)

-"I felt that I was just as good as other people" -> less than 1 day -> 1-2 days -> 3-4 days -> 5-7 days

specific (acquired) immunity

-"learns" to identify specific antigens, develops tools for antigens -specific white blood cells produce antibodies -vaccines -T cells produce cytokines (chemical messengers of immune system)

affective (emotion) symptoms

-> depressed mood OR -> loss of interest/pleasure in activities -feelings of worthlessness or excessive guilt

cognitive causes of anxiety disorders

-attentional biases for threat (more likely to pick up on a threat cue)

how to measure stressors

-checklists (limitations: situational) -interviews that are coded (1=low, 5=high)

environmental/learning causes of anxiety disorders

-classical conditioning (little Albert) -social observational learning (learn fear from a parent)

Biological causes of depression

-concordance rates are higher in MZ (46%) v DZ (20%) twins -neurotransmitters- low serotonin, chemical imbalances

two way connection between immune and nervous systems

-cortisol ("stress hormone")- released by brain, can affect immune system -cytokines- released by immune system, can affect brain

economic impact of depression in US

-cost in 2000-> $83.1 billion -mostly from sick days in workplace costs

cultural relativity of mental illness

-culture bound/shaped syndromes -disorders/illnesses represented around the world; find less evidence in other areas of the world -behaviors that might impair functioning in one system may have less interference in another culture system

DSM-V

-current model -emphasizes observable symptoms, meeting criteria -idea that symptoms are not the actual disorder but the overlying cause of the disorder -greater flexibility for presenting diagnostic conclusions compared to prior model -primary and secondary format is retained -recommends reporting psychosocial and contextual factors -expanded section on culture-bounded

positive (additive) symptoms of schizophrenia

-delusions -disorganized speech and behavior -hallucinations

cognitive symptoms

-difficulty thinking, concentrating, being indecisive -thoughts of death

what factors predict obedience in Milgram's study?

-distance of "student" -distance of experimenter -role model of defiance -legitimacy of authority

brain abnormalities in schizophrenia

-enlarged ventricles -blood flow abnormalities -fewer total neurons in the thalamus

mania

-euphoria -high mood, feeling high, on top of the world -excessive activity (speech, reduced sleep) -flight of ideas -racing thoughts, loosely connected -increase in goal directed activity -risky behavior -inflated self esteem, grandiosity, invisible feeling --> followed by an episode of major depression

negative (deficit) symptoms of schizophrenia

-flat/blunted affect -social withdrawal -apathy

RC week 2

instill intergroup competition; week long athletic tournament, increase in ethnocentrism (callings names, physical aggression)

health psychology

integrates research on health and psychology; applies psychological principles to promote health and well-being

impression formation

integrating information to form an overall judgement about a person; thin slices of behavior; importance of non verbal cues

traumatic event

intense fear, helplessness, horror; direct threatened or actual fear of death or injury on yourself or witness it

social support

kind of support/comfort we gain from relationships

flat/blunted affect

lack of emotional response; no expression of feelings; voice monotonous and face immobile

depression

low mood

brain washing

make (someone) adopt radically different beliefs by using systematic and often forcible pressure; using principles of cognitive dissonance; ex. POW in Korea, made prisoners write anti-US essays, started to agree with what they were writing, 20 prisoners ended up staying in Korea after war

greatest proportion of disability in developed nations

mental illness

social facilitation

mere presence of other people enhances performance (arousal); -facilitation of simple tasks -inhibition of complex tasks -culturally universal process

Segerstrom and Miller (2004)

meta analysis of acute v chronic stress (300 articles)

priming

method for assessing strength of association between concepts

Psychoneruoimmunology

mind, brain, immune system -chronic stress reduces efficiency of the immune system

MAOIs

monoamine oxidase inhibitors; increase serotonin and norepinephrine; Nardil

Beck's cognitive triad

negative views about the self, the world and the future

neurodevelopmental disorders

neurologically based disorders that are revealed in a clinically significant way during a child's developing years

delusion of reference

neutral events are given special and personal meaning "The person on the TV is talking to me"

What is mental illness?

normal psychological functioning <---> abnormal psychological functioning

delusion of control

one's thoughts or actions are controlled by the outside "the CIA is controlling my mind"

chronic stress

overall immune-supression (aren't designed to deal with longterm stress); decreased lymphocytes, decreased ability to ward off tumors (animal studies); more likely to die, more colds, impaired wound healing (human studies)

resistance

parasympathetic nervous system returns physiological functions to normal; recovery

Festinger's 1959 cognitive dissonance study

participant doing a boring task-> ask them to lie to someone and tell them that the task was fun for either a $1 or $20 reward; the $1 reward wasn't sufficient justification for lying so participants ended up actually believing the task was fun; dissonance led to altering of attitudes about enjoyability of task

Ambady & Rosenthal (1993)

participants viewed soundless 30 sec clip of a college professor lecturing, rated professor on various traits-- thin slice judgments agree with one another, mean reliability .72; thin slice judgments also predicted end of semester course evaluations--statistically significant .76**; thinner slices of 2 or 5 sec still have statistically significant findings

Ataque de nervios

people become hysterical, exhibiting violence and sometimes not even remembering the event; found mostly in middle aged women; uncontrollable screaming during periods of crisis

social cognition

perception; thinking about other people (impressions, judgement, inferences); make judgments within the first few seconds of meeting someone

Stanford prison study revisited

person who had a breakdown was faking it; guard had fake attitude (improv exercise); no mention of ability to leave study in informed consent form; audio recording says guards were told to be tough

Hans Selye

physician /endocrinologist; coined the term "stress"

Albert Ellis

pioneer in Rational-Emotive Therapy (RET), focuses on altering client's patterns of irrational thinking to reduce maladaptive behavior and emotions

derubeis, siegle and holen (2008)

placebo, SSRI, therapy groups -study 1: 8 weeks, therapy and antidepressants doing better 16 weeks, all doing better -study 2: continue SSRI or therapy, less relapse in symptoms for therapy

prognosis

prediction about course

ferrai et al (2013)

prevalence of diagnosed clinical depression: -most depressed countries- in Middle East and Africa, Afghanistan (>20%) -least depressed countries- Japan (<2.5%), China, Mexico (collectivist cultures)

Benzodiazepines

primarily increases the activity of GABA (calming neurotransmitter); typically short term use (may lead to dependance, dangerous when combined with alcohol); Xanax, Ativan, valium

anxiety disorders

psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety (ex. generalized anxiety disorder)

personality disorders

psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning (ex. narcissism, borderline)

stereotypes can be

publicly expressed (explicit), privately held (explicit) or unconscious (implicit)

sympathetic nervous system

quick; fight or flight; releases epinephrine and norepinephrine; adrenaline

obsession

recurrent, intrusive thoughts/mental images, can't prevent thoughts (ex. might have hit someone with my car)

mere exposure effect

repeat exposure leads to positive attitudes; familiarity; ex. advertisements

SSRI

selective serotonin reuptake inhibitor; works mechanically with serotonin; prozac, zoloft

Applied Behavior Analysis

shapes behavior through reinforcers (rewards)

Revisiting Robber's Cave

sheriff intervened with "frustration exercises", first experiment failed ( kids could not be persuaded to hate each other, suspicious of camp counselors); intervened more heavily in RC

symptoms

signs of disorders

HPA axis

slow, prolonged stress; releases cortisol (the stress hormone); repeated or prolonged activation leads to wear and tear on the body's stress regulatory systems, leads to illness

Berkman and Syme (1979)

social connections are beneficial regardless of stress -men v women, dying over 9 years -more socially integrated least likely to die in time frame

Persistent Depressive Disorder (Dysthymia)

Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months.

Thin-slice judgments

People can make surprisingly accurate judgments quickly and automatically; not without occasional error

Stanford Prison Experiment

Philip Zimbardo's study of the effect of roles on behavior. Participants were randomly assigned to play either prisoners or guards in a mock prison. study ended after only 5 days. prisoner went crazy.

General Adaptation Syndrome (GAS)

Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion.

disorganized speech and behavior

Severe tangentially in the conversation Loose associations between topics; Sudden derailment of thought; Unusual positions or actions

physical attractiveness stereotype

The presumption that physically attractive people possess other socially desirable traits as well: What is beautiful is good.

eating disorders

US/the west; concept is different

kitty genovese case 1964

stabbed repeatedly outside her apartment, observed by 38 neighbors, no one helped her, someone called 30 min after her first cry for help

Deindividuation

state of reduced individuality and self-awareness that leads to reduced attention to personal standards (ex. mob mentality, rioting)

behaviors are consistent with

strong attitudes

Asch study of conformity 1951

task: in a group of other "participants", pick which line matches the standard line (one person and a group full of researchers) -75% conformed on at least one trial (18) -30% conformed every time -compared to >1% in private condition -conformity increases with group size until about 4 members

Clifford and Walster (1973)

teachers given subjective information on a child's academic ability (the same throughout) and a picture of a child (attractive/unattractive based on social ideas of attractiveness); guess IQ, wellness of social relationships, parents attitudes towards school; teachers who are given a more attractive picture with the same academic information rate that student higher

social loafing

tendency for people to work less hard in a group than when working alone; you don't pull weight when you don't feel personally responsible for output

Montreal Cognitive Assessment (MoCA)

testing on memory and cognitive function

alarm

the first phase of the stress response, in which the person faces a challenge and starts paying attention to it; heightened sympathetic arousal; temporary drop in normal resistance

dopamine hypothesis

the idea that schizophrenia involves an excess of dopamine activity

Transference

the patient's transfer to the analyst of emotions linked with other relationships

Ringelmann Effect

the phenomenon by which individual performance decreases as the number of people in the group increases

social psychology

the scientific study of how we think about, influence, and relate to one another; individual behavior in a social context

bystander effect

the tendency for any given bystander to be less likely to give aid if other bystanders are present; assume someone else will step in

diffusion of responsibility

the tendency for individuals to feel diminished responsibility for their actions when they are surrounded by others who are acting the same way

outgroup homogeneity effect

the tendency to view outgroup members as less varied than ingroup members; "they're all the same"

realistic group conflict theory

the theory that prejudice arises from competition between groups for scarce resources; ingroup favoritism and outgroup derogation

Nalini Ambady

thin slice judgments and impression formation

psychotherapy

treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth

behavioral medicine

treatment of illness using behavioral and medical knowledge

fundamental attribution error

we tend to overestimate internal, and underestimate external, causes for other's negative behavior... while doing the opposite for ourselves

Diagnosis and Statistical Manual of Mental Disorders (DSM)

what people use to categorize various illnesses

counterconditioning

a behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning

Antidepressants

a class of psychotropic medications used for the treatment of depression; work to increase norepinephrine and/or serotonin; with or without psychotherapy; can also treat other disorders

halo effect

a cognitive bias in which our overall impression of a person influences how we think about their specific traits

major depression

a disorder characterized by severe negative moods or a lack of interest in normally pleasurable activities

bipolar depression

a disorder marked by alternating or intermixed periods of mania and depression

rational emotive behavior therapy

a form of cognitive behavioral therapy; Albert Ellis; client is confronted with irrational beliefs, develops a more realistic way of thinking

psychotic disorders

a group of psychological disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality (ex. schizophrenia)

fear hierarchy

a list of situations in which fear is aroused, in ascending order

stress

a pattern of responses (behavioral, psychological, biological) that arise when individuals perceive that they cannot adequately cope with the challenge or threat -variety of responses -perceived, subjective -perceived that challenge or threat exceeds ability or resources

locus of control

a person's tendency to perceive the control of rewards as internal to the self or external in the environment

just-world hypothesis

a strong need to believe the world is a just and predictable place; "we reap what we sow"; ex. assuming a homeless person did something to deserve their lot in life (lazy, drugs) and less likely to think about situational causes (lack of health care, unemployment)

cognitive restructuring

a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs

flooding

a treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless

phobia

abnormal fear; characterized by fear and avoidance (safety seeking); avoidance makes it worse

audience inhibition effect

acting cool and calm in front of others is valued; look to others for cues

compulsion

actions, irresistible urge to act on obsession (ex. drive back and check)

PTSD

an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience

OCD

an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

panic disorder

an anxiety disorder that consists of sudden, overwhelming attacks of terror; fight or flight; fear of fear itself; symptoms mimic heart attack; derealization

stressor

an environmental event or stimulus that poses challenge or threat; disrupts equilibrium; varied and diverse; not only negative -objective -severity (major life events v daily hassles) -duration (chronic v acute)

cognitive dissonance

an uncomfortable mental state due to contradiction between two attitudes or between an attitude and a behavior

main effects model

asserts that social support contributes directly to well-being and positive health and that these beneficial effects occur even in the absence of stress

Finger Tapping Test

assess neuromuscular function; rate of how many finger taps in 60sec

Test of Variables of Attention (TOVA)

assesses impulsivity, inattention; kids with ADHD are very bad at this

natural killer cells (NK cells)

attack and destroy antigens

internal (personal) attribution

attributing cause to something about the person or the self

external (situational) attribution

attributing cause to something external to the person or the self (such as the situation)

Milgram (1963)

behavioral study of obedience; teacher is true participant, student controlled to zapper and said they have a heart condition, teacher teaching student to match, controlled voltage; when they objected the researcher told them to continue; went until teacher refused, finished or student was "unconscious"

delusion of persecution/paranoia

belief that others wish to persecute you; bizarre plots and ideas "They are out to get me"

delusion of grandeur

believe self to be overly powerful, important ; have special traits or abilities "I am an advisor to the president"

buffering effects model

beneficial effects of social support occur only in the presence of stress

Autism Spectrum Disorder

characterized by extreme difficulty communicating and forming relationships, difficulty using language and sensory disorder

Leon Festinger

cognitive dissonance theory

Latane and Darley (1968)

completing a questionnaire when room fills with smoke; 3 conditions (work alone, with one researcher, with 2 researchers) Did they tell experimenter about smoke? -more reported smoke when they were alone and that decreased as there were more people in the room

leading cause of death for adults in the developed world

coronary heart disease; accumulation of fatty deposits along artery walls and hypertension increase risk for heart attack

RC week 1

create ingroup; cooperative camp activities, develop identities (rattlers and eagles)

exhaustion

depletion of resources; susceptible to disease

common cold of mental illness

depression

Seligman's learned helplessness theory

depression occurs when people (and other animals) become resigned to the idea that they are helpless to escape from something painful; classical conditioning; not trying to get out of negative situation; "why try?"

unipolar depression

depression that alternates with normal emotional states

etiology

development of disorder

discrimination

differential action towards individual

diathesis-stress model

disorder develops when an underlying predisposition is coupled with a precipitating environmental event

bipolar disorders

disorders marked by alternating or intermixed periods of mania and depression

post-decision dissonance

dissonance aroused after making a decision, typically reduced by enhancing the attractiveness of the chosen alternative and devaluating the rejected alternatives; ie buyer's remorse

diagnosis

distinguish between disorders

Antipsychotics

drugs used in the treatment of psychotic disorders that help alleviate hallucinations and delusional thinking; decrease dopamine by blocking dopamine receptor sites -traditional: work on + symptoms -atypical: work on +/- symptoms

justification of effort

effort for the task/group causes dissonance, dissonance leads to anxiety and distress, people inflate the task/group's importance and their commitment; ex. hazing

RC week 3

encouraging intergroup cooperation; contact is not enough... must have super-ordinate (shared) goal, eased tensions, friendships formed

acute stress

enhanced natural immunity; suppression of specific immunity

attitudes

evaluations (feelings, opinions, beliefs) of people, events, objects, and ideas; formed through experience and socialization; can be conditioned

kitty genovese revisited

exaggerated witnesses and their responses in original; sensationalism (culture, media)

assessment

examination of a person's mental state to diagnose possible psychological disorders; ongoing- doesn't stop after one diagnoses

Robbers Cave Experiment

experiment which showed that even arbitrary group distinctions (camp teams) can cause a bitter rivalry and discrimination, thus demonstrating in-group/out-group biases

delusion

false belief -grandeur -persecution/paranoia -reference -control

hallucinations

false sensory perceptions -auditory- hearing voices -visual- seeing figures

specific phobia

fear of a specific object or situation -ex. claustrophobia, arachnophobia

social phobia (social anxiety disorder)

fear of interacting with others or being in social situations that might lead to a negative evaluation

prejudice

feelings and attitudes towards an individual based on group membership; leads to differential treatment

humanistic (client-centered) therapy

focus on the whole person; "client" and not "patient"; therapist has unconditional positive regard for the client (acceptance and support); Carl Rogers

problem-focused coping

focuses on task based approach to solving a problem

emil kraepelin

founder of modern psychology; A pioneer of diagnostic categorization in mental health who was one of the first to assign formal labels to particular clusters of symptoms

depressive disorders

general category of mood disorders in which people show extreme and persistent sadness, despair, and loss of interest in life's usual activities (ex. major depression)

Granulocytes

general white blood cells

stereotyping

generalized belief about other people based on their social group; not bad in and of themselves, we all have them

social influence

groups influence individual attitudes and behaviors

Payne (2001)

gun or tool (target object) white or black face (face prime) -participants were quicker to pair black faces with guns, slower to pair with tools -participants make more errors pairing black faces with guns (when its really tools)

cardiovascular system

heart and blood vessels

manic

high mood

emotion-focused coping

how you feel about it

attribution

identifying causes for an event or someone's behavior; impact how we feel and therefore how we behave

free association

in psychoanalysis, a method of exploring the unconscious in which the person relaxes and says whatever comes to mind, no matter how trivial or embarrassing

social striving

increased individual effort in group settings - more common in collectivist cultures

Schizophrenia

"splitting of the mind"; a break with reality, characterized by alterations in thoughts, perceptions, or consciousness; 1% prevalence rate; no sex difference; high genetic contributions

depression symptoms

(5 or more present in a 2-week period) -must include either -> depressed mood OR -> loss of interest/pleasure in activities -significant appetite or weight change (>5% body weight) -insomnia or hypersomnia -psychomotor agitation or retardation -fatigue or loss of energy -feelings of worthlessness or excessive guilt -difficulty thinking, concentrating, being indecisive -thoughts of death