Psychology Film Final Exam

What is the treatment of choice for PTSD?

Prolonged exposure to the trauma

Tyler Represents the Narrator's

Shadow

Severe Trauma

"The person who suffers from a severe trauma disorder must decide between surviving in a barely sub-lethal misery of numbness and frustration, and taking a chance that may well bring her a better life, but that feels like stupidly issuing an open invitation to the unspeakable horror that waits to consume her alive. And in the manner of the true hero, she must choose to take the risk"

Acute and Postraumatic Stress Disorder: Avoidance

-Attempts to avoid thoughts, feelings related to the event -Avoid people, places, or activities that remind them of the event

Diagnosis of ASD and PTSD

-DSM-5 groups ASD and PTSD in a new diagnostic grouping -Trauma- and stressor-related disorders -Dissociation is involved in many PTSD symptoms, not just the explicit dissociative symptoms -The flashbacks can cause one to dissociate from reality

Acute and Postraumatic Stress Disorder: Dissociative Symptoms

-Dazed and act "spaced out" -Depersonalization -Derealization -Dissociative amnesia

EMDR

-Francine Sharpiro -Eye Movement Desensitization Reprocessing -Includes rapid back-and-forth eye movements -Prolonged exposure appears to be the "active ingredient"

Acute and Postraumatic Stress Disorder: Negative Mood or Thoughts

-Inability to experience positive emotions -Persistent fear, anger, or guilt, or feelings of detachment from others -Numbing of responsiveness/ emotional anesthesia

Brief Historical Perspective

-Maladaptive reactions to trauma have long been an interest to the military -"Shell shock" or "combat neurosis" -Vietnam War prompted much interest in PTSD due to delayed reactions to combat being very common

Why is trauma no longer defined as "outside of the usual human experience"?

-Many people suffer from ASD symptoms following a trauma -Many traumatic stressors are a common part of the human experience

Acute and Postraumatic Stress Disorder: Arousal or Anxiety

-Predicts a worse likely course of the disease -Hypervigilance: Enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect activity -Restlessness, agitation, and irritability -Exaggerated startle response

Acute and Postraumatic Stress Disorder: Rexperiencing

-Repeated, distressing images or thoughts -Intrusive flashbacks -Horrifying dreams -Dissociative state

CBT FOR PTSD

-The most effective treatment for PTSD is re-exposure to trauma -Prolonged exposure -Imagery rehearsal therapy -Cognitive restructuring

Confidentiality

1. Dr. Davenport tells his wife details that Antwone had told him during their sessions 2. Confidentiality is compromised when sessions are held in the psychiatrist's living room with the door open and his wife in the house, and later, in a men's room 3. Davenport says "I love you, son"-Antwone becomes a surrogate son to the psychiatrist, who is himself in denial about the pain of his childless marriage

Charlie's First relationship

1. Emotional numbness with his first girlfriend 2. Wasn't able to tell her how he really felt-getting angry with this situation and did not know how to deal with it

Psychological Factors in ASD and PTSD Emotional processing

1. Engage emotionally with trauma 2. Articulation and organization of the chaotic experience 3. Cognitive shift: the world is not a terrible place—meaning making

Psychological Factors in ASD and PTSD Two-factor theory

1. Classical conditioning creates fear when the terror of trauma is paired with the cues associated with it 2. Operant conditioning maintains avoidance by reducing fear (negative reinforcement); avoidance prevents the extinction of anxiety through exposure 3. The role of dissociation is debated: May not be adaptive, may be related to more PTSD

Charlie says "I get so messed up inside, like i am not there or something" This is an example of:

Dissociation

Closure

1. Davenport argues with the young man that all of his troubles come down to a need to deal with his past 2. His main therapeutic intervention is to encourage Antwone to seek out his long-lost mother and confront her with his anguish and torment such that he can find relief

Structures of the Brain Implicated in Schizophrenia

1. Decrease in: -Total brain volume -Enlarged ventricles -Working memory attention -Motor planning

Dr. Davenport is an illustration of which therapist stereotype?

Dr. Wonderful

Fight Club

1. Dissociation as it is construed in Fight Club -inability to access immediate experience of the self, connection to other people, or the here and now-to be present in the moment 2. The Narrator is not merely as an individual, but as an archetypal member of contemporary society

Charlie & Sam Disconnect

1. Doesn't really know what he wants 2. Doesn't understand why he cannot connect to Sam, to whom he is attracted 3. Memories are brought back by situations similar to the trauma

Men

1. 18-25 onset 2. Poor social functioning 3. More schizotypal traits 4. More negative symptoms 5. More likely chronic 6. Poor Response to treatment

Women

1. 23-25 onset 2. Good social functioning 3. Fewer schizotypal traits 4. More positive symptoms 5. Less often chronic 6. Better response to treatment

Trauma

1. Adverse life experiences -Not necessarily life threatening, but definitely life-altering -Examples include grief/loss, divorce, verbal abuse/bullying, and just about everything else... -The trauma itself isn't the problem-it is the aftermath -If it was traumatic to the person, then it's traumatic

Positive Symptoms

1. Also called psychotic symptoms. 2. Hallucinations -Perceptual disturbances -Can occur in any of the senses -Persistent over time 3. Delusional Beliefs -Peculiar beliefs that are rigidly held in spite of their preposterous nature -Most common are paranoid and grandiose (Unrealistic sense of superiority) -Fragmented

New Therapies

1. Although exposure therapy is often effective, many patients experience "fear relapse" over time 2. Patients with PTSD have trouble learning to suppress fearful memories of their traumas 3. Researchers reasoned that the high levels of stress experienced by PTSD patients might inhibit brain areas, such as the prefrontal cortex, involved in learning to suppress fear 4. Combining propranolol (controls heart rate) with traditional exposure therapy may be able to facilitate extinction learning and lasting fear reduction in patients with PTSD

Antidepressant Medication

1. Antidepressants and therapeutic re-exposure are first-line therapies for PTSD 2. Effectiveness of SSRIs is likely at least partially due to the high comorbidity between PTSD and depression 3. Traditional antianxiety medications are not effective in treating PTSD 4. Only 30% treated recover fully

Hollywood Ending

1. Antwone ends up helping the therapist 2. This relationship has the potential to create unreal expectations within patients and to promote the acceptability of boundary violations

Fisher Trauma

1. Antwone has a dream 2. Antwone is already suffering from self-doubt and shame about his past, he reacts with angry outbursts when his self-esteem was challenged. 3. Antwone has to recall the abuse and heartbreak he suffered

Antwone Thanksgiving

1. Antwone meets Dr. Davenport at his house for Thanksgiving 2. A violation of therapist-client boundaries

Antwone Therapy

1. Antwone needs to be evaluated by a therapist 2. Does not want to talk-wants the therapist to ask him questions 3. Realizes that he can benefit from talking if he wants to stop the violent outbursts 4. How does that make you feel? What type of therapy? 5. The initial three sessions pass, and Dr. Davenport has made a diagnostic decision that Fisher not be discharged from the navy 6. Feels that he needs more therapy 7. Having sensed that he has somehow failed the young man-engages in a series of boundary violations

Derealization

1. Aspects of the world, or one's relationship to it, seem changed in ways that entail shifts in the perceptual qualities of experience 2. These include colors going flat or brightening, sounds becoming distant or more sharp, time slowing down or speeding up, images becoming less or more clear, distant, and/or intense, and objects looking different or unreal or, conversely, "ultra-real" 3. Survivors of traumatic events frequently report alterations in color as one among the many perceptual distortions that marked their peritraumatic experience

New Research

1. Brain marker of poor memory in schizophrenia patients identified -Possible key to understanding, treating cognitive symptoms of disease 2. A landmark study, based on genetic analysis of nearly 65,000 people, has revealed that a person's risk of schizophrenia is increased if they inherit specific variants in a gene related to "synaptic pruning" -- the elimination of connections between neurons

Friends

1. Charlie develop friendships. It is when his support group is the strongest that his symptoms subside 2. PTSD is a chronic and debilitating disorder which may be associated with substance use disorders. Throughout the movie, we see Charlie experiment with a variety of drugs

Sam

1. Charlie develops a crush on his friend Sam and experiences his first kiss with her

Charlie's Fight

1. Charlie ends up hitting someone and doesn't remember doing it 2. What is this called? Forgetful Amnesia

Perks of Being a Wallflower

1. Charlie was hospitalized for the summer after his best friend commits suicide 2. Charlie suffers from PTSD and is about to embark on his first year of high school

Charlie's Aunt

1. Charlie's anxiety goes back to the first traumatic event in his life, the death of his Aunt Helen 2. His aunt was killed in a car accident when he was a young boy. She was on her way to get him a surprise and he believed it was his fault 3. He idolized his Aunt and wishes she were there to comfort him as he struggles with starting high school

Psychosocial Treatment

1. Family-Oriented Aftercare -Attempts to improve the coping skills of family members -Includes an educational component -Emphasis on improving communication and problem-solving 2. Social Skills Training -Structured, educational approach that involves modeling, role-playing, and social reinforcement 3. Cognitive Therapy -Specialized cognitive treatments 4. Cognitive enhancement therapy (CET): Designed for patients who have recovered from active symptoms, but continue to exhibit cognitive disability-working memory 5. Assertive Community Treatment -Delivered by interdisciplinary team -Institutional programs

Causes Genetics

1. First-degree relatives 2. The average concordance rate for MZ twins is 48%, whereas the comparable figure for DZ twins is 17% 3. Suggests strong genetic factors 4. Also compelling evidence for the importance of environment

Dopamine Hypothesis

1. Focuses on the function of specific dopamine pathways in the limbic area of the brain 2. Hypothesis grew out of attempts to understand how antipsychotic drugs improve the adjustment of schizophrenic patients 3. Elevated sensitivity to dopamine-drugs block D2 receptors

Tetris for PTSD

1. Focusing on a highly engaging visual-spatial task, such as playing video games, may significantly reduce the occurrence of flashbacks 2. Stimulating a process called "memory reconsolidation," during which the memory is re-formed in the brain

End of Solois

1. Gets Nathaniel cello lessons in an apartment-Steve is hoping it will help him 2. Should he be forced into therapy and medication? 3. He does not want the help that Steve wants to give him! 4. Steve realizes that he can only be Nathaniel's friend and does not need to save him 5. Having more social connections can change brain chemistry and help Nathaniel

Treatment-Antipsychotic Medications

1. Have relatively specific effects to reduce psychotic symptoms 2. Usually takes two to three weeks before improvement is seen with regard to psychotic symptoms 3. Positive symptoms respond better than negative symptoms 4. A substantial minority of patients, perhaps 25%, do not improve on classical antipsychotic drugs 4. Motor Side Effects -Extrapyramidal symptoms: Muscular rigidity, tremors, restless agitation, peculiar involuntary postures, and motor inertia -EPS may diminish spontaneously after three or four months of continuous treatment -Tardive dyskinesia: Syndrome consists of abnormal involuntary movements of the mouth and face, such as tongue protrusion, chewing, and lip puckering, as well as spasmodic movements of the limbs and trunk of the body 5. Second-Generation Antipsychotics -Atypical antipsychotics -Less likely to produce motor side effects -As effective as typical antipsychotics for treatment of positive symptoms -Not significantly more effective for negative symptoms

Charlie's Birthday

1. He experienced alterations in cognition and mood including an inability to remember aspects of the trauma 2. Reminders in the environment bring back intrusive memories of his trauma 3. Drugs can bring on the flashbacks

Treatment of Dissociative Disorders

1. Hypnosis 2. Abreaction: Release of a previously repressed emotion, achieved through reliving the experience that caused it 3. Ultimate goal in treating DID is integration of the personalities 4. Antianxiety, antidepressant and antipsychotic medications are used to reduce distress

Dissociative Disorders-Social Factors

1. Iatrogenesis: the manufacture of a disorder by its treatments 2. Were "cases" created by the expectations of therapists?

Catatonia

1. Immobility and marked muscular rigidity; excitement and overactivity, waxy flexibility 2. Also associated with a stuporous state; reduced responsiveness

Insomnia?

1. In the film the Narrator says, "With insomnia nothing's real. Everything's far away. Everything's a copy of a copy of a copy" 2. Which dissociative disorder does resemble? -Depersonalization

Portrayal of Therapy

1. It also provides a positive image of therapy and a psychiatric hospital, which is rare in Hollywood 2. Films providing this kind of insight into psychiatric conditions can help eliminate the stigmas we still see today 3. The therapist does not over-step boundaries and helps Charlie deal with the his feelings while re-experiencing the trauma

Causes Adoption Studies

1. Leonard Heston's longitudinal study (1966) indicate genetic factors play role in development of the disorder 2. However there are environmental factors also

Dissociative Disorders-Biological Factors

1. Little to no evidence of biological and genetic factors 2. Research suggests that a fragmented sleep-wake cycle helps explain dissociative symptoms 3. Sleep disturbance associated with dissociation -Improved sleep decreased dissociation in experimental situations

Why should you doubt claims that dissociative identity disorder is common?

1. Most cases of dissociative disorders are diagnosed by a handful of ardent advocates 2. The frequency of the diagnosis of dissociative disorders in general, and DID in particular, increased rapidly after release of the very popular book and movie Sybil 3. The number of personalities claimed to exist in cases of DID has grown rapidly, from a handful to 100 or more 4. Dissociative disorders are rarely diagnosed outside of the United States and Canada; for example, only one unequivocal case of DID has been reported in Great Britain in the last 25 years

Dissociative Amnesia

1. Most common type 2. Females more than males 3. Abrupt onset, abrupt termination, few re-occurrences' 4. May be or generalized or selective 5. Stressors: disasters, emotional trauma, domestic violence

Dissociative Identity Disorder

1. Most severe and chronic dissociative disorder 2. Original personality is generally amnestic of and unaware of the other personalities, but may be aware of certain aspects of other personalities 3. Each may have their own set of memories name and description, age, sex or race 4. Controversial if have different physiological characteristics 5. Severe psychological & physical abuse (mostly sexual) in childhood leads to a profound need to distance ones self from horror and pain. 6. During abuse, the child attempts to protect him / herself from trauma by dissociating from the terrifying acts, becoming in essence another person who could not be subject to abuse or who is not experiencing abuse 7. The dissociative selves become a long term, ingrained method of self protection from emotional threats

What does PTSD look like?

1. No one clinical picture but not like it is shown on television/movies 2. Can't stereotype, although it's done 3. There are some "hallmarks" -Nightmares -Poor sleep -Anger -Numbness or sadness -Avoidance of groups

Acute Stress Disorder(ASD)

1. Occurs within four weeks after exposure to a traumatic stress and characterized by dissociative symptoms as well as: -Re-experiencing, avoidance of reminders, and marked anxiety or arousal

Viral Infections

1. People who develop schizophrenia are somewhat more likely than other people to have been born during the winter when viral infections are more prominent

Biological Effects of Exposure to Trauma

1. People with PTSD show alterations in the functioning, and perhaps structure, of the amygdala and hippocampus 2. The sympathetic nervous system is aroused and the fear response is sensitized in PTSD 3. Does trauma change the brain? -Differences between people with and without PTSD are correlations

Pregnancy and Birth Complications

1. People with schizophrenia are more likely than the general population to have been exposed to various problems during their mother's pregnancy and to have suffered birth injuries 2. Dietary factors 3. Birth complications

Violin on the Street

1. Positive symptoms of schizophrenia 2. Disorganized thoughts, irrelevant responses, spelling names 3. Steve looks for Nathaniel because he found out that he did attend Julliard and now he is living on the streets 4. Wants to write a story to bring awareness to the homeless problem in LA 5. See signs of schizotypal personality disorder when he was younger and then a social withdrawal which usually happens before the psychotic /active symptoms appear

Comorbidity

1. Presence of two chronic diseases or conditions in a patient 2. High for depression, other anxiety disorders, and substance abuse 3. Anger: usually very prominent; risk for suicide

Frequency of Trauma, PTSD, and ASD

1. Prevalence of PTSD -6.8% of people living in the United States -90% of people living in Detroit have experienced a trauma with 9% developing PTSD -Most common cause: Unexpected death of loved one -20%-40% of children develop PTSD

Negative Symptoms

1. Responses or functions that appear to be missing from a person's behavior 2. More stable than positive symptoms 3. Affective and Emotional Disturbances -Blunted affect: Reduction in the intensity of an individual's emotional response -Affective flattening: Do not have the full range of emotional expression that others do -Anhedonia: Inability to experience pleasure -Many people with schizophrenia become socially withdrawn -Both a symptom and coping strategy -Lack of will, becomes apathetic, indecisive -Impoverished thinking, poverty of speech -Psychomotor retardation 4. Disorganization -Thinking Disturbances -Involve disorganized speech -Saying things that do not make sense -Irrelevant responses to questions, disconnected ideas, using words in peculiar ways -Word Salad: Loose associations or derailment: shifting topics too abruptly -Perseveration: Persistently repeating the same word or phrase over and over

Depersonalization

1. Similar to derealization except that the object of distortion is the experience of the self rather than of the world 2. Feelings of being separate from what is happening, feeling like an automaton or a mere spectator of events; feelings of floating outside one's body; and feeling that one's body, or one's relationship to it, has changed in some way 3. For many survivors of traumatic events, elements of their initial experience are later re-experienced as flashbacks, and reactivity to cues reminiscent of the original event

Causes and PTSD and ASD

1. Social Factors in ASD and PTSD -Nature of the trauma and social support -Victims of trauma are more likely to develop PTSD when the trauma is more intense -With less severe stressors, social support after a trauma can play a crucial role in alleviating long-term psychological damage 2. Biological Factors in ASD and PTSD -Genetic contributions-MZ twins

The Soloist

1. Someone sends him a cello and Steve wants to get him off of the street and on medication 2. Believes that with treatment he can play the cello professionally. However he does not take Nathaniel's wishes into account 3. First psychotic break (active symptoms) Nathaniel starts to hear voices when playing at Julliard 4. New therapy uses virtual reality to create a person for the voices which helps them engage in a dialogue 5. Steve wants to get him off of the street and on medication, but Nathaniel does not want to be treated 6. He chooses to be on the street-wants control of his life 7. He does not want to live in an apartment

Dissociative Fugue

1. Sudden unexpected travel away from home or ones customary place of work, with inability to recall one's past 2. Confusion about personal identity or assumes new identity (partial or complete) 3. Spontaneous, rapid recovery 4. Recurrences rare 5. Common after disasters, emotional stress, heavy alcohol abuse, medical causes-epilepsy, head trauma

Amygdala

1. The amygdala receives sensory information from the five senses, via the thalamus, attaches emotional significance to the input, and then passes along this emotional "evaluation" to the hippocampus 2. In accordance with the amygdala's "evaluation" of importance, the hippocampus is activated to a greater or lesser degree, and functions to organize the new input, and to integrate it with already existing information about similar sensory events

Charlie Losing It

1. The flashbacks become overwhelming 2. Guilt-believing that it was his fault that his aunt died 3. Blacked out 4. Displaces his feelings of emptiness on others 5. Makes excuses for his aunt-she had a terrible life 6. The therapy helped him

What stage is Nathaniel experiencing?

Prodromal

Childhood Trauma

1. The more abuse an individual experienced, the greater the individual's risk of heart disease, cancer, diabetes, liver disease, and emphysema 2. Aggression, increased sexualization, and other deviant social behaviors commonly seen in maltreatment victims, coupled with traumatic effects on intelligence, attention, and learning, lead to increased school dropout and expulsion rates for maltreated children compared to non-abused children 3. Studies of trauma children have identified a number of important brain regions that are smaller in size. 4. One particular type of attachment, disorganized attachment, is associated with very negative behavioral outcomes, especially violence and aggression, in trauma victims.

Schizophrenia Overview

1. The most common symptoms of schizophrenia include changes in the way a person thinks, feels, and relates to other people and the outside environment. 2. No single symptom or specific set of symptoms is characteristic of all schizophrenic patients. Schizophrenia may actually be different disorders with difference causes. 3. Schizophrenia is a devastating disorder for both the patients and their families 4. Among mental disorders, it is the second leading cause of disease burden

Phases

1. The period of risk for the development of a first episode is considered to be between the ages of 15 and 35 Phases 1. Prodromal: Precedes the active phase and is marked by an obvious deterioration in functioning 2. Active/Psychotic: Positive, negative, disorganized symptoms 3. Residual: Follows the active phase and is defined by signs and symptoms that are similar to the prodromal phase. The dramatic symptoms have improved but the person continues to be impaired

Dissociative Disorders

1. The symptoms of dissociative disorders are characterized by persistent, maladaptive disruption in the integration of memory, consciousness, or identity -Includes psychologically produced amnesia -Confused travel long distances from home -Existence of two or more personalities in one person 2. Controversial and disbelieved by many

Finds Mother

1. This leads to a lengthy search that culminates in a standard Hollywood "cure". 2. Fisher confronts his mother in an emotional scene, and then returns to the embrace of a newfound extended family

More Fight Club

1. Throughout Fight Club one encounters numerous instances between clinical dissociation and the detachment of life in the 21st century 2. Not a sleep disorder, but dissociative symptomatology, in this case in the form of "lost time": "I nod off. I wake up in strange places. I have no idea how I got there"

Acute and Traumatic Stress Disorders

1. Traumatic stress -Defined in the DSM-V as an event that involves actual or threatened death or serious injury to self or others and creates intense feelings of fear, helplessness, or horror

More Amygdala

1. Under a normal range of conditions, this system works efficiently to consolidate memories according to their emotional priority 2. However, at the extreme upper end of hormonal stimulation, as in traumatic situations, a breakdown occurs 3. Overwhelming emotional significance registered by the amygdala actually leads to a decrease in hippocampal activation, such that some of the traumatic input is not usefully organized by the hippocampus, or integrated with other memories

Some of the diagnostic criteria are different for ASD and PTSD Normal reactions to trauma?

1. What Defines Trauma 2. DSM-5 definition: -An direct exposure to actual or threatened death, serious injury, or sexual violation -Sexual violation is a new part of the definition -Being witness to actual or threatened death, serious injury, or sexual violation -Learning of violence to a loved one -Through repeated exposure to details of trauma

What outpouring of emotions is this?

Abreaction: Expression and consequent release of a previously repressed emotion, achieved through reliving the experience that caused it

This negative symptom is one of the most common symptoms of schizophrenia

Blunted Effect

Which of these statements is false?

Catharsis is involved in PTSD treatment

Which concept of psychoanalytic therapy is illustrated when Dr Davenport says " I love you son"

Counter transference

Posttraumatic Stress Disorder (PTSD)

Defined by symptoms of re-experiencing, avoidance, and arousal, but PTSD is either longer lasting or has a delayed onset

Defenses

Frequently used in all dissociative disorders: 1. Repression: Disturbing impulses are blocked from consciousness 2. Denial: External reality is ignored 3. Dissociation: Separation & independent functioning of 1 group of mental processes from others-(mental contents exist in parallel consciousness)

A disorder that is inadvertently caused by a physician, medical or surgical treatment, or a diagnostic procedure is known as

Iatrogenic

Inappropriate Affect

Incongruity and lack of adaptability in emotional expression

How does MDMA assisted Psychotherapy work?

MDMA can make it easier for people with chronic, treatment resistant PTSD to confront their traumatic memories

Why was acute stress disorder added to the DSM-5

May be a predictor of PTSD

Dissociative disorders involve ________ outside of conscious awareness, and extreme cases involve a split in the functioning of the individuals _________

Mental Processing & Self

What is wrong with Dr. Davenport with telling Antwone that the sessions have ended and he needs to find his family?

Once he finds his family he needs someone to help process his emotions

In the two factor therory of PTSD the second factor, _________, maintains avoidance by reducing fear

Operant Conditioning

Schizophrenia is a disorder that is most often treated ____________

Over an extended period of time

Why did Charlie have an intrusive flashback on his birthday?

The candles and singing brought back memories of his birthday

Later on...

The individual's life, in situations that are vaguely similar to the trauma—perhaps merely because they are startling, anxiety provoking, or emotionally arousing—amygdala-mediated memory traces are accessed more readily than are the more complete, less shrill memories that have been integrated and modified by the hippocampus and the cerebral cortex

What type of hallucinations do individuals with schizophrenia usually experience?

Voices which are demanding and abusive

What symptom is Nathaniel displaying when he is on the side of the road speaking gibberish?

Word Salad