PY 358 Test 1

Diagnosing Psychological disorders: -DSM-III, DSM-III-R -DSM-IV and DSM-IV-R

-1980: Departed radically from predecessors. First, attempted to take an atheoretical approach to diagnosis, relying on precise descriptions of disorders as presented to clinicians rather than on psychoanalytic or biological theories of etiology. -Second major change: specificity and detail with which criteria for identifying a disorder weree listed made it possiblee to study reliability and validity. -Popular: primary was its precis descriptive format and neutrality with regard to presuming a cause for diagnosis. . . . -ICD-10 (1992). US required by treaty obligations to use ICD-10 codes in all matters relatd to health. To mak ICD-10 and DSM as compatible as possible, fourth edition was made. -Based on sound scientific data. -Perhaps most substantial change was that the distinction between organically basd and psychologically based disorders that was prsent in previous editions was eliminated. -We now know that even disorders associated with known brain pathology are substantially affected by psych and social influences.

The 3 major models of psychopathology: 3) Psychological traditional

-2 causes of maladaptive behavior: social and cultural influences AND learning tools taking place in the environment with the treatment set on reeducating the individual through rational discussion Moral Therapy: Treating institutionalized patients as normally as possible in a setting that reinforced normal interactions -INDIVIDUAL ATTENTION, no restraint or seclusion Asylum Reformation and Decline of Moral Therapy: -Post Civil War, waves of new patients -Dorthea Dix: reform treatment of insane Major Schools Emerge: 1) Psychoanalysis (Freud's elaborate theory of the structures of the mind and the role of unconscious behaviors in determining behavior) 2) Behaviorism (John B. Watson, Pavlov, Skinner: how learning and adaptation affect development of pathology)

-Psychological testing -Evidence based assessment: using scientific literature to inform the way in which we conduct clinical assessment -3 categories of psychological tests

-Distinct from psychological assessment we have the category of psychological testing -EBA: Term borrowed from medicine, using scientific literature to inform the way in which we conduct clinical assessment or clinical practices more broadly, because talking about assessment and testing here, simply call this EBA as opposed to Evidence Based Treatment or Evidence Based Practice -Assessment for psychological disorders must be reliable and valid. -3 Categories: Projective tests, Personality inventories, Intelligence testing

Gene-environment correlation model/reciprocal gene-environment model

-Genetic endowment may increase the probability that an individual will experience stressful life events -Depression: seek out difficult relationships or other circumstances that lead to depression -If you and your spouse each have twins who have been divorced, you two will likely divorce

-Glutamate -GABA

-Glutamate: excitatory transmitter that turns on mangy different neurons, leading to action: MSG (increase amount of glutamate) -GABA: inhibitory NT, inhibit or regulate the transmission of information and action potentials -Reduce anxiety: benzodiazepines -GABA BROADER than anxiety, reduce overall arousal and temper our emotional responses -NOT SYSTEM responsible for anxiety, but rather serotonin system -"Chemical brothers" balance functioning in brain, fast acting keep up with many influences from environment that require action or restraint

Interactions of psychosocial factors and neurotransmitter systems -Insel et al. Rhesus monkey example -2 groups -Benzodiazepine inverse agonist -Same level of neurochemical substance acting as NT had different effects on behavior depending on psych and env histories of monkeys

-Insel et al. (1988) -Understand how PS factors and NT systems interact in 2 groups of Rhesus monkeys -Control and anxiety: almost all identical except in their ability to control what went on in their cages (access to toys, treats, and food) -1 group: free access to toys and treats, but 2nd group only got toys and treats when the first group did. Members of the 2nd group had same number of toys and treats, but could not choose when they got them. -1st group grew up with sense of control over things, whereas the 2nd group did not. -Benzodiazepine inverse agonist (cause extreme burst of anxiety) (neurochemical with the opposite effect of a NT) -> 1st group (lots of control in their environment) behaved much differently to the 2nd group who were anxious, they got angry and aggressive and would attack other monkeys -The 2nd group (who had no control over their environment) ran into a corner and displayed extreme signs of anxiety and panic. -Same level of neurochemical substitute acting as a NT had different effects on behavior depending on psychological and environmental histories of the monkeys -Interaction of PS factors and NT systems

Historical conceptions of PP: Biological causes -Syphilis -Germ Theory of Disease -Emil Kraepelin (Diagnosis and categorization: first goal of study of PP...)

-Renewed interest in physical causes to PDs -Beyond Mind-Body problem -> Syphilis: Untreated syphilis got into the brain (STD) and sex organs quite far from brain, but left untreated syphilis had symptoms that mimicked psychosis: delusions of grandeur (I'm Queen Elizabeth) (perceptions and beliefs not based in reality) or hallucinations (see things that aren't there: ex: seeing arm on fire). Allowed us to break the mind-body dualism and begin to as a discipline develop hypotheses thaat linked mind and body. Early 1800s. General paresis condition with symptoms consistent with psychosis of syphilis (often resulted in death: Germ Theory of Disease: specific bacteria cause syphilis and can effectively be treated with medicine - prevent psychological manifestation of syphilis) -Emil Kraeplin: Founding father of psych - known for Diagnosis and Categorization (first goal of study of PP: describe or come up with common language for PDs - put PDs in bins - created DSM)

Dopamine

*Implicated with addiction disorders, depression, schizophrenia and ADHD, recent development of second-generation antipsychotic drugs may prove differently (has weak effects on dopamine receptors) -Dopamine more general effect throughout specific regions of brain, switch that turns on various brain circuits possibly associated with certain types of behavior. Once switch is turned on, other NT may then inhibit or facilitate emotions or behavior. -Circuits merge and cross with serotonin circuits at many points and therefore influence many of same behaviors., Balance each other L-dopa: dopamine agonist (increases level of dopamine) switches on locomotor system, regulates ability to move in coordinated way and once turned on influences serotonin activity (Parkinson's disease) -Mesolimbic system (Sch.) basal ganglia path (locomotor system) - 2 major dopamine pathways

The nervous system is divided into 2 systems: the central nervous system and the peripheral nervous system -CNS includes... What does it do? -PNS includes .... -SNS is responsible for -ANS is responsible for and is further broken down -Symp. NS responsible for -Parasymp. NS responsible for (Heavily implicated in pacemaking of heart, link between emotion regulation and cardiac automatic functioning could show a top-down influence on heart from prefrontal cortex

- The central nervous system includes the brain and the spinal cord. Processes all information received from our sense organs and reacts as necessary. It sorts out what is relevant from what isn't. - The peripheral nervous system is further broken down into the autonomic nervous system and the somatic nervous system. - The SNS is responsible for all voluntary movements (muscle movements). -The ANS is responsible for automatic processes outside of cognitive awareness such as breathing and controlling heart rate. -The ANS is further broken down into the sympathetic nervous system and the parasympathetic nervous system. -The Symp. NS is responsible for the fight-or-flight response - the release of stress hormones such as cortisol and activation of the HPA axis. -The Parasymp. NS is responsible for bringing us back down to rest after activation of stress hormones and stress responses. Physiological research finds that the PNS is heavily implicated in control of heart rate and same nerves including the vagus nerve (cranial nerve that has tracings on pacemaking of heart), this link between emotion regulation and cardiac autonomic functioning suggest a top-down influence on heart from prefrontal structure

Structure of the brain Brain stem: hindbrain (medulla, pons, cerebellum) midbrain thalamus, hypothalamus Forebrain: Limbic system (hippocampus, amygdala) Cerebral cortex (4 lobes, prefrontal cortex)

-2 Parts: Brain stem and forebrain 1) Brain stem: lower and most ancient part of the brain, handles most of the essential automatic functions (breathing, sleeping, moving coordinately) 2) Forebrain: more advanced and evolved 1) Lowest part of BS: hindbrain: contains medulla, pons, cerebellum -Regulates many automatic activities -C: controls motor coordination 2) Midbrain: also located in brain stem: coordinates movement with sensory input and contains parts of the reticular activating system, processes of arousal and tension 3) Top of brain stem: Thalamus and hypothalamus, regulating behavior and emotion -Relay between forebrain aand remaining lower areas of BS. 1) Base of forebrain: limbic system: hippocampus, amygdala, cingulate gyrus, septum: regulate our emotional experiences and expressions and our ability to learn and to control impulses Basal ganglia, caudate, nucleus: control motor activity 2) Largest part of forebrain: cerebral cortex: 80% of neurons in CNS, our distinctly human characteristics, look to future, reason, plan, create DIVIDED IN 2 HEMISPHERES: May seem completely independent, though both can perceive and think and remember, indicates each have different specialties. LEFT: Verbal and other cognitive processes Right: World perception and creating images -Each hemisphere have 4 lobes : temporal, parietal, occipital, frontal 1) Temporal: recognize various sights and sounds with long term memory 2) Parietal: recognize various sensations of touch and monitor body positioning 3) Occipital: associated with integrating and making sense of various visual inputs 4) Frontal: most interesting, front of frontal lobe called prefrontal cortex: higher-cognitive functioning such as thinking reasoning planning for future long-term memory, synthesizes all information received from other parts of brain and decides how to responds. Also enables us to relate to world around us

Diagnosing Psychological disorders: DSM-5 Frank example Social and cultural considerations in DSM-5

-2013 (David Kupfer). Carried out in collaboration with ICD-11. International leaders working simultaneously on both. -Largely unchanged, some new disorders introduced, others reclassified. -Use of dimensional axes for rating severity, intensity, frequency, or duration of specific disorders in a relatively uniform manner across all disorders is a new feature. -Introduces cross-cutting dimensional sypmtom measures, not specific to any particular disorder (the assessments) -Idea would be to monitor the symptoms, If present, across course of treatment to presenting disorder -0-4 scale . -Frank's case, initial observations indicated an OCD diagnosis. He might also have long-standing personality traits that lead him systematically to avoid social contact (schizoid personality disorder). Job and martial difficulties might be indicated where clinicians note psychosocial or environmental problems that are not part of the disorder but might make it worse or affect treatment planning. -Criteria for disorders include the provision that the disorder must cause clinically signifiant distress or impairment in functioning in social, occupational, or other important areas of functioning. Individuals who have all symptoms as noted earlier but do not cross this "threshold" of impairment could not be diagnosed with this disorder. -One change in the DSM-5 is to make this judgement of severity and impairment more systematic by using a dimensional scale. In addition to rating overall impairment, impairment specifically associated with the disorder (if present) is also rated. Must be rated at least 4 in severity to meet criteria for psych disorder. Many times, disorders such as OCD would be 2-3, meaning all of symptoms are there but in too mild a form to impair functioning. (Subthrehold) . . . -By emphasizing level of stress in environment, DSM-III and DSM-IV facilitated more complete picture of individual. -DSM-IV integrated important social and cultural influences on diagnosis, a feature that remains in DSM-5 (Culture refers to values, knowledge, and practices that individuals derive from membership in diff ethnic, religious, or other social groups. as well as how the membership in these groups may affect the inidividual's perspective on their experience with PD) -Plan referred to as 'cultural formulation' allows disorder to be described from perspective of patient's personal experience and in terms of priamru social and cultural grouos (such as Hispanic or Chinese) -Cultural considerations must not be overlooked in making diagnoses and planning treatment.

Creating a diagnosis: -Mixed Anxiety-Depression

-A number of potentially new diagnostic categories were considered in publication of DSM-5. . . 1) for years people coming to primary care clinics had complained of minor aches and pains that prove to have no physical basis. They also complain of feeling uptight, down in dumps, or anxious. -Their symptoms for both anxiety and depression classic but not frequent or severe enough to meet criteria for existing anxiety or mood disorder. Because many individuals present with some minor symptoms of a given disorder, it is important to set thresholds high enough that only people are clearly are suffering some impairment qualify for category. (Substantial legal and policy implications contingent on a diagnosis - eligible to ask govt. for financial reimbursement or disability payments) -Health-care would be further strained and fewer resources could be given to the severely impaired. -ICD-10 seeing it as prevalent throughout world, created category for mixed anxiety-depression, but not defined or had any criteria to allow further examination. -Results indicsted peoplee presenting with number of anxious and depressed symptoms who did not meet criteria for existing anxiety or mood disorder (because theey did not have the right mix and or severity of symptoms) weree common in primary care settings. Substantially impaird in occupational and social functioning and experienced great deal of distress. -Such people could be distinguished from peopl existing with anxiety or mood disorders on basis of symptoms with very careful and detailed assessment procedures utilized. -Could not yet verify the reliability of the diagnosis or predictive validity at time. -Therefore, DSM-IV placed M A-D at appendix, reserved for new diagnoses undeer study with possibility of becoming full diagnostic category in future editions. -NEW STUDIES: Although peeople do present these symptoms, relatively rare in absence of a current or previous anxiety or mood disorder. Symptoms do not last long, and was difficuklt to identify condition in reliable fashion, thus not even placed in appendix of DSM-5.

Judy's example continued -Biological factors -Behavioral factors -Emotional factors -Social factors -Explain multiply determined phobia Judy is experiencing

-All of the influences played off of each other and were at the root cause of Judy's phobia. Phobia: Behavioral factors: 2) -Conditioned response to sight of blood -Fed off biological factors - Hallmark of phobias: avoid and escape situations involving blood Biological factors: 1) -Genetics - inherited tendencies -Physiology - (e.g. lightheadedness, fainting) Emotional factors: 3) -Fear and anxiety -Fear of fainting, worrying about health Social factors: 4) E.g. attention from others -May reinforce her responses -Explain multiply determined phobia Judy is experiencing (What is underlying multiple integrative approach to Psychopathology) - 4 different influences at root cause of Judy's phobia Judy's case included four factors seen in the Integrative Approach - Proving PSYCHOPATHOLOGY IS MULTIPLY DETERMINED: Psychological disorders are complex (complex trajectories - from birth to death and lots of inputs along the way those inputs react with underlying genetic and biology to influence the expressions, manifestations, and progression of PDs)

Psychophysiological assessment -EEG -ERP -Alpha waves

-Another method for assessing brain structure and function specifically nervous sytem activity generally. -Measurable changes in nervous system that reflect emotional or psychological events. -Electroencephalogram (EEG): measuring electrical activity in the head related to firing of a specific group of neurons reveals brain wave activity. -A person;s brain waves can be assessed in both waking or sleeping states. In an EEG, electrodes are placed directly on various places on scalp to record different low-voltage currents. -When brief periods of WWEEG are recorded in response to specific events, such as hearing a psych meaningful stimulus, response is called an event-related potential (ERP) or evoked potential. -Have learned that EEG patterns are often affected by psych or emotional factors and can be an index of these reactions or a psychophysiological measure. In a normal, health, relaxed adult waking activities are characterized by a regular pattern of changes in voltage termed alpha waves. -Alpha wave pattern is associated with relaxation and calmness. During sleep, we pass through several stages of brain activity at least partially identified by EEG patterns. During deepest most relaxed stage, typically 1-2 hours after a person falls asleep, EEG recordings show pattern of delta waves slower and more irregular than alpha waves, which is normal for this stage of sleep. -If frequent delta wave activity occured during waking stage, it might indicate dysfunction of localized areas of brain. -Psychophysiological assessment of other bodily responses may also play a role in assessment: Heart rate, respiration, and elctrodermal rsponding (galvanic skin response: meausre of sweat gland activity controlled by peripheral nervous system) -Assessing psychophysio response to emotional stimuli is important in many disordeers, PTSD (stimuli such as sights or sounds associated with trauma evoke strong psychophysio responses even if patient is not fully aware)-> -Also used in many sexual dysfunctions or disorders (sexual arousment assessed through direct measurement of penile circumference or vaginal blood flow to erotic stimuli) -physio measures are also important in assessment and treatment of conditions such as headaches or hypertension - form basis of treatment as well as biofeedback (leveel of physio respoding such as blood pressure readings are fed back to patient by meters so patient can try to regulate those responses) -Physiological assessment is not without limitations: requires great deal of skill and technical expertise. Produce inconsistent results because of procedural or technical difficulties or nature of response itself. More sophisticated psychophysio assessment is most often used in theoretical investigations of nature of certain psych disorders, particularly emotional disorders.

-Multidimensional integrative approach

-Approach to the study of psychopathology that holds psychological disorders as always being the products of multiple interacting causal factors -No influence operates in isolation. Each dimension - biological or psychological - is strongly Influenced by the others and by development, and they weave together in various complex and intricate ways to create a psychological disorder. -To say that psychopathy is caused by a physical abnormality or by conditioning is to accept a linear or one-dimensional model. Most scientists and clinicians believe abnormal behavior results from multiple influences. A system, or feedback loop, may have independent inputs of many different points, but as each input becomes part of the whole, it can no longer be considered independent. A systemic perspective on causality. No particular influence cannot be considered out of context. Context, is the biology and behavior of the individual, as well as the cognitive, emotional, social, and cultural environment because any one component of the system inevitably affects the other components. Judy example: -Biological influence: Vasovagal syncope: sinking feeling or swoon caused by low blood pressure In the head. Cause of VS could be an overreaction of the sinoaortic baroreflex arc: compensates for sudden increase in blood pressure by lowering it Phobia is also highly inherited, but some people with little to no syncope reaction develop the phobia anyways, so to cause blood-injection-injury phobia, a complex interaction must occur between emotional, cognitive, social, behavioral, and biological factors. -Behavioral influence: saw a movie with graphic scenes of blood and got bad reaction, her reaction an UCR became associated with situations similar to the scenes in the movie -Emotional influence: biology influencing behavior, but behavior/thoughts/emotions could also influence biology Emotions can affect physiological responses such as blood pressure and heart rate and respiration Emotions also changed the way she thought about situations involving blood and injury, which motivated her to behave in ways she did not want to -Social influence: Judy's friends and family rushed to her when she fainted: did their support help or hurt?Rejection by authority figures can make psych disorders worse Strong effects of social attention may actually increase the frequency and intensity of the reaction Developmental influence: passage of time, at certain times we may enter a developmental critical period when we are more or less reactive to a given situation or influence than at other times

Creating a diagnosis: -Premenstrual Dysphoric Disorder

-Bias and stigmatization -Clinicians identified small group of women who preseented with severe and incapacitating emotional reactions associated with late luteal phase of menstrual period -In view of suffering and impairmeent associated with condition, proponents argued that women deserved the attention, care, and financial support that inclusion in a diagnostic category would provide. -Arguments against: relatively little scientific info existed, substantial objections that what could be a normal endocrinological stage experienced by most or all women would be stigmatized as a PD. (Endocrinological or Gynecological rather than mental?) -Should a comparable male disorder (aggression relatd to male hormons) be includd too? -Appendix in DSM-III-R -Variety of scientific findings began to accrue that supportd the inclusion of disorder in DSM-IV. Although rather vague or less severe symptoms of PMS occur in 20-40% of women, only small proportion of them (4.6%) suffer from most severe symptoms associated with LLPDD. In addition, substantial number of womne with no other psych disorder meeet criteria for LLPDD. -Abnormalities in several biological systems associated with clinically significant premenstrual dysphoriaa, and several types of treatment showed promise of being effective -Cite issue of stigmatization warning recognition might confirm cultural belief that menstruation and resulting disability make women unfit for positions of respon. DSMIV- Appendix, further study. Name change. -Epidemiological studies from around the world supported existence of disabling premenstrual symptoms in about 2-5% of women.With another 14-18% xpriencing moderate symptoms. -Specific treatments and new info on effective treatment is published frequently. One of diffs encounterd has been distinguishing PMDD from premenstrual exacerbations of other disordeers (binge eating disorder, mood disorders). -Nature and timing of symptoms to make a valid distinciont between two. -Accumulating evidence thus far seems to sgguest PMDD is best considered a disorder of mood rather than endocrine and should continue to be considered a mental disorder. -DISTINCT PSYCH DISORDER IN DSM-5.

Emotional factors -Cognitive aspects: Appraisals -Physiological aspects: Connections between lower brain (not prefrontal cortex) and experience -Behavioral aspects: likely to escape, freeze, approach, attack situation -Hostility and your heart: coronary disease, formation of plaques due to increase blood pressure and heart rate due to conflict

-CA: Appraisals (ways you process world around you that are fundamental to your emotional experiences), attributions and ways of processing the world around you that are fundamental to your emotional experiences -PA: Connections between lower brain (NOT prefrontal cortex) and experieence -BA: Whether or not you are likely to escape, freeze, approach, or attack a situation -HAYH: Role of personality traits (anger and hostility) and what it means for your long term health -Timothy W. Smith -Study of couples: If you are hostile, cranky, likely to be at greater risk for developing coronary disease than not -Hostile behavior and mental conflict in couples leads to coronary disease -> very early on in progression of disease -> Atherosclerosis (hardening of arteries) - different stage to ATH (Coronary calcification being an early stage) -> when have increase in heart rate and blood pressure through conflict those increases sheer endothelium linings of arteries - starts down long train of artery hardening that leads to blocking of arteries in formation of plaques that can cause heart attacks and strokes -Particularly males conflicted in a marriage, bad for your heart

Clinical assessments: -Clinical assessment: systematic ... and ... of psychological, biological, and social factors present within an individual with a possible ... -Diagnosis stark contrast to CA -Process of determining whether the particular problem afflicting the individual meets all criteria for ... as said in the ... -Assessment (3 are the nuts and bolts of the underlying pieces of the instruments we might use to understand the broader reading of assessment) 1) Reliability: consistency of a .... 2) Validity: veracity/truthiness of a .... 3) Standardization: consistency across ... -Starbucks example

-CA: Systematic evaluation and measurement of psychological, biological, and social factors present within an individual presenting with a possible PD. EX: Not sure whether someone entering the office might meet the criteria or pass the threshold for an actual PD, so to determine whether or not that is the case, need to use a clinical assessment, some type of systematic evaluation or way of determining how psychological, biological, and social factors within an individual are present or indicative of a possible disorder -CA is a stark contrast to a diagnosis: -D: Process of determining whether the particular problem afflicting an individual meets all criteria for PD as set forth in the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition - Bible for all mental health professionals in the US -A: Ways in which assessments are evaluated (broad term of CAs) 1) R: Consistency of a measure, which coincides with 2) V: "veracity or truthiness" of a particular measure - Measuring what it is supposed to measure 3) S: Consistency across different measures (process by which certain set of standards/norms determine technique to make its use consistent across different measures: comparison of scores to someone like you and not to different people) EX: Starbucks: excellent at S and still are: If you go to any SB and order a caramel macchiato it will taste the same. SB goes to great lengths to ensure S. Apply to V: SB providing us with a caramel macchiato, and that is what we get, we're getting what we're intending to get (drinking what we're supposed to be drinking) - not asking for a CM and getting a vanilla latte

Neuron structure -Neurotransmitters -Cellular level for NS -Dendrites -Axon hillock -Axon, signal direction -Presynaptic neuron -Postsynaptic neuron -Synaptic terminal -Synaptic gap, synapse -Myelin sheath

-Cellular level for nervous system is the neuron. Neurons receive chemical messages in the form of NTs and those chemical messages jimp from neuron to neuron so they can make their way through the brain and the body. 1) Chemical messages are received at the dendrites. Branch-like structures at the end of one neuron. 2) NTs pass through the junction of a neuron that links the nucleus to the rest of thee neuronal body (axon hillock). 3) NT then moves through the axon (in the signal direction) towards the subsequent neuron they are trying to connect with The presynaptic neuron is the cell sending the chemical messages, where as the postsynaptic neuron receives the chemical messages. The synaptic terminal is where the NT is set to be released from the presynaptic neuron. The synaptic gap or synapse is the space between the presynaptic neuron and the postsynaptic neuron. This gap is where the NT is then taken up by the dendrites of the postsynaptic neuron. The myelin sheath is the white 'wrapper' around the axon. Myelinated neurons allow signals to travel down the axon much quicker than if they were not present. 4) The axon terminates at the synaptic terminal (the synaptic gap is the space between one neuron and the next.)

Behavioral Model (Psychological Traditional) Pavlov and CC Behaviorism

-Cognitive-behavioral model, social learning model Pavlov and CC: type of learning - a neutral stimulus paired with a response until it elicits that response -Stimulus generalization -CC process begins with stimulus that would elicit a response in almost anyone with no learning (UCS) -CR can be olearned in 1 trial, but repeated pairing of UCS and CS usually occurs -Extinction -Scientific measurement and precision _ in psychology -Titchener - introspection - _ John B. Watson - Behaviorism: no introspection psychology could be made scientific (purely objective) -Albert - reach for rat- loud noise - showed fear if rat, then in all white fluffy objects -Mary Cover Jones - fear can be learned or classical conditioning can it be learned? Bring rabbit closer and have other kids who are not bothered by it -2 decades later, Joseph Wolpe: systematic desensitization (individuals gradually introduced to objects or situations so they could extinguish the fear, added element of relaxation/fear BEHAVIOR THERAPY: Paved way for phobia reduction, seldom used today BF Skinner -> Operant conditioning: type of learning in which behavior changes as a function of what follows the behavior -Behavior not automatically elecited by UCS -Like Watson, a science of human behavior must be based on observable events and relationships among these events -Thorndike: Law of effect: behavior either strengthened or weakened depending on consequences of that behavior -Reinforcement: to 'reward' because it connotes the effect of the behavior -Schedules of reinforcement -The primary way to develop new behavior is positive reinforcement, not punishment, not best in long run Shaping: Process of reinforcement successive approximations to a final behavior/set of behaviors -Scientific principles of psychology applied to clinical _ -Little room for biology in behavioral model originally because disorders were largely considered environmentally-determined reactions (did not account for development of psychopathology across lifespan)

Peripheral nervous system 1) Somatic nervous system 2) Autonomic nervous system HPA system

-Coordinates with the brain stem to make sure the body is working properly. 2 major components: 1) SOMATIC NERVOUS SYSTEM 2) AUTONOMIC NERVOUS SYSTEM 1) Controls muscles so damage in this area might be difficult to make voluntary movement such as talking 2) Includes SYMPATHETIC AND PARASYMPATHETIC Regulate cardiovascular system and endocrine system -Endocrine system: each endocrine or gland procudes its own chemical messenger or HORME and is released direclty in bloodstream -Adrenal gland, epinephrine -Thyroid, thyroxine -Pituitary - master gland - variety of reg. hormones -Gonadal glands - sex hormones -Hypothalamus x endocrine system : HPA Axis -Dysregulation of HPA axis: depression -Endocrine regulation can play role in depression, anxiety, schizophrenia, stress-related physical disorders, among others (psychoneuroendocrinology) Sympathetic NS: -Mobilized body during times of stress or danger -Heartbeat ^/^ blood flow to muscles, respiration ^, adrenal glands are stimulated Parasympathetic NS: Balance sympathetic system Normalize our arousal and facilitate storage of energy

Psychological testing: Intelligence testing -Binet, Stanford -IQ -Mental age -Chronological age -Deviation IQ -Wescheler Test

-Developed for one specific purpose: to predict who would do well in school (Alfred Binet and Theodore Simon: commissioned by French govt. to develop test that would identify slow learners who would benefit from additional help) -Lewis Terman of Stanford -> Stanford-Binet Test -Test provided a score known intelligence quotient (IQ) initially calculated by using child's mental age. EX: Child who passed all questions on 7 yo level and none on 8 yo level had a mental age of 7. This mental age was then divided by the child's chronological age and multipled by 100 to get the IQ score. Problems because a 4 yo neeeded only 1 year above his or her chronological age to have an IQ of 125, whereas an 8 year old needed 2 years to get the same score. -Current tests use what is called Deviation IQ: a person;s score is cmopared only with scores of others of the same age. -Weschler Tests : another widely used set of intelligence tests. Adults, children, young children. All tests included verbal scales (vocab, knowledge of facts, short-term memory, verbal reasioning skills) and performance scales (psychomotor ability, nonverbal reasoning, ability to learn new relationships) -Does a lower than average IQ mean a person is not intelligent? Not necessarily. Numerous reasons for low score (native languge) -Do these skills represent the totality of what we consider intelligence?

The 3 major models of psychopathology: 1) Supernatural traditional model:

-Deviance was a reflection of good versus evil occurring in an individual. -Demons and Witches: Roman Church and Catholic church split, people turned to magic and sorcery to solve problems. Individuals were probably responsible for any misfortune (work of the devil). <- see similar response from homosexuals who contract HIV. -Treatments: Exorcism, shaving cross in head, clung to wall in front of church. -Begun to be natural vs. supernatural explanations for mental disorders such as sloth/melancholy and stress/anxiety. Oresume. -King Charles VI - some saw his insanity as a reflection of God's anger. Physician moved him from home to home, but the physician later died and his condition got worse. If possession treatments sometimes worked, but if they did not, the subject would be left in confinement, beatings, or torture. Mass hysteria: Large-scale outbreaks of a bizarre behavior. May demonstrate the phenomena of emotion contagion: experience of an emotion seems to spread to those around us. -Modern example: 'smelling something funny' and getting sick from person to person Moon and stars: -Gravitational effects on body fluids had profound effect on psychological functioning.

Genetic contributions to psychopathology Dominant and recessive genes Genome

-Genes are long molecules of DNA at various locations on chromosomes within the cell nucleus Hair color and to a certain extent height and weight are influenced by genes, but our weight and even our height can be affected by nutritional, social, or cultural factors - our genes seldom determine our physical development in any absolute way -A few rare disorders can be determined strongly by one or more genes (Huntingdon, PKU) -We can change thee way the environment interacts with and affects the genetic expression of this disorder -Other than identical twins, every person has unique set of genes -46 chromosomes, 23 pairs -First 22: provide programs for development of body and brain, 23: sex -Simple pairs of molecules bound together in DNA molecules, ordering of base pairs can influence the way the body works -A dominant gene: one of a pair of genes that strongly influences a particular trait - need only 1 of them -Most of our behavior, personality, intelligence probably polygenic - all of which in turn are influenced by the environment. -Human genome (individual's complete set of genes) - sophisticated procedures used such as quantitive genetics (sum up all tiny effects across many genes) and molecular genetics (focus on examining actual structure of genes) -Hundreds of genes can contribute to the heritability of a single trait -Only a small proportion of the genes in any one cell are turned on or expressed, specialized genes. -Environmental factors, in form of social and cultural factors, can determine whether genes get turned on. EX: Mother rats licking and grooming, stress hormone modulator -Half of our enduring personality traits and cognitive abilities to genetic influence (genetic factors determined stability in cognitive abilities, whereas environmental factors were responsible for any changes) -Genetic factors make some contribution to all disorders but account for less than half of the explanation -Specific genes or small groups of genes may ultimately be found to be associated with certain PDs, much of the current evidence suggests that contributions to PDs come from many genes, each having a relatively small effect -Genetic contributions cannot be studied in the absence of interactions with events in the environmental that trigger genetic vulnerability or "turn on" specific genes -We may assume that once maturity is reached, structure and function of our internal organs and most of our physiology are set or the brain being hard-wired. A competing idea is that the brain and its functions are plastic, subject to continual change in response to the environment.

Gene X Environment -Genes provide... -Genes code for proteins and proteins are implicated in behavior, may not always have an overt expression of someone's underlying genetics though -Small effect size -Role of environment

-Genes provide boundaries (think of book-ins in a bookcase - hold books and provide boundaries for what is possible, but things may not always be expressed behaviorally.) - Genes code for proteins and proteins are implicated in behavior - May not always have an overt expression of someone's underlying genetics. -Effect size small (effect sizes of single genes and single genes polymorphisms exerting any kind of effect on behavior is actually quite small) -Usually multiple genes are at play when talking about real shifts in behavior/behavioral expressions of genetics. -Environment plays a role!

The 3 major models of psychopathology: 2) Biological traditional model

-Hippocrates and Galen: psychological disorders could be treated like any other disease. May also be caused by a brain pathology or head trauma and could be influenced by heredity or genetics. -If the brain were the seat of wisdom, conscious, intelligence, and emotions then the disorders would be located in the brain. -Humoral treatment of disorders: normal brain functioning related to 4 bodily fluids (blood, black bile, yellow bile, phlegm) -Disorders resulted from too much or too little of these. First example of an association to psychological disorders as a 'chemical imbalance'. -Heat, dryness, moisture, cold: excesses of more or less humors: increase or decrease one of the 4. -Bloodletting, leeches. -Saw hysteria as a somatic symptom disorder affecting only women (wandering uterus). -Syphilis: -Similar symptoms to psychosis (delusion of persecution and grandeur), 5 year onset to death. -FIRST TIME behavior and cognitive symptoms were traced to a curable infection. (Germ Theory of Disease) -John P. Grey: -Champion of biological tradition in US -The causes of insanity were almost always physical. Mentally ill should be treated as physically ill. And should have rest, diet, good environment. -Hospitals were more humane, but they soon became impersonal. Proper ventilation, room temperature. -Soon became so large and impersonal, that individual attention did not occur. -100 years later, Deinstitutionalization occurred (causing individual attention, but patients were release to own communities as the increase in chronically disabled patients became homeless.)

Diagnosing Psychological disorders: -Classification issues

-If we could not order or label objects or experiences, scientists could not communicate with one another and our knowledge would not advance. Knowing how one species of insects differs from another allows us to study its functioning and origins. When we are dealing with human behavior or human behavioral disorders, however, the subject of classification becomes controversial. Some poeple have questioned whether it is proper or ethical to classify human behavior. -Within PP, definitions of "normal" and "abnormal" are questioned, as is the assumption that a behavior or cogniition is part of one disorder and not another. Some would prfer to talk about feelings and behaviors on a continuum from happy to sad or fearful to nonfearful rather than to create categories as mania, depression, and phobia. -Few of us, howver, talk about our own emotions or those of our friends by using a scale, we talk about being happy, sad, angry, depressed, fearful and so on.

Diagnosing Psychological disorders: -Classical or Pure Categorical approach -Dimensional approach -Prototypical approach -Reliability -Validity

-In what different ways can we classify human behavior? 1) Distinct categories of disorders that have little or nothing in common with one another, for example either you hear voices and experience other symptoms of schizophrenia or you do not. -Emil Kraepelin: Biological tradition. Assume every diagnosis has a clear underlying patho-physiological cause, such as bacterial infection or malfunctioning endocrine system. Each disorder is unique. -When diagnoses are thought of in this way, causes could be psych or cultural instead of pathophysio, but there is still only one set of causative factors per disorder, which does not overlap with those of other disorders. Each disorder is fundamentally different, we need only one set of defining criteria which everybody in the category must meet. -To be diagnosed with depression one must meet all criteria. Thus, if they did, clinician would know cause of disorder. -Quite useful in medicin, extremely important for a physician to make accurate diagnoses -Most psychopathologists believe psych and social factors interact with biol factors to produce a disorder. Therefore, mental health field has not adopted a classical categorial modeel to pp. Clearly inappropriate due to complexity of psych disorders. 2) Quantify various attributes to a psychological disorder along several dimensions, coming up with a composite score. MMPI good example. "Dimensionalizing a disorder": depression on a continuum from mildly depressed in the morning (something most of us might experience) to feeling so deeply depressed that suicide seems like the only solution. -We note the variety of cognitions, moods, and behaviors with which the patient presents and quantify them on a scale. 1-10. -Though applied to past particularly in personality disorders, relatively unsatisfactory. Most theorists have not been able to agree on how many dimensions aree required, some say 1 others as many as 33. 3) Categorial approach (1) but with twist that it basically combines some features of each of former approaches. Identifies certain essential characteristics of an entity so that you and others can classify it, but it also allows certain nonessential variations that do not necessarily change the classification. EX: Dog, key general aspects and descriptions that make a dog a dog. But also have different sizes, colors, breeds. -Requiring a certain number of prototypical criteria and only some additional number of criteria is adequate. -Not perfect because there is a greater blurring at boundaries of categories, and some symptoms apply to more than one disorder, fuzzy categories. -Advantage of fitting better with current state of our knowledge of psychopath than a categorical approach and is relatively user-friendly. EX: Major depressive disorder in DSM-5, although both have requisite of five symptoms that bring them close to prototypes, they look different because they only share one symptom (DSM-5 based on this approach) . . . . -Any system of class. should describe specific subgroups of symptoms that are clearly evident and can be readily identified by experienced clinicians. -If the disorder is not readily apparent to both clinicians, the resulting diagnoses might represent bias. EX: Clothes -> elicit different comments from friends, biases -One of the most unreliable categories in current class. is the area of personality disorders - chronic, trait-like sets of inappropriate behaviors and emotional reactions that characterize a person's way of interacting with the world. Determining the presence or absence of this type of disorder during one interview is still difficult. -The more reliable the nosology, or system of class., the less likely bias is to creep during a diagnosis . . . -There are several types of diagnostic validity. Construct validity (signs and symptoms chosen as criteria for the diagnostic category are consistently associated or 'go together' and what they identify differs from other categories.) -The discriminability of construct validity might be evident not only in presenting symptoms ubt also in course of the disorder and possibly in the choice of treatment. It may also predict familial aggregation, extent to which disorder would be found among patient's relatives. A valid diagnosis tells clinician what is likely to happen with the prototypical patient: may predict course of disorder and likely effect of one treatment over another (predictive validity) When the outcome is the criterion by which we judge the usefulness of the diagnostic category (criterion validity) Create for a diagnosis of say social phobia it should reflect the way most experts in the field think of social phobia as opposed to depression. need to get the label right (content validity)

-Mental Status Exam -Systematic observation of an individual's behavior -1) Appearance and behavior (overt behavior, attire, appearance, posture, expressions) 2) Thought processes (rate of speech, continuity of speech, content of speech) 3) Mood and affect (predominant feeling state of individual, feeling state accompanied by what an individual says) 4) Intellectual functioning (type of vocabulary, use of abstractions and metaphor) 5) Sensorium (awareness of surroundings, in terms of a person or self and clinician, time, and place - "oriented times three")

-Included in the CI -Systematic observation of an individual's behavior -When person is in front of you, as clinician look over all these different domains such as appearance (is the person present), behavior, motor activity, making eye contact, speech, mood, affect, linear thinking, content of thoughts being expressed (are they delusional, paranoid, obsessive, normal or unremarkable), suicidality (do people deny or talk openly about intent or plan to harm or kill themselves), hallucinations, cognitions, good insight (understand and fess up to presenting problem or any underlying PP) -Appearance: Is person appropriately groomed and dressed? -Sensorium: Does the person know the day or the week, the time of day, who he or she is? -Behavior: IS the person tearful or sad? Passive or guarded? Fidgeting? Is motor activity slowed down or retarded? -EC: IS EC appropriate? Or gazing downward? -Goal is to gain aa sense behaviorally of some ubnderlying PDs -If someone is gazing downward, motor activity is slow or retarded, tearful behavior -> DEPRESSION as possible diagnosis especially if it is paired with depressed mood, blunted or flat affect (low and dragging, think Eeyore), suicidal thoughts -> all things give picture along with asking about symptoms of Depression in the CI that depression may indeed be present The mental status exam is often divided into categories when we write up a report that accompanies the CI (Appearance and Behavior, Thought processes, Mood and affect, Intellectual functioning, Orientation or sensorium)

Integrative approach to Psychopathology Psychopathology is MULTIPLY DETERMINED. Judy's example

-Injection-injury phobia and factors that underly this particular psychological condition: Judy is 16. Increased episodes of fainting. Beegan 2 years ago when she saw a graphic film of frogs being dissected (saw muscle, tissue, and blood). She began to feel lightheaded and decided to leave the room, but the images did not leave her. She continued to be bothered by the images and occassionally felt queasy, began to avoid situations in which she might see blood or injury, stopped looking at magazines that might show gory images. Found difficulty to look at raw meat and bandaids because they were brought on by feared messages and images to her mind. Eventually anything her parents or friends said that evoked an image of blood or injury caused Judy to feel light-headed. It got so bad that one of her friends said Cut it Out and she felt faint. 6 months ago, before visit, Judy actually faintd because she unavoidably encounterd something bloody. Her family physician and others found nothing wrong with her. By time she was referred to clinic, she was fainting 5-10 tims a wek oftn in class. Problematic and disruptive in school, students would flock to hr and help. Class was interuppted and because no one could find anything wrong with her she was sent to principal who suspended her because he thought she was being manipulative even though she was an honor student. -Judy met the criteria for a phobia (a psych disorder characterized by markedly persistent fear of an object or situation) -Judy's reaction was quite sever: may avoid careers, may avoid injections even when they may ned them, which could put their health at risk. -But many people have similar reactions that are not as severe when they receive an injection or see someone injured whether blood is visible or not.

Psychoanalytic Theory (Psychological Traditional) Therapy -Humanistic

-Jung, Adler - though psychodynamic Self-actualizing: all of us could reach our highest potential, in all areas of functioning if we had the freedom to grow -Every person is basically good and whole, blocks on the outside of individual can block actualization -Marlow: hierarchy of needs (cannot progress until satisfy lower levels) -Carl Rogers: most influential humanist: person-centered therapy - therapist is passive, few interpretations as possible Unconditional positive regard: complete and almost unusual acceptance, most of clients feelings and actions -Relatively little new info to psychopathy -no research, stressed unique and nonquantitative experiences of the individual

Behavioral therapy in practice -Key principles for treatment in insomnia are behavioral -Association of bed and restfulness, not... -CBT: Stimulus control -Toddler example

-Key principles for treatment in insomnia are behavioral: If you have problems staying asleep or falling asleep at night, you should get out of the bed. Do not want to associate your beed with anything but sleep (principles of conditioning). -Bed should not be a place for anger or frustration or wakefulness or sadness -> nothing but sleep or amorous activities. Cognitive behavioral therapy tennent behind a key facet of insomnia: Stimulus control: If you take longer than 20 minuts to fall aslepe or are awake for longer than 20 minutes at night, that is a bad thing. At that time you should get up and move to another location usualyl a chair - when you feel you are abele to return to sleep, you should go back to your bed. -Toddler: Pair bed with readiness to sleep so she knew when she got into her bed that it was time to fall asleep (no problems with sleep) -Foundations of behaviorism and behavioral therapy very much have vestiges in treatments for things people experience commonly (Insomnia 12-15% of general population)

Diagnosing Psychological disorders: -Prognosis (again) -Idiographic strategy -Nomothetic strategy -Classification -Taxonomy -Nomenclature

-Learning how Frank may resemble other peoplee in terms of the problems he presents is important for several reasons. Go back and find a lot of the info from prior cases that could be applicable for Frank's case. Can see how the problems began for other people, what factors seemed influential, and how long the problem lasted. -The clinician can form general conclusions and establish a prognosis (the likely future course of a disorder under certain conditions) -If we want to determine what is unique about an individual's personality, cultural background, or circumsntace, we use what is known as an idiographic strategy - lets us tailor our treatment to the person. But to take advantage of info already accumulated on a particular person or disorder, we must be able to determine a general class of problems to which the presenting problem belongs. This is known as nomothetic strategy. -C: Simply any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations (nomothetic strategy) -Classification in scientific context taxonomy - classification of entities for scientific purposes (insects, rocks, or if subject is psychology: behaviors) -Apply a taxonomic system to psychological or medical phenomena or other clinical areas, you use the word nosology. -Nomenclature: describes names or labels of the disorders that make up the nosology (for example anxiety or mood disorders) -DSM-5 is the classification system used in the US and widely throughout world with closely related International Classification of Diseases (ICD-10)

Neuroimaging (Pictures of Brain) -2 categories 1) CAT, MRI 2) PET, SPECT, fMRI

-Look inside nervous system and take increasingly accurate pictures of the structure and functions of the brain. 1) Procedures that examin structure of the brain, such as size of various parts and whether there is any damage. -Computerized axial tomography (CAT/CT scan): first neuroimaging technique which used multiple X-ray exposures of brain from different angles. Noninvasive, particularly useful in locating brain tumors or injuries. Repeated x-radiation can cause risk for cell damage. -Nuclear magnetic resonance imaging (MRI): high-strength magnetic field through which radio frequency signals are transmitted. Signals "excited" brain tissue, altering protons in hydrogen atoms. Alteration is measured, along with time it takes for protons to relax or return to normal. More expensive and originally took 45 minutes, but now little as 10 minutes and cost is decreasing. Claustrophobic. 2) Procedures that examine actual functioning of the brain by mapping blood flow and other metabolic activity. -Positron emission tomography (PET) scan: injected with tracer substance attached to radioactive isotopes, or groups of atoms that react distinctively. Substance interacts with blood, oxygen, or glucose rushes to these areas of the brain creating "hot spots" picked up by detectors that ideentify location of isotopes. We can learn what parts of brain are working and what parts are not. PET scans also useful in supplementing MRI and CT scans when localizing sites of trauma resulting from head injury or stroke, as well as when localizing brain tumors. -Look at varying patterns of metabolism that might be associated with different disorders. -Expensive -Available only in largee medical centers -Single photon emission computed tomography (SPECT) different tracer substance is used, less expensive, less sophisticated equipment to pick up signals. Is used more often that PET scans -Most exciting procedures that have been developed to work more quickly than regular MRI. Using sophisticated tech, procedures could only take miliseconds and can actually take pics of brain at work, recording its changes from one second to the next. Functional MRI or fMRI - largely replaced PET scans in leading brain imaging centers - BOLD-fMRI (most common, Blood Oxygen level dependent) Some of latest research in neuroimaging seeks to view brain all way down to levels of synapse. Detect activity at receptors for neurochemicals. -Brain imagery procedures hold enormous potential for illuminating contribution of neurobiological factors to psych disorders.

Scientific method in psychopathology

-Most important development of psychopathology is the adoption of SM to learn more about nature of PDs, causes, and treatment -Scientist practitioner: mental health professionals who take a scientific approach to clinical work, may function as SP in 1 or more of 3 ways 1) Keep up with current diagnostic and treatment procedures. 2) Evaluate own assessments or procedures to see if they work. 3) Conduct research, in clinics or hospitals, to see if they can information about disorders or their treatment.

Integrative approach to Psychopathology Psychopathology is MULTIPLY DETERMINED. 1) Biological 2) Behavioral 3) Emotional 4) Cognitive 5) Social 6) Cultural 7) Developmental

-NO ONE INFLUENCE ON PSYCHOPATHOLOGY OCCURS IN ISOLATION. -PP IS MULTIPLY DETERMINED! 1) BIOLOGICAL 2) BEHAVIORAL 3) EMOTIONAL 4) COGNITIVE 5) SOCIAL 6) CULTURAL 7) DEVELOPMENTAL All feed into the development and progression of psychological disorders (like PP)

Beyond DSM-5, Dimensions and Spectra

-New findings on brain circuits, cognitive processes, and cult. factors that affect our behavior could date diagnostic criteria relatively quickly. -Exclusive reliance on discrete diagnostic categories has not achieved its objective in axhieving a satisfactory system of nosology. -In addition to problems noted earlier with comorbidity and fuzzy boundary between diagnostic categories, little evidence has emerged validating these categories such as discovering specific underlying causes associated with each category. -Is is also clear that current cats. lack treatment specificity. That is, certain treatments such as CBT (cognitive-behavioral) or specific antidepressant drugs are effective for a large number of diagnostic cats. that are not supposed to be at all similar. -New approach? Most people agree this approach will incorporate a dimensional strategy to a much greeater extent than in DSM-5. -The term "spectrum" is another way to describe groups of disorders that share certain basic biological or psych qualities or dimensions. EX: "Asperger's Syndrome" (a mild form of autism) was integrated with autistic disorder into a new category of 'autism spectrum disorder'. -More conceptually substantial and consistent dimensional approaches are in development an dmay be ready for DSM-6 in 10-20 years. -In area of personality disorders, concluded that personality disorders are not that qualitatively distinct from personalities of normal-functioning individuals in community samples. Instead, personality disorders simply represent maladaptive and perhaps extreme variants of common personality traits. -Anxiety and mood disorders: have proposed a new dimensional system of class. based on previous research demonstrating that anxiety and depression have more in common than previously thought and may best be represented as points on a continuum pf negative affect or a spectrum of eomotional disorders. -It is now assumed that neurobiological processes will be discovered that are associatd with specific cognitive, emotional, and behavioral patterns or traits (for example bhavioral inhibition) that do not necessarily correspond closely with current diagnostic categories.

Diagnosing Psychological disorders: Diagnosis before 1980

-Observations of depressed, phobic or psychotic symptoms stretch back to earliest recorded observations of human behavior. Many so detailed that w could make a diagnosis today of those described. Only recently have we had attempted the difficult task of creating a formal nosology that would be useful for scientists and clinicians around the world. -As late as 1959, 9 systems for classifying PD, only 3 listed 'phobic disorders' -Creating a useful nosology is easier said than done -Early efforts of classifying PP arose out of biological tradition, Kraepelin first identified what we now know as schizophrnia (dementia praecox: deterioration of brain that sometimes occurs with advancing age and develops earlier than it is supposed to) - reflected belief that brain pathology is cause of a particular disorder -Bipolar disorder too (manic depressive psychosis) -Kraepelin's theorizing that psych disorders are basically biological disturbances had greatest Impact on development of our nosology and led to early emphasis on classical categorical strats. -1948: WHO added section classifying mental disorders to ICD-6 -1952: DSM-1 -Late 60s: systems of nosology begin to have some influence on mental health professionals. -1968: DSM-2, ICD-8: leaders in mental health began to relize importance of trying to develop a uniform system of classification (nearly identical to DSM-2). Lackd precision, often relying heavily on unproven theories of etiology not widely accepted by all mental health professionals. Little reliability.

Psychoanalytic Theory (Psychological Traditional), cont. Self-psychology Collective unconscious

-Outgrowths of psychoanalytic theory Self-psychology: Theory of formation of self-concept and crucial attributes of self to progress toward health or conversely neurosis -Object relations: study of how children incorporate images memories and values of a person important to them they are emotionally attached to - introject, become integrated part of the ego or assume conflicting roles in determining identity of self . Jung: Collective unconscious: wisdom accumulated by society and culture stored deep individuals memories and passed generationally, spiritual and religious drives as strong as sexual drives -Adler: inferiority complex Both show basic qualities of human nature and the strong drive to self-actualization: realize one's full potential -Others emphasized development over life span and influence of society and culture on personality Erikson: crises and conflicts in 8 specific life stages

Psychological testing: -Personality inventories -MMPI -MMPI-2

-Paul Meehl (some questions from magazines might have face validity, make sense when you read them, but is this necessary?) -Self-reported questionnaires that assess personal traits. What is necessary from these types of tests is not whether the questions necessarily make sense on surface, but what answers to questions predict. -Content of the questions become irrelevant, importance lies in what answers predict. Minnesota Multiphasic Personality Inventory (MMPI): In stark constrast to projective tests, MMPI are base don an empirical approach (collection and evaluation of data) not theoretical interpretation -Little room for interpretation -Problem: Time and tedium of responding to 550 items. Individual responss not examined, but the patterns of responses is reviewed to see whether it resembles patterns from groups of people who have specific disorders. On concern arose early in development of MMPI potential of some popl eto answer in ways that would downplay their problems. To assess this possibility, MMPI includes additional scales to detrmine validity of each administration (Lie scale: is a person trying to falsify answers to look good? Infrequency scale: measures false claims about psych problems or determines whether person is answering randomly, Subtle Defensiveness Scale: assess whether person sees themselves in unrealistically positive ways) -More recent versions of this tst liminate problms with original version, problems caused partly by original selective samplee of people, and partly rsulting from wording of questions. Sexist questions. Insensitive to cultural diversity. -1980 US Census of AAs and NAs for first time, addition new items have been added that deal with contemporary issues such as self-esteem, type A personality, family problems (MMPI 2) -Some research suggests that the information provided by MMPI though informative does not necessarily change how clients are treated and may not improve their outcomes.

Gene-Environment Correlation Model, Reciprocal Gene-Environment Model: Genetic endowment may increase the probability an individual will experience stressful life events. Those with blood-injury-injection phobia may also have personality trait like impulsiveness that makes them more likely to be involved in minor accidents that would result in them seeing blood. -DIVORCE EXAMPLE: no one gene causes divorce to extent that it is actually genetically determined. Tendency to divorce is certainly related to various inherited traits such as being high-strung, impulsive, or short-tempered vs. timid and unassertive. So, an inherited trait will make it more likely to choose an incompatible spouse. -Environmental factors might be choosing an incompatible spouse -Really social, interpersonal, psychological, and environmental factors go with who we get married to and why we stay married: Combination of genes and environment -Context plus sensitivity

-Perhaps the relationship betweeen genes and environment is more complex than we thought. -Also called Reciprocal Gene-Environment Model. -EX: DIVORCE: Probability of divorce - divorcing doubles over probability if your fraternal twin is also divorced. This is then increased sixfold if your identical twin is divorced. Twin studies often usd as models of gene x environmnt becaus identical twins carry the same geneetic info, fraternal twins to a lesser extent, but also have different environmntal inputs. -No one gene causes divorce to extent that it is actually genetically determined - The likelihood or tendency to divorce is almost certainly related to various environmental aspects (in addition to genetic aspects or INHERITED TRAITS including being high-strung, impulsive, or short-tempered), but environmental factors might be choosing an incompatible spouse (if you are unassertive and timid, you might choose a dominant and strong mate who might be very difficult to deal with -> many get divorced and find it is difficult to not be attracted to another individual who has same personality traits and may also be difficult to live with.) -This could be environmental (poor judgement), but really it is social, interpersonal, psychological, and environmental factors that go into who we get married to and why we stay married. Genes could contribute but probably more likely to be a combination of genes and environment. -Context plus sensitivity: Combination of both genes and environment as seen in divorce example. What do you come to the table with plus what is the specific environmental context you are dealing with.

Neuropsychological testing -Bender Visual Motor Gestalt Test -Luria-Nebraska, Halstead-Reitan

-Pinpoint the location of brain dysfunction --Bender Visual Motor Gestalt Test Measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction in such a way that the clinician can makee educated guesses about the person's performance and the possible existence of brain impairment. Assess brain dysfunction by observing effects the dysfunction on the person's ability to perform certain tasks. Though you do not see damage, you do see results. -Simple neuropsychological tst - child given seris of cards on which ar drawn various lines and shapes. Task is to copy what is drawn on card. Errors compared to children of same age. Number of error exceeds certain figure, brian dysfunction might be suspected. Test is less sophisticated than others because nature and location of the problem cannot be determined with this test. -Two of the most popular advances tests of organic (brain) damage that allow more precise determinations of locations of problem: Luria-Nebraska Neuropsychological Battery and Halstead-Reitan NP Battery (elaborate battery of tests to assess variety of skills in adolescents and adults: Rhythm Test, Strength of Grip test, Tactile Performance test) -Types of studies raise issue of false positives or false negatives (Times when test shows a problem when none exist or when no problem is found though some difficulty is prsent) -Fortunately, used primarily as screening devices and are routinely paired with other assessments to improve likelihood that real problems will be found,. -Some tests require HOURS to administer, score, and interpret and are therefore not used unless specific disorders or learning disorders are suspected

General psychopathology terms Psychopathology is not simple: The effect does not imply the cause (EX: Headache given Aspirin, the headache did not occur due to a lack of Aspirin.) -Presenting problem -Clinical description: the unique combination of... -Prevalence of disorder -Incidence of disorder -Course (3 types) -Difference in onset (2 typs) -Prognosis: the anticipation of...

-Presenting problem: a traditionally shortened way of indicating why the person came to the clinic -Clinical description: the unique combination of behaviors, thoughts, and feelings that make up a specific disorder -Prevalence of a disorder: How many people in the population have said disorder -Incidence of a disorder: How many new cases occur over a given period -Course: Disorders follow an individual path Chronic course: last long time or lifetime Episodic course: few months to slight recurrence at later time Time-limited course: improve without treatment, little-to-no risk of recurrence -Difference in onset: -Acute onset: Begin suddenly -Insidious onset: develops gradually over an extended period Prognosis: Anticipated course of a disorder -Dvlmpt. Psych: study of changes in behavior over time Etiology: study of origins (why does a disorder begin: causes)

-Central nervous system -Neuroscience: knowing how the nervous system, especially how the brain works is central to any understanding of our behavior, emotional, and cognitive processes Neurons Dendrites, axon, action potential Glial cells Neurotransmitters Excitatory or inhibitory neurotransmitters

-Processes all information received from our sense organs and reacts as necessary. It sorts out what is relevant from what isn't. -Checks memory banks to determine why the information is relevant -Implements the right reaction -Spinal cord: facilitate the sending of messages to and from the brain -Neurons: transmit information throughout the nervous system: contains cell body with 2 types of branches 1- Dendrite: receive messages in form of chemical impulses 2- Axon: transmits these impulses to other neurons Connections: between dendrite and axon in the synapse -Electrical impulses where information is sent down the axon (Action potential) -Terminal button: end of axon -Synaptic cleft: small space where impulse must pass -Neurotransmitters: biochemicals that are released from the axon of one neuron -Glial cells: some of which modulate neurotransmitter activity: once thought as passive and merely connected and insulated neurons -Some neurotransmitters are excitatory (increase likelihood that the connecting neuron will fire) and others are inhibitory (decrease likelihood) -Excesses or insufficiencies associated with different groups of PDs -Too much or too little of 1 NT is seen as too simplistic

Historical conceptions of PP: Psychological causes -Psychoanalytic theory -Freud and Brewer: Freud elaborated on the theory of the mind (personality) -Anna O. -Hypnosis and talk therapy

-Psychological, social, and culture as causal factors. -Psychoanalytic theory: school of thought -Freud and Brewer: inspired by Mesner's study of hypnosis. Freud: The role of unconscious (thought processes outside our awareness) processes in driving behavior -Elaborate theory of the structure of the mind (Personality!) (A lesser known contribution of Freud) Anna O. a famous case study by Freud and Breuer. Theories were based largely on case observations. Using key aspects of scientific method (very systematic for the time.) - Observation, being chief among them. In treatment for hysterical symptoms. She was young, smart, symptoms traced to time period when her father developed a serious illness. She was responsible for caring for her father when he was sick, spent many hours by his side - months after she noticed blurry vision and difference in moving right arm or legs, sometimes she experienced difficulty speaking, behavior became erratic or unpredictable. -Talk through and trace each symptom to a hypothetical cause - B and F concluded that hysterical ailments remitted after they talked to and worked through all the issues that surrounded her father's care - modern psychotherapy - used cases to come up with PA theory. -Anna was converting her psychological stress into physical symptoms -Freud and Breuer used cases of real, individual people using the scientific method of observation (1st step of SM) to try to understand the role of unconscious processes (outside of conscious thoughts or awareness - not actively thinking about -> Anna wouldn't think "I'm under a lot of stress, so I should go blind!") ANNA O. SUMMARIZED: -Treated for hysteria by Breuer and Freud -Limb paralysis on right-side of body -Disruptions to vision, speech, hearing -Unpredictable behavior -Treatment? Hypnosis (influenced by Mesner) and talk therapy (going through each symptom with Anna and speaking out loud symptom by symptom)

Behavioral and cognitive factors -Martin Seligman (Learned helplessness, learned optimism: optimism and health: positive psychology) -Bandura (Social learning, Bobo doll)

-Psychopathology is multiply determined! -MS: LH: When rats or other animals encounter conditions over when they have no control (rats confronted with occasional foot shocks, if learned they could do something such as press a lever to avoid the shock, then they would, but if animals learned their behavior had no effect on foot shocks (no matter what they did), they became helpless - gave up attempting to cope and developed an animal equivalent of depression -Optimism and health: Positive psychology -B: SL: Modeling or observational learning - people do not have to experience a certain event themselves in their environment to learn something, they can simply learn by seeing what happens to someone else in a given situation. -Bobo doll: Kids watch someone beat up inflatable doll, did exactly that (did not have to learn themselves but simply observed by viewing others) "Children see, children do."

Interactions of psychosocial factors and NT systems Psychosocial effects on development of brain structure and function Circuits are strongly influenced perhaps even created by psychological and social factors. We cannot consider nature and cause of psychological disorders without examining both biological and psychological factors.

-Psychosocial factors could directly affect levels of NTs -Monkeys: one group free access to toys and treats, but second group did not (could not choose when to get them) -Benzodiazepine inverse agonist: burst of anxiety -When injected, group with no control: crouched in corner with severe panic -Group with control: angry and aggressive SAME LEVEL OF NT had different effects depending on psychological and environmental histories of the monkeys. Significant interaction between psychosocial factors and NTs. Could psychosocial influences directly affect functioning and perhaps structure of CNS? -Crayfish, won battle and estabilished dominance, increased serotonin caused certain set of neurons more likely to fire., but if lost set of neurons less likely. -Naturally occurring NT have different effects depending on previous psychosocial (PS) experience of the organism -Effects of serotonin are reversible if the losers did regain dominance -Bully rats produced changes in mesolimbic dopamine system of smaller mouse (wanting no part of bigger rat -> recluse, usually assoviated with reward and even addiction. New learning and other positive changes in the brain, turned on in mesolimbic dopamine system by a psych experience: such that the mesolimbic system had different effects on the mouse than it usually does because of the mouse's unique experience - facilitate avoidance and isolation (reinforcement and even addiction) . . . -It also seems that the structure of neurons themselves can be changed by learning and experience during development and that these effects on the CNS continue throughout our lives. -Active rats had many more connections between nerve cells in the cerebellum and grew many more dendrites, suggesting enormous plasticity in brain structure as result of experience. Stress during early development can lead to substantial changes in functioning of HPA axis. -Monkeys in larger groups, increase grey matter involved in social cognition. -Increased grey matter density in several temporal lobe regions of brain in people who have larger Facebook networks. -It seems that very structure of nervous system is constantly changing as result of learning and experience, even into old age.

-Semistructured clinical interviews - often paired with BA -Behavioral assessment (MSE) -Psychotherapy

-SS CI: Using carefully phrased ?s into a consistent manner to elicit information from a client, often paired with a behavioral assessment (so that clinicians are sure they have inquired about the most important aspects of particular disorders: lacks spontaneity) -BA: using direct observations to assess individual's thoughts, feelings, and behaviors (Mental Status Exam) or going to their home or workplace to report behavior directly -Difference between assessments and PT -Psychotherapy: Effective by decreasing overall need for health services and procedures. L-T health improvements can teach people coping skills they can continue to use throughout their lives. Yet use of PT to treat mental or behavioral health issues has decreased over the last decade, while use of drugs to address such problems increases. -Some problems such as anxiety and mild to moderate depression, PT alone is often best first treatment option. For many patients with mental health problems, PT works better than drugs. PT often has positive affects even after treatment is completed. For some disorders a combination of medication and PT is often the best treatment. Primary care physicians is many consumers first health care professional they consult with about their health issues. Many of these issues stem from behavior or emotional factors. All consumers and HC providers should be aware of the benefits of PT to address many of these factors. -Potential value of PT can provide in both improved outcomes and cost savings. APA continues to support collaboration between psychologists with other health care providers as part of the integrated health care teams. PT is highly effective, but only when consumers have access to it.

Cultural, social, interpersonal factors -Size and strength of social networks really important for health -Social effects on health and well-being broadly -Coen study (Common cold) -Telomere links (Biological aging: did not nominate spouse as primary source for support)

-Size and strength of social networks is really important for health. Impacts susceptibility to common cold. Maintain physical distancing, but stay connected to family and friends! Vital to health during COVID season. -Coen: 276 healthy volunteers - used nasal drops to expose them to rhinovirus (common cold) - quarantine for a week - measure extent of participation in 12 types of social relationships (parent, spouse, friend, colleague) and other factors related to likelihood of developing a common cold (smoking, poor sleep) -Greater extent of social ties (networks), smaller chance you have of catching the common cold, even after all factors are taken into account or controlled for -Fewest social ties - >4x likely to catch the cold -Social and interpersonal factors also important in realm of biological aging. Telomere links are the caps at the end of DNA - help keep DNA in check and keep from degradation (aglet in shoelace - keeps shoelace from fraying) - shorter telomere despite chronological age, worse off you are in physical health. -Social relationships important for telomeres - if you did not nominate your spouse as a primary source for social support, shorter telomeres reported (underlies that social relationships are vitally important for your health.)

Social effects on health and behavior -Social influences on elderly -Social stigma

-Social relationships seem to protect individuals against many physical and psychological disorders, such as high blood pressure, depression, alcoholism, arthritis, the progression to AIDs, and bearing low birth weight babies -Not just absolute number of social contacts that is important, actual perception of loneliness (some people can live alone and be with few ill effects or feel lonely despite having frequent social contacts) -Even whether or not we come down with cold strongly influenced by quality and extent of our social network -Effect extends to pets! -Social and interpersonal factors seem to influence psych and neurobiological variables such as the immune system -Thus, we cannot study psych and biological aspects of psych disorders (or physical disorders for that matter) without taking into account the social and cult context of the disorder -Thus, the effects of a biological factor (drug) on psych characteristics (the behavior) were uninterpretable unless the social context of the experiment was considered. (Amphetamine increased dominant behaviors in monkeys high in social hierarchy and submissive behaviors in those that were not) -Some people think interpersonal relationships give meaning to life and that people who have something to live for can overcome physical defecencies and even delay death. -It is also possible that social relationships facilitate health-promoting behaviors. -they found that believing oneself embedded firmly in a social context was just as important as having a social network. Poor long-term adjustment was best predicted in those who perceived that their social network was disintegrating, regardless of whether it actually was or not. -The incidence of schizophrenia was 38% greater in men who had been raised in cities than in those raised in rural areas. -In summary, we cannot study psychopathology independently of social and interpersonal influences and we still have much to learn. Individual symptoms are strongly influenced by social and interpersonal context. Social Influences on Elderly -It may be advantageous for elderly people to become physically ill, because illness allows them to reestablish the social support that makes life worth living Social stigma: -Psych disorders continue to carry a substantial stigma in our society. -In addition in their role in causation, social and cult factors substantially maintain disorders because most societies have not yet developed the social context for alleviating and ultimately preventing them.

Epigenetics

-Studies to date have overemphasized the extent of genetic influence on our personalities, our temperaments, and their contribution to the development of PDs. The environment can still mold and hold its own biological interactions that shape who we are. -Even if born from stressed parents, stressed offspring, if raised by calm and supportive behaviors of mothers could be passed down through the upcoming generations of rats independent of genetic influences. (Behavior of mom altered endocrine response to stress) The environmental effects of early parenting override any genetic contribution to be anxious emotional or reactive to stress. -We can only talk about a heritable contribution only in the context of the individual's present and past environment -Though the environment cannot change our DNA, it can change the gene expression -EPIGENETICS: Stress, nutrition, or other factors can affect this epigenome, which is then passed down the next generation and maybe for several others -Genome itself did not change, so once chaotic environment disappears, the epigenome will fade -Neither nature nor nature influences development of personality and behavior alone

Clinical assessment, diagnosis

-Systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. A diagnosis is the process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder, as set forth in fifth edition of the DSM. EX: Frank: Sever distress and anxiety centering on marriage. "I've been really tense around the house and we've been having a lot of arguments. I've also been really uptight in my job, and I haven't been getting my work done." Always begin by asking paatient to describee for us, in a relatively open-ended way, the major difficulties that brought him or her to the office. This strategy tends to break the ice. Allows us to relate details of patient's life revealed later in the interview to the central problem as seen through the patient's eyes. "I can't seem to concentrate, and lots of times I lose track of what my wife's saaying to me, which makes her mad and we'll have a big fight. I worry most about geetting fired and then not being able to support my family. A lot of the time I feel like I'm going to catch something - you know, get sick and not be able to work and then failing in my job and in my marriage, and having my parents and her parents both telling me what an ass I was for getting married in the first place." Glancing up only occassionally to make eye contact, leg would twitch.Frank also closing eyes tightly for period of 2-3 seconds, during these periods with eyes closed that leg would shake. Became increasingly clear Frank was feeling inadequate and anxious about handling situations in his life. "I try not to think of something when I close my eyes. I have these frightening thoughts, it's hard to even talk about them. Terrible sights of people falling down and frothing at the mouth - seizures, epilepsy. I do everything possible to get those thoughts out of my head as quickly as I can. If I really jerk my leg and pray real hard for a little while the thought will go away." EX: Brian: Recently discharged from tour of duty in army. Evaluation of sexual problems. "I'm a homosexual. Yes, and I want to be straight. Others are attracted to me, I can tell by how they look at me. I know they talk about me behind my back (They wouldn't dare approach me.)"

Behavioral assessment -Analogue settings

-Takes process of mental status exam (sample how people think, feel, and behave and how thse actions might contribue to or explain their problems) one step further. Using direct observation to formally assess an individual's thoughts, feelings, and behavior in specific situations or contexts. May be more appropriate than an interview in terms of assessing individuals who are not old enough or skilled enough to report their problems or experiences. -Sometimes people withhold information deliberately because it is embarrassing or unintentionally because they aren't aware it is important. -Clinician may go person's home or workplace or even into local community to observe person and reported problems directly. Others set up role-play simulations in a clinical setting. -In behavioral assessment, target behaviors (what is bothering a particular prson) are identified and observed with the goal of determining the factors that seem to influence them. May sem easy, but even this aspect can be challenging. -Most clinicians assume that a complete picture of a person's problems requires direct observation in naturalistic environments. But going into a person's home, workplace or school isn't always possible or practical, so clinicians sometimes arrange analogue settings (similar settings, simulated situations). -Other resarchers are using hypnosis to produce analogous assessments by inducing symptoms of psychopathology in healthy individuals to study these characteristics in a moree controlled way.

Neurotransmitters -GABA -Glutamate -Serotonin, Monoamine -Dopamine, Catecholamine -Norepinephrine, Catecholamine -High levels of dopamine -Low levels of D -Moderately high levels of S -Low in S and D -Good mix of D, S, O -High mix of N and Adrenaline

-The biochemicals that are released from the axon of one neuron and transmit the impulse to the dendrite receptors of another neuron. 1) GABA - Inhibitory: Regulates transmission of information. Very important in process that governs sleep. 2) Glutamate - Excitatory: Turns on neurons (Acting in direct opposition of GABA) - Wakefulness and arousal. 3) Serotonin - MONOAMINE (A class of NTs) - Many of our behaviors. Depression, Cardiovascular disease. 4) Dopamine - CATECHOLAMINE - Pleasure-seeking (involved very broadly in substance use and misuse disorders) - Implicated in severe mental illness schizophrenia. 'Fun button' 5) Norepinephrine - CATECHOLAMINE - Respiration - heart rate - blood pressure High levels of dopamine - (thought to be implicated in) schizophrenia Low levels of dopamine - anxiety Moderately high levels of serotonin - happiness Both low levels of serotonin and dopamine - depression Good mix of dopamine, serotonin, oxytocin (responsible for milk let-down (breast feeding) PAIR BONDING HORMONE/the love hormone) High mix of norepinephrine and adrenaline - Flight-or-flight stress response

Neurotransmitters, brain circuits (paths of neurons sensitive to one NT that cluster together and form a path more commonly going a separate way, but sometimes overlapping with other paths) Agonist Antagonist Reuptake Monoamine NTs Amino acid NTs

-The effect of NT activity is less specific, they often seem to be related to the way we process information. -Changes in NT activity may make people more or less likely to exhibit certain behaviors in certain situations without causing the behavior directly SO... The currents intersect so often that changes in one NT result in changes in the other, often in a way scientists cannot yet predict. -Agonist: effectively increase activity of one NT by mimicking its effects -Antagonist: decrease or block a NT, inverse agonists: produce effects opposite to those produced by NT -Reuptake: once a NT is released, quickly broken down and brought back to synaptic cleft of same neuron, so quickly adjust back to environmental changes and situational demands (nervous system can) 2 Types of NT: 1) Monoamines: Serotonin, dopamine, norepinephrine 2) Amino acids: GABA, glutamate

Psychological testing: -Projective testing -Rorschach inkblot test -TAT

-They must be reliable so that 2 or more people administering the same test to the same person will come to the same conclusion about the problem. They must be valid so that they measure what they say they will measure. -Include specific tools to detrmine cognitive, emotional, or behavioral responses that might be associated with a specific disorder and more general tools that assess long-standing personality features. . 1) Projective tests: include a variety of meethods in which ambiguous stimuli, such as pictures of people or things, are presented to people who are asked to describe what they see. The theory here is that people project their own personality and unconscious fears onto other people and things (the ambiguous stimuli), and without realizing it reveal their unconscious thoughts to the therapist. Because these tests are based in psychoanalytic theory, have been controversial. 3 of the most wideely used projective tests: Lack of validity and reliability makes them less usefukl as diagnostic tests. 1) Rorschach inkblot test: includes 10 inkblot pictures that serve as ambiguous stimuli, extremely controversial because of lack of data on reliability and validity. 2) Thematic Apperception Test (TAT): Best known projective test after Rorschach. Series of 31 cards - 30 with picturs on them and 1 blank card - instructions ask person to tell dramatic story about picture. Test of imagination, one form of intelligence. -Based on notion that peopl will reveal their unconscious mental processes through their storiees about the pictures. Variations: modifications included changes not only in appearance of people in pics but for situations depicted, formal systems for stories including Social Cognition and Object Relations scale. How these stories people tell about pics depend on examiner's frame of reference and what the patient may say. In response to concerns about reliability and validity, John Exner developed standardized version of inkblot test called Comprehensive System, specifies how the cards should be presented, what examiner should say, how responses should be recorded. 3) Sentence completion method

Genes X Early Environment and Depression (Caspi) -5-HTT Gene, Serotonin transporter gene -LL, SS -Interaction of allele type and childhood maltreatment.

-Using a methodological design known as prospective longitudinal birth cohort. -Conducted in Dunedin Multidisciplinary Health and Development (study in New Zealand) -Studied 847 individuals from ages 3-26, followed people over time. -Assessed genetic factors: -5-HTT Gene 'Serotonin transporter gene': Likely implicated in depression (a candidate gene) -Long allele (LL) (Genes and exert influence on people by alleles): Better coping with stress. If have LL of 5-HTT gene, likely to be better at coping with stress. -Short allele (SS): Poor ability to cope with stress. -Assessed Major Depression by diagnostic interview. -Placed people in different categories according to level of maltreatment during childhood. -Interaction effect: None of this (allele type) mattered if nobody experienced childhood maltreatment. Those who were severely maltreated as children and were better able to cope with stress, really did not have an increased probability in developing a major depression episode. But those individuals with shorter alleles and severe maltreatment were quite likely to have a major depressive episode.

Cultural, social, and interpersonal factors -Gender

-Voodoo, Evil Eye, other fears -Fright disorders: characterized by exaggerated startle responses, aand other observable fear and anxiety reactions -But also susto has only 1 cause: individual believes he or she has become object of black magic -Friends and family thus ignore individual after brief period of grieving, assuming death has already occurred -Fear and phobias are universal, but what we fear is strongly influenced by our social environment. -Gender: -Gender roles have a strong and sometimes puzzling effect on psychopathology. -Likelihood of having particular phobia is powerfully influenced by gender -But a social phobia is strong enough to keep someone from attending parties or meetings affects men and women more or less equally but perhaps for different reasons. We think these substantial diffs have to do with at least in part cultural expectations of men and women or our gender roles. EX: Equal number of men and women experience that could lead to insect or small animal phobia, such as being bitten by one, but in our society it isn't always acceptable for a man to show his fear To avoid or lessen a panic attack, some males drink. Alcoholism. -It even seems that men and women may respond differently to the same standardized psych treatment -Well-established ability of women to recall emotional memories somewhat better than men may facilitate emotional processing and long term treatment gains. -Bulimia nervosa: young female or gay males -Females unique response to stress called "Tend and befriend" to protecting themselves and their young through nurturing behavior (tend) and forming alliances with larger social groups particularly other females (befriend) -Our gender doesn't cause psychopathology, but because gender role is a social and cultural factor that influences the form and content of a disorder.

-Review from Chapter 1: -Study of psychopathology has 3 goals (Describing psychological disorders, Investigates causes of psychological disorder Etiology, and Evaluating and implementing treatments) -Historical conceptions of PP: Broader headings or traditions: Being possessed by evil demons and associated response of Catholic church included exorcism (supernatural tradition), conception of biological tradition with humors and beeing out of balance as seen in Ancient Greece, and the psychological tradition with Freud, Rogers, and later behaviorism or behavioral therapy 1) Psychoanalysis 2) Psychodynamic: direct descendent of psychoanalysis 3) Humanistic: Included work most notably by Carl Rogers (view of psychotherapy and essential important component of positive regard, but especially focus on emphatic listening (client to share emotions in a judge-free environment): much like Mr. Rogers - someone who will sit down and listen to you, convey a sense of understanding/compassion/and caring -Carl Rogers on empathy: Power of emphatic listening: Empathy is an element given too little importance in understanding of personality dynamics and for effecting changes on personality and behavior -Empathy is a delicate and potent tool and rarely seen in real-life situations History of Rogers: Empathy is the sympathetic understanding of the individual's particular view of thee world. -Simply listening attentively was important for being helpful. Most effective listening is listening for emotions that were behind the words and discern a pattern of feeling behind what was being said (best response is to reflect these feelings to the client) -Rogers began to focus on the therapist response rather than empathic quality of listening - became cautious of techniques - explaining in minute detail - Tendency to focus on therapist's responses had consequences: 1) Approach came to be known as a technique: Non-direct therapy (technique of reflecting client's feelings -> Just say back last word the client said") -Rogers then preferred to talk of qualities of unconditional positive regard (complete and almost unqualified acceptance of most of client's feelings or actions) and therapist congruence: the balance between their inner experience and outward expression. By being congruent, these two states match and therefore the therapist is authentic: There is no facade for the presented to the client, the therapist is real and/or genuine, open, integrated and authentic during their interactions with the client) (2 other conditions that were growth-promoting in a relationship with the client) -More research was proving that the higher the degree of empathy in a relationship was possibly the most potent factor in bringing about change and learning. -US past decade, new approaches to therapy: Gestalt, Psychodrama, Primal, Bioenergetics, Rational emotive, transactional: appeal lies in fact that in most instances the therapist is clearly the expert actively manipulating the situation often in dramatic ways for clients benefit, decrease fascination with such expertise in guiding people Behavior Therapy: Also based on expertise - fascination with that approach is on rise. A technological society has been delighted to find a technology by which a man's behavior can be shaped even without his own knowledge or approval to goals therapists choose or chosen by society. Philosophical and political implications become more visible. MOST IMPORTANT STUFF ON BACK

-Ways to be with people that promote self-direct change and locate power in person not in the therapist. Empathy: Jean Jinlun: At all times a flow of experincing to which the individual can turn as a referent to discover the meaning in what he is experiencing, empathy points sensitively to felt maning which client is experincing in this particular moment -In order to focus on that meaning and carry it to full and uninhibited experiencing, Example: Man makes vaguely negative statements about father. It seems like you might be angry at your father. No Disatisfied? Perhaps Disappointed in him? Yes. yes. That's it. I am disappointed In him. I've been disappointd in him ever sense I was a child because he is not a strong person. -Disappointment matches viscural experiencing that is going on within and a person has a very sure knowledge of that flow and can really tell when you ar speaking to it. Right word types exact meaning of flow that has not been able to label or understand himself. Enables him to bring into awareness the real meaning of what is going on within. -Roger's defintiion of empathy: A process, not a state. The way of being with another person which is termed empathic has several facets: 1) Means enteering private perceptual world of other and becoming throughly at home with it. 2) Invokes very sensitive momnt to moemnt to the changing felt meanings which flow in other person to the feear, rage, or whatever he or she is experincing 3) Temporarily living in his life, moving about it in delicately without maaking judgement sensing meanings of which they are scarecly aware but not trying to uncover feelings of which they are totally unaware (would be too threatening) 4) Communicate your senses of their world as you look with fresh and unfrightened eyes at elements which they are fearful 5) Frequently checking with him as to the accuracy of your sensing and being guided by his responses 6) COnfident companion to them in their world by pointing to the possible meanings in the flow of their experiencing 7) Help them focus on this useful type of referent to experience his meaning more fully and move forward with own experiencing

Cognitive science and the unconscious -Implicit memory

-We simply seem able to process and store info and act on it without having slightest awareness of what info is or why we are acting on it. -Blind slight or unconscious vision - he could not only reach for objects but could also distinguish among objects and perform most of functions usually associated with sight -Same thing in hypnosis: process of dissociation between behavior and consciousness -Implicit memory: When someone clearly acts on basis of things that have happened in past but can't remember events. (Conscious memory for events called explicit memory) (ANNA O.: behavior evidently connected to implicit memories of her father's death) -Methods for studying: Black box, unobservable feelings and cognitions inferred from individual's self-report or behaviors -Stroop color-naming paradigm -Color naming is delayed when meaning of word attracts participant's attention despite efforts to concentrate on color, that is meaning of word interferes with participants ability to process color information, psych disorders could cause much slower rate at naming colors of words associated with their problem - thus can now uncover patterns of emotional significance, even if participant cannot verbalize them or is not aware of them -Differences in processing of neural activity in the brain depending on whether the person is aware of the info or not -No assumptions can be made about elaborate structure existing in the mind that is continually in conflict, no evidence to support existence of unconscious with such a complex structure and array of functions

Life-span development -The 'end of history' illusion -Erikson -Principle of Equifinality

-We tend to look at psych disorders from a snapshot perspective, we focus on a particular point in a person's life and assume it represents the whole person -"The end of history" illusion: makes us think that we will change very little in years to come -Erikson: suggested we go through 8 major crises during our lives, each determined by biological maturation and social demands at particular times, We DO grow and change beyond 65. -Illustrates comprehensive approach to human development advocated by life-span developmentalists. -Found that the environment had different effects on brains of these animals depending on developmental stage. (placed in complex environments: juvenile, adult, old age) -Simulating environments can affect brain function in a positive way at any age, disease progression of disorders that typically begin in adulthood or old age slowed down through enriched environments -Term of pregnancy in complex environment, advantage of more complex cortical brain circuits. -Influence of developmental stage and prior experience has a substantial impact on development and presentation of psych disorders, an inference that is receiving confirmation. -In depressive (mood) disorders, children and teens do not receive same benefit from antidepressant drugs as do adults. And for many of them these drugs pose risks that are not present in adults. Principle of Equifinality: -We must consider a number of paths to a given outcome. -Different paths can also result from interaction of psych and biological factors during various stages of development. -Perhaps if we better understand why some people do not encounter the same problems as others in similar circumstances we better understand particular disorders, assist those who suffer from them, and even prevent some cases from occurring. Conclusion: "Chemical imbalance" "Lack of willpower: - Just not enough. One-dimensional terms without considering many influences.

Behavioral and cognitive science -Learned helplessness -Learned optimism

-When rats or other animals encounter conditions over which they have no control. But if the animals learn their behavior has no effect on their environment - sometimes get shocked and sometimes don't no matter what they do - become helpless. -Same phenomenon may happen with people who are faced with uncontrollable stress in their lives. People become depressed if they decide or think they can do little about stress in lives even if seems to others something can be done. People make an attribution they have no control. -Illustrates necessity of recognizing different people process information about events in environment in different ways. Learned optimism: people faced with considerable stress and difficulty in their lives nevertheless display an optimistic upbeat attitude they are likely to function better psychologically and physically (live 7.5 years longer) -Positive psych - explore factors that account for positive attitudes and happiness

Serotonin

-Widespread nature of these circuits, influences a great del of behavior particularly in how we process information -Regulates behavior, moods, thought processes -Low levels: instability, impulsivity, tendency to overreact to situations (aggression, suicide, impulsive overeating, excessive sexual behavior) -LOW SEROTONIN LEVEL MAKES US VULNERABLE TO CERTAIN PROBLEMATIC BEHAVIOR WITHOUT DIRECTLY CAUSING IT -Serotonin has slightly different effects depending on the type or subtype of receptors involved -SSRIs affect serotonin most directly than other drugs -Anxiety, mood and eating disorders

Psychosocial influences on brain structure and function -OCD: CBT rewire circuitry. Exposure and response prevention: brain circuits normalized through psychological intervention.

.-What can we do to influence psychopathology? -Forms of treatment: -Neurosurgery: EX: OCD: Neurosurgery might be viable on occasion, but not preferred. If suffering and other treatments have failed, likely option. -Cognitive behavioral treatment: Rewire brain circuitry (intrusive thoughts that are very unpleasant: strong desire to do something terrible such as slam a child's head into a wall - negative and very distressing) - lead to behavioral drive to neutralize that awful thought acted out in compulsions (repetitive behaviors) -Exposure and response prevention (CBT): Exposes person to something distressing and then does not allow the person to engage in behavior to neutralize that distressing thought or image (over time it extinguishes behaviors and helps with OCD more broadly -Behavior and fMRI (ERP): Not treated for OCD versus treated with ERP and repeated brain imagery Found that brain circuits were normalized through psychological intervention (only other way to alter brain functioning in psychosocial way is through meditation and mindfulness)

Behaviorism: 1) Developed in response to Psychoanalytic approaches 2) Emphasized scientific experiments. 3) Utilizes conditioning principles. (Reinforcement/Reward, Punishment) 4) Classical conditioning and chemotherapy example

1) Behavioral model can be tied to events in Russia and US that was for a desire to form alternative psychological model that was as important, but brought real systematic development of more scientific approach to psychological aspects of PP. -In response to PA: Very internal and introspective (Freud and Breuer influenced by Mesner: hypnosis to understand unconscious mind) certainly useful for uncovering underlying PP, they are notoriously difficult to study in a traditional scientific way (This is how behaviorism took shape) 2 and 3) Main points in global or broader sense of Behaviorism 4) Because chemotherapy is such a potent stimulus by itself (very lengthy), it has known side effects (nausea, vomiting) that over time make the sight of a chemotherapy bag or hearing the footsteps of a nurse trigger sensations of nausea and or vomiting in patients that have not yet received medication. NS (bag, nurse) becomes conditioned over time (a CS for the CR of nausea and/or vomiting) because of the UCS (chemotherapy) being so potent. Chemotherapy is a modern example for the work of Pavlov.

Behaviorism: Contributions by Pavlov, Wolpe, Watson, and B.F. Skinner 1) Classical conditioning (Pavlov) - Dogs 2) Behaviorism/Classical conditioning (Watson) - Little Albert: Disinterested in introspection 3) Systematic desensitization (Wolpe) - Helps with phobias 4) Operant conditioning (Skinner) - Reinforcement/Punishment -Behaviorism came to be to understand PP - formed out of science and reaction to analytic practices of the day. Skinner, Pavlov, and contemporaries interested in a scientific approach to the study of human behavior and thought this was a great way to approach PP.

1) Came up with CC through his work on dogs. Took a NS (ringing a bell) and paired that with something we knew would elicit a particular response in dogs (meal time or food). Resposne that was naturally occurring in these dogs was salivation (UR). Saw food -> knew dinnr was soon and salivation occurrd and when Pavlov paird the food with the bell, ventually over time th bell alone became enough to elicit salivation on dog in aabsence of actual food (UCS: food, CS: bell, both produce the same response CR: responsee to bell, UCR: resposne from food) 2) Building on Pavlov's work, the American spent time working with 11 month old Albert. Interestd in behaviorism - disatisfied by analytic principles (introspection: subjects reported their feelings and thoughts after experiencing certain stimuli - inconsistent discouraged experimental psychologists - known as "arm chair psychology") that was put forth by Titchener - decided that psychology's focus on introspection was headed in the wrong direction and physiology and methods of Pavlov probably would be more palatable, quantifiable, and moreo bjective. So in order to advance the field, Watson worked with Albert. Albert was presented a harmless fluffy rat to play with (curious, not afraid, enjoyed playing with it) Every time he reached for the rat, a loud noise was made - noise was very aversive and after very short period of only 5 trials, Albert showed faint signs of fear to the white rat. Determined Albert displayed a mild fear of any white, fluffly object even Santa's beard. Expanding on Pavlov's work, Watson was able to demonstrate other examples of CC and even expanded to a "generalization effect" (not just white fuzzy animals, but Santa's beard was enough to elicit a fear response from Albert - crying) 3) Pioneer. Disatisfied also was with interpretations of PP put forth by PA pracittioners, also Influenced by Pavlov and wider field of behavioral psych/behaviorism. SD: Individuals when gradually introduced to objects or situations that they feared, was helpful in actually extinguishing that fear - in presence of something phobia inducing (phobic stimulus or object) that individuals had space and time enough to tst reality and see nothing bad would happen. Example: Albert's friend Peter was naturally afraid of white rabbits (no need to subject Peter to CC to be afraid), let's bring a rat into the room and friends for Peter and Peter then observes nothing bad will happen with the rat and nothing bad will happen to other kids in room and over time he may be desensitized to the rat. 4) Physical environment or context that people live in hold some power or weight in terms of influencing behavior. People could learn through principles of CC through reinforcemnt in particular. EX: Restaurant punchcard (Eat 10 burritos get the eleventh free - Reinforcement schedule: guides our behavior (more likely to return there even if they like other places a little more)) -OC: Specific consequences are associated with voluntary behavior. Most things we do socially provide context for other people to respond to us, in one way or another providing consequences for our behavior: REINFORCEMENT INCREASE LIKELIHOOD OF PROMOTING A BEHAVIOR, PUNISHMENT: DECREASE (boys behavior by shouting may occur despite no UCS, the boys' behavior influences his parent's behavior, which influences the behavior of other customers - he changes the environment) -EX: BOY SHOUTING, PARENTS' BEHAVIOR IF SCOLD: LESS LIKELY TO PERFORM THE BEHAVIOR AGAIN, IF CLAP MORE LIKELY TO LAW OF EFFECT: BEHAVIOR IS EITHER STRENGTHENED OR WEAKENED -Behavior depends on environment, behavior can change the environment, behavior operates on the environment -Provide context for evolution of study of PP along with reintroducing us to ideas that fall under broad category of behaviorism or behavioral therapy, we will talk about treatments for several PDs involving behaviorism as behaviorism is the precursor to cognitive-behavioral approaches in therapy.

Clinical description (basic terms) 1) Presenting problem 2) Prevalence 3) Incidence 4) Course (Chronic or Episodic) 5) Onset (Acute or Insidious)

1) Presenting problem: a specific problem or set of problems that indicate why a person came to treatment (may come with list of symptoms, talk openly about what you have been experiencing. When you go to psychotherapy appointmeent you will show up with a specific set of problems or problem (may be symptoms) that say why you are there. EX: I've been feeling down for the past couple weeks, I've lost weight, my appetite has been down, have had sleeping problems, suicidal thoughts. Likely you have major depression. The presenting problem would be major depression. 2) Prevalence: How many people in the population have this disorder 3) Incidence: How many new cases of a disorder occur in a particular time period Step 3 closely follows 2. EX: COVID-19, Prevalence rate 1%, up 500 cases. Incidence of COVID-19 of 8 days went from 1-20% (560+ cases) 4) Course: The somewhat individual pattern a disorder follows. Chronic course: Last for long period of time without remitting Episodic course: Wax and wanes 5) Onset: How did the disorder start? Acute onset: Began suddenly Insidious onset: Develop gradually over extended period

What is abnormal behavior (Lecture)? -3 components of abnormal behavior -What could distress be? These are all manifestations of psychological dysfunction. -Lady Gaga example -3 individuals facing wrong way in elevator example -Coach O and LSU football team example -Woman waking up late example -Is it easy or difficult to understand what constitutes as abnormal behavior?

1) Psychological dysfunction within an individual 2) That is associated with distress or impairment in functioning 3) And a response that is not typical or culturally expected. -Has to be something present that is dysfunctional within a person (in their mind) and can be expressed overtly in their behavior that causes some sort of impairment or distress in functioning. -Distress could be anxiety, stress, feeling blue or down: these are all manifestations of psychological dysfunction, which should cause some impairment in functioning. EX: Friendship difficulties, difficulties in school/family/work AND is often accompanied by a response that is not typically or culturally expected. EXS: Lady Gaga in frog dress - Is LG abnormal? She is simply wearing a dress which could be psychological dysfunction, but can not simply determine a psychological disorder. Though Lady Gaga may wear a dress that is outside cultural bounds, it certainly is not fully indicative of AB according to our definition. 3 individuals facing the wrong way in an elevator: violates social norms (the convention that when we ride elevators we face outward), unusual and not culturally expected, but not abnormal in psychological dysfunction. Coach O and LSU football team - what they do could be abnormal or upsetting to some of us, but does not characterize psychological dysfunction - same as Auburn football team. Woman awake late - presents to clinic with difficulties both in initiating and maintaining sleep. Had problem for more than 6 months and more than 3 nights a week and is getting in the way of work and school. Could potentially be a diagnosable case of Insomnia Disorder, a diagnosable condition in the DSM-5 that would fall under the category of abnormal behavior and psychological dysfunction. -THE OUTLINE OF OUR COURSE is to distinguish what falls under the category of Abnormal Behavior or Psychological Dysfunction in terms of disorder and what is in the bounds of typical functioning, but is a little odd. -We should be able to describe psychological disorders and understand about the treatments that meet these conditions head on. Takeaway: It can be quite difficult to define or understand what constitutes as abnormal behavior. Course Objectives: 1) Summarize important concepts in abnormal psychology. 2) Describe major theories of abnormal psychology. 3) Critically examine, in writing, current research topics in abnormal psychology.

Psychosocial influences: -Cultural, social, interpersonal factors (1) -Life span development (plays role in understand PP and PD more broadly) (2) -Equifinality -Individuals with brain damage: may start differently and end up in same place when it comes to PP Number of paths to a given outcome

1) Role of social integration particularly important during COVID and studies showing being socially integrated actually helpful in preventing common cold infection (Coen) -Whether or not you rated your marital spouse as supportive was important for cellular aging processees that occur within the body (Barger and Cribbet) (how social support influences your health) 2) Life Span, Life Span Development Approach Concept of equifinality and PP (Dante Cicchetti) many pathways you must consider a number of paths to a given outcome. -May start differently and end up in same place when it comes to PP EX: Individual with brain damage and anther individual with brain damage may have equal severity, but there may be different levels of a disordeer's expression or different levels of a disorder depending on the individual's healthy support systems (faamily, friends) or flexible (adaptive) personality characteristics (self efficacy) might be able to overcome the challenges of brain damage or injury and mainly expressed only mild behavior or cognitive disturbances, but those without social support or perdsonality that are incapacitating may suffer a great deal more in terms of physical disability from the same brain injury. The number of paths to a given outcome, Equifinality (main idea behind the life-span developmental factors as they contribute to PP)

Psychoanalytic model 1) Structures of mind: What is it called today? 2) Defense mechanisms 3) Stages of psychosexual development -The personality has three aspects (#1)... id, ego, superego -Id = pleasure principle -Ego = closer to awareness, balance, reality principle -Superego = moral guardian

1) Structure of the mind (called personality today) -> conscious thought (ideas, thoughts, and feelings of which we are aware of. Everything else below the water) 2) Defense Mechanisms 3) Stages of psychosexual development The personality has 3 aspects: Id (really associate with unconscious mind: hitting the FUN button: drive for food, drive for sex, great PLEASURE. EX: When UA wins, id below our awareness might want UA to win again because it exuded joy and pleasure), Ego (closer to awareness: reality principle, sense of self: could be more easily recalled, ensures we act realistically), Superego (moral guardian, conscious go between id and ego)

The process of neurotransmission explained (the transmission from 1 neuron to another) 1) Creation of NT and formation of vesicles in cell body of pre neuron 2) Transport down axon of pre cell (along action potential) 3) At pre terminal, NT released in synapse or gap between 2 neurons 4) NTs attach selves to receptors, or bine site that acts in excitatory or inhibitory way 5) NT molecules than separate from receptors 6) Reuptake back to pre terminal 7) Vesicles without NT transported back to pre cell body 8) Process again -SSRIs

1) The creation or synthesis of a NT and formation of vesicles (transporters of the NT) are formed in the cell body of the presynaptic neuron. 2) The transport of the NT down the axon of the pre cell occurs (along an Action Potential: change in electrical currents) 3) At pre terminal, synapse or gap between this and the next neuron. NT are released into the synapse/gap. 4) The NTs attach themselves to receptors (of the post cell) or binding site that acts in an excitatory way (to get things going) or in an inhibitory way (to block things). 5) The NT molecules then separate out from the receptors. 6) Reuptake of NT back into the pre terminal and thus pre neuron. 7) Those vesicles without NT aare transported back to cell body. Components recycled within machinery of human body. 8) Process starts over. -Some drugs we talk about (selective serotonin reuptake inhibitors: block reuptake of serotonin back into pre terminal -> understand how serotonin works at neurochemical level) -Drugs like Paxil or Zoloft are primary examples of SSRIs

Behavioral and cognitive science (how we acquire and process information and how we store and ultimately retrieve it)

Cognitive and Cognitive processes: -Simply pairing 2 events closely in time is not what's important in this type of learning. Rather, a variety of judgements and cognitive processes combine to determine the final outcome of this learning, even in lower animals such as rats. -If one animal never saw the meat powder except for the 50 trials following the metronome sound (contiguity-only), whereas the meat powder was brought to the second group many times between the 50 times if was paired with the metronome (contiguity-and-random), the groups of animals would learn two different things. The first animal may learn the sound of the metronome meant meat powder whereas the second animal learned that the meat sometimes came after the sound and sometimes without the sound. -This type of learning enables us to develop working ideas about world that allow us to make appropriate judgements. We can then respond in a way that will benefit or at least not hurt us. In other words, complex cognitive processing of information, as well as emotional processing, is involved when conditioning occurs even animals.

Insomnia disorder example -Presenting problem -Prevalence -Course -Diathesis-stress model (Predisposing factors, precipitating factors, perpetuating factors) -Etiology -Treatment

EX: 1) Presenting problem: Someone may go to clinic or doctor and say have trouble initiating and maintaining sleep, go on for 6 months and occurs at least 4/7 nights a week - cause work and social relationship issues (irritability) -> describing PP for insomnia disorder 2) Prevalence: In US high, 10%, general population. Higher in older adults and certain key populations such as certain cancer sufferers. Diathesis-stress model: Predisposing factors: People come to table with certain predisposing factors (come with certain things for disposition) EX: Prone to worry, anxious temperament, 60 years old Precipitating factors: Stressful event occurs (retirement and moving) - role transition. Disrupts sleep for several nights a week, maybe persists and goes away on own, but what if you can't shake it? (Going from Acute Insomnia to Early Insomnia) Perpetuating factors: After the move and losing job, did not remit. Now they may stay awake frustrated or worry about the next day, elongating the course of the disorder. (Early to chronic insomnia) 4) Course: Chronic course (chronic insomnia) stays fairly chronic for multiple years to decades. Expect a consistent chronic course. 3 Goals of PP: Etiology: what causes the disorder? (The stressful events, factors that cause the insomnia to perpetuate) Treatment: Psychological treatment far more effective than medicine, last longer and more durable

Diathesis-stress model. -The model we use to underly the association between genes and the environment. -Insomnia: predisposing factors (genes), precipitating factors (stressor), perpetuating factors

EX: Insomnia: Our ways of understanding the development and progression of insomnia best classified according to a diathesis-stress model, or the 3-P Model -Individuals have predisposing factors that they may come to the table with and put them at risk for developing insomnia (female gender, age, being a driven person, perfectionistic, prone to anxiety and worry). If you came to table with predisposing factors, and experience -Stress, Precipitating factors, simply stressful events (changing jobs, moving, or something positive such as having a child or getting married) -> These stressful events interact with predisposing factors and lead to acute insomnia episode(s). Many people quite commonly get an episode of acute insomnia through big life events or even daily hassles. But for 10-15% of general population, continue to have difficulties with sleep. We see -Perpetuating factors creep in (behavioral factors or cognitive/thinking factors) that help maintain episode of insomnia into weeks, months, and years. Involve poor habits around sleep, such as staying in bed when you cannot fall asleep. Over time, these perpetuating factors take hold, still stress present, and always having predisposing factors.

Psychoanalytic Theory (Psychological Traditional) Therapy -Designed to reveal nature of unconscious mind and conflicts Free association Dream analysis Transference -Psychodynamic psychotherapy PA as a whole: -Unscientific -No careful measurement -No way to prove or disprove hypotheses

Free association: say whatever comes to mind without socially required censoring Dream analysis: reflecting primary process thinking of the id, systematically relates dreams to symbolic aspects of unconscious conflicts Transference: patients come to relate to therapist, much as they do to important figures in childhood -Resent therapist (resentment to parents) -Fall in love with therapist (strong feelings for parents) -Countertransference -Approach seldom used today - symptoms may leave - underlying conflict not solved, new set of symptoms could emerge - symptom substitution . -Loosely related set of PA approaches -Eclectic mix of tactics with a social and interpersonal focus (PD PT) 7 tactics: 1) focus on affect and expression of patients emotions 2) exploration of patients attempts t o avoid topic or engage in acts that hinder to progression of therapy 3) identification of patterns in patients actions, thoughts, feelings, experiences, relationships 4) emphasis on past experiences 5) focus on patients interpersonal experiences 6) the emphasis of the therapeutic relationship 7) exploration of patients wishes, dreams, fantasies -Briefer, deemphasis on personality reconstruction and relieve suffering associated with personality disorders

ABCs of Observation (Observational assessment) Informal observation Formal observation Self-monitoring Brief Psychiatric rating scale

OA: usually focused on the here and now. Therefore, clinician's attention is usually directed to immediate behavior, its antecedents (what happened just before the behavior), and its consequences (what happened afterward). EX: Violent boy: A: His mother asking him to put his glass in the sink B: Boy throwing glass C: Mother's lack of response The boy was bing reinforced for his violent outburst by not having to clean up his mess. And because there was no negative consequence for his behavior, he will probably act violently the next time he does not want to do something. Example of informal observation. Informal observation problem is that it relies on observer's recollection as well as interpretation of the events. Formal observation involves identifying specific behaviors that are observable and measurable (called an operational definition). Example: It would be difficult for 2 peopl to agree on what "having an attitude" looks like. An operational definition, however, clarifies this behavior by specifying that this is "any timee the boy does not comply with his mother's reasonable requests". Once target behavior is selctd and defined, observer writwrs down each time it occurs along with th antecedent and the consequence. Goal is to see whether there are any obvious patterns of behavior and then to design a treatment based on these patterns. . . . . People can also observe their own bhavior to find patterns. Goal here is to help clients monitor their behavior more conveniently. When behaviors occur only in private, self-monitoring is essential. A more formal and structured way to observee behavior is through checklists and behavior rating scales of the many such instruments for assessing a variety of behaviors, the BRIEF PSYCHIATRIC RATING SCALEE assesses 18 general levels of concern. 0-7 point scale, rating scale screens for more moderate to severe psychotic disorders. -A phenomenon known as reactivity can distort any observational data. Any time you observe how people behave, the mere fact of your presencee may cause theem to change etheir behavior. Behaviors peeople want to incrase, such as talking mor in class, tend to increase, and behaviors people want to decreass, such as smoking, tend to dcrease when they are self-monitored.

The science of psychopathology: -Misconception of PP 1) Clinical Psych, Counseling Psych, Ph.D.: -4-5 years at graduate program under mentor followed by one year internship -practitioner approach in academic medical center or hospital -service-related role as administrator in hospital -nonprofit clinic -full-time research -focus strictly on research (clinical) -emphasis on wholistic views of person and intersectionality (counseling) -very competitive degree 2) Clinical Psych, Psy.D. -doctorate under phd program -focused on clinical practice and less on research -tuition and fees not covered unlike #1 -lack certain level of vigor and are not as regulated -not as competitive degree 3) Psychiatry MD -med school, go on residency -prescribe medication -not as extensive as 1 and 2 -not as well-versed in theories that underly PD -less informed on cognitive and behavioral treatments than 1 and 2 -very competitive degree 4) Psychiatric social work MD -really short degree -really get out and help people -flexible degree (academic hospital treating patients, case work, involved in policy) 5) Psychiatric nurse, Ph.D. -masters in nursing and then specialized training as psych nurse -prescribe, more versed in therapy than 4 with training as nurse 6) Marriage and family therapist, MD -couples solving martial problems, help families work through conflict

Psychopathology: the scientific study of psychological disorders (If someone has depression, GAD, PTSD: that is a PD, the scientific study of these and other said disorders) Misconception of PP that if you take it you will probably be a therapist talking to a patient on a couch. But there are many different paths you can take when you study PP. 1) Clinical Psychology and Counseling Psychology, Ph.D. spend 4-5 years at grad program study under mentor, 1 year internship, become licensed, take national and state test (could take a practitioner approach in an academic medical center, hospital, open own shingle, service-related role as an administrator in a hospital system, oversee a non-profit clinic, do full-time research) -Focus strictly on PP more research-oriented (Clinical) -Emphasis on wholistic views of person and intersectionality (culture, race, ethnicity) (Counseling) 2) Clinical Psychology Psy.D. doctorate under the Ph.D. program. Very focused on clinical practice and much less on research. Your tuition and fees are covered in a Ph.D. program, but not in a Psy.D. program and could end up thousands in debt. -Lack certain level of vigor, not as regulated 3) Psychiatry M.D. Psychiatrists go to med school and go on to residency and fellowship, can prescribe medication while they get training in psychotherapy. Not as extensive as clinical or counseling psychologists get. -When distinguishing between psychologists and psychiatrists: Where did you obtain your degree? (Med school or no.) Can you prescribe medicine? -Do not get as well-versed or grounded in the theories that underly psychological disorder and therefore less informed on cognitive and behavioral treatments than are clinical psychologists 4) Psychiatric social workers Master's Degree Getting out and actually helping people. This degree is short (1-2 years), able to work outside the lab. Clinical psychologists may oversee and/or supervise the therapy of a whole team of social workers. -Flexible degree, work in academic hospital actually treating patients, do case work, get involved in childhood or abuse cases, help families, or could get involved in policy 5) Psychiatric nurse Master's, Ph.D. begin with a masters in nursing or nurse practitioner and get specialized training as a psychiatric nurse. Most cases have prescribing privileges, maybe more versed in therapy to social worker counterparts with training of being a nurse 6) Marriage and family therapist Master's Degree Primarily focused on couples solving marital problems or issues, help families work through conflict or sources of strain within the family unit -Clinical psychologists and med school (Psychiatry) very competitive to get into, average clinical psych PHD program get between 150-300 applicants every year and will take anywhere from 4-8 people in a class -PSYD may take anywhere from 10s-100 much less competitive -Can be a long or short road and a lot of different options to choose from if you want a career that involves the science of PP -All degrees mentioned are flexible (can do a lot with your degree when you are finished)

Psychoanalytic Theory (Psychological Traditional) -Freud's Psychonanalytic Model (3 facets)

-'Hypnotized' - undetectable fluid in all living organisms 'animal magnetism' (Mesmer -> Charcot: mesmerism effective in number of psychological disorders -> Freud and Breuer: -Unconscious mind and its apparent influence on production of psychological disorders (recall and relive emotional trauma made unconscious to relieve tension) -Anna O. - paralysis in right and both legs and then different symptoms (relive trauma of father's death -> process of treating the behaviors one at a time) Freud-Psychoanalytic Model: 3 Facets: 1) Structure of the mind and the distinct functions of personality that sometimes clash with 1 another 2) Defense mechanisms with which the mind defends itself from these clashes or conflicts 3) Stages of early psychological and sexual development that provides for millions of our inner conflicts 1) Mind - 3 major parts of functions 1) Id: source of our strong sexual and aggressive feelings 'the animal in us', operates according to pleasure principle 2 basic drives: life and fulfillment, and death and destruction continually on opposition of each other Primary process of thinking: emotional, irrational, illogical with fantasies of sexual aggression, selfishness, envy 2) Ego: ensures we act realistically operates on the reality principle - secondary reasoning (logic and principles) 3) Supergo: conscience - moral principles instilled in us by parents and culture - counteract dangerous and sexual drives 2) Defense mechanisms: ego fights continual battle, anxiety is a signal that produces conflict which alerts the ego to give out a defense mechanism to keep primitive emotions associated with conflict in check Anna Freud -More severe internal conflicts produce a lot of anxiety can trigger self-defeating defensive processes (phobic and obsessive symptoms) -Denial (refuse to acknowledge some aspects of objective reality) -Displacement (transfer feelings or response to an object that causes discomfort to one that is not) -Projection (falsely attribute own unacceptable feelings to another) -Rationalization (conceal true motivations for action through elaborate reasoning) -Reaction formation (substitute behavior that are the direct opposite of unacceptable) -Repression (block disturbing wishes from conscious) -Sublimation (direct potential feelings or impulses into socially acceptable behavior) 3) Developmentive perspective on studying abnormal behavior -Oral, anal, phallic, latency, genital -Distinctive patterns that gratify basic needs and satisfy drive for physical pleasure EX: Oral: focus on food -If we do not receive appropriate gratification during a specific stage, then leaves a particular strong impression (fixation) that reflects in adult life - excessive thumb sucking -> chew pencils, bite nails, lead to tendencies of dependency or passivity -Oedipus complex, fate to kill father and marry mother > strong feeling of envy to father, fear of lust for dad to remove son's penis (Castration anxiety) keep lustful impulses in check, in phallic stage resolve ambivalent relationship with parents and reconcile simultaneous love and anger to father, move to libidinal impulses for heterosexual relationships -Electra complex, replace mom, possess her father, girl's desire for penis - develop healthy heterosexual relationship and look forward to having a baby -All non-psychotic disorders resulted from underlying unconscious conflicts and resulted from conflict and implementation of ego defense mechanisms (neuroses: neurological disorders) -Ego psychology: individual slowly accumulates capacities and skills in reality testing and defenses, in abnormal behavior ego is deficient in regulating such functions

The cerebral cortex and the four lobes of the brain -All lober part of larger structure called cereberal cortex -Temporal (LTM, s, s) -Parietal (T, BoP) -Occipital -Frontal (HoHOCF) -Executive functioning

-All lobes part of larger structure called cerebral cortex (sits atop brain stem) Temporal: Long-term memory consolidation and recognizing sights and sounds Parietal: Recognizing touch and monitoring body position Occipital: Vision Frontal: Prefrontal Cortex: House of higher-order cognitive functioning including reasoning, planning, and long-term memory. Placed broadly under umbrella of executive functioning - all tasks we do everyday that help us plan, organize, reason, and go about our daily lives in manner we're accustomed to.

Emotions: -Mood -Affect -Components of an emotion -Anger and your heart

-Emotion of fear programmed in all animals, which suggests it serves a useful evolutionary function flight (mobilize to escape from danger) or fight (fend it off) response -Fear activates your cardiovascular system, decrease blood flow to limbs, redirected to skeletal muscles. Conserve heat. Void body of all waste material and eliminating digestive processes further prepare organism for concentrated action and activity. Emotion of fear is a subjective feeling of terror, a strong motivator for behavior and a complex physiological or arousal response. -Emotion linked to action tendency (tendency to behave in a certain way, elicited by an external event (threat) and feeling state (terror) and accompanied by a possibly characteristic physiological response) -The principal function of emotions can be understood as a clever means guided by evolution to get us to do what we have to do to pass our genes successfully to coming generations, emotion: short lived -MOOD: Persistent period of affect or emotionality. Enduring or recurring states of depression or excitement (mania) as mood disorders. Alternatively, both anxiety disorders and mood disorders could be emotional disorders. Affect: valence dimension of an emotion. Positive affect: experienced during joy. Negative affect: anger, fear. With arousal dimension (activated or high arousal vs. deactivated or low arousal) any emotional experience can be assigned as a point on this 2-dimensional system. Circumplex model of emotions. Affect can also refer to momentary emotional tone that accompanies what we do or say. -Affective style is sometimes used to summarize commonalities among emotional states characteristic of an individual Components of an emotion: -3 related components: behavior, physiology, and cognition -BEHAVIOR: Emphasize that emotion is way of communicating between 1 member of species to another, may be one reason emotions seem contagious -PHYSIOLOGY: primarily as a brain function, areas of brain associated with emotional expression are generally more ancient and primitive than areas associated with higher-cognitive processes such as reasoning -COGNITIVE: change in person;'s environment are appraised fin terms of potential impact on person THINKING AND FEELING CANNOT EBE SEPARATED Anger and your heart: -Negatively valenced emotions such as hostility and anger can increase a person's risk of developing heart disease -Sustained hostility with angry outbursts contributes more strongly to death from heart disease than other well-known risk factors -The investigators found ability of the heart to pump blood efficiently through body dropped significantly during anger but not during stress or exercise -Anger affects heart through decreased pumping efficiency -Adopting a forgiving attitude can neutralize the toxic effects of anger on cardiovascular activity. -Anger and hostility contribute to heart disease, but so do many other factors including a genetically determined biological vulnerability Emotions and psychopathology: We now know that suppressing almost any kins of emotional response, such as anger or fear, increases sympathetic nervous system activity, which may contribute to psychopathology. -One interesting possibility is that a panic attack is simply normal emotion of fear occurring at the wrong time, when there is nothing to be afraid of -Thus, basic emotions of fear anger sadness or distress and excitement may contribute to many psych disorders and may even define them. Emotions and mood also affect our cognitive processes, if your mood is positive then your associations, interpretations, and impressions also tend to be positive.

-DSM-IV - 1994. DSM-IV-TR (Text Revision) - Late 90s/Early 2000s. (Changes from DSM-III to DSM-IV). -DSM-V - 2013. -Developer -New... -Some disorders... -Which system removed? -More... -Very important change in regards to autism or Asperger's. -Criticisms of DSM-V -Comorbidity: the presence of more than one disorder in the same person -Reliability/validity -New diagnostic system -Beyond DSM-V. -What again is the dimensional approach to classifying PDs?

-Did not want to rely on expert consensus. -Changes were to be based on scientific evidence. -Multiaxial system was retained (kept same 5 axes). 1) Clinical disorder 2) Personality disorders and mental retardation 3) General medical conditions 4) Psychosocial and environmental problems 5) Global assessment of functioning (Cribbet learned this system.) -Developed by former chair of Psychology at the University of Pittsburgh, David Kupfer. -New disorders introduced. -Some disorders reclassified. -Multiaxial system removed. -Dimensional ratings of severity, intensity, and duration of disorders/PDs (put in place of multiaxial system). -More culturally sensitive. -Important change in categories we might think of as Autism or Asperger's were all placed now on a single continuum or dimension. Reflects change in move from categorial or carving nature at its joints way of thinking to a more dimensional way of thinking. -The issue of comorbidity - attempt to place things on a continuum and think of cross-cutting aspects that might be common to all PDs, issue of comorbidity or overlape among disorders is a bit problematic. -Emphasized reliability at the expense of validity (less concern with are we measuring what we are supposed to measure) -Starting fresh with a new diagnostic system - can be a pain to learn -Going forqard there will be modifications to the DSM-V as were and have been in past. Some of these modifications may center around more of a dimensional approach to the classification of PDs. Thinking along continuums that we can have ranges of more commonplace behaviors all the way up to disorders.)

Norepinephrine

-Part of endocrine system -Stimulate at least 2 groups of receptors: alpha-adrenergic and beta-adrenergic receptors -Beta-blockers: hypertension (difficulties with regulating heart rate) - drugs block beta-receptors so that their response to a surge of norepinephrine is reduced, keeps blood pressure and heart rate down -Basic bodily functions such as respiration, another circuit appears to influence emergency reactions or alarm responses - 2 major circuits in CNS

Biological traditional treatments

-Physiological interventions of electrical shock and brain surgery. (Their effect of new drugs discovered on accident). -Insulin: calmed patients but originally was for not eating. -Insulin Shock Therapy: induced mild enough convulsions to cause seizures, and elate the patient (memory loss) -Led way to modern electro-shock therapy. -50s first effective drugs discovered, opium used as sedative. Also saw neuroleptics (major tranquilizers) for hallucinations and delusions. -Benzodiazepines, led to common use (most common) in 70s. -General pattern for drug therapy is initial enthusiasm followed by disappointment.

Historical conceptions of PP: Supernatural causes -Possessed by... -Treatments included... -Modern day? -The Mind-Body Problem: -Descartes' Mind-body dualism -Gut-Brain Axis: microflora in gut and depressive state: houses body's inflammatory response

-Possessed by demons, witches. Disciplines such as promotion of art, Catholic church involved. -Treatment included exorcism: people were displaying odd behaviors that individuals thought were possession, due to evil spirits and those individuals possessed were the root cause of misfortune in local communities - exorcism = viable treatment to get rid of or expel any demons from victims. Modern: Blame moon in erratic or odd and abnormal behavior The Mind-Body Problem: Descartes' Mind-body dualism: mind and body completely separate things no crossing between the 2. Catholic church: body was a vessel for soul and mind was the seat or house for the soul, so how could the 2 things be intertwined? had to be separate. Historical conceptions of PP lead to the Gut-Brain Axis: Psychosomatic medicine: source of many conditions such as depression. May be due to feedback loop between brain and gut - all gut microflora may send signals back to brain and closely related to depressive state - houses body's inflammatory response. Fix your gut, fix your brain!

PRESENT DAY STUDY OF PSYCHOLOGICAL DISORDERS

-Supernatural - superstition prevails, but has little influence on scientists -Biological, psychoanalysis, behavioral continue to further our knowledge of psychopathy -Each tradition had its own failures. 1) Scientific method not applied to theories or treatments - evidence to prove or disprove theories (not developed), many people accepted fads and superstitions which proved to be false 2) health professionals to look at psychological disorders narrow from their POV alone 1990s: -Increase in sophistication of scientific tools and methods -Realization that no one influence: biological, behavioral, cognitive, emotional ever occurs in isolation -Our normal and abnormal behavior is the product of a continual interaction between psychological, biological, and social influence ADOLF MEYER: CURRENT PSYCHOPATHIC THEORY IS THAT CURRENT VALID MODEL OF PSYCHOPATHY IS MULTIDIMENSIONAL AND INTEGRATIVE. -Watson: psychological and social influences and contribution of biological factors in consequential.

Implications of psychopathology -psychosocial influences on brain structure and function -Surgeon example (more general role of brain function in development of personality) -OCD -Initiating factors vs. maintaining factors -Psychological treatment on brain damage -Use of drugs and psychological treatment

-Specific structures in the brain do not for most part cause disorders, even widespread damage most often results in motor or sensory deficits -Psych disorders typically mix emotional, behavioral, and cognitive symptoms -More general role of brain function in development of personality, with goal of considering how different types of biologically driven personalities might be more vulnerable to developing certain types of psychological disorders -EX: Genetic contributions might lead to patterns of NT activity to influence personality -OCD: Though brain size and structure same, increased activity in frontal lobe (cerebral cortex: orbital surface), activity in these areas seem to be correlated, if 1 area is active then the other areas are too (gulate gyrus, caudate nucleus). These areas contain several pathways of NT and one of the most concentrated is serotonin. -Lesions in this area that interrupt serotonin circuits seem to impair ability to ignore irrelevant external cues, damage to this brain circuit could cause someone acting on every thought or impulsee EX: Successful accountant: brain surgery, fired due to engaging in lengthy and uncontrollable compulsive rituals, area of brain may be damaged due to removal of the tumor (orbital frontal cortex) BUT SAME PEOPLE WITH DAMAGE IN LESION MIGHT ACT DIFFERENTLY. So damage to this brain area may just increase negative affect more generally rather than OCD specifically. May be possible activity in this area might be a result of repetitive thinking and ritualistic behavior that characterizes OCD, rather than a cause. - - - - - -Sometimes effects of treatment can tell us something about the nature of psychopathology. -Reasons why a problem develops (initiating factors) are not necessarily same as reasons why still persists (maintaining factors), so in order to treat the problem effectively, typically more important to know and target maintaining factors than initiating factors. -If you knew someone with OCD and faulty brain circuit, would you do surgery? Surgery should be last resort. -Development of drugs affecting NT activity could help. -What about NO SURGERY, NO DRUGS? -Psychological treatment COULD be powerful enough to affect the circuit directly. -Cognitive-behavioral therapy: exposure and response prevention , brain circuit had been changed. Depending on the disorder, psychopathology results in either a normalization of abnormal patterns of activity, the recruitment of additional areas, or both. EX: Study of placebo effects, treatments to result in behavioral and emotional changes in patients (direct brain function change), presumably as a result of psychological factors such as increasing hope and expectations of conditioning effects -Impersonal administration produced greater results than no treatment, but addition of strong relationship added substantially to therapeutic benefit. -Antidepressants and placebos changed brain function, but in somewhat different parts of brain, different mechanisms of action? -Placebos alone not as effective as prescribed medication, but every time given prescription, also treating patient psych. by inducing positive expectations for change -In treatment of pain, both placebo and opiate overlapped in brain regions -Multiple brain systems and neurochemical modulators, including opioids and dopamine seem to be involved in the placebo effect on pain perception -Complex differences (and some similarities) between drug (bottom up) and psychological treatment and CBT (thinking patterns in the cortex in turn affected emotional brain: top-down originates from cortex and works down to lower brain) -Brings hope to one day choosing best treatment or combination based on analysis of individual brain function -Precision medicine

Another diathesis-stress model example -Alcoholism

-The threshold for a disorder may be reached when the diathesis (a general genetic vulnerability) interacts with a life event (usually a stressor), with the stressful event being enough to tip the scale and move it into a disorder.

Psychoanalytic model cont. -Psychodynamic psychotherapy (more palatable for modern terms. focus on affect and expression of emotions, attempts to avoid topics, patterns in thoughts/feelings/actions/relationships, interpersonal experiences, emphasize therapeutic relationship, explore wishes/dreams/fantasies) -Humanistic theory: stark contrast -Person-centered therapy -UPR: 'warm fuzzy feeling' -Empathy -Defense Mechanisms: Repression, Denial, Projection, Displacement, Regression, Sublimation

1) Structure of the mind 2) Defense Mechanisms 3) Stages of psychosexual development -> oral, anal, phallic, latency, genital Psychodynamic Psychotherapy: -Out of PA. Something more palatable in modern times. What happens over history of PP is constant revision of guiding theories. -Focus on affect (feeling states, NOT MOOD which is enduring: so anger or sadness) and the expression of patients' emotions -Explore patients' attempts to avoid topics -Identify patterns in patients' thoughts, feelings, actions, relationships -Focus on patients' Interpersonal (relationships with other people) experiences -Emphasize therapeutic relationship -> How are you in the room with the therapist? Are the same things you talk about in therapy occurring outside of therapy? -Explore patients' wishes, dreams, fantasies. Humanistic Theory: Stark contrast to PD Theory and PA approaches Carl Rogers (think of Mr. Rogers): -Person-centered therapy - focused on patient, interested in idea that w can reach our highest areas of functioning if w all had the freedom to grow. We as therapists, should take somewhat of a passive role about behavior, but simply give the individual a chance to develop by therapy without any threats to the self. -Unconditional positive regard: almost unqualified and complete acceptance of person's feelings, actions, behaviors "warm fuzzy feeling" -Empathy? True sympathetic understanding of how the client or patient views the world (take own perspective out of the equation and take time to understand how you see someone else's views on things)

-Testable questions -Research study design: 1) Developing testable questions -Hypothesis -Testability -DV -IV -Confound -Internal validity 3 Ways to ensure internal validity 1) Control group 2) Randomization 3) Make sure we account for confounding variables by measuring them in our study

-"What is a testable question?" "How do we know if something is a testable question?" We are talking about the concept of research and study of research design. -Being a good consumer of science! (Learn from this course to be one!) This means... 1) Developing testable questions (be a critical reader of all the info that comes in around you especially from news sources) -Hypothesis: To be a good consumer of science, first step is asking yourself what is being reported on is something that can actually be tested? An educated guess or statement that can be supported by data. Can the question that is under examination be subject to a hypothesis? -Testability: The ability to support a hypothesis. Experimental hypothesis include an Independent Variable and a Dependent Variable (In research studies or experiments, we have Experimental Hypotheses). -DV: An aspect of a phenomenon that is measured and is expected to be changed or influenced by the IV. -IV: The aspect that is manipulated or thought to influence change in the DV. -Confound: Any factor occurring in a study that makes the results uninterpretable because a variable other than the IV may affect the DV. (Research studies often have a compounding factor) -The extent to which the results of any study can be attributed to the IV. 1) Control group: The same as the experimental group in every way except they are not exposed to the IV (In an experimental design) 2) Randomization: Assigning people to different research in a way such that each person has an equal chance of being placed in any group (gets rid of individual differences) 3) Make sure we account for confounding variables by measuring them in our study (so we might control them systematically or statistically) -Analogue models create in the controlled conditions of the lab aspects that are comparable (analogous) to the phenomenon under study -EX: Bulimia researchers could ask volunteers to binge-eat in lab, question them before, during, and after they ate and whether it made them feel more or less anxious, guilty, etc. -If they used volunteers of any age, gender, race, or background researchers could rule out influences on participants' attitudes about eating that they might not be able to dismiss if the group contained only people with bulimia. In this way, such 'artificial studies' help improve the internal validity. A subject is observed in an artificial setting.

-DSM-I (1952) -DSM-II (Changes from DSM-I, cons of DSM-II) (1969) -DSM-III (3 big changes from DSM-II) (1980 -5 axes of DSM-III

-1952 APA published DSM-I (Diagnostic and Statistical Manual of Mental Disorders) -1969 APA published DSM-II (revised because DSM-I lacked precision, relied heavily on unproven theories of etiology, little reliability) Still had these same cons. -Over time, we have gotten a lot better at classifying PP and as we've done that we've really needed to update our manuals to reflect ways of thinking about PDs. -These issues of precision and unproven theories of etiology and relatively low reliability did not go away with the DSM-II, still around. Improvements were quite incremental at that time. -1980: More modern take on DSM -1) Atheoretical description of disorder/PDs (Did not rely on biological or psychoanalytical theories of etiology that were present in prior DSM-I and DSM-II). 2) Diagnostic criteria had much greater specificity and detail. (Could be much more reliable and valid and we could study their reliability and validity). 3) Multiaxial approach to diagnosis: What was new and very important. -Axes are as follows and easily accessible in this version and subsequent versions 1) Disorder itself 2) Personality disorders 3) Medical issues (any medical issues about the participant, patient, or client) 4) Psychological stress 5) Current level of adaptive functioning (Global rating of 0-100 how well are you doing out there in the world?)

-An MMPI Type (Example) -Is there a well-defined code type?

-A type is an individual's elevations above a certain clinical cutoff level -The t-score is the clinical cutoff level line (as seen in photo). -The t-score of this individual has points 1, 3, and 5 above scales 1, 3, and 5 (elevations above the cutoff level). Scale 5 is not interpreted for elevation because it is a masculinity/femininity scale and really has to do with basic gender role stereotypes, so not used in well-defined code type, but 1 and 3 are. -Here, we have a 1-3 code type (because elevations are above the clinical cutoff level for scales 1 and 3). 1 being the highest at 67, with 3 being the second highest 66, and these are the t-scores (excluding scale 5). -Individuals with similar profiles may... (People are likely to have these particular characteristics if they have this profile): -Are likely using denial and repression excessively and have little insight into their own needs, conflicts, and symptoms. -Somatic symptoms (individuals are likely to manifest their stress in their bodies through pain, tension, numbness, etc.) are likely. -What we know from the MMPI and tons and tons of data over years and years of study is that if people respond in a certain way on this test, and express this particular protocol, they are likely to have these personality characteristics.

-Neuropsychological testing -Pros, cons -Uses -Executive functioning -Dels Kaplan Executive Functioning Test

-Another category related to IQ testing. -Measure cognitive abilities in a broader sense (attention, concentration, memory, motor skills, perception) that allow clinicians to have some insight into a person's performance and possible brain impairment. -Often used in cases of traumatic brain injury, stroke, evaluations of people who are clinically insane. -Some of the things in IQ tests are measured such as attention, memory, and perception, but also gives us other things including concentration and motor skills. -May require hours to administer (Administration of an entire neuropsychological battery could take as long as 6 hours to administer from start to finish.) -Typically have good reliability and validity. -Designed to get something called executive functioning (prefrontal cortex: where we have all of our higher-order thinking skills - planning, certain aspects of attention, perceptual skills, memory) -If your particular questions relate back to pragmatic or practical uses of NP tests have to do with understanding where certain brain regions are deficient or damaged - good test to use. EX: Dels Kaplan Executive Functioning Test: Can take up to 6 hours to administer. Aspects of memory, have to manipulate discs and move them around on 3 pegs to show motor skills, etc.

-Personality inventories (Meehl) -Empirical approach -Face validity, predictive utility -MMPI (Pros) (How it was tested)

-Began to think more about ways we could use data in more empirical ways or approaches. (In response to both projective tests and other types of self-reports of personality widely used in the field around the 30s and 40s.) -Inventories of the time were highly face valid: Instead of asking somebody about if they were feeling blue/down or losing appetite, or poor sleep, the question would simply read: Are you feeling depressed? -Whereas the previous questions that have to do with symptoms of depression might be mixed in with a whole host of questions such as: I enjoy cheating at Solitaire. I like to watch the weather report. I enjoy playing Scrabble. I am anxious most of the time. , Questions where you cannot really understand on a face level what it is that the person is trying to predict or understand about you. -Good thing about what Meehl did: Combined all different types of questions into a personality inventory and gave it a lot of predictive utility: it was able to predict based on someone's responses very very accurately their personality and other aspects of PP - This was an empirical approach to the study of personality. -Meehl's MMPI (Minnesota Multiphasic Personality Inventory), was grounded in an empirical approach and corrected some of criticism of PTs namely heavy reliance on subjective scoring. -The most prominent goal of the MMPI was to group people into types (of personalities). Since its conception has been an MMPI-2 (turn of century), MMPI-2-RF, and a close development of an MMPI-3 which is soon to release. -Goes along with PAI (Personality Assessment Inventory), NEO P-IR, MCMI) all of which more or less utilize the empirical approach to try and understand personality -Left very little room for subjective interpretation (MMPI) -Many people living in MN in early part of last century and in subsequent updates to this PI took this test - hospital admitees, UM hospital system, along with incoming freshman and applicants to graduate programs in clinical psychology at UM all filled out this questionnaire. Thousands and thousands of data points that these folks could use and meant not only did it have good reliability and good validity, but they could develop profiles or types based on commonly found responses on the MMPI.

-Personality inventories -Face validity vs. predictive utility (Meehl) -Based on ... -Goal of grouping people into ... -MMPI -Pros of MMPI

-Criticism taken up by behaviorists -> These (projective) tests designed to understand personality and PP had a large subjective component and not reliable or valid. Movement toward heavy reliance toward science and empiricism began to take hold and did so in form of PIs. -Self-report questionnaires that assess personality -Paul Meehl - mid-late 40s and 50s - staunch empiricist -Personality tests of that day were very high in face validity (wording of questions seemed to fit type of information that was desired) Meehl questioned this approach - Is this really necessary? Do we really want people to understand what we're asking them on the surface by the content of the question? NO. Relied on idea of predictive validity or predictive utility (given the responses to a series of questions, can we actually understand and ultimately predict what might happen to somebody in the future?) -Based on empirical approach. -Corrected some of the criticisms of Prospective Tests. Goal of grouping people into types. Approach taken by Meehl in terms of assessment of personality this goal. -Through series of 300+ true/false questions, Meehl able to determine different types of people or different profiles. -Holds true with different aspects of personality inventories including newer ones (MMPI, PAI, NEO-PI-R, MCMI) -Minnesota Multiphasic Personality Inventory: Paul Meehl developer -Very little room for subjective interpretation (DIFFERENCE BETWEEN MMPI AND PTs) -Original data came from people with and without PDs who were living in Minnesota (All incoming freshman ant patients in hospitals and clinics at University of Minnesota). -Good reliability and validity (was able to achieve standardization of the test over time through refinement) -Very widely studied

-Intelligence Testing -Cons

-Developed to predict who would perform well in school (Given someone's general level of intelligence or IQ, what's the likelihood she or he will perform well in school?) -Still tests the probability that someone will perform well in school -Early versions and current versions to some extent are biased toward Caucasians - there have been efforts to correct this -Issues with construct of intelligence - Ask: Define intelligence. Many would give some sort of similar response, but many of you would give different responses as well (slippery construct: book smarts, street smarts, artistic ability, capability) One's performance on IQ testds has implications for being able to assess that person for PP, certain types of treatments we might be able to use, and interplay between that and actual PDs. -IQ: Originally mental age / chronological age x 100 Now: Deviation IQ - compare only to scores of others of same age -Binet-Stanford

-External validity -Generalizability -Statistical vs. clinical significance while it would be SS result, it might not have much CS, meaning that chance in BP isn't likely to cause the need for medication or any intervention -> not life threatening in any way what so ever Very important especially in current problems we face such as COVID-19: Vaccines likely to become very hot topic in near future and so when all those companies are conducting clinical trials, may be getting SS results, but what we really need to look out for are the practical or clinical significance of their findings.-These kinds of info help us to determine whether or not the research is good in addition to aspects like the internal validity, particularly when it comes to vaccine trials this idea of randomization patients.

-Do the results of this study apply to other groups of people and in other settings? EX: Blood pressure as an outcome - BP device - individual able to walk freely and openly as device monitors and measures your BP -If we were interested in the influence of PERSONALITY on changes in BP we could conduct an internally valid experiment by bringing people into lab, measuring their personality, manipulating something stressful to occur in lab setting, and measure BP responses to that stressor. Lot of experimental control, measure all our confounding variables, measure IV and DV, while keeping all other factors constant - the experimental design, however, very artificial (get someone into lab and discuss something stressful and assume that is what extends out into the real world) -Enterprising folks develop these ambulatory BP monitors so that people could walk around in natural environment and have their BP measured at different times of day and night and see what is going in relation to those BP readings with the individual -Typically try to balance internal and external validity Ideally most experiments conducted, even in a lab -Very important topic under broad idea/understanding of what it means to be a good consumer of science -SS: The probability of obtaining an observed effect by chance is small. Involves numbers. The p-value in research. -A result of a study is statistically significant (p < 0.5 less than 5% chance probability that results are due to chance -> be more confident those results are due to what we are actually conducting in terms of experiment itself) -Are the results meaningful? One way we quantify and measure CS is by using a metric called EFFECT SIZE: When we conduct statistical tests, under the category called interventional statistics : not only do we get a p-value (associated with our results), also get effect size which lets us know if our experiment is both SS and CS). -Do they have real-world weight? EX: Blood pressure might see that BP increases by only 1 millimeter of Hg (unit to measure BP by) and while it would be SS result, it might not have much CS, meaning that chance in BP isn't likely to cause the need for medication or any intervention -> not life threatening in any way what so ever) EX: BP 1 unit increase in millimeter of Hg in your stress level lab study might be SS, but certainly not CS. Very important especially in current problems we face such as COVID-19: Vaccines likely to become very hot topic in near future and so when all those companies are conducting clinical trials, may be getting SS results, but what we really need to look out for are the practical or clinical significance of their findings. -These kinds of info help us to determine whether or not the research is good in addition to aspects like the internal validity, particularly when it comes to vaccine trials this idea of randomization patients.

-Kupfer on DSM-V changes: "Developmental Lifespan Approach" (Many of our disorders begin in childhood and adolescence) "Gender, Cultural Diversity and Sensitivity" "Organization: Good introductory section on how to use the book (Section 1), Section 2 - diagnostic criteria, Section 3: with emerging measures and alternative ways to think about models for personality disorders and number of conditions we hope people will study that are not necessarily ready for prime-time -20 Chapters a number of disorders are assigned, bipolar disorder, PTSD have their own chapters (Chapters organized in clusters): ICD-11, receptive to some advances in neuroscience and genetics -Set guidelines for clinicians: 5.0, 5.1, 5.2: not have to wait for 20 years for new findings. -Diagnosis: Changes to DSM-V: -Emphasized? (How do natural development processes that occur over the lifespan interface with the development and progression of PDs) and? -Addition of ___ category (Autism spectrum, ADHD, motor disorders) -Strong emphasis on?

-Emphasized Development (Life span development how do natural development processes that occur across the lifespan/over someone's life, interface with the development and progression of PDs: well reflected in addition of neurodevelopmental disorders category) and culture -Addition of Neurodevelopmental Disorders Category (included autism spectrum disorders, motor disorders, and Attention Deficit Hyperactivity Disorder) -Hoarding disorder added as a new disorder -Dissociative fugue (dissociative state where a person forgets their entire identity and everything about themselves and often moves and uproots from where they live to another state of part of the world) no longer a disorder -Strong emphasis on cultural and social factors specifically the DSM-V authors really interested In understanding the values, knowledge, practices that individuals derive from their membership in specific religious or ethnic groups or other social groups as well as how membership in these groups may have impacted that individual's perception of their own experience with PD

-Diagnosing psychological disorders -Idiographic -Nomothetic -Nosology, classification or taxonomy -Categorical vs. dimensional approaches to clinical nosology

-Idiographics - understanding what makes a person unique. What is unique about his or her personality, cultural background, life circumstances. "An idiographic approach to the diagnosis of Psychological Disorders." -EX: Colleague interested in OCD - involves varying intrusive and anxious thoughts that pop into the mind and things that might be done behaviorally to try and neutralize those thoughts such as counting, checking, washing hands, turning doorknob 5 times before opening it, counting to 5 before turning on stove -> uses idiographic approach to understand OCD, does this by providing one individual client assessments that include the symptoms of OCD over and over again for course of day (13-15 times a day) for 4-5 weeks in a row. Does this to see what makes that person unique and how their uniqueness as an individual interfaces with the symptoms of OCD. -Nomothetic approach to diagnosing PDs: classifying the problem (just as you would classify beetles or types of birds - take same approach with PDs) -Nosology is the context of medical or psychological phenomena: it is the classification or taxonomy (involved in classifying something for scientific purposes - like whales, rocks, insects, birds) -There is a hot debate as to whether or not PDs are categorical (Do I have it or do I not) or dimensional: -Either yes or no. Do I have schizophrenia? YES or NO. Do I have depression? Yes or no. -Sometimes people experience maybe perhaps quite frequently symptoms of depression that are not full-blown depression, but could move in that direction along a continuum or dimension and that that is a better way to classify PDs. And people that advocate for this dimensional approach would say perhaps that the categorical approach is "carving nature at its joints" and potentially missing very important info about someone's particular manifestation fo say anxiety or depression than we would of if we simply used the categorical approach.

-Behavioral genetics -Endophenotype -Studying behavioral genetics -Proband -Familial aggregation -Issue of shared environments

-Interactions of genes, experience, and behavior (Idea that we can actually study how genes, experience, and behavior all interact or intersect) -Phenotype: observable characteristics or behaviors of an individual (eye color, degree of shyness) VS. Genotype: genetic makeup of an individual -Genetic mechanism that contributes to problems causing certain symptoms - Where this field is really moving, this corresponds with rapid advance of science is that 3rd concept of quite intense study especially within the category of adult PP is this idea of endophenotypes. EX: Group of genes responsible for impairing working memory in schizophrenia (Thinking used to be that in the case of schizophrenia, maybe we were looking for a 'schizophrenia gene', something that was carrying a lot of the weight/variance for schizophrenia itself and then look to the genotype: instead, people are searching for gene or group of genes responsible for a particular characteristic or aspect of a PD (Take a good look at this specific endophenotype). This again involves the study of the genes responsible for this problem in particular (working memory in schizophrenia) along with the genes or candidate gene responsible for that particular problem. -Scientist can examine behavioral patterns or emotional traits within the context of a family and when we do this we often identify a proband -The person who has the trait of interest (e.g. someone who has bipolar disorder) Family member with that trait particularly singled out for our study EX: Study familial nature of Bipolar Disorder - would have to identify a proband (someone who has BPD and then look for linkages with that person and other people in the family, most often first-degree relatives - parents, siblings, offspring) -If there is a genetic influence, expect to see the trait more in first-degree relatives compared to second-degree relatives. -Family studies show us if there is genetic influence we expect to see a trait occur more in first-degree than second-degree relatives. -FA: Tendency of a disorder to run in families: EX: Study natural occurring short sleepers, people who go with less than 6 hours of sleep a night because that was just simply how much sleep these people needed (not wake up for work or school, just in general) - these people were happy and positive people, we assume people are cranky, down, low mood, but quite the opposite of what we see in naturally-occurring short sleepers (get all this genetic info and geniology, but also gaining behavioral and psychological information as well) -Issue of shared environments: families usually live together, so similarities may be due to environmental factors as well as genetics.

-Types of Research Methods 1) Individual case studies -Pros, Cons -The Quasi-Experiment 2) Correlational studies (Research by correlation)

-Invesitgating 1 or more individuals intensely. -Does not use the scientific method -Relies heavily on clinical observations -Maintaining internal validity is difficult. -Have we discussed an individual case study in this course? Anna O. (Patient of Freud) -OCD studying colleague using the IDIOGRAPHIC APPROACH, is also conducting a case study. -Do two variables relate to each other? -Being a good consumer of science! "How a tiny dose of aspirin can prevent cancer!" May see extravagant eye-catching headline - meant to grab your attention, being a good consumer of science, you might ask yourself the following question: Is this relationship causal or just correlational? CORRELATION DOES NOT IMPLY CAUSATION. (Often because third variable is at play.) -Third variable issue: something else may be getting in the way of association or correlation between the two variables of interest EX: Aggression was linked to ice-cream sales. When ice-cream sales went up, so did aggression. -Might say: Really interesting! But is likely a third variable that is potentially causing aggression. -> It's hot outside! When temperature is up, people tend to get a little irritable and we also know that ice-cream sales increase. -Positive Correlation: Ice-cream and aggression example.

-MMPI example -Validity scales -Scales from 1-0 for different types of symptom presentations, elevated reveal personality of individual

-Left side: Scales that assess the validity of the instrument based on participant responses (Lie Scale, Infrequency Scale, Subtle Defensiveness Scale: see oneself in unreal positive ways) -Clinical scales on right-hand profile form -Different scales ranging from (1-0) standing for different types of symptom presentations - through combination of those scales when elevated that tells us a little about the personality of the individual

3) Experimental designs -Experiment -Group Experimental Designs (Clinical Trial: Implies level of formality and rules -> Randomized clinical trial)

-Manipulating an IV and observing its effects on the DV -> the variable we are measuring -Types of Experimental Designs: Group ED: For treatment studies, IV is the treatment. -Methods of GED: 1) Clinical trial: want to understand if your treatment for insomnia actually reduces insomnia symptoms: broad heading of GED - A CT Is an experiment used to determine if something is effective and safe in terms of a treatment. Implies certain level of formality with regard to how it is conducted and tends to follow a number of generally accepted rules: often cover how you should select research participants, how many people should be included in the study, how those people should be assigned, and how the data should be analyzed. -Within the category of CT, we have a 2nd category: RCT: where participants in the CT are randomly assigned to either the experimental group or the control group. This particular type of group experimental design allows us to have stronger inference about our results of our study EX: Dismantling study for CBT for insomnia -Stimulus control theory, sleep restriction therapy, MCI, weightless control therapy -Response (number of people who responded favorably to a treatment) -Remission (those who remitted in terms of symptoms)

Physical exam

-Many patients with problems first go to a family physician and get a physical. A clinician might recommend on with particular attention to medical conditions sometimes associated with specific psych problem. Many problems presenting as disorders of behavior, cognition, or mood may have a clear relationship to a temporary toxic state (bad food ,wrong amount of medicine, or onset of medical condition) -If current medical condition or substance abuse situation exists, clinician must ascertain whether it is merely coexisting or causal usually by looking at onset of problem.

-Early efforts towards Diagnosis -Emil Kraeplin (one of the first psychiatrists to... did so through...)

-One of the first psychiatrists to classify PDs and did so through the biological POV -Kraeplin advocated for biological causes -Dementia praecox (best categorized as what we now know as schizophrenia) and manic depressive psychosis (best categorized now as bipolar disorder) (Lots of his work focused on these 2 particular disorders) -Kraeplin was interested in the categorical approach to classificastion of PDs and came largely from biological tradition and applied that to study of PP and chief among his goals was trying to define and distinguish what was normal from what was abnormal. In his mind, because each PD was fundamentally different from another, we really need one defining set of criteria in which everyone in that category has to meet. EX: Bunch of symptoms of Major Depression, presence of depressed mood, weight loss or gain, inability to concentrate, and 7 other symptoms must be met, then that person would be diagnosed with depression (even though depression was not a term at that time, you get the idea). -1952 APA published DSM-I (Diagnostic and Statistical Manual of Mental Disorders) -1969 APA published DSM-II

-Psychological Testing Review -3 Categories of Psychological Testing -EBA (Evidence based assessment) -Two types of Projective Tests

-PT is a really broad category that includes projective tests that have roots in psychoanalytic and psychodynamic traditions along with personality inventories which are rooted in an empirical foundation that is the desire to move away from something subject and move toward some more based on data, and finally IQ testing. -There are 3 different types of tests commonly used by clinical and counseling psychologists to begin to understand PDs and PP in humans. -EBA is the assessment for PDs must be reliable and valid. Grew out of medicine trends that said we should really be looking towards data driven approaches specifically in the form of the randomized-control trials for understanding what types of treatments are effective (in the medical domain) and that was then translated into therapy (in the psychological domain) and finally onto psychological assessments. -1) Inkblot/Rorschach test 2) Thematic Apperception Test: Administered by a clinician to a patient or client, involves these ambiguous pictures on which the client would 'project' his or her thoughts and desires. -Came with following prompts or stems which were to be read verbatim each time a card was presented: "Tell a dramatic story about the picture." "This is a test of imagination, one form of intelligence." -Highly subjective in terms of scoring (no real or objective ways to discern underlying personality or PP)

-Time course of our research designs -Cross-sectional designs -Longitudinal designs

-Take a group/cross sectionof the population at different age groups. Not doing anything to follow anybody over time, just comparing cohorts (age groups) - or let's say "Insomniacs" group everyone together and get people who are 20, 30, 40, and 50 and so all at same time are studied -Study one group of people over time -May start in 1990 where they are born, then ages 5, 15, 25. Same group of people studied at multiple time points. -(LD are not only the more potent type of research) you have to take into account specific experiences of the generation being studied (cross-generational effect) -Cohort effect: con of CSD: confounding of age and experience -CGE: con of LD: trying to generalize findings of groups of the study participant EX: Drug-use history of young adults in 60s/70s vastly different from those born in the 90s

Diagnosing Psychological disorders: -Criticisms of DSM-5 -Labeling, misuse of DSM

-We still have fuzzy categories that blur at edges, making diagnostic decisions difficult at times. -Individuals are often diagnosed with more than one psych disorder as a result, comorbidity. -Criticisms center on 2 other aspects of DSM-5 and ICD-11. Systems strongly emphasize reliability, sometimes at expense of validity. If sole criterion for establishing depression were to hear the patient say at some point they "felt depressed" the clinician could theoretically achieve perfect reliability. But this achievement would be at expense of validity because many people with differing psych disorders or none occassionally say they aree depressed. -Second, methods of constructing a nosology of mental disorders have a way of perpetuating definitions handed down to us from past decades even if they might be fundamentally flawed. -Systems are subject to misuse, some of which can be dangerous and harmful. . -A related problem that occurs any time we categorize people is labeling. Something in human nature causes us to label even if as superficial as skin color, to characterizee the totality of an individual. -If disorder is associated with impairment in cognitive or behavioral functioning, the label itself has negative connotations and contributes to stigma, which is a combination of stereotypic negative beliefs, prejudices, and attitudes resulting in reduced life opps for devalued groups in question. -Have been many attempts to categorize intellectual disability, described levels of severity as moron, imbecile, and idiot (most severe). When terms were introduced, picked up negative connotations and were used as insults. -DSM-5 dropped term mental retardation and instead changed to intellectual disability. -In any case, once labeled, individuals with a disorder may identify with negative connnotations associated with that label which might affect their self-esteem

-Projective tests -Rorschach tests, also known as inkblot tests -Thematic Apperception Test (TAT) -Disadvantages of both

1) Designed to resemble ambiguous figures that are presented by clinician to the client and idea is through some sort of ambiguous stimuli is presented such as pictures of people or things and when are presented, individual who is the client is asked to simply describe what they see - People project their own personality and unconscious fears onto other people and things and thus we can use these ambiguous stimuli and sort of almost without realizing it people will reveal their own unconscious thoughts to the therapist -Psychodynamic, psychoanalytical approaches to PP (fall under this domain) -Developed by Hermann Rorschach to study perceptual processes and for diagnosis (for sole purpose of diagnosis) -10 inkblots as ambiguous stimuli presented 1 at a time (Person allowed to talk freely about what he or she sees - and unconscious thoughts and desires projective on ambiguous stimuli) through very intense and systematic coding scheme called Exner Scoring System- info is extracted from that narrative Cons: 1) Lacks data on reliability and validity 2) Although the administration was standardized, the Interpretation was subjective. -Exner scoring system . . . 2) TAT: Unusual images or pictures certainly ambiguous - not sure what is going on here and you may begin to make a story about what is happening here -Idea is through these ambiguous pictures, people project unconscious thoughts and desires upon them -Morgan and Murray in mid 1930s - Harvard -31 cardS: 30 pictures, 1 blank. 20 Cards typically used for administration "Tell a dramatic story about the picture." "This is a test of imagination, one form of intelligence." - Directions same for each card. Administration is standardized and very easily carried out by clinician (Same instruction). Same concerns of Rorschach test - low in reliability and validity and despite standardized administration, subjective scoring still present. -Criticism taken up by behaviorists -> These tests designed to understand personality and PP had a large subjective component and not reliable or valid. Movement toward heavy reliance toward science and empiricism began to take hold.

The study of PP -3 main goals 1. Describe... 2. Investigate... 3. Evaluate and implement...

3 Main Goals: 1) Describe psychological disorders The symptoms, the characteristics of certain PDs (such as depression) EX: Depression: characteristics and symptoms: feelings of blue for more days than not for at least 2 weeks, increase/decrease in sleep, weight gain or loss, these symptoms help as describe that PD 2) Investigate causes of PDs Still under active scientific investigation and inquiry. Humans are very complex, as is the mind. We may have very clear causes for hypertension (increased blood pressure) much much less clear on what causes depression. Psychology as a field is in its infancy - despite historical background, to the study of PP, compareed to medicine or other hard sciences (physics, anatomy), psychology as a discipline is quite young - thinking of causes has not been as ingrained in our natural history as say planetary alignment or basic physic laws 3) Evaluate and implement treatments Not only about how to describe PD and its causes, we'll talk about treatment. Not just medication, but cognitive and behavioral approaches (changing the way you think and changing the way you behave - how doing so affects the causes of PP)

Mental status exam 1) Appearance and behavior 2) Thought processes 3) Mood and affect 4) Intellectual functioning 5) Sensorium (oriented times 3)

-Involves systematic observation of an individual's behavior. Trick for clinicians is to organize their observations of other people in aa way that gives them sufficient information to determine whether a psych disorder might be present. Mental status exams are mostly performed relatively quickly. In course of interviewing or observing patient, exam covers 5 categories. 1) Appearance and behavior: Dress, general appearance, posture, facial expressions, motor and body behavior 2) Thought processes: Listen to a patient talking: rate of flow of speech (quick/slow)? Continuity of speech (make sense)? Content of speech could prove evidence for delusions (distorted views of reality) or ideas of reference (everything everyone else does somehow relates back to them), hallucinations (things a person sees or hears when things are not really there). Brian: Ideas of reference. His strongly held conviction about his homosexuality was a delusion. But, his negative attitudes toward homosexuality were real. 3) Mood and affect: Mood: predominant feeling state of the individual. Does individual talk in a depressed or hopeless manner? How pervasive is the mood? Affect: the feeling state that accompanies what we say at a given point (usually "appropriate", could be "inappropriate" if say you were laughing about someone dying, "flat" or "blunted" if no affect is in variety of happy or sad things discussed by speaker) 4) Intellectual functioning: Reasonable vocabulary? Memory? 5) Sensorium: General awareness of our surroundings. What date it is, time it is, where they are, who they are. Most of the time clear or "oriented times 3" (person, place, time). -Mental status exam allows clinician to make a preliminary determination of which aras of the patient's behavior and condition should be assessed in more detail and perhaps more formally. Frank: Persistent motor behavior (#1) in form of twitch ld to discovery of connection with troublesome thoughts. Beyond, appearance was appropriate, intelligenc well, oriented times 3. Displayed anxious mood, but affct was appropriat. -Direct remainder of clinical interview and additional assessment and diagnostic activities to identify the possible existence of a disorder char. by intrusive, unwated thoughts and attempts to resist them (OCD). -Information provided by patients to psych and psychiatrists is protected by laws of "privileged communication" or confidentiality in most states. Even authorities could not get information without consent from patient. Only exception is when clinician judges that because of patient's condition, some harm or danger to either patient or somebody else is imminent.

-Intelligence Testing -Alfred Binet, Théodore Simon -Louis Terman of Stanford -Wechsler Adult Intelligence Scale Fourth Edition (WAIS-4) -Which IQ test is more commonly used today?

-Intelligence testing got its start in 1904, with Binet and Simon commissioned by the French government to develop a test for "slow learners" and came up with an early version of the IQ test (these individuals did not know they were making an IQ test, and quite honestly were interested in understanding who would benefit from remedial help during the educational process). -B and S developed a series of tasks that presumably measured skills of children needed to succeed in school (measured attention, memory, reasoning, verbal comprehension, and perception). -Gave this test with these smaller tasks to a large number of schoolchildren and eliminated the tasks that did not really distinguish slow learners from children who did well in school. -After doing this several times, over several revisions, and sample administrations, they had a test that was relatively easy to administer and did what it said it was going to do (predict academic success) -Terman in 1916 translated a revised version of this test for use in the US. Became more broadly known as the Stanford-Binet test and was much more like what we would think of along the lines of a traditional IQ test. -Provided a score or an intelligence quotient (IQ), calculated using a child's mental age (if got all questions right for a 7 year old level, but none for an 8 year old level, your mental age would be 7 years old) divided by chronological/actual age and multiplied by 100 to get the IQ score. -Test went through several revisions and is still used to some extent today, but perhaps more widely used today is... -Wechsler series of tests used more commonly today. There is one for adults and one for children, this perhaps if what you really think of when you think of an IQ test today. -We've done IQ tests on enough people that we have a normal or 'bell curve' distribution in the general population of IQ. The sort of mean or average score on the IQ test is 100 and the standard deviation is 15. -If you have IQ of 145 you are 3 standard deviations above the mean and are very very intelligent. Likewise, if you have an IQ of 70, you are several standard deviations below the mean and anything below 70 is considered the range of mental disability or mental retardation. -Intelligence testing really had its roots in trying to understand who would perform well in school, and still tests to some extent the probability that someone will do well in school. -Issues with construct of intelligence: What exactly constitutes intelligence? (IQ test is designed to measure things such as attention, memory, reasoning, verbal comprehension, perception). -But we have to ask ourselves do these skills really represent totality of what we consider intelligence? -Some more recent theories from scholars in the field perhaps intelligence involves more than those things including the ability to be resilient or adapt to the environment, ability to generate new ideas, process information more effectively and efficiently. -However, what you should know about the modern day versions of IQ tests is that they do in fact tend to be reliable and valid instruments to the extent that they predict academic success.

-Types of Reliability -Test-Retest -Interrater -Types of Validity -Predictive -Concurrent . -The Clinical Interview -Includes info about past/current _, _, _ -Detailed _ -Assessment of _

1) T-R R: Will you get a similar result if you take the same test again? (Give someone with severe depression a personality test should test out same or similarly now as they will 6 months from now) 2) I R: Do two or more raters get the same answers on a test? (Me and another clinical psychologist evaluates behavior of a potential patient, we should be able to, if rating the same person, get similar ratings when using the same rating scale -V depends on R 1) P V: How well does this assessment do in terms of predicting future outcomes? (Take personality assessment - do quite well in predicting future outcome MMPI: certain scales quite predictive for cardiovascular disease risk among other outcomes) 2) C V: Does your measure or assessment hold up to other similar measures or assessment materials? (Give MMPI or other personality inventory: is it going to perform as well as other measures of personality?) . -Any assessment in a clinical setting includes osmething called a clinical interview. -CI: Information about past and current behavior, attitudes, and emotion, as well as a detailed life history and an assessment of the presenting problem (What brings you in today?). -What brings you in today? Could be depression, anger, anxiety, unusual or bizarre experiences, court ordered you to come in, substance misuse issues, etc. -Clinician sits with prospective patients in room and interviews them -Interviews depending on the setting, usually take an hour in length (sometimes a little longer - goal to get picture of who it is exactly that is walking through your doors, and is seeking treatment for whatever reason) -Get a sense of that person: Where did you grow up, Who is in your family, What are your family relationships like, What kinds of jobs have you had, How much education do you have? -And include more detailed questions about the problem itself (What brings you in today? What symptoms are you presenting with? "I've been feeling down and blue for about 2 weeks, lost my appetite, lost weight, not sleeping well, angry all the time, lost interest in doing things I don't normally want to do -> Leading down path to suggest perhaps you have major depression. Ask more questions about that ask questions about other related PDs like GAD, bipolar disorder. Just to make sure you are arriving at an appropriate diagnosis. -Often times the end goal of a clinical interview is to produce a diagnosis, may not always be the case, but in most instances that is true. Put together all the pieces of a person's life that are pertinent toward the presenting problem.

Key concepts in assessment -Reliability -Validity -Standardization

Process of clinical assessment in psychopathology has been likened to a funnel. Clinician begins by collecting lot of information across broad range of individual's functioning to determine where source of problem may lie. After getting preliminary sense of overall functioning, clinician narrows focus by ruling out most problems in some areas and concentrating on areas seen as most relevant. Three basic concepts that determine value of our assessments 1) Reliability: The degree to which a measurement is consistent. We expect that presenting the same symptoms to different physicians will result in similar diagnoses. One way psychologists improve reliability is by carefully designing assessment devices and then conducting research on them to ensure that 2 or more raters will get same answer (interrater reliability) They also determine whether techniques are stable oveer time. (test-retest reliability) 2) Validity: Whether something measures what is designed to measure - whether a technique assess what it is supposed to. Comparing results of an assessment measure under consideration with the results of others that are better known allow you to begin to determine validity of the first measure (concurrent or descriptive validity) How well your assessment tells you what will happen in the future (Predictive validity) 3) Standardization: the process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measurements. Example: If you are an African American male, 19, and from middle-class, your score on a psych test should be compared with scores of others like you aand not to scores of different peeople.

Behavioral and cognitive science -Social Learning # (modeling or observational learning) -Prepared learning %

#: Do not have to experience certain events in their evironment to leave effectively. Rather they can learn just as much by observing what happens to someone else in a given situation Modeling or observational learning: type of learning requires a symbolic integration of the experiences of others with judgements of what might happen to oneself -The importance of the social context of our learning, much of what we learn depends on our interactions with other people around us (social neuroscience) %: Genetic endowment influence what we learn -We learn fears and phobias selectively We have become highly prepared for learning about certain types of objects or situations over he course of evolution because this knowledge contributes to survival of the species. We are more likely to learn to fear snakes or spiders than rocks or flowers, even if we know rationally that the snake or spider is harmless. -In absence of experience, we are less likely to fear guns or cars or electrical outlets, even though they are potentially deadlier. -Sex difference may exist for this type of learning: females part. sensitive to this type of learning (may account for greater incidence of snake and spider phobias in women) -Survival is quickly learning to avoid poisonous food

Biological traditional consequences

-Hospitalize patients (due to undiscovered brain pathology, they were seen as not curable). -Centers focused on diagnosis rather than on treatment. -Active intervention and treatment were all but eliminated despite availability of some effective approaches.

Prototype and psychopathology

A prototype is a DSM-5 diagnostic criterium - "Typical" profile of a disorder (compared to how 'apparent' a disorder actually is) because we may never satisfactually define 'disease/disorder' -PATIENT may have only some symptoms/features and still meet criteria for disorders because set of symptoms close to prototype DSM-5 FEATURE: addition of dimensional estimates of severity of specific disorders (0-4 scale). Psychopathology iI the scientific study of psychological disorders. -Clinical psychologists and counseling psychologists - grad-level study for 5 years. Causes and treatments of PD and to diagnose, assess, treat these disorders. -Psychiatrists: also investigate nature and cause of PDs, from biological standpoint, make diagnoses and offer treatment. -Psychiatric social workers: social and family situations of individuals with PD -Psychiatric nurses: care and treatment of patients with PD in hospitals -Marriage and family therapists and mental health counselors: clinical services by hospitals or clinics

Psychological disorder What classifies abnormal behavior?

Abnormal behavior: 1) A psychological dysfunction within an individual associated with 2) distress or impairment in function 3) and a response that is not typical or culturally expected 1) A breakdown in cognitive, emotional, and behavioral function EX: A fear leading up to every date -> emotions not functioning properly (even if there is nothing to be afraid of) A mild version (queasy not FAINTING) > know where to draw the line between normal and abnormal dysfunction -A continuum instead of categories that are present or unpresent Having a dysfunction not enough to meet psychological disorder criteria 2) Individual is extremely upset. It is normal to be distressed (and suffering) and is a part of life. -Some disorders see suffering absent (impulsiveness associated with a manic episode) -Impairment also not enough -EX: Some people just identify as shy or lazy -Most PDs just extreme expressions of otherwise normal emotions, behaviors, and cognitive processes 3) Occur infrequently -> deviates from average (more deviation, more abnormality) -Violating social norms EX: cultural differences in PDs -"possessed" in Western culture -> not accepted/expected -Robert Spadsky -> Maasai people Cross-cultural psychology -A social standard of normal can be misused (harmful dysfunction: out of person's control? -> something they do not want to do) EX: mental inst. -> for protesting (still a social norm violation) -Widely accepted definition of a psychological disorder: DSM-5, behavioral/psychological/biological dysfunction criteria: "typical" profile of a disorder (compared to how 'apparent' a disorder actually is - because we may never satisfactually define 'disease/disorder' -PATIENT may have only some symptoms/features and still meet criteria for disorders because set of symptoms close to prototype DSM-5 FEATURE: addition of dimensional estimates of severity of specific disorders (0-4 scale).

Diathesis-stress model

Individuals inherit tendencies to express certain traits or behaviors which may then be activated under conditions of stress. -Diathesis/vulnerability: inherited tendency, a condition that makes someone susceptible to a disorder When the right kind of life event, such as a certain type of stressor, comes along the disorder develops. EX: Judy: Diathesis: seeing the graphic video Diathesis -> genetically based Stressor -> environmental The smaller the vulnerability, the greater the life stress required to produce the disorder. -5HTT gene (diathesis) Childhood experience that was severe and negative maltreatment (stressor) -Neither genes nor life experiences (environmental) can solely explain the onset of a disorder such as depression.

Epigenetics. -The study of .... that activate or deactivate parts of the ... strategic times and locations -Field of study with great implications for psychopathology and stress sensitivity. -Rat pup example: Lick your rats!

The study of chemical reactions that activate and deactivate parts of the genome at strategic times and speicifc locations (Gene X Environment Influences on PP - really talking about Epigenetics because this is when the modification occurs). -Rat pup example: LICK YOUR RATS! -Glucocorticoid Receptor: GR gene (relaxation after certain events) -Lack of maternal care through licking causes the GR gene to remain inactive, which will make the rat have a harder time relaxing after stress even into adulthood/rest of life. Also has influence on adult personality. -But if attentive care, activates the GR gene.

The clinical interview, semistructured clinical interviews.

The interview gathers information on current and past behavior, attitudes, and emotions, as well as a detailed history of the individual's life in general and of the preseenting problem. Clinicians determine when the specific problem started and identify other events (life stress, trauma, or physical illness) that might have occurred about the same time. In addition, most clinicians gather at least some information on patient's current and past interpersonal and social history. To organize information obtained during an interview, many clinicians use a mental status exam. . -Made up of questions that have been carfully phrased and tested to elicit useful information in a consistent manner so that clinicians can be sure they have inquired about the most important aspects of particular disorders. Clinicians may also depart from set questions to follow up on specific issues. -Clinicians can feel confident that a semistruc. interview will accomplish its purpose, but disadvantage is that it robs the interview of some of the spontaneous quality of 2 people talking about a problem. Also, if applied too rigidly, may inhibit the patient from volunteering useful info that is not directly relevant to questions being asked. Fully structured interviews administered by computers have not caught on for this rason.