Abnormal Psychology, Exam I Study Cards

Chapter 1 Introduction and Historical overview

Psychopathology Study of why people think, behave, and feel in abnormal, unexpected ways.

“something wrong with a person’s psychology”

A search by clinicians for the reasons why people behave, think, and act in abnormal ways. Focus is on

• Description

• Causes

• Treatment


Abnormal Behavior Given social, cultural, and situational factors, any behavior or thought that is maladaptive or has a negative affect

Characteristics:

• Personal Distress (emotional pain and suffering)

• Disability (impairment in a key area)

• Violation of Social Norms (makes others uncomfy)

Cultural relativism: behavior determined by culture and society

• Dysfunction: Wakefield’s harmful dysfunction

DSM-IV-TR includes all these characteristics


Stigma Having a negative connotation – how we think about mental illness. Labeling someone based on our assumptions, and negativity is attached in a big way.

Apply label� refers to undesirable attributes� people seen as different� discrimination


What are the three historical views? (guiding perspectives over time)

Supernatural: mental illness is due to supernatural forces (demonology, God, possession, etc)

Biological: originated with Hippocrates, says that psychopathology is due to dysfunction in the brain, it is similar to physical disease

Psychological: says that psychopathology is due to something in the environment like stress or trauma

These views dictated how mental illness has been treated, and how people with mental illness were treated


Freud • Influenced by Bruer

• Emphasized stages of psychosexual development

• Importance of unconscious processes

Repression and defense mechanisms

Influenced psychoanalytic theory:

• Free association

• Analysis of transference

• Understand conflicts and find healthier ways dealing with them,.


Behaviorism Suggests that behavior develops through classical conditioning, operant conditioning, or modeling. People with symptoms just need to reinforce OTHER behaviors. Shift was towards observing things that we can see, and moving away from unconscious

• John Watson father of behaviorism, focused on learning and observable behavior

• BF Skinner: positive and negative reinforcement, showed that operant conditioning can shape behavior


Cultural Relativism Says that behavior is determined by culture and society, and that there is no universal for human behavior.

• Think of gender roles in different parts of the world


Wakefield’s Harmful Dysfunction Says that must be harmful to the self or society, and must be an element of dysfunction, something operating in a way that deviates from how it should operate.

Someone might deny harm to themselves or society but actually be doing harm!


Demonology Earliest idea of mental illness. Believed that demons and evil spirits possessed the mind to cause mental illness, and that exorcism was the only treatment. They drilled holes in the skull to let the, escape (trepanning)


Hippocrates Gave earliest biological explanation

Thought that mental illness was caused by natural as opposed to supernatural causes, and that it was located In the brain

• Imbalance of four humours of the body

Black bile (infection)

Yellow bile (anxiety)

Phlegm

Blood


Timeline of Psychopathology

Supernatural � Biologicacl (Hippocrates) �Dark Ages (supernatural) � Witches � Lunacy Trials � Aslyums (Priory of St Mary of Bethlehelm � Pinel (humanitarian treatment) � William Tuke and Society of Friends � Dorthea Dix � NAME � can be inherited (Behavioral genetics) � Eugenics � Psychological Approaches � Mesmer � Bruer � Freud (psychoanalytic theory) � Neo-freudians � Adler � Behaviorism (Watson, Thorndike, skinner) � Modeling (Bandura and Menlove) � Behavior therapy


Lunacy Trials Organized by the government (13th century England) to determine sanity. Lunacy refers to theory that attributes insanity to misalignment of the room and stars


Priory of St. Mary of Bethlehelm • One of the first mental institutions

• Exploited those with mental illness

• Origin of term bedlam

• Treatment non-existent or harmful


Phillipe Pinel Pioneered humanitarian treatment

Took Control of Aslyum

Wanted to treat people with dignity, like humans, to cure


Moral Treatment • William Tuke and Sociey of Friends, York Retreat

• Provided a calming environment

• Gave patients purposeful activity

• Talked with attendants


Dorthea Dix Crusaders for prisoners and mentally ill in the United States

Urged improvements in institutions

Established 32 new public hospitals,

But too large to maintain moral treatment

Hospitals staffed with physicians


Kraepelin • Pioneered classification of mental illness based on

biological cause

• Noticed groups of symptoms tended to co-occur, called it a syndrome, evidence of a biological cause

• Published first psychiatry text

Dementia Praecox (schizo) and manic depressive psychosis (bipolar disorder)


Behavioral Genetics - emergence “The extent to which behavioral differences are due to genetics”

After Kraepelin noticed that symptoms tended to co-occur and termed this a syndrome, was noted that these syndromes ran in families and could be inherited, so investigated causes

Eugenics: only those with desirable traits should be allowed to “breed” (period of enforced sterilization”


Psychological Approaches View mental illness as due to psychological functions

Dysfunctional thinking patterns, behavior determined by reward/punishment, things in the brain that couldn’t be understood due to biology

Mesmer: used animal magnetism and hypnosis to treat hysteria

Bruer: Used hypnosis to facilitate catharsis


Freud Psychoanalytic theory: Human behavior is determined by unconscious forces, things we aren’t aware o that an observer cannot see

Psychopathology results from conflicts among these unconscious forces

ID: unconscious, energy is libido, operates according to pleasure principle, reduces tension through wish fulfillment and fantasies

EGO: develops to consciously control the ID, conscious and operates according to reality principle

SUPEREGO: our conscience, societal influence


**Stages of Psychosocial Development

Oral Stage

Anal Stage

Phallic Stage

Latency period

Genital Stage


Defense Mechanisms

Rationalization: justifying with socially acceptable reasons over real

Repression: blocking threatening memory from consciousness

Regression: return to more primitive levels of behavior

Denial: refusing to admit something unpleasant happening

Reaction formation: transforming anxious thoughts into opposite

Displacement: taking it out on someone/something else


**Conflict between ID,EGO,Superego • ID vs EGO

• EGO vs Superego

• Superego vs ID


Neo-Freudians (Jung and Adler) Jung: Analytical psychology

Collective unconscious

Archetypes

Adler: individual psychology

Striving for superiority

Inferiority complex

Move towards rational thinking


Conditioning Classical Conditioning: Pavlov, learning by temporal association

When two events repeatedly occur close together in time, they become fused in mind before long, respond in same way to both events

US (meat) --> UR (salivate)

US (meat) + bell --> UR (salivate)

CS (bell) --> CR (salivate)

Operant Conditioning: (Thorndike) Looked at learning through consequences.

Law of Effect: any behavior followed by a pleasurable consequence will be repeated, unpleasant consequence will be discouraged.


Conditioning continued (Skinner) Skinner Box

Positive and Negative Reinforcement and Punishment

(provide definitions and examples)

Positive Reinforcement: something added increases behavcior

Negative reinforcement: something taken away increases behavior, so behaviors that terminate a negative stimulus are strengthened

Positive punishment: something added decreases behavior

Negative punishment: something removed decreases behavior


Modeling and Shaping Modeling: Learning without any reinforcement

• Bandura and Menlove (children and fear of dogs)

Shaping: reward a sequence of responses that approximate a final response (rats and pushing a lever)


Behavioral Therapy “Application of procedures and principles used in operant conditioning”

• Must identify problems causing behavior and replace

them with better ones. Therapist is like a coach

Counterconditioning: causing same stimulus to elicit a different response (instead of fearing the bridge, being able to drive over it)

Systematic Desensitization: used often in treatment of phobias and anxiety disorders. Identify phobia and then use relaxation techniques and expose to what afraid of at different levels, lead up to ultimate fear

**Aversive Conditioning**

Chapter 2 Current Paradigms in Psychopathology

Paradigm A conceptual framework or general perspective.

Ways that people think about mental disorder, how we organize information around it, has implications for how people are treated

Helps shape what we investigate treat and how we define abnormal behavior


Genetic Paradigm Says that psychopathology is caused or influenced by heritable factors. Heredity plays some role in most behavior!

Genes and the environment interact, and this leads to psychopathology. Think of nature via nurture

Gene Exoression: proteins influence whether the action of a specific gene will occur

Heritability: extent to which variability is due to genetics. Is a group rather than an individual indicator

Shared environment: events and experiences family members have in common

Nonshared environment: events and experiences unique to member


Neuroscience Paradigm Emphasizes the role of the brain, neurotransmitters and other systems like the HPA axis in psychopathology. View that behavior can best be understood by reducing it to its basic biological components. Ignores more complex views of behavior.

Axon includes:

Cell body, dendrites, axon, and terminal button

Treatment is often via drugs and biological treatments to rectify specific problems of the brain.

Neurotransmitter: chemical substance released in the synapse of a presynaptic neuron

Receptor sites on postsynaptic neuron absorb NT (excitatory or inhibitory reaction)

Reuptake: reabsorption of leftover NT by the presynaptic neuron


Psychoanalytic Paradigm • Derives from the work of Freud

• Contemporary contributions are in treatment, including ego analysis and brief therapy

• Criticized, but highlights importance of childhood experience, the unconscious, and that causes of behavior aren’t always obvious


Cognitive Behavioral Paradigm Behavior is reinforced by consequences!

• Attention, escape or avoidance, sensory stimulation, access to desired object or events

• To alter behavior, alter the consequences

• Systematic desensitization

Emphasizes schemas, attention, and irrational interpretations and their influence on behavior as major factors in psychopathology

• Has usually blended cognitive findings with the behavioral in an approach to intervention that is referred to as the cognitive behavioral (beck and ellis focused on altering patients negative schemas and interpretations)


Emotion (and factors across paradigms) Plays a predominant role in a number of disorders

Expression, experience, and physiology of emotion can be disrupted

Expression: showing emotion

Experience: feeling it

Physiological: how the experience of the emotion affects physiological state

• Disturbance of emotion seen in 90% of disorders

Other factors important in psychopathology: Culture, ethnicity, gender, social support, relationships. Women more likely depressed than men, social support determines success of therapy


Diathesis-Stress Integrates several points of view

Assumes that people are predisposed to react adversely to environmental stressors.

Diathesis: underlying predisposition: m ay be genetic, neurobiological, or psychological and may be caused by

Stress the triggering event, like early childhood experience,

genetically influenced personality trait, or sociocultural influences

• Diathesis is within a person (genetic neurobiological) and stress is external to person


Behavior Genetics Study of individual differences in behavior attributable to differences in genetic makeup

Genotype: genetic material inherited by an individual, unobservable

Phenotype: expressed genetic material, observable behavior and characteristics

So phenotype = genotype + environment interaction!

Gene Environment Interaction: ones response to a specific environmental event is influenced by genes, interaction is recipricol.


Epigenetics Study of how the environment can alter gene expression or function

Rats born to mothers with low parenting skills and RAISED by mothers with high parenting skills showed lower levels of stress reactivity, AND increased gene expression implicated in stress response

Graph: having at least one short Allele means greater lilklihood of developing depression.


Neurotransmitters and Psychopathology Norepenephrine: anxiety disorders

Seratonin and Dopamine: depression and schizophrenia

GABA: anxiety

Possible Mechanisms:

• Excessive or inadequate levels

• Insufficient reuptake

• Excessive number or sensitivity of postsynaptic neuron


Brain Structure and Function Sulci: define regions or lobes

Frontal: thinking and reasoning abilities

Parietal: touch recognition

Occipital: recognition of sights and sounds, long term memory

Temporal: integrates visual input

Hemispheres: halves of the brain separated by corpus callosum

LEFT: speech and analytical thought

RIGHT: spatial relations and pattern re cognition


Autonomic Nervous System Responsible for involuntary functions, involved in anxiety disorders

Sympathetic Nervous System: (fight or flight): excitatory functions

Parasympathetic Nervous System: quiescent function, except for gastrointestinal activation


HPA Axis (Neuroendocrine System) Involved in the stress response

1) Hypothalamus triggers release of CRF

2) Pituitary gland releases ACTH through blood

3) Adrenal cortex triggers release of cortisol, stress hormone

Blood sugar elevated and metabolic rate increases


Contemporary Psychodynamic Paradigms EGO ANALYSIS:

• emphasis on the ego vs ID

• focus on interaction with the environment

• current experience (vs childhood events)

• Proponents were Horney, Freud, Erikson, Rapaport, etc


Brief Psychodynamic Therapy • Time limited

• Active therapist involvement

• Concrete goals

• Development of coping skill

• Current life and experiences

• Transference downplayed

Most in response to criticism from insurance companies that it takes too long! Must have diagnosis within three sessions


Criticism of Psychoanalysis • No formal research

• Inadequate and non-representative samples

• Continuing impact

GOOD POINTS…

Personality shaped by early childhood

Behavior influenced by unconscious

Causes of behavior not always apparent or obvious


Systematic Desensitization Expose someone who has fear of object or event to what they fear in combination with relaxation techniques

• Important treatment for anxiety disorders


Cognitive Science Cognition: a mental process which includes perceiving, judging, reasoning, conceiving, and recognizing

Schema: Organized network of previously accumulated knowledge

Role of attention in psychopathology: anxious individuals more likely to attention to threatening stimuli


Beck’s Cognitive Therapy

• Therapy that helped to identify and then change maladaptive thought patterns.

“Nothing ever goes right for me!”

• Originally developed for depression (BDI) – depression caused by information processing biases. Made patients search for evidence as support of their biases


Ellis’s Rational-Emotive Behavior Therapy

Identified and challenged patients’ irrational beliefs

Irrational beliefs: Internal, repetitive thoughts that reflect assumptions abot the self

“in order to be happy, I must be loved!”

• Musts or shoulders that are commonly unrealistic demandws that we place on ourselves and others

Eg people shouldn’t make mistakes”


Paradigms of Psycopathology

Psychodynamic

Neurobiological

Cognitive-Behavioral

Genetic

Diathesis-Stress

Chapter 3 Diagnosis and Assessment

Diagnosis and Classification Diagnosis: provides the first step into thinking about causes of symptoms and in planning treatment

Advantages:

• Communication among professionals, clinical care

• Advances search for causes and treatments

• Diagnosis is important – must be made within 3 sessions

Classification: of disorders is by symptoms and signs so the diagnosis is a cluster of symptoms

**only in psychopathology does classification and diagnosis get hazy because we don’t have discrete tests


Reliability

Consistency of measurement

Inter-rater reliability: agreement of observers or clinicians. Why we have the DSM – so two doctors from different backgrounds can look at same patient and make same diagnosis (.7 is acceptable)

Test-retest reliability: similarity of scores across repeated test administrations or observations (mood may not have it)

Alternate forms: similarity of scores on tests that are similar, but not identical. Similar forms meant to test same thing should have similar results… trying to test the same thing in a different way

Internal Consistency: extent to which items on a test are related to one another


Validity ACCURACY How well test measure what we are trying to find out

Content Validi: extent to which measure samples domain of interest

Criterion Validity: extent to which a measure is associated with another measure

Concurrent means that two measures are given at same time (Hopelessness and depression)

Predictive means the ability of the measure to predict another variable measured at some future point in time (GPA and salary)

Construct Validity: correlating multiple indirect measures of the attribute to give abstract construct legitimacy (if we find correlation) DIAGNOSES in DSM are constructs, strong one predicts many char.


DSM-IV-TR Manuel used for making diagnoses

Diagnostic and Statistical Manual of Mental Disorders

In the 4th edition, 5th by 2010, multiaxial system

Published by American Psychological Association (APA)

Axis I: Clinical Disorders (come and go)

Axis II: Mental and Personality Disorder (permanent)

Axis III: general medical conditions

Axis IV: Psychosocial and environmental factors

Axis V: GAF Score (global assessment of functioning)


History of the DSM

DSM-1952: Called “reactions” because thought that soldiers came back from WWII and reacted to trauma

DSM II 1968: Neuroses (disorders) and psycos (categories)

DSM III (1980) major revision (disorders and multiaxial system)

DSM III-R 1987

DSM IV TR background of disorders added

DSM V 2010?

** Most concerned with inter-rater reliability and construct validity


Axis I Disorders

Childhood/Infancy/Adolescent Disorders: Learning and Developmental Disorders

Substance related disorders

Schizophrenia and Psychotic disorders

Anxiety Disorders (GAD, Panic disorder, OCD

Mood Disorders (major depression and bipolar)

Eating Disorders (Anorexia nervosa and Bulimia Nervosa)


Improvements in DSM-IV-TR Specific Diagnostic Criteria: less vague!

More extensive descriptions

• Essential features

• Associative features (lab findings)

• Differential diagnoses (helps to distinguish 2 disorders from one another)

Increasing number of categories: comorbidity 45%

Issues and diagnostic categories in need of further study

Increased cultural sensitivity (cultura bound syndromes)


Diagnosis: Cultural/Ethnic Influences Culture can influence:

• Risk factor for disorder

• Symptoms experienced and how described

• Willingness to seek help

• Availability of treatments

New DSM-IV-TR includes framework for evaluating role of culture and ethnicity, and a description of the cultural factors of each disorder


Criticisms of the DSM Categorical vs Dimensional Diagnosis:

Categorical Classification: Yes or no, it’s there or not

Dimensional Classification: having more of a gradation, degree to which a symptom is present

DIMENSIONAL better capture an individuals functioning

CATEGORICAL has advantages for research and understanding, but clinicians don’t like because a person might be impaired in certain areas, but doesn’t meet full criteria � doesn’t get funded for treatment


Should we Classify in the first place?

Criticisms of classification:

• Label � stigma

Treated differently by others

Difficulty finding a job

Never goes away, changes to “in-remission”

• Categories don’t capture uniqueness of person, and don’t define the person. Classification may emphasize trivial similarities, and relevant information might be overlooked


Psychological Assessment

Techniques employed to:

• Have basis for making decision

• Describe client’s problem

• Determine causes and come to diagnosis

• Develop treatment strategy

• Monitor progress of treatment

Ideal assessment involves many measures and methods

(interviews, personality assessment, inventories)


Psychological Assessment Methods

Interviews Clinical (pay attention to how questions answered, if there is appropriate emotion) and Structured (on paper) Paradigm influences information sought in interview. Good rapport is essential.

Psychological Tests

Personality Tests (MMPI) self report measure yields profile of psychiatric functioning with a subscale to catch fakers,

Projective Tests,: response to ambiguous stimuli reflect unconscious process

Intelligence Tests: good for detecting mental retardation

Direct Observation Antecedents � consequence unit

Self Observation self monitoring, problem is reactivity


Neurobiological Assessment Brain Imaging:

CT or CAT scan (computerized axial tomography): reveals structural abnormalities by detecting differences in tissue density

MRI (magnetic resonance imaging): higher quality than CT

fMRI: allows to look at blood flow (blood oxygenation levels) as an indication of neural activity. Structure and function

PET Scan: Positron Emission Tomography: Brain function, less common, inject radioactive isotope, radioactively tagged glucose emits positrons that are picked up from scanner

** not good methods for diagnosing disorder


Neurotransmitter Assessment Post Mortum studies: look at brain after someone has died

Metabolite Assays: (byproduct of NT deactivation) can measure this amount in the person’s body – but not great reflection of NT in brain because is also gives NT in the entire body. Limited measure of causation

Neuropsychologist: someone who studies how abnormalities in the brain affect aa perons’s cognition, and behavior

Neuropsychological Tests: interviews that measure brain or cognitive functioning (batteries)


Psychophysiology study of bodily changes that accompany psychological characteristics or events. How behaviors and cognitions are linked to these bodily changes

Electocardiogram (EKG): heart rate measured by electrodes placed on chest

Electrodermal responding (skin conductance) : sweat gland activity measured by electrodes placed on hand

Electroencephalogram (EEG): Brain’s electrical activity measured by electrodes placed on scalp


Cultural Bias and Assessment Measures developed for one culture or ethnic group my not be valid or reliable for another clture. Most are developed for white men, not just a language barrier. But also a factor

Not just a matter of translation, meaning may be lost in translation

Cultural bias can lead to minimizing or exaggerating psychological problems in people that come in for help

Chapter 4 Research Methods

Terms of Research Science: The systematic pursuit of knowledge

Theory: method of explaining and predicting phenomena that is supported by empirical evidence taken as fact, set up to be disproven

• A good theory is falsifiable

• A set of prepositions developed to explain what is observed

Hypothesis Specific testable predictions about what will occur if a theory is correct


Research Methods in Psychopathology Case Study: Descriptive biographical information about an individual

Correlation: Relationship between two or more variables. No manipulation by scientists, what is happening in nature. Most common and easiest to conduct

Experimental Studies: Manipulation of an independent variable and DV. DV is what we are looking fo9r change. And there is random assignment


Case Study Detailed biographical description of an individual

Family history, Medical history

Ethnicity, Gender, Personality and adjustment issues

Social support around them, day to day environment

Childhood

Educational background, and experience with therapy

Usefulness: rich description, good for hypothesis, rare disorders, good for disproving hypothesis, also good hypothesis generator

Limitations: BIAS (paradigm may influence observations) Cannot rule out altere explanations, and generalizability is limited


Correlational Method Correlational Coefficient ranges from -1 to 1

Direction Negative relationship: variables move in opposite directions

Positive relationship/correlation: variables move in same direction

Constant: no relationship

Strength (magnitude): the higher the absolute value, the stronger the relationship

Statistical Significance: probability less than .05% something other than chance is happening here! Larger samples increase likelihood that result is significant

CORRELATION DOES NOT IMPLY CAUSATION (confounding variable)


Longitudinal vs Cross Sectional Study Longitudinal: study done over many years with the same people to see if causes are present before disorder develops

High Risk Model: include only those who are at greatest likelihood of developing a disorder – reduces the cost of longitudinal research

Cross Sectional Design: looking at simultaneous factors, taking data at one point in time and looking at two different things, causes at effects measured at the same time.


Correlational: Epidemiological Research

Study of the distribution of disorders in a population

Three features of a disorder

• Prevalence: number of cases that are here long

• Incidence: number of new cases that occur

• Risk Factors: associated with higher chance of having a disorder (men vs women)


Correlational: Behavioral Genetics Index cases/Probands: people who actually have the illness, a sample of individuals with psychopathology

Concordance: Co-occurencec or similarity of diagnosis (concurrent people have the same diagnosis)

Family studies: degree to which people are related in a family, and relationship of degree of relatedness and degree of disorder

Twin Studies Monozygoric twins : 100% genes Dizygotic twins 50%

Adoptee Method: Study of adoptees who have biological parents with psycopathology

Cross Fostering: Study of adoptees who have adoptive parents with psychopathology


The Experiment Provides information about ausal relationships (does x cause y?) involves Independent variable, DV, Random assignment

Can evaluate treatment effectiveness – most often used in psychopathology research

Internal validity: extent to which experimental effect is due to independent variable (so if groups differ too much, bad thing! GOOD internal validity means that change is probably due to experiment

Control Group: People that don’t receive treatment, the standard against which treatment effectiveness is judged (placebo)

External Validity: extent to which results generalize beyond study


Analogue Experiment Experiments that aren’t possible in psychopathology (if not ethnical) we can examine related or similar behavior in the lab… people with a certain diagnosis may come into the lab, and then there is a manipulation done…

• Elicit symptoms

• Select samples with similar attributes

• Animal research


Single Subject Experimental Research Examine how individual participants respond to changes in the independent variable

Reversal ABAB Design (girl in book that was afraid of sharp foods)

Baseline (A) � Treatment (B) � Withdrawal (A) � Reinstatement (B)


Integrating Findings from Multiple Studies Meta Analyses: allows us to come to some conclusion about if hypothesis supported

• Identify relevant studies

• Compute effect size (transform to common scale)

• Smith et al meta analyzed 475 outcome studies and said that psychotherapy is effective

Chapter 5: Anxiety Disorder

Fear vs Anxiety Anxiety: apprehension about a future threat

Fear: response to an immediate threat – the present oriented mood state triggers the fight or flight response

**both can be adaptive: May save life (fear) and anxiety can increase preparedness (improve performance)


Anxiety Disorders Deal with atypical, maladaptive levels of anxiety. As a group are the most common psychiatric disorders. 25% of people report anxiety at some point, phobias most common

Major Anxiety Disorders:

• Specific phobia or social phobia

• Panic Disorder

• GAD

• OCD

• PTSD

• Acute Stress Disorder


Phobia Disruptive fear of a particular object or situation that causes concern

• Fear out of proportion to actual threat

• Realization that is excessive

• Symptoms must interfere with job or social life

Two types: specific and social

Animals (snake most common)

Situations

Blood, infection, injury (only parasympathetic response)

Natural environment - Comorbid with physical disorders


Etiology of specific phobia Mowrer’s Two Factor Model:

Step 1: Classical Conditioning: pairing of stimulus with aversive UCS leads to fear (classical conditioning) so we are attaching fear to an unconditioned stimulus based on a bad experience

UCS = dog bite (seeing, hearing about, experiencing)

Step 2: Operant conditioning: avoidance maintained through negative reinforcement… avoiding what we are afraid of to ease anxiety and feel good

Problems: many people never experience interaction with aversive object (what if they dob’t remember?) specific types alludes to prepared learning (innate)


Social Phobia

Persistent, intense fear of social situations

• Fear of attention, scrutiny, evaluation

• 33% also diagnosed with avoidant personality disorder

• Often beings in adolescence

• Depends on range of situations avoided, could be

Generalized or specific


Etiology of Social Phobia Two Factor Model

• Avoidance and safety behaviors

Safety behaviors may actually make other person uncomfortable (looking away, fidgeting) to make first person even more awkward

• Cognitive factors

Negative self evaluation

Fear of negative evaluation by others

High standards and performance in front of others


Treatment of Phobias Psychological treatments that emphasize exposure procedure – fqce what triggers anxiety, and see that it’s not so bad

Systematic desensitization: relaxation plus imagined exposure to feared object. For social phobia, might be exposure in small group setting/interaction.

Also use social skills training to reduce use of safety behaviors

Cognitive Therapy: good for social phobias but not specific phobias, because specific phobia people KNOW they have distorted beliefs, and most of cognitive therapy is figuring that out.

Medication: but if affect fear response system not as great because we don’t get symptoms when exposed to what we fear.


Panic Disorder Marked by frequent panic attacks that are unrelated to specific situations… bouts of unexplainable anxiety

• Must also be worried about having attacks in the future

• At least one month after the first case

Sudden intense episode of apprehension, fear, impending doom.

• Sweating, nausea, labored breathing, dizziness, heart palpitations,

Depersonalization: feeling like out of own body

Derealization: feel like things around you aren’t real. Can be cued or uncued


Etiology of Panic Neurobiological Factors LC (norepenephrine)

Genetic predisposition (identical twins: 30% chance)

Interoceptive conditioning: classical conditioning response to somatic symptoms

Cognitive Factors: fear of bodily changes and fear of fear hypothesis

Exoectations about negative consequences of attack in public


Treatment of Panic and Agoraphobia PCT (panic control therapy)

• Exposure to somatic sensations with relaxation and hierarchy

Cognitive Behavioral Therapy: Increase awareness of thoughts about physical sensations, patients learns to challenge maladaptive beliefs


War Article Greater Risk: those with greater threat of loss or actual loss

Those with fewer coping resources


Symptoms of Anxiety Disorders Somatic, emotional, cognitive, and behavioral


Generalized Anxiety Disorder (GAD) Trademark symptom: constant worry, lasts at least 6 months

• Restlessness, fatigue, interferes with daily life, often begins in adolescence

Etiology of GAD: GABA deficits

Borkovec’s cognitive model: worry is reinforcing because it distracts from negative emotions and images that may be more painful for a person to confront – worry is tolerable compared to this. There is no exposure, so anxiety never distinguishes.

Treatment: cognitive behavioral models, challenge and modify negative thoughts, increase ability to tolerate uncertainty, worry only during scheduled times

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Obsessive Compulsive Disorder (OCD) Obsessions: intrusive, recurring and uncontrollable thoughts or urges that are experienced as irrational. Most common are contamination, sexual, and aggressive

Compulsions: impulse to repeat certain behaviors or mental acts. Extremely difficult to resist the impulse, may involve elaborate ritual

Etiology: Hyperactive regions of the brain (Anterior cingulate, orbitofrontal cortex, Caudate nucleus). Operant reinforcement: compulsions are negatively reinforced by reduction of anxiety. Person wants to engage in compulsion to get rid of anxiety generated by obsessions.


Treatment of OCD Exposure plus response prevention (ERP): most widely used treatment – enduce something to cause to perform compulsion, then NOT let them do that, then gradually expose t anxiety, and extinguish compulsion.

Cognitive Therapy: challenge beliefs about anticipated consequences of not engaging in compulsion

Medication


PTSD (Post traumatic stress disorder) Extreme response to severe stressor, event leads to intense fear of helplessness, for diagnosis symptoms must be present for at least a month

Symptoms

1) Reexperiencing the traumatic event

2) Avoidance of stimuli (avoid situations or numbing)

3) Increased arousal (startle response, hypervigilance)


Etiology of PTSD Nature of trauma: highest risk most severe trauma)

Neurobiological: Smaller hippocampal volume, increases receptor activity to cortisol

Behavioral: two factor model

Psychological

Perception of control

Avoidance coping, dissociation, memory suppression


Treatment of PTSD • Exposure to memories and reminders of original trauma

Either direct (in vivo) or imaginal, treatment may originally INCREASE symptoms

Cognitive Therapy: enhance beliefs about coping abilities

Medications:

Treatment of ASD may prevent PTSD


Acute Stress Disorder Symptoms of ASD are similar to PTSD

Duration is what is different (short term reaction)

Experienced by 90% of rape victims

More than 2/3 with ASD develop PTSD


Comorbidity Anxiety Disorder ¾ with anxiety disorder have another disorder

60% meet criteria for major depression

½ individuals with anxiety disorder meet criteria for another one

General and Sociocultural Factors

Genetics; twin studies suggest heritability for phobias

Neurobiological: overactive fear circuit (and amygdale)

NT: serotonin, gaba, NP


Risk Factors Anxiety Disorder Cognitive: perceived control (those who believe have little control are more vulnerable) and attention to threat (pay more attention)

Social: negative life events often precede disorder onset

Chapter 6: Somatoform Disorders

Somatoform Disorders Pain Disorder

Body dysmorphic disorder

Hypochondriasis, Somatization disorder

Conversion Disorder

Psychosomatic Disorders: Physical illness present, psychological factors contribute to illness

Malingering: Deliberate faking of physical symptoms to avoid unpleasant situations

Factitous Disorder: Deliberate faking of physical symptoms to gain medical attention


Pain Disorder Person experiencing severe, prolonged pain

Cannot be accounted for by organic pathology

Is caused or intensified by psychological factors like stress

Individual is unaware of psychological origins

Diagnosis is challenging


Body Dysmorphic Disorder Some sort of defect with the body focus

Preoccupation with and extreme distress over imagined or exaggerated defect in appearance

Attempt to camoflague or hide defect

½ have suicidal thoughts, onset is adolescence, sluightly more common in women than men, prevalence less than 1%

High levels of comorbidity:

Some think BDD and OCD are the same thing


Hypochondriasis Preoccupation with fears of having a serious disease, despite medical assurance, lasting at least six months

Usually critically of medical professionals

Onset is typically early adulthood, and is comorbid with anxiety and eating disorders


Somatization Disorder Someone with physical symptoms (with no apparent cause) that would warrant medical attention, but are calm, accepting, stoic about it.

Maybe people feel that distress is more appropriately expressed through physical symptoms?


Etiology of Conversion Disorder Psychoanalyic perspective: Individual experiences distressing event, and unable to express emotional distress, so memory of event pushed into unconscious

In women linked to electra complex

No empirical support

Social and Cultural Factors: Decrease in incidence since first half of 19th century, does it have to do with more repressed sexuality?

• More prevalent in rural areas and lower SES, and in non western cultures

Cognitive Behavioral Model: preoccupation with body or physical health, gross misinterpretation of symptoms/feelings, negative thoughts exacerbate symptoms


Conversion Disorder Lose functioning in different parts of the body

Sensory or motor function impaired but no known neurological cause

Vision impairment, seizures, coordination problems, Anesthesia, Aphonia, Anosmia, La Belle Indifference

Onset: usually occurs after significant stressor

Cormorbid with substance abuse, personality disorder, BDD, prevalence less than 1%

Somatization disorder has symptoms in several areas of body, conversion is localized to sensory and motor function


Etiology of Conversion Disorder Psychoanalyic perspective: Individual experiences distressing event, and unable to express emotional distress, so memory of event pushed into unconscious

In women linked to electra complex

No empirical support

Social and Cultural Factors: Decrease in incidence since first half of 19th century, does it have to do with more repressed sexuality?

• More prevalent in rural areas and lower SES, and in non western cultures


Treatment Somatoform Disorder Pain Disorder: antidepressants and psychotherapy (validate pain, teach relaxation, and coping strategies)

BDD: Antidepressants and CBT (also for hypochondriosis and somatization disorder)

Somatization Disorder: validate physical complaints, minimize use of tests and medicine, avoid prolonging attention, treat underlying depression and anxiety

Conversion Disorder: Reinforcement of high functioning behavior may help


Dissociative Disorders Disruption of consciousness, but more severe in disorders

Defining feature is disruption in consciousness, memory, or identity

All experience dissociation at some level, like zoning out :P lala…

Dissociative amnesia

Dissociate fugue

Depersonalization disorder

Dissociative Identity Disorder DID

** best way to study is with case study


Dissosicate identity Disorder (DID) Used to be multiple personality disorder

Each with unique behaviors, relationships, and memories

Memory gaps are common when alters are in control

Rare disorder! Symptoms: headache, hallucination, self harm suicide attempts

Comorbid with: PTSD, depression, borderline personality disorder, substance abuse, phobias

More common in women than men


Epidemiology DID Major increase in diagnosis since 1970s because of media attention

DSM III (1980) made more explicit diagnostic criteria to address this surge

Etiology of DID, Two major theories

Posttraumatic model: results from sever psychological and or sexual abuse as child

Sociocognitive model Is a form of roleplay in suggestible individuals

Can be done by hypnotized students

Only partial memory deficit in DID patients

Differs by clinicians, few clinicians diagnose, after therapy starts

gnose the majority of cases


Treatment of DID Mainstays of most treatments:

Empathetic support of therapist REALLY important

Integration of alters into one fully functioning individual

Improved coping skills

Psychoanalytic approach adds Re-experience the traumatic event thought to underly the disorder (hypnosis)


Summary of Somatoform Disorders Features somatoform disorders: physical problems without organic cause

Features dissociative disorders: extreme distortions in perception, memory, or identity

BOTH rare but we have quote few movies because they are interesting

Chapter 7: Stress and Health

Defintiions

Coping: how people try to deal with problems

Social Support

Structural: person’s basic network of social relationships (marital status and friends)

Functional: quality of a person’s relationships

Stress: Body’s alarm reaction � Resistance � Exaustion

Allostatic load: price body pays in response to stress and high levels of cortisol, becomes more susceptible to disease


Psychophysiological Disorder

Physical diseases produced or influenced in part by psychological factors of stress, social support, and negative emotions

• Life stress is relevant to all disorder, so appears on Axis III

Etiology diathesis: stress in nature, but stress described in psychological or biological terms

Biological diathesis: emphasize effects of allostatic load or changes in the immune system caused by stress

Psychological diathesis: emphasize focus on how emotional states, personality traits, cognitive appraisals, and specific types of coping with stress

Most successful accounts of etiology are those that integrate both


Cardiovascular Disease Include hypertension and coronary heart disease

Etiiology: tendency to respond to stress with increases in blood pressure or heart rate Anger, hostility, cynicism, anxiety, are linked to these conditions


Asthma Respiratory systems overresond to allergies or have been weakened by prior infection

Psychological factors are anger, anxiety, depression, stressful life events, and family conflict


AIDS Arises from behavior that appears irrational and generally is preventable by psychological means

Focus of prevention is to change people’s behavior - to promote safer sex and discourage sharing of needles


Treatment Psychophysiological Disorder

Physical dysfunction is valid – so medication used

Primary aim is to reduce stress, anxiety, depression, or anger

Focus is on changing unhealthy behavior, encouraging breast self exam, intervention, adhering to medical treatment intervention

Stress Management Intervention: help people without diagnosable problems avail themselves of techniques that allow them to cope with the inevitable stress of everyday life and ameloriate toll of stress on body.

Documents

Abnormal Psychology, Exam I Study Cards