Exam 1: Ch 1-3 Flashcards
What are the four D’s?
Criteria to consider in making an assessment of ab/normality: deviance, distress, dysfunction, and danger
Deviance
Behavior that is unexpected in its cultural context (e.g. gender role expectations)/ behavior that is rare (e.g. being a hermit or genius)
What may help define what is statistically abnormal?
The number of people displaying a personality characteristic (bell curve)
Distress
The individual suffers and wants to be rid of the behavior (e.g. phobia), but people are not always aware of problems that their behavior may create for themselves or others
Dysfunction
The behavior prevents normal daily functioning, or causes emotional or physical harm (e.g. hoarding)
Prehistorical approaches to abnormality
Theory: caused by evil spirits
Treatment: trephination (drilling holes in the skull)
Danger
The person is a danger to themselves or to others
Ancient China approaches to abnormality
Theory: imbalance of Yin/Yang
Treatment: diet and lifestyle
Ancient Greece and Rome approaches to abnormality
Theory: imbalance of natural forces
Treatments: rebalance natural forces
Hippocrates’ approach to abnormality
Theory: imbalance of “humors”-blood, phlegm, black bile, yellow bile
Treatment: leeches, bloodletting
Middle Ages Europe approach to abnormality
Theory: possessed by evil spirits
Treatment: drive out evil spirits via exorcism
Renaissance approach to abnormality
Theory: mental disorders are like medical illnesses
Treatment: created asylums (mental “hospitals”)
What were the issues with the Renaissance approach to abnormality?
There were no effective cures and treatment was often inhumane
What two hypotheses regarding abnormality arose in the 20th century?
Somatogenic and psychogenic
Somatogenic hypothesis
Evidence of bodily causes for psychological symptoms (e.g. general paresis)
Psychogenic hypothesis
Evidence of psychological causes for bodily symptoms (e.g. hysteria)
What changes were made in the 20th century regarding mental illness?
1950s: first effective antipsychotic medications revolutionized treatment
1960s: civil rights push includes for mental illness
Deinstitutionalization, return to community
Insufficient funding of needed community resources, still problematic
Biopsychosocial approach
Individuals with mental illness should be understood from an integrative perspective which includes psychological, social, and biological variables
Biological perspective
Emphasis on biological processes (i.e., genetics)
Psychological perspective
Emphasis on psychological factors, such as early childhood experience and self-concept
Social perspective
Emphasis on interpersonal relationships and social environment
Modern perspectives on abnormality
Biopsychosocial approach: behavior has multiple determinants
Vulnerability-stress approach: individual vulnerabilities vary, individuals’ life events vary; the interaction of these variables may precipitate psychological disorders, or not
Evidence-based treatments
Research-supported recommendations for treating specific disorders
Clinical research methods
Case studies, correlational studies (epedemiological studies, longitudinal studies), experimental studies (independent and dependent variables, control groups, random assignment, confounds, blind or double-blind designs), quasi-experimental, meta-analysis (statistical analysis of a collection of independent studies, e.g. of treatment success)
Presenting problem
Why the person has come for help
Clinical description
Unique combination of behaviors, thoughts, and feelings that make up a disorder
Corse of a disorder
Characteristic pattern of how a disorder progresses
Prognosis
Anticipated course of a disorder
Prevalence of a disorder
How many people in the population as a whole have the disorder at a particular time
Incidence
How many new cases are diagnosed in a specific time, e.g., a year
Comorbid
Having more than one disorder at the same time
Etiology
Casual factors
Differential diagnosis
Distinguishing among disorders that have symptoms in common
Abnormal psychology
The scientific study of abnormal behavior undertaken to describe, predict, explain, and change abnormal patterns of functioning
How is abnormal behavior/thoughts/emotions defined
Those that differ markedly from a society’s ideas about proper functioning-break the norms of society
Do feelings of distress need to be present for a person’s functioning to be considered abnormal?
Not necessarily-some people who function abnormally maintain a positive frame of mind
Is behavior being dangerous a necessary feature of abnormal behavior?
No-although danger is often cited as a feature of abnormal psychological functioning, research suggests that it is the exception rather than the rule
Treatment/Therapy
A procedure designed to change abnormal behavior into more normal behavior
According to pioneering clinical theorist Jerome Frank, what are the three essential features all forms of therapy have?
- A sufferer who seeks relief from the healer
- A trained, socially accepted healer, whose expertise is accepted by the sufferer and the sufferers social group
- A series of contacts between the healer and the sufferer, through which the healer tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior
What did people in prehistoric societies believe about all events around and within them?
They resulted from the actions of magical, sometimes sinister, beings who controlled the world; in particular, they viewed the human body and mind as a battleground between external forces of good and evil
What was trephination used as a treatment for?
Severe abnormal behavior-either hallucinations, in which people saw or hear things not actually present, or melancholia, characterized by extreme sadness and immobility
The purpose of opening the skull was to release the evil spirits that were supposedly causing the problem
How did Egyptian, Chinese, and Hebrew writings as well as the Bible explain abnormal behavior?
Possession by demons
The Bible describes how an evil spirit from the Lord affected King Saul and how David feigned madness to convince his enemies that he was visited by divine forces
What did Hippocrates think an excess of yellow bile caused?
Mania, a state of frenzied activity
What did Hippocrates think an excess of black bile cause?
Melancholia, a condition marked by unshakable sadness
In the Middle Ages, what was the believed reason for psychological abnormality? Why?
Satan’s influence-during this time, the power of the clergy increased greatly throughout Europe. The church rejected scientific forms of invesitgation and controlled all education-religious beliefs (highly superstitious and demonological) came to dominate all aspects of life
Bedlam
Bethlehem Hospital in London
In this asylum, patients bound in chains cried out for all to hear
Bedlam has come to mean a chaotic uproar
Moral treatment
Treatment that emphasized moral guidance and humane and respectful techniques
State hospitals
Effective public mental hospitals developed by each state, intended to offer moral treatment
Factors leading to the reversal of the moral treatment movement
- The speed with which the movement spread-cause money and staffing shortages, declining recovery rates, and overcrowding
- The assumption that all patients could be cured if treated with humanity and dignity
- The emergence of a new wave of prejudice against people with mental disorders-the public viewed them as strange and dangerous
What two factors were responsible for the rebirth of the somatogenic perspective?
- The work of Gernman researcher Emil Kraepelin, who published an influential textbook arguing that physical factors like fatigue are responsible for mental dysfunction. He also developed the first modern system for classifying abnormal behavior, listing their physical causes and discussing their expected course
- New biological discoveries, including that syphilis led to general paresis, an irreversible disorder with mental symptoms like delusions of grandeur and physical symptoms like paralysis
When did the somatogenic perspective truly begin to pay off for patients?
Not until the 1950s, when a number of effective medications were discovered
What were some treatments used in the somatogenic perspective before medications were found?
Tooth extraction, tonsillectomy, hydrotherapy, lobotomy, eugenic sterilization
When did the psychogenic perspective gain a following?
When studies of hypnotism demonstrated its potential
Hypnotism
Procedure in which a person is placed in a trancelike mental state during which they become extremely suggestible
Mesmerism
A treatment developed by Austrian physician Friedrich Anton Mesmer, where he had patients sit in a darkened room filled with music, then he would appear, dressed in a colorful costume, and touch the troubled area of each patient’s body with a special rod
Psychoanalysis
Holds that many forms of abnormal and normal psychological functioning are psychogenic. In particular, unconscious psychological processes are at the root of such functioning
Technique of psychoanalysis
A form of discussion in which clinicians help troubled people gain insight into their unconscious psychological procedures
Types of psychotropic medications
Antipsychotic drugs, which correct extremely confused and distorted thinking; antidepressant drugs, which lift the mood of depressed people; antianxiety drugs, which reduce tension and worry
Psychotropic medications
Drugs that primarily affect the brain and reduce many symptoms of mental dysfunction
Deinstitutionalization
Releasing hundreds of thousands of patients from public mental hospitals
Private psychiatric hospitals
Car that is paid for by the patients themselves and/or their insurance companies
Private psychotheraphy
outpatient care in which individuals meet with a self-employed therapist for counseling services
Community mental health approach
Community care for people with severe psychological disturbances
Prevention
Rather than wait for psychological disorders to occur, many of today’s community programs try to correct the social conditions that underlie psychological problems (e.g., poverty or violence in the community) and to help individuals who are at risk for developing emotional problems (e.g., teenage mothers)
Positive psychology
The study and enhancement of positive feelings such as optimism and happiness, positive traits like hard work and wisdom, and group-directed virtues, including altruism and tolerance
What are some of the psychological schools of thought?
Biological, cognitive-behavioral, humanistic-existential, sociocultural, and developmental psychopathology
Clinical psychologists
Professionals who earn a doctorate in clinical psychology by completing four to five years of graduate training in abnormal functioning and its treatment as well as a one-year internship in a mental health setting
Psychiatrists
Physicians who complete three to four additional year of training after medical school (a residency) in the treatment of abnormal mental functioning
Clinical researchers
Have worked to determine which concepts best explain and predict abnormal behavior, which treatments are most effective, and what kinds of changes may be required
Nomothetic
A general understanding of the nature, causes and treatments of abnormal functioning, in the form of laws or principles that apply across people
Case study
A detailed description of a person’s life and psychological problems. It describes the person’s history, present circumstances, and symptoms and may also include speculation about why the problems developed and descriptions of the person’s treatment.
How are case studies helpful?
- Can be a source of new ideas about behavior
- May offer tentative support for a theory
- May challenge a theory’s assumptions
- May show the value of new therapeutic techniques
- May offer opportunities to study unusual problems that don’t occur often enough to permit a large number of observations
What are the limitations of case studies?
- Reported by biased observers (therapists who have a personal stake in seeing their treatments succeed)
- Rely on subjective evidence
- Provide little basis for generalization
What three features of the correlational and experimental methods enable clinical investigators to gain general insights?
- The researchers typically observe many individuals
- The researchers apply procedures uniformly
- The researchers use statistical tests to analyze the results of a study and determine whether broad conclusions are justified
Correlation
The degree to which events or characteristics vary with each other
Correlational method
A research procedure used to determine the co-relationship between variable
Positive correlation
When variables change in the same way
Negative correlation
The value of one variable increases as the value of the other variable decreases
Correlation coefficient
The direction and magnitude of a correlation
+1 is a perfect positive correlation
-1 is a perfect negative correlation
Statistical significance
If there is less than a 5% probability that a study’s findings are due to chance, the findings are statistically significant and though to reflect a true correlation
Confounds
Variables other than the independent variable that may also be affecting the dependent variable
Double-masked design
Both participants and experimenters are unaware of the groups participants are assigned to
Quasi-experimental designs
Designs that fail to include key elements of a “pure” experiment and/or intermix elements of both experimental and correlational studies
Matched designs
Investigators make use of groups that already exist in the world at large
Natural experiments
Nature itself manipulates the independent variable, while the experimenter observes the effects
Analogue experiments
Researchers induce laboratory participants to behave in ways that seem to resemble real-life abnormal behavior and then conduct experiments on the participants in the hope of shedding light on the real-life abnormality
Single-case experimental design (single-subject experimental design)
A single participant is observed both before and after the manipulation of an independent variable
Longitudinal study
Investigators observe the same individuals on many occasions over a long period of time
Epidemiological studies
Reveal how often a problem, such as a particular psychological disorder, occurs in a particular population
Incidence
The number of new cases that emerge in a population during a given period of time
Prevalence
Total number of cases in the population during a given period; includes both existing and new cases
What are some important neurotransmitters?
Acetylcholine, Norepinephrine, GABA, Serotonin, Dopamine, Glutamate, Endorphins
Acetylcholine
One of the first neurotransmitters to be discovered, and the most common; involved in memory and Alzheimer’s
Norepinephrine
Important to bodily and psychological arousal; involved in bipolar disorder
GABA
Main inhibitory neurotransmitter, restrains some behaviors; GABA deficiency important in anxiety
Serotonin
Regulation of sleep and wakefulness, important in mood disorders; hallucinogenics (LSD, mescaline) stimulate serotonin
Dopamine
Controls pleasurable emotions; related to schizophrenia (over- and underactivity in different areas) and Parkinson’s (deficit)
Glutamate
Major excitatory neurotransmitter, enhances action potentials, important in “rewiring” the brain; involved in learning and memory
Endorphins
Disrupt pain messages
Agonists
Drugs that enhance the action of specific neurotransmitters
Antagonists
Block the action of specific neurotransmitters
Default/Intrinsic network
Interacting areas involved in internal activity
Becomes less active when other networks involving external stimuli are activated
Some disorders (e.g., schizophrenia) involve problems with turning this network on and off
Central executive network
Higher-order cognition and attentional tasks
Salience network
Monitoring critical external and internal states; discrepancies->activate central executive
Coordinating biological subsystems
A single neuron is stimulated, communicates with another, then with many other interacting neurons, forming neural networks
Bundles of neurons form named brain areas, coordinating to manage specific functions
Brain areas form circuits, working together on particular types of functions and in various arrangements
The nervous system is divided into coordinating subsystems
The nervous and endocrine systems coordinate whole-body responses via hypothalamic stimulation of the pituitary gland
Endocrine system
Hypothalamus stimulates the pituitary gland which stimulates other glands which release hormones into the bloodstream
Genes
The units of heredity that help determine the characteristics of an organism; genes are the blueprints for building a person, the detailed plan-psychological disorders may involve the plan or how the plan unfolds
Alleles
Genes come in different “flavors” and can mutate over time
Gene expression
Whether a particular gene is turned on or off; environmental factors (inner and outer) affect gene expression
Epigenetics
Genes themselves may not be changed by the environment, but instructions for gene expression can be coded and passed down
Behavioral genetics
Behavioral geneticists study how genes and the environment interact to influence psychological activity
Polygenic
Influenced by many genes
Psychodynamic model
Focus is on unconscious motivations
Structure and development of personality:
Id: instinctive, emotional
Ego: practical, rational
Superego: moral, spiritual
Unconscious conflicts –> anxiety
Defense mechanisms protect us from anxiety
Psychosexual stages
Children develop through a sequence of psychosexual stages
Each stage has a focus of frustration and/or pleasure, and a developmental task to be resolved
Stages and focus: oral, anal, phallic, latency, genital
Disorders occur when the developmental task for a particular stage is not adequately resolved
The person becomes stuck of “fixated” at that stage, focused on the unresolved developmental task
Psychodynamic treatment
Treatment approach” the “talking cure” to gain insight into unresolved unconscious conflicts
Therapy involves “working through” the now-conscious conflicts until resolved
What are the three behavioral approaches to abnormality?
Classical conditioning, operant conditioning, and social learning
Classical conditioning
Learning by association
Can learn associations that are dysfunctional (e.g. phobias)
Therapy: extinction and counter-conditioning
Operant conditioning
Learning by consequences of behavior
Reinforcement and punishment
Treatment: programs to reinforce desired and extinguish undesired behavior (e.g., token economies, skill development)
The power of negative reinforcement to maintain dysfunctional behavior: escape learning, avoidance learning
Social learning approaches
Two types:
Observational learning (may be without awareness), and modeling (intent to imitate)
Vicarious classical and operant conditioning
In treatment:
Therapist modeling new behaviors and demonstrating new associations or contingencies involved
Cognitive approach to behavior/abnormality
People’s thoughts are the most immediate or powerful influence on their behavior
“Automatic” ways of thinking lack awareness
Types of cognition
Causal attributions
Control beliefs
Dysfunctional assumptions
Causal attributions in depression
Negative events: internal, stable, global causes
Positive events: external, unstable, specific causes
Control beliefs in depression
Learned helplessness
Traditional cognitive therapy
Becoming aware of automatic thinking
Challenging the logic and evidence for automatic thoughts
Developing alternative ways of thinking
“New wave” cognitive therapy
Mindfulness, awareness of thoughts
Thoughts are just thoughts, no need to react
Accept thoughts, rather than challenge them
Cognitive-behavioral therapy
Combining behavioral and cognitive techniques, mutually reinforcing
Humanistic approaches to abnormality
Humans strive for self-actualization, to grow and develop, to be authentic
Disorders come from pressures to conform to others’ expectations and values
Treatment: provide therapeutic environment for individual growth
E.g., client-centered therapy (Carl Rogers)
Client-centered therapy
A personal encounter between therapist and client, providing unconditional positive regard, accurate empathy, congruence (genuineness)
Facilitates the client’s personal growth
Existential approach to abnormality
Reality of the human condition is that: we are born and die alone, we are free to choose our lives, we are responsible for our own choices, death is certain
Disorders come from existential anxiety
Treatment: finding meaning in one’s life, therapist facilitates person’s search for it
Sociocultural approaches to abnormality
Focus on a larger social unit rather than the individual
Roots of psychological disorders are within the person’s relationships, family, or groups, rather than the individual
Treatment: interpersonal, family, or group therapies of different kinds
What information is collected when assessing and diagnosing psychological conditions?
Start with the presenting problem
Mental status exam
“Funnel approach”
History, including family history
Physiological factors
Psychological factors
Sociocultural factors
Collecting symptoms and history
Current symptoms: How much do they interfere with the client’s ability to function? How does he/she cope with stressful situations?
Recent events: have any negative or positive events happened lately?
History of psychological disorders: has the client experienced symptoms similar to the current symptoms at some time in the past?
Family history of psychological disorders: Does the client’s family have a history of any psychological disorders or symptoms?
Physiological and neurophysiological factors
Physical condition: any medical conditions?
Drug and alcohol use: Is the client taking any drugs that could cause symptoms? Is the client taking any prescriptions that could interact negatively?
Intellectual and cognitive functioning: Any cognitive deficits that could cause symptoms?
Funnel approach
Start broadly –> narrow down –> zero in
Assessment tools
Clinical interview: structured or unstructured
Symptom questionnaires
Objective psychological tests, e.g. Personality, IQ
Projective psychological tests, e.g. Rorschach inkblot test
Physical exam
Brain imaging e.g. MRI scan
Neuropsychological tests (e.g. perceptual)
MMPI-2 Profile
Shows scores indicating normality, depression, and psychosis
High scores begin at 66 and very high scores at 76
An unusually low score (40 and below) may also reveal personality characteristics or problems
Observational assessment
Focuses on antecedents, behavior, and consequences
Syndrome
Certain symptoms that regularly occur together and follow a particular course
Classification system
Diagnostic categories based on syndromes
ICD
International Classification of Diseases used by WHO
DSM
Diagnostic and Statistical Manual of the American Psychiatric Association
First published in 1952, 2nd version 1968
Based on psychoanalytic theory, issue of validity
Low reliability, not very influential
DSM-IV
DSM III 1980, revised 1987
DSM-IV 1994, updated 2000, specifies behavioral criteria for diagnosis, including duration, reliability improved
System of prototypes, rather than strict categories or dimensions
Evaluation of DSM-IV
Improved reliability over earlier versions, but possible over-focus on reliability to exclusion of validity
Differential diagnoses difficult
Dimensional perspective might be useful
Cultural issues
Consensus building involved in DSM development
DSM-5
Released 2013
Dimensional approach
Personality disorders reviewed, likely to be revised
Childhood Disorders revised
Research Domain Criteria (RDoC)
A new approach to developing a classification system for psychiatric disorders (National Institute for Mental Health)
Research-based process
Starts with identifying normal range of functioning across multiple levels – genetic, brain functioning, behavioral and environmental.
