Final

Question 1

Defenses against anxiety in everyday life

Answer 1

Magical thinking, obsessions, compulsions, perfectionism, rumination, dissociation, drugs, alcohol

Question 2

Anxiety disorders and prevalence rates

Answer 2

Phobias
Generalized anxiety disorder
Panic attacks
Panic disorder
Panic disorder with agoraphobia
Social anxiety disorder
OCD
Eating disorders- anorexia, bulimia
Body dysmorphic disorder
PTSD- only in DSM caused by an event, has to be preceded by a trauma
Anxiety all together- 18%

Question 3

Post-traumatic stress disorder

Answer 3

• Only disorder in DSM 5 that has to be caused by an event
• An anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened
• Family members of victims can develop the disorder, can occur at any age
• Many people with PTSD repeatedly re-experience the ordeal in the form of flashbacks, memories, nightmares, or frightening thoughts, especially when exposed to events or objects reminiscient of the trauma, also anniversaries
• Could also have emotional numbness, sleep disturbances, depression, anxiety, irritability, anger outbursts, intense guilt
• Many people try to avoid reminders or thoughts of the ordeal, diagnosed when symptoms last more than a month
• Physical symptoms are common but treated without realizing where they stem from

Question 4

PTSD criteria

Answer 4

-

Question 5

Trauma

Answer 5

• Spectrum of traumatic impact
• Mind responds to trauma through narrowing of associations, can range from isolation of affect to complete forgetting
• Evolutionary challenge- knowing or not- great strength of humans is remembering and communicating, but traumatic events are too devastating for someone to remember fully
• Solution is a compromise, to remember partially if at all

Question 6

To treat trauma

Answer 6

Tell story over and over again in a trusting relationship, takes this to work through the narrowing
Systematic desensitization for phobias- gradual exposure to feared stimulus paired with physical relaxation
CBT for social anxiety- examining automatic thoughts leading to fears
PTSD- Repetitive disclosure and retelling of trauma to widen the mind’s associative range to allow the events to be integrated in memory

Question 7

Medicating anxiety

Answer 7

Barbiturates- first meds for anxiety, central nervous system depressants

Question 8

Anxiety- neurologically

Answer 8

Connections between amygdala and locus coeruleus generate anxiety, LC is major cluster of NE cells that sends axons to parts of the brain to increase vigilance, so antidepressants can reduce anxiety (?)
HPA axis and CRF- releases cortisol when mind perceives danger (?)

Question 9

Anxiety and experience

Answer 9

If take rats away quickly, fine, but if take babies away for a while, have biobehavioral measure issues (come back to these)

Question 10

Anxiety meds 2

Answer 10

Benzodiazepines target specific anxiety symptoms without tranquilizing the entire nervous system
Librium, etc, Xanax
Cause a physical dependence, must be tapered off slowly, 100% effective but hard to taper off, and overdose makes you high, psychiatrists divided on value of long term use

Question 11

Benzodiazepines work

Answer 11

GABA agonists, intensify firing of GABA neurons, GABA calms down system, affect opening of chloride channels in GABA neuron receptors
GABA receptors have binding sites for other NTs, when receiving BZs, opens channel wider, when wider, more chloride, when open, neuron less likely to fire, this lessens anxiety without fatigue
Barbituates open these channels with or without GABA, leaves them open for a long time, more powerful but lethal effects

Question 12

Experiential approach to diagnosis

Answer 12

Problems in love, work, and play

Question 13

Object relations intro

Answer 13

Development of selfhood, at first internalize caregivers and represent self and others in mind, when we relate to others, we either relate to them or project our own stuff onto them if we are troubled, as you develop and realize what you are good at and learn your limits, more trauma in early childhood, more early internal representations are problematic and you project these things onto others, early experiences are powerful
Internal world where there are representations of the self in relation to representations of the object

Question 14

Levels of functioning

Answer 14

Love (friends, family/parents, romantic partner)
Work (career, mentors, skills/performance)
Play (weekends, substance use, vacations)
Mild, moderate, severe, personality disorder
Can mix these

Question 15

Personality disorder

Answer 15

Repetition- same mistakes over and over
Repetitions lead to being stuck and self-destructive behavior
Chronic unhappiness and anxiety that is part of repetition and more complicated than a simple depressed mood
All together, something immature or childlike about how a person is stuck

Question 16

DSM personality disorder

Answer 16

An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, leads to distress or impairment

Question 17

False choice between projection and perception via identification

Answer 17

Our perceptions of other people are constructions, composed of social understanding, cultural cues, expectations, fears, influenced by individual experience
- So how we understand our relationships is based on these things
There is a spectrum between a reasonable recognition of the other person’s motivates or actions- perception through identification- and a distorted interpretation where a person’s motivations are misinterpreted or seen as the opposite of their actual intention- projection
There is some projection in all perceptions but those who project a great deal in their perceptions, across domains, are likely to be labeled with a personality disorder
- If someone raised in abusive household, won’t be trusting, struggle with intimate relationships, expecting betrayal, if that expectation is solid, see betrayal when not there

Question 18

Clusters of personality disorders

Answer 18

A: schizophrenic spectrum disorders

more like being stuck bc of collision of innate temperament and early experience
B:
C:

Question 19

Object Relations Model of Self Development
Separation and Individuation

Answer 19

Autism- 0-2 months- implies that infant is immersed in sensorimotor experience which will lead to attachment and awareness of others
Symbiosis- 2-6 months- parents and babies mirror each other, in symbiotic relationship, babies don’t have ideas about self and other, parents are an experience that occurs often
Separation-individuation- 6-24 months including
hatching subphase- 6-10 months- infants crawl, explore, tolerate momentary separation from caregivers, experience themselves as separate from their caregivers in basic ways, peek a boo, babies check back visually when crawling off from parents
practicing subphase- 10-16 months- now walking, ventures out to play then rushes back to be held by parents, running away and coming back, rarely stubborn, constructing mental images of caregivers to reflect on when away and choose a favorite stuffy or blanket as a transitional object
rapprochement subphase- 16-24 months- realize limits of omnipotence, have awareness of their separateness and of their caregiver, increases in cognition and motor development lead to shadowing and darting away, child’s simultaneous need for autonomy and support, increase in aggression, toilet training, verbal no, issues of autonomy and control

Question 20

Early mechanisms of object relations process

Answer 20

Incorporation- undifferentiated internalization (two year old held by mother laughs when water hits mother’s toes)
Introjection- internalizing parent or ideal object as differentiated (six yo believes parent knows everything)
Identification- valued qualities of other are ascribed to self (11 yo realizes love of music is like mother)

Question 21

Early defenses

Answer 21

Projection- splitting off unwanted feelings, thoughts, etc onto others
Splitting- perceiving others and self as all good or all bad
Idealization and devaluation- viewing self as bad and other as ideal or vice versa
Projective identification- through subtle interpersonal cues, a person provokes the other into reenacting an earlier relationship

Question 22

Personality disorders- object relations

Answer 22

People with PDs had an interference with development of personality, so depend on primitive defenses instead of higher order ones like intellectualization, isolation of affect, rationalization

Question 23

Borderline personality disorder symptoms

Answer 23

come back
Idealized relationships, self harm, efforts to avoid imaginative, splitting- unstable
Do impulsive things to self regulate

Question 24

BPD study

Answer 24

Give TAT to patients, found way to code these to measure level of object relations and quality of social cognition
Found the way that people with BPD make up stories is quantifiably different from others
Score TAT responses on four dimensions:
Complexity of representations- people with BPD often see black/white, patients made up characters who were less differentiated from others
Social causality- stories had fewer plausible reasons for interpersonal motivations and events
Affect tone- emotions of a story, amount of malevolence, marked presence of malevolent motivations and events
Capacity for emotional investment- degree character shows investment in relationships, characters less likely to show mutuality and trust in each other
Using projectives empirically and understanding BPD

Question 25

BPD study 2

Answer 25

Same database, looked at early memory test
Coded for affect tone of relationship paradigms
BPD patients recalled early memories with higher levels of malevolence- interpersonal violence, betrayal, aggression

Question 26

BPD study 3

Answer 26

Added to database patients with early sexual abuse
Found early memories with instance of deliberate injury
Found harm in earliest memory distinguished sexually abused and non abused
High scores on affect tone (increased malevolence) also sorted abused from non-abused

Question 27

Dependent personality disorder symptoms

Answer 27

come back
“Easy” patient but don’t get better

Question 28

Antisocial personality disorder

Answer 28

Come back

Question 29

Narcissistic personality disorder

Answer 29

come back

Question 30

Two hit model of PDs

Answer 30

Temperament: high excitability, impulsivity, anxiety + early experience: stress, chaos, violence/drug use, abuse = BPD or ASPD

Genetic vulnerability to depression/BPD 2 + early experience: stress, chaos, violence/drug use, abuse = BPD or ASPD

Anxiety + neglect/devaluing by parents = NPD or DPD

Question 31

Psychotherapy with PDs

Answer 31

Goal is to restructure the personality:
perception and understanding of social events
become aware of projections and distortions
anticipate consequences of choices
develop a realistic and stable sense of self
find mutuality and intimacy with others

see a lot, help BPD not act out, NPD silence to make anxious, reparenting

Question 32

Psychotherapy

Answer 32

A strategic use of intimacy, one tells the other intimate things, the other one listens not just to hear but to shed light on it

Question 33

Psychotherapist guidelines

Answer 33

Boundaries- brings another relationship into therapeutic relationship, allows for sanitized contact
Therapist abstinence- don’t tell story about self, say it in 3rd person, getting emotional needs met
Fidelity to the process- more than just what patient says, different nuances

Question 34

Universal psychotherapy components

Answer 34

• Forming the alliance- listening, making connections, demonstrating empathy and strength
• Setting goals- either explicitly or through wished for versions of future
• Creating an interpersonal space- putting focus on patient, using silence, speaking to emotional experience
• Interpreting what the patient does/doesn’t know- questioning, clarifying, confronting, interpreting

Question 35

Schools of psychotherapy

Answer 35

Psychoanalysis- projection focus, Freud
Psychoanalytic psychotherapy- transference focus, sitting up not lying down etc
Psychodynamic psychotherapy- associations to past, practical problem solving that is mindful of projections, transference, power of past to affect present

Behavior therapy- behavior change, rewarding some behaviors and discouraging others through reinforcement
Ratio-emotive therapy- rational solutions, common sense
Cognitive behavioral therapy- homework, not great for deep problems but very effective for mild dep or anx
Cognitive-affective therapy- CBT + psychodynamic, core schemas

Group psychotherapy- identity within group process
Family psychotherapy- interpersonal family process
Dialectical behavioral therapy- mindfulness, BPD and bipolar, class, learning to identify emotional states and gain emotional regulation

Question 36

Freud’s categories

Answer 36

Free association- what comes to mind
Transference- projections onto analyst
Counter-transference- analyst’s projection
Analysis of resistance and defenses- interpreting ways of avoiding analysis and anxiety
Making what is unconscious conscious- interpreting underlying thoughts and feelings

Question 37

In psychodynamic treatment, the patient

Answer 37

Discourse- what patients say, talk about events, past, relationships, dreams, feelings about therapy and therapist
Process- mental experience, automatic thoughts, visual memories, feelings, anxiety, disavowed thoughts, feelings about therapist, internal representations of self others etc

Question 38

In psychodynamic treatment, the therapist

Answer 38

Discourse- what is spoken, opening narrative, directing inward, identifying defenses, confronting self-destructive behaviors, interpreting disavowed motives and feelings
Process- mental experience, automatic thoughts, feelings, attention to process of the hour, internal representations of self and others, defenses hopefully acknowledged, considering timing and form of interpretation, attention to empathy/anxiety gradient: too much empathy and just support patient- nothing happens, if confront every problem- overwhelm them with anxiety, should add information that you’ve been keeping self from knowing, set you a little off center, every patient wants to get better but has some resistance

Question 39

CBT

Answer 39

Short term, a contract, questionnaire for depression and anxiety, very focused
Encourage patients to observe own thoughts
Point out automatic thoughts that generate depily ressed mood and anxiety
Have them rate the likelihood of automatic thoughts being true
Predict which situations will trigger those thoughts and subsequent feelings
Assign homework
Relationship with therapist is primarily unexamined

Question 40

Therapeutic process of CBT w psychosis

Answer 40

?

Question 41

Primary tools of CBT

Answer 41

Patient and therapist agree to contract with ultimate goals
Baseline measures of dep and anxiety
Th assigns hw, daily journals describing events truggering automatic thoughts linked to dep or anx
Setting specific goals, using exposure therapy to help patients face frightening events
Ongoing evaluation of symptoms using questionnaires

Question 42

Psychodynamic therapy

Answer 42

Assumes some principles of psychoanalysis- dynamic unconscious, defenses against painful feelings, transference, deepening the awareness of the patient
But no couch, analytic silence, blank screen of analyst, yes attention to cognitive distortions and real life problems

Question 43

Leroy psychotherapy

Answer 43

Forming the alliance: allowing for many sessions where Leroy played by himself
Creating an interpersonal space: responding to Leroy carefully, allowing the boy to hear himself
Interpreting what the patient does or doesn’t know: Japan blows up

Question 44

Psychotherapy outcome research issues

Answer 44

Keeping patient and therapist variables constant
Patient: symptoms, capacity for therapy, intelligence, SES and culture
Therapy: training, orientation, experience, effectiveness, SES and culture
Measuring process and outcome variables
Functioning at baseline, relationship, how do you set length, measure improvement after

Question 45

“gold standard” empirically based psychotherapy

Answer 45

Single symptom
Session by session treatment manual
Treatment length determined in advance
Baseline and outcome measurements standardized