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ADMH > Impulse & Behaviour > Flashcards

Impulse & Behaviour Flashcards

1
Q

Addiction is characterized by …?

A
  • An inability to consistently abstain.
  • An impairment in behavioural control.
  • Craving.
  • Diminished recognition of problems with behaviours & interpersonal relationships.
  • A dysfunctional emotional response.
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2
Q

What are some similarities between substance addictions and non-substance addictions?

A
  • Both psychoactive drugs & certain behaviours produce a dopamine surge in the midbrain.
  • Individuals who are “genetically predisposed” to addiction are at higher risk for reward deficiency syndrome.
  • May be a reward-seeking element.
  • Impulsivity & compulsivity may be involved and support the initiation and maintenance of the behaviour.
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3
Q

What types of associative learning processes are identified across the entire spectrum of addiction - most notably, in substance use and gambling?

Is this the case for behavioural addiction?

A
  • Positive and negative reinforcement.
  • Operant and classical conditioning.
  • Behavioural control changes from outcome seeking to antecedent stimuli.
  • Transition from impulsive to compulsive behaviour.

No, this is not necessarily the case for behavioural addiction.

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4
Q

What is one definition of behavioural addiction?

A

A repeated behaviour leading to significant harm or distress. The behaviour is not reduced by the person and persists over a significant period of time. The harm is of a functionally impairing nature.

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5
Q

What are the 2 components of a behavioural addiction?

A

1) Significant functional impairment or distress as a direct consequence of the behaviour.
2) Persistence over time.

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6
Q

What is “addictiveness”?

A

Causing or tending to cause addiction: An addictive substance.

Characterized by or susceptible to addiction: An addictive personality.

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7
Q

In Psychology Today - The Myth of Addictiveness, why do they say that addictiveness is a myth?

A
  • The idea is backwards.
  • The purpose of addictive behaviour is to reverse feelings of overwhelming helplessness. Therefore, any activity is suitable to express and temporarily relieve those feelings of helplessness.
  • It is that action that becomes repetitive & compelled.
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8
Q

What are 4 crucial exclusionary criteria of behavioural addictions?

A

1) The behaviour is better explained by an underlying disorder (i.e. depression)
2) The functional impairment results from an activity that, although potentially harmful, is the consequence of willful choice (i.e. sports)
3) The behaviour can be characterized as a period of prolonged intensive involvement that detracts time & focus from other aspects of life, but does not lead to significant functional impairment/distress.
4) The behaviour is a result of a coping strategy.

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9
Q

What is impulsivity?

A

An overvaluation of short-term reward over long-term goals.
Actions without foresight that are poorly conceived, prematurely expressed, unnecessarily risky, and inappropriate to the situation.

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10
Q

What are the key elements in impulsivity?

A
  • Automatic response
  • Aversion to delay/intolernace of delayed rewards
  • Lack of thought
  • Maladaptive predisposition to rapid reactions
  • Behaviours are inappropriate in terms of scale or potential risk
  • Linked to executive control & disinhibition
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11
Q

Impulsive behaviours can be conceptualized as the core symptoms of a broad range of psychiatric disorders, such as…?

A
  • ADHD
  • Bipolar affective disorder
  • BPD
  • Substance use
  • Gambling
  • Internet gaming
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12
Q

What are behavioural symptoms of disruptive, impulse-control & conduct disorders?

A

Stealing, lying, risky/promiscuous behaviour, aggressive or volatile behaviour.

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13
Q

What are cognitive symptoms of disruptive, impulse-control & conduct disorders?

A

Obsessiveness, irritability, rage, poor concentration.

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14
Q

What are social/emotional symptoms of disruptive, impulse-control & conduct disorders?

A

Low self-esteem, social isolation, being detached, anxiety, drastic shifts in thoughts, guilt, regret.

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15
Q

What is a distinguishing feature of people with personality disorders?

A

The rigidity of their pattern of over- or under-control and the severity and persistence of their impulse control problems.

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16
Q

What are the 3 core features of personality disorders?

A

1) Problems with disordered thinking
2) Problems with emotional regulation
3) Problems with impulse control

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17
Q

What are examples of under-controlled impulses?

A

Recklessness, disregard for rights & needs of others, drug use, risky sexual behaviour, over-spending, self-injury, binge eating.

i.e. Borderline Personality Disorder

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18
Q

What are examples of over-controlled impulses?

A

Reluctance to do anything that involves risk, reluctance to try new things, over-conscientiousness, being scrupulous.

i.e. Avoidance Personality Disorder

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19
Q

What are the 10 personality disorders?

A 
Antisocial
Avoidant
Borderline
Dependent
Histrionic
Narcissistic
Obsessive-Compulsive
Paranoid
Schizoid
Schizotypal
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20
Q

Which personality disorders are in Cluster A?

A

Odd, eccentric.
Social awkwardness and social withdrawal.

Paranoid, Schizoid, & Schizotypal

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21
Q

Which personality disorders are in Cluster B?

A

Dramatic, emotional, erratic.

Borderline, Narcissistic, Histrionic, & Antisocial

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22
Q

Which personality disorders are in Cluster C?

A

Anxious, fearful.

Avoidant, Dependent, & Obsessive-Compulsive.

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23
Q

What is compulsivity?

A

Persistent behaviour that is inappropriate to the situation and has NO obvious relationship to an overall good.
Tendency to repeat the same, often purposeless, acts, which are associated with undesirable consequences.
Endure for long periods of time.

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24
Q

What are some key elements of compulsivity?

A
  • Repetitive behaviours performed to certain rules or in a stereotypical fashion.
  • An exaggerated sense of threat from the outside world.
  • Rituals/routines are performed to reduce anxiety.
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25
Q

What are the obsessive-compulsive and related disorders?

A
  • OCD
  • Body dysmorphic disorder
  • Hoarding
  • Trichotillomania
  • Excoriation
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26
Q

What are some similarities with impulsivity and compulsivity?

A
  • Complex constructs
  • Multi-faceted
  • Share a relationship with various personality & cognitive dimensions
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27
Q

How is impulsive behaviour different from compulsive behaviour?

A

Impulsive behaviour is a rash action with the aim of achieving a reward, while compulsive behaviour can occur without reference to the original goal of the behaviour (like a habit).

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28
Q

How does compulsivity become a feature of habitual drug use?

A

1) Behaviour is driven by associations triggered by stimuli - not a clear goal.
2) Individual is unable to reverse the repetitive behaviour pattern, leading to compulsive drug use.

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29
Q

Are impulsivity and compulsivity polar opposites?

A

No. They may occur simultaneously or at different times within the same disorder.

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30
Q

What is the cycle of addiction?

A

Emotional trigger -> Craving -> Ritual -> Using -> Guilt -> Emotional trigger

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31
Q

What are some risk factors for addiction?

A

Biological: ADHD or other learning disabilities, addiction running in the family.

Psychological: Low self-esteem, passivity, external locus of control.

Environmental: Ready access, abuse/neglect, peer norms, membership in a marginalized group.

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32
Q

What is family environment a pivotal factor in determining?

A

An individual’s ability to cope with life’s difficulties.

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33
Q

Attachment with primary caregivers has been shown to have an influence on the development of …?

A
  • Equal relationships with peers
  • Emotional abilities
  • Other mental health components during adolescence
34
Q

What is the relationship with substances/behaviours an attempt at replacing?

A

The lack of safety and security one experiences - looking for a solution “out there” to make up for a lack “in there”.

35
Q

What is secure attachment?

A

Positive view of self and positive view of others.

  • Ability to self-regulate emotions, affect, and behaviour.
  • Feel comfortable with both intimacy and with independence.
36
Q

What is anxious-preoccupied?

A

Negative view of self and positive view of others.

  • Seek high levels of intimacy, approval, and responsiveness from their partners.
  • Value intimacy to such an extent that they become overly dependent.
  • Doubt their worth as a person and blame themselves for the attachment figure’s lack of responsiveness.
37
Q

What is dismissive-avoidant?

A

Positive view of self and negative view of others.

  • Desire a high level of independence.
  • View themselves as self-sufficient and invulnerable to feelings associated with being closely attached to others.
  • Deal with rejection by distancing themselves.
38
Q

What is fearful-avoidant?

A

Unstable view of self and of others.

  • Tend to feel uncomfortable with emotional closeness.
  • View themselves as unworthy of responsiveness from their attachments.
  • Seek less intimacy from attachments and frequently suppress and deny their feelings.
39
Q

What is emotional regulation?

A

An individuals’ ability to modify which emotions they feel, as well as when and how such emotions are experienced and expressed.

40
Q

What is alexithymia?

A

The inability to recognize emotions and their subleties and textures.

41
Q

What are the 2 dimensions of alexithymia?

A

1) Cognitive: Child or adult has difficulty in identifying, interpreting, and verbalizing feelings. The “thinking” part.
2) Affective: Difficulties arise in reacting, expressing, feeling, and imagining. The “experiencing” part.

42
Q

How can alexithymia complicate recovery?

A

It can be challenging for those who struggle with alexithymia to cope with co-existing psychological disorders because of their innate vulnerability to understanding themselves and others.

43
Q

What is emotional intelligence?

A

The capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathetically.

44
Q

How is a lapse different from a relapse?

A

Lapse: A slight error/slip, a temporary fall, especially from a higher to a lower state. A state of ambivalence.

Relapse: A breakdown or setback in a person’s attempt to change or modify any target behaviour.

45
Q

How are lapses and relapses similar?

A

Both is a return to some previous pattern following a sincere desire to discontinue that behaviour pattern.

46
Q

What are the goals of relapse prevention?

A
  • To prevent the occurrence of relapse after initiating change.
  • To prevent a lapse from turning into a full-blown relapse.
  • To maintain a balanced lifestyle.
47
Q

The greater one’s self-efficacy, the ______ likely a relapse will occur in that situation.

A

Less

48
Q

What is a high-risk situation?

A

Any situation that poses a threat to the individual’s sense of control (self-efficacy) and increases the risk of potential relapse.

49
Q

What are the 3 primary high-risk situations?

A

1) Negative emotional states
2) Interpersonal conflicts
3) Social pressure

50
Q

What is a negative emotional state?

A

Involve situations in which the individual is experiencing a negative/unpleasant emotional state, mood, or feeling prior to the first lapse occurring.

51
Q

What is interpersonal conflict?

A

Involve situations involving an on-going or relatively recent conflict associated with any interpersonal relationship - marriage, friendship, family members, employers.

52
Q

What is social pressure?

A

Includes situations in which the individual is responding to the influence of another person or group exerting pressure on the individual.

53
Q

What is coping?

A

Efforts, both action-oriented and occurring within the mind, to manage environmental and internal demands and conflicts among them which tax or exceed a person’s resources.

54
Q

What is a coping response?

A

Any response that enables an individual to get through a high-risk situation without relapsing.
Vary in complexity and quality.

55
Q

What is the relapse process?

A

High risk situation -> Effective or ineffective coping response -> Increased or decreased self-efficacy -> Decreased or increased probability of a lapse

If there is a lapse, then the abstinence violation effect occurs along with the perceived effects of substance, which may lead to a full-blown relapse.

56
Q

How are high-risk situations often planned in a subconscious or covert manner?

A

Lifestyle imbalances -> Urges AND cravings -> Cognitive distortions

57
Q

What are the 3 primary cognitive distortions?

A

1) Rationalization
2) Denial
3) Seemingly irrelevant decisions (SIDs)

58
Q

What are the 4 main categories of relapse prevention strategies?

A

1) Identifying personal high-risk situations
2) Coping skills training methods
3) Cognitive restructuring methods
4) Lifestyle intervention strategies

59
Q

How can you identify personal high-risk situations?

A
  • Self-monitoring procedures
  • Self-efficacy ratings
  • Autobiography
  • Description of past relapses and relapse fantasies
60
Q

What are some types of coping skills training methods?

A
  • Relapse rehearsal
  • Relaxation training & stress management
  • Education about immediate & delayed effects of the behaviour/substance use
  • Relapse contract
  • Reminder cards
61
Q

What are some cognitive restructuring methods?

A

1) Self-efficacy
2) Positive outcome expectancies (POEs)
3) Abstinence violation effect (AVE)/giving up

62
Q

What are some strategies for handling POEs?

A
  • Identify triggers
  • Daily monitoring of cravings
  • Education about cravings
  • Labeling and detachment
  • Distraction
  • Coping imagery
  • Cue exposure
63
Q

What is the abstinence violation effect (AVE)?

A

Reframing the lapse/relapse into an opportunity for growth, understanding and learning.

64
Q

What is gambling?

A

Wagering money or something of value for an unpredictable outcome that is largely influenced by chance.

65
Q

What are the 4 brain pathways implicated in our experience of pleasure?

A

1) Ventral tegmental area to nucleus accumbens/basal forebrain
2) Amygdala and hippocampus
3) Olfactory cortex and subcallosal cortex
4) Prefrontal cortex and anterior cingulate gyrus

66
Q

What is the feedback loop in healthy use of pleasurable activities?

A

1) Intermittent use of the behaviour causes small spikes of dopamine release, increasing salience.
2) Memories and emotions are formed and interact with our salience network to trigger drive.
3) Self-regulation and inhibitory control are sufficiently regulating our drive so that we do not become impulsive or compulsive.

67
Q

What are the 2 major theories in the psychology of reward?

A

Classical conditioning and operant conditioning.

68
Q

What is classical conditioning?

A

An unconditioned stimulus (UCS) produces an unconditioned response (UCR). Things that normally don’t elicit a response become paired to the UCS, and become the conditioned stimulus (CS).
Subsequently, with enough pairings, the CS elicits the UCR in the absence of the UCS.

69
Q

What is operant conditioning?

A

The frequency of a behaviour occurring is modified depending on the response it elicits.
The strength of a behaviour is modified by reinforcement or punishment.

70
Q

What are the 4 types of reinforcement in operant conditioning?

A
  • Positive reinforcement (produces favourable outcome)
  • Negative reinforcement (removes unfavourable outcome)
  • Positive punishment (produces unfavourable outcome)
  • Negative punishment (removes favourable outcome)
71
Q

What are the different types of reinforcement schedules?

A
  • Continuous reinforcement
  • Fixed ratio
  • Variable-ratio
72
Q

Which type of reinforcement is the most resistant to extinction?

A

Variable-ratio schedules.

73
Q

What are near misses?

A

When you appear to have almost won.

74
Q

What are loss-disguised-as-wins (LDW)?

A

Pay-outs that are less than the initial wager, as if you “won” something back, using a system called “multi-line betting”.

75
Q

What is the role of control in gambling?

A

Games such as craps and slots give users the illusion of control - highly interactive and allow players to feel that they’re doing something.

76
Q

What are some risk factors for gambling?

A
  • History of mental health problems
  • History of trauma/abuse
  • Family history of gambling
  • Few interests/hobbies
  • Poor self-esteem
  • Poor coping styles
  • Stress
  • Early big wins
  • Social isolation
  • Financial burdens
  • Recent life changes
  • Easy access
77
Q

What is the feedback loop in individuals with problematic gambling?

A

1) Dopamine surges are greater in response to gambling, thus increasing their salience.
2) Memories and emotions associated with the gambling activity are prominent, serving to always remind them of the activity.
3) The high salience increases the drive to pursue the activity.
4) The prominent memories and emotions serve to reduce inhibitory control, and self-regulation is no longer able to control the drive.

78
Q

What is the best form of gambling screening?

A

Asking.

Be non-judgmental and provide a safe environment (as usual).

79
Q

What is the Problem Gambling Severity Index?

A

A 9 question survey that mirrors the diagnostic criteria, with a score from 0-3 per question.
Allows a self-report scale to augment your interview and help quantify how problematic the gambling is.

80
Q

How can CBT address gambling?

A

Help address and replace irrational thought processes, feelings, and beliefs that maintain compulsive behaviours.
Understanding and correcting cognitive biases associated with games of chance.
Providing financial management techniques is key.

81
Q

How can MI address gambling?

A

Assisting people from the pre-contemplative stage to move towards action and maintenance.
Explores ambivalence towards change.
Facilitating intrinsic motivation and self-efficacy.
Fostering commitment.

ADMH (8 decks)

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