L012 - Disorders and Treatments Flashcards
What is Abnormality?
It is hard to define
While statistical methods use statistical norms to define what is not “normal”, clinical psychologists and psychiatrists use a different system
Normal vs. Abnormal.
something
What are the four Ds of psychopathology? When is it okay to diagnose a patient according to those 4Ds?
Deviance
Dysfunction
Distress
Danger
Behavioural and mental problems need to be consistent to diagnose a patient
What is Deviance regarding the 4Ds of psychopathology?
Behaviors, thoughts and feelings that are not in line with normal or usually accepted standards
What is dysfunction regarding the 4Ds of psychopathology?
Thoughts, behaviors and feelings that are disruptive to one’s regular routine or interfere with day-to-day functioning
What is distress regarding the 4Ds of psychopathology?
Behaviors, thoughts and feelings that are unsetting and cause pain, suffering and/or sorrow
What is danger regarding the 4Ds of psychopathology?
Thoughts, behavior and feelings that may lead to harm or injury to self or others.
What are Disadvantages of labelling disorders?
Stigma
Disapproval / poor treatment discrimination or isolation because they are different
Fuelled by lack of information and discomfort
Common mental health stigma; dangerous, conscious choice
Can be anticipated, experienced, perceived or internalized
You can think that it is your fault/that you are stupid but it is not your fault
Is a barrier in accessing mental health care or seeking help
Self-fulfilling prophecy
Some patients use the label of having a mental health disorder as an EXIT; labels to rely on and think they can overcome this
“I have no control over it” - yes you somewhat do
What are advantages of labelling disorders?
Provide a common language for clinicians, researchers and insurance companies
Enable research
Informs about treatment
Financial coverage of treatment
Explanation and empowerment
According to historical views of mental illnesses, what is the demonic model?
View of mental illness in which odd behavior, hearing voices, or talking to oneself was attributed to evil spirits infesting the body
People were accused of witchcraft when having a mental disorder.
According to historical views of mental illnesses, what is the medical model?
Perception that mental illness was due to a physical disorder requiring medical treatment.
Institutionalization: Governments began to house troubled individuals in asylums.
Bloodletting and snake pits were often used as treatments, in line with the scientific knowledge of the time
Drilling holes in skulls to release the “spirits” from their minds
What are new developments that were made from the historical models in the past century?
Moral treatment: approach to mental illness calling for dignity, kindness, and respect for the mentally ill.
Made adjustments as seemed fit because it was not morally correct
Deinstitutionalization: (1960s to 1970s) government policy that focused on releasing hospitalized psychiatric patients into the community and closing mental hospitals.
What are the current views on mental illnesses?
The biopsychological model suggests that there is not one single factor or event that causes a psychological disorder, rather it is the interactions of a person’s biological makeup, psychological experiences and social environment that determine their risk for a psychological disorder.
- Biology – physical health, genetic vulnerabilities, drug effect
- Social – peers, family circumstances, family relationships
- Psychological – coping skills, social skills, family relationships, self-esteem, mental health
What is epigenetics?
The study of changes in organism caused by gene expression rather than the alteration of genes.
One of the mechanisms by which environmental factors interact with biological factors
What is the biopsychosocial model?
Acknowledges the interplay between biological, psychological and social influences.
A way of understanding what makes people healthy by recognizing that biology, psychology and social context all combine to shape health outcomes
What is the Diagnostic and Statistical Manual of Mental Disorders (DSM)?
first published in 1952, is currently in its 5th edition (DSM-V)
Provides a list of symptoms and a decision rule on how many of these symptoms must be present for a diagnosis
DSM is based on the biopsychosocial approach; acknowledges the interplay between biological, psychological and social influences.
The DSM-V uses a lifespan development organization scheme to classify psychological disorders into 19 MAJOR AREAS, starting with disorders usually diagnosed in childhood and ending with those usually diagnosed in older adulthood
What are the restrictions of DSM classification?
These symptoms must be present before the age of 5
Two people can have the same disorder but not have the same symptoms
What are the most commonly known disorders?
Anxiety disorders
Obsessive compulsive disorders
Bipolar disorders
Post-traumatic stress disorders
Depressive disorders
Schizophrenia
What are the most commonly known disorders?
Anxiety disorders
Obsessive compulsive disorders
Bipolar disorders
Post-traumatic stress disorders
Depressive disorders
Schizophrenia
What are examples of Anxiety disorders? Hint – Most common psychological disorders in the U.S.
Panic disorders
Unexpected panic attacks – abrupt surge of fear
Followed by consistent concern and worry about additional attacks or their consequences and/or avoidance
Panic attacks – you get symptoms out of nowhere in 2-5mins
Symptoms can include pounding heart, fear, feel like you are about to die
General anxiety disorders
Continuous, chronic anxiety and worry that is hard to control and that interferes with daily functioning
Individuals with general anxiety disorder usually believe in the benefit of worry – they think their anxiety helps them
What is the difference between obsessions and compulsions?
Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.
Compulsions are behaviours an individual engages in to attempt to get rid of the obsessions and/or decrease distress.
What is the Attributional Theory?
negative events attributed to causes that are
Internal (vs external)
Stable (vs temporary)
Global (vs specific)
What is Rumination?
Focusing repetitively and passively on the symptoms of distress and on the possible causes and consequences of distress
What are gender differences in depression?
Appear around adolescence
Female are more diagnosed with depression than males but males also peak in adolescence
May be attributed to
Gender differences in cognitive styles
Attributional styles, rumination, negative cognitions about attractiveness
Gender socialization
Stronger interpersonal engagement, stronger engagement with feelings
Genetic factors
Hormonal levels
Estrogen may have an impact on females being more depressed
Women in our society are more likely to be depressed because
Have stronger social norms
Higher expectations
More likely to be judged if they do not reach expectations
What are Bipolar disorders?
There are two types of bipolar disorders;
Bipolar Disorder I: at least one manic episode, no major depressive episode is required
Bipolar Disorder II: at least one hypomanic episode and one major depressive episode is required
Mania is characterized by abnormally elevated or irritable mood, accompanied by increased activity or energy
inflated self-esteem
Decreased need for sleep
Racing thoughts and distractibility
Increase in goal-directed activity
Increased risk-taking
Increased talkativeness
Productive high; cannot focus long, may refuse to take pills because they believe that their productivity is rewarding them or getting better.
What is the difference between both bipolar disorders?
The manic episodes (shorter or less severe – in extreme cases, not even any)
Hypomanic episode (longer and more severe)
Period of time
Severity of symptoms
What is Schizophrenia?
Schizophrenia is a brain disease that involves certain structural brain abnormalities.
These include enlarged ventricles and neurotransmitter abnormalities.
They are more likely to have:
ENLARGED VENTRICLES
*abnormalities in the thalamus
deficiencies in the auditory cortex and Broca’s and Wernicke’s areas which are responsible for language abilities (might explain voice hallucinations)
What do we mean when we say positive symptoms of schizophrenia? Give examples.
Positive symptoms: behaviours that were NOT PRESENT prior to begin of disorder
Not helpful – adaptive
Delusions – ex. Walking and you make eye contact with someone and you think it was personal and there were intentions behind it
Hallucinations – perceptions that occur without external stimuli (most commonly sensory or auditory)
Disorganized thinking
Abnormal motor behaviors (e.g., catatonic behavior) - decreased reactivity in the environment
What do we mean when we say negative symptoms of schizophrenia? Give examples.
behaviors that were LOST since onset of disorder
loss of motivation to take care of oneself (avolition)
flat affect
reduction in speech output (alogia)
Explain why one identical twin might develop schizophrenia and why another on would not?
There are genetic contribution factors like
Genetic predispositions, prenatal problems or birth complications
but there are also other factors like
Biological events during adolescence and the interaction with an environmental stressor that can cause this to happen
What is Psychotherapy?
A process in which a professionally trained therapist systematically uses tools derived from psychological principles to help a patient reach a given psychologically relevant goal
What are Common goals of psychotherapy?
To relieve distress and reduce symptoms of psychotherapy
To build insight or self-awareness
To promote growth
The way these goals are organized is specific to your theoretical orientation
What is Psychodynamic therapy?
Rooted in psychoanalysis: Freud
Analyzing unconscious processes through different methods (free association, daydreams, dreams)
Current psychodynamic psychotherapy
Focuses on how repressed emotions influence current behaviors and thoughts
Identifies recurrent themes and patterns in thoughts, feelings, relationships
Focuses on interpersonal relationships (object relations, attachment)
Has a developmental focus
Aims to help a patient’s insight and self-awareness
Hopefully lead the patient to experiment with changing their behavior and approach to new relationships
Patient-driven: therapist sits there and listens occasionally saying interesting, what next.
Patient’s job: keep producing content
Therapist: organizes content into an understanding based on theory about what’s going on in the patient’s unconsciousness creating stuck points/ holding them back
What is Behavioural therapy (kind of set up as opposite of psychodynamic) ?
↳ Incredibly concrete
↳ All human experiences = conditioned
↳ Like re-training dog, you can re-train people’s responses
- coexisting w/ psychoanalysis
What is Humanistic therapy (person-centered therapy) ?
First to conceptualize therapy as a working relationship
3 facets;
Unconditional positive regard
Empathy
Congruence (Genuineness)
No hierarchy between client and therapist
Non-directive
The goal of the treatment is to increase the insight of the patient
First approach where therapists are acting like people
Massive shift from psychotherapy
What is Cognitive Behavioral Therapy (CBT) ?
Cognitive behavioural therapy
Intergrated cognitive interventions and maintained behavioral interventions when appropriate
Therapists can actually intervene not just understand and empathize with the patient’s cognitions and behaviors
What we think affects the way we act and feel
What we feel affects what we think and do
What we do affects how we think and feel
1913 – First Wave: Classic behavioral therapies
Classical and operant conditioning; systematic desensitization. Focus is on behaviors, not thoughts
1954 – Second Wave: Incorporation of cognitions. Rise of mainline cognitive-behavioral therapy
1970s/80s - Third Wave: More about metacognitions – accepting thoughts instead of changing them
What are Cognitive interventions ?
Defined thoughts as automatic units of information from the brain – with distortions
Observer stance: Identifying negative thoughts
Short cuts that our brain tends to take to make ourselves better or wors
Give examples of Common Cognitive Distortions
All or nothing thinking
If I am not perfect, I failed
Over-generalizing
Thinking nothing good ever happens after something bad happened to you
Mental filter
Only paying attention to certain types of evidence
Disqualifying the positive
Thinking something good you did does not count because you had help (hard on yourself)
Jumping to conclusions
Mind reading
Imagining we know what others are thinking
Fortune telling
Predicting the future
Magnification (catasrophising) and minimization
Blowing things out of preoptoritions. [catastrophising] or inappropriately shrinking something to make it seem less important
Emotional reasoning
Assuming that because we feel a certain way, what we think must be true
Should/must
Using words like should or must or ought can make us feel guilty or like we have failed
Labelling
Assigning labels to ourselves or other people. (loser, idiot…)
Personalization
Blaming yourself or taking responsability for something that wasn’t completely your fault. Conversely, blaming others for something that was your fault
What are Behavioral interventions?
Activation for depression (depression, low mood)
Exposure (more for anxiety/fear stimulus)
What is Interoceptive exposure?
Internal stimuli (health, anxiety, panic disorder)
Ex. Breathing through a straw to control breathing and show they are okay
What is Experiental exposure in regards of trying to get rid of fears?
(facing their fears)
Experience of feared stimulus
What is Imaginary exposure/virtual exposure ?
Talk about/imagine a feared stimulus
What is behavioral activation?
When working with depression, take a “fake it till you make it” approach. You need to do it anyway, the motivation may com after, re-engage with the world/let consequences naturally
What is graded exposure?
Create a scaffolded plan of gradually more anxiety-provoking exposure exercises
Phobia of Lizards:
1. think of a lizard for x seconds
3. look at pictures of a lizard
6. go to a pet shop and look at a lizard container
8. Touch a lizard?
If you put acute anxiety on a scale from 1 to 10 (panic), aiming for exposure exercises to trigger anxiety from 4-6
Use distress tolerance techniques/cognitive techniques to habituate to each exposure level – once anxiety drops below 4 for a given activity/exercise, move to the next
What are Criticism of CBT ?
Mechanical/mechanistic, humans are not computers and this change is difficult to implement:
Thought suppression is not possible for humans (ACT)
Too focused on symptom change and not patient experience/values (efficacy vs. effectiveness)
Support for hypothesized mediators of change is weak
Techniques not developed in a lab
Humans are not computers, you cannot just re-program them
Changes are hard to implement
If told not to think about something, you will only think about it more accidentally
What is the difference between cognitions and metacognitions?
Cognitions
“lizards are dangerous”
Metacognitions
Thoughts and judgements we have about our thoughts (how you relate what you are thinking)
“this thought is true, I need to leave and get away from this lizard”
“I am sucha loser for thinking lizards are scary – I need to hide this or everyone will know”
“what a weird thought I just had”
What is the Values card approach?
Patient seperate the cards into three stacks
Very important to me – usually ends up being too big and patient needs to re stack them
Important but “take it or leave it” mindset
Not important to me
Efficacy vs. Effectiveness
Effectiveness is the extent to which an intervention produces an outcome under ordinary day-to-day circumstances
Efficacy is the extent to which an intervention produces a beneficial result under ideal/laboratory conditions
Issues:
Wait-list control for people who are acutely ill
Different therapists may give different “doses”
Patients are usually relatively uncomplicated cases (e.g., no comorbidity)
Highly controlled treatments
What is the DODO BIRD effect? And the experiment proving this?
Claim that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes
Benefit comes from engaging in psychotherapy, not specific elements
Null hypothesis: If Dodo bird conjecture is true, effect sizes will be roughly equivalent
Alternate hypothesis: if Dodo bird conjecture is false, effect sizes will not be homogenous
Result: effect sizes very similar, null hypothesis was not rejected
What are COMMON FACTORS?
Client characteristics
Positive expectancy
Distress
Treatment structure
Techniques/rituals
Exploration of “inner world”
Adherence to theory
Therapist qualities
Cultivates hope
Warmth and positive regard
Empathy
Change process
Opportunity for cartharsis/ventilation
Acquisition/practice of new behaviours
Therapeutic rationale
Foster insight/awareness
Relationship elements
Development of alliance
What are the Client Characteristics?
Obviously someone who comes in at a 9 out of 10 daily anxiety is going to be going to take longer to treat or be treated less effectively maybe than someone at a 5 out of 10.
Expectancy is a big one People who don’t think therapy is going to help are rarely helped by therapy.
What is the ABSOLUTE FOUNDATION of all therapy?
Working relationship between a therapist and patient is the ABSOLUTE FOUNDATION of all in therapy (client needs to trust you)
What is Bibliotherapy?
Therapy through books of self-help. Not recommended for people with severe mental illness but can help people with mild-moderate distress or peop;le that have difficulty accessing care
