L1 - Understanding models Flashcards
Learning objectives of the course
- Describe the main characteristics of the disorders covered.
- Recognize and identify disorders in case descriptions.
- Explain the key principles of the main psychological and neurobiological models of anxiety and mood disorders.
- Use psychological and neurobiological models to explain how these mechanisms cause and maintain the disorders.
- Evaluate the scientific support for the main psychological and neurobiological models of anxiety and mood disorders.
- Describe the most common evidence-based interventions for mood, anxiety and psychotic disorder such as cognitive behaviour therapy.
- Design an experiment to answer a research question concerning the role of psychological and neurobiological processes in mood and anxiety disorders.
Introduction
Info about the course that is relevant for studying
- When they use the word describe - expected less detail in answers than when they use evaluate
- When they use evaluate: actively engage with the materials
Learning objective of this lecture
- Explain the Advantages and Limitations of Using Models in Clinical Psychology: Gain insight into the strengths and weaknesses of applying theoretical models to understand, diagnose, and treat psychological disorders.
- Explain and Identify Transdiagnostic Processes: Develop a clear understanding of what transdiagnostic processes are, their role in clinical psychology, and how to identify them in the course materials.
- Describe the Prevalence of Disorders Discussed in MAPD: Analyze and articulate the prevalence rates of the psychological disorders covered in the course, including trends and variations over time.
- Explain the Basics of the Network Perspective on Mental Disorders: Learn the foundational concepts of the network approach to mental disorders, including how symptoms and risk factors interact to create complex systems of psychological distress.
Models in psychopathology
How does a general model of psychopathology look like? What are its components?
The model in the picture includes the lecture numbers as well because there was no picture without them
- early experiences and predispositional vulnerability (difficult to predict based on genetics but it is helpful to see its role) lead to vulnerable phenotype
- vulnerable phenotype leads to emotional disorders but those can be intercepted by protective factors and stressors which make the development of the disorder less or more likely
How do theories and models relate in psychology?
- Every model has a theory which starts with an observation in clinical practice that tries to explain a certain phenomena
- the theory tries to predict the future by proposing that the phenomena should be observable in data
- This data could be consistent with what the theory predicted and we make generalisations
- Then via abduction we formulate hypothesis to further explain the theory
How do models in psychology and mathematics differ?
- Theories in psychology are vague and we are missing the hard sciencies’ evaluation which is concrete and precise based on observable phenomena
- Models from mathematics/physics inspired psychology to develop its own models with the same structure (example of a model developed from theory in physics↓)
Example of psychological model
This model propses the cognitive theory which is trying to explain the link between negative moods and cognitions (especially seen in depression)
What are two ways that theoretical models can be applied in psychology?
- Most models are generalised and formulated on a group level
- However, new research is happening to investigate individual level (what lead to the disorder in an individual?)
- Important because helps identify potential stressors and protective factors in specific groups of people who share some similarities
What is a new approach that is arising within psychology?
- Traditional approach in psychology: verbal theories attempt to explain observed phenomena, but there is a “black box” (question mark) in between
↪ a lack of clarity in how theories generate predictions - Now instead of the black box, psychologists are proposing a way to get to the explanation of phenomena
- formal model: theoretical ideas translated into mathematical or computational models
- statistical pattern: the model produces quantifiable, testable predictions
- phenomenon: these predictions can then be compared to real-world data, creating an empirical anchor
What is the critique on psychological theories and how does that further supports the need for formalization?
- Psychological theories tend to be formulated so vaguely or abstractly that it is difficult to falsify or test them (lack precise, testable hypotheses) → in contrast to fields like physics where theories make clear numerical predictions
- However, that is not saying that psychological models are not useful, rather that it’s difficult to transition them to applicable scenarios which is a problem since models exist especially for therapists to guide tratment and diagnoses
- formalization helps bridge theory and practice
Why are formal models advantageous to verbal theories?
- The important thing in psychology is that the interventions delivered to clients are useful and effective
- Because formal models have the part where the theory is actually tried against real data, it can improve and we can get rid of the ones that don’t help
- E.g. Chronological Assessment of Suicifal episodes (CASE)
How does the example of CASE, developed by Shea, show the importance of testable applicability of the model in real life
- The lecturer with his team implemented this model in the guidelines on suicidal prevention and it was actually showing positive results from the clinical practice
- Later it turned out that Shea (the author of the model) meant the model differently which shows that in formal models what matters is whether it can be testable to see whether it’s effective
- It was unclear whether the psychologists or Shea made an error but it shows that the point is that it was applicable in practice
- Later, the psychologists updated the model and used the backing by Shea
How does DSM affect the prevalence and thinking about mental disorders?
The underlying idea of DSM is based on the medical model which states that the brain causes all symptoms of disorders so if we treat these symptoms, the disorder would disappear
- Changing definitions/criteria of disorders changes how many people qualify as having a disorder
What impact do model have?
- Diagnostic Criteria Affect Prevalence Estimates
- Thresholds for Diagnosis Influence Who is Counted
- Introduction of New Disorders
- Diagnostic Inflation and Overpathologization
Next flashcards are gonna be about the article he discussed
What was the article about? What sample did they use?
- Data from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS-3), analyzing trends in common mental disorders over time
- It compares data from 2007-2009 (NEMESIS-2) and 2019-2022 (NEMESIS-3), including the impact of the COVID-19 pandemic
- DSM IV and V diagnoses assessed with Composite international diagnostic interview (CIDI)
- Multistage, stratified random sampling procedure
- First, a random sample of municipalities was drawn
- A random sample of individuals aged 18-75 years was drawn from the Dutch population register; N=6000
- Examined mood disorders, anxiety disorders, substance use disorders and ADHD: CIDI 3 used for diagnostic assessment → lifetime and 12 month prevalence
How were the participants assessed whether they are presenting symptoms of disorders?
What is the difference between life-time prevalence and 12-month prevalence?
Lifetime prevalence: experience of symptoms anywhere in your life
12-months prevalence: experience of symptoms in the past year
What were the lifetime and 12-month prevalence of the disorders?
Lifetime prevalence
- Half of respondents had any lifetime disorder (48.4%)
- Most prevalent:
- Mood and anxiety (27.6% and 28.6%)
- Substance use (16.7%)
- ADHD (3.6%)
- The most prevalent specific disorders were major depressive disorder (24.9%), social phobia (13.1%), specific phobia (11.8%) and alcohol use disorder (12.8%)
12-month prevalence:
- 1/4 respondent met criteria for any disorder (25.9%)
- Of those with any lifetime disorder, more than half (53.5%) also had a disorder in the past year
- Most prevalent:
- Anxiety (15.2%)
- Mood (9.8%)
- Substance use (7.1%)
- ADHD (3.2%)
What were the socio-demographic correlates?
- Primary or lower secondary education and low household income were associated with mood disorders, anxiety disorders and ADHD
- Women were more likely to have any mental disorder in the past 12 months
- The prevalence of mood and anxiety disorders was higher in women
- Respondents living alone were more likely to have all disorder categories
- Unemployed or disabled people were worse off in all categories
- The prevalence of substance use disorder and ADHD was higher in men
- Lower age was associated with higher prevalence of all disorder categories
- Higher degree of urbanisation was associated with higher 12-month prevalence (country of origin was not)
What were the trends found in the 12-month prevalence?
Prevalence rate of any DSM-IV mood, anxiety or substance use disorder increased from NEMESIS-2 to NEMESIS-3
- There is a significant increase in mood disorders (6.0% → 10.8%) and anxiety disorders (10.1% → 15.6%) over time
- Substance use disorders increased slightly (5.5% → 7.1%), but this was not statistically significant after controlling for socio-demographics
- Overall mental disorder prevalence increased from 17.4% to 26.1%
- The ratio of those with mild, moderate and severe disorders remained the same in 12-month prevalence
- The percentage of people with 2+ disorders increased
What were the trends in service use for mental health problems?
- General medical and specialised medical health care significantly increased, as well as psychotropic medication use
- Unmet need for care also increased (indicating gaps in service accessibility)
What was the trend in life-time prevalence?
- In 2007: 20% of people in the Netherlands suffer from an anxiety or mood disorder at some point in their lives
- In 2020: 48% of people in the Netherlands suffer from an anxiety or mood disorder at some point in their lives
Drastic increase!
What was the impact of COVID-19 Pandemic?
Prevalence rates DID NOT differ significantly before vs during the pandemic
How did the study explain the contradiction with other COVID-era studies that found that increase in prevalence rates?
- Short-term mental health symptoms vs diagnosed disorders
↪ Many previous studies mainly used self-report symptom scales, which measure temporary distress rather than formally diagnosed mental disorders.
↪ This study used structured clinical interviews (CIDI 3.0) to diagnose DSM-5 disorders, which assess long-term mental disorders rather than short-term stress reactions
↪ COVID-era studies measured short-term mental health symptoms, whereas this study measured diagnosed disorders, which do not change as quickly
- New mental health disorders developed & then recovered
↪ Although some people may have developed new mental disorders during the pandemic, others may have recovered during the same period
↪ The net effect might have balanced out, leading to no overall change in prevalence
- Social support & coping mechanisms
↪ Many people experienced stress during COVID-19, but not all stress leads to a mental disorder
What are some factors that may have helped prevent an increase in long-term mentak disorders?
- Stronger family/social support networks (people spent more time at home)
- Flexibility in work and study (remote work reduced workplace stress for some)
- Government financial assistance programs (reducing financial distress for some groups)
Which disorder did they find a decrease in from pre to during covid period? And what are the possible reasons?
The study found a small drop in substance use disorders during the pandemic
Possible reasons:
- Less access to alcohol and drugs (lockdowns, bar closures)
- Changes in lifestyle (fewer social gatherings where substance use occurs)
What possible explanations do the authors provide for the trends they found?
- Higher increase for people aged 18-34 and students (12-month prevalence)
- the further individualisation of society
- social media
- increasing pressure to succeed
- current social problems (e.g. shortage of affordable housing, climate change concerns)
- difficulty coping with setbacks (not immediately having a successful job…)
- urbanisation effects
- Urbanisation: Living in a city -> more disadvantages today than before
- The increase in mood and anxiety disorders: more recognition; people admit more; less stigma
What are the limitations of this study proposed by the authors
- The validity and reliability of the modified CIDI 3.0 has not been formally investigated
- Prevalence rates are based on retrospective recall (possible underreporting)
- Survey non-response could lead to bias in prevalence estimates
- those with insufficient mastery of Dutch, those with no permanent residential address, and those who were long-term institutionalized were excluded from participation
What is the reaction of psychologists on the discussion whether all the attention to mental healthy is healthy?
It is healthy!
The question is not whether we should pay attention to mental health issues, but in what way. Openness ensures that people with complaints, especially young people who often feel more reluctance, can be directed to help sooner. Unfortunately, the stigma surrounding mental health issues is still significant.
By informing people effectively, they are also better able to assess the severity of their complaints. And they have a better understanding of whether, how, and when intervention is necessary. Attention and reliable information are crucial. Making people aware without imposing it on them.
What were the prevalence rates of suicidal thoughts, plan and attempts in 2007, according to NEMESIS-II?
Suicidal thoughts: ‘Have you ever felt so down that you thought about committing suicide?’
Suicide attempt: This is determined by the question ‘Have you ever attempted suicide?’
- Suicidal thoughts: 8.3% (lifetime) 1.1% (12 months)
- Suicide plan: 3.0% (lifetime) 0.4% (12 months)
- Suicide attempt: 2.2% (lifetime) 0.1% (12 months)
In the 90s these rates were much higher → might be that the questions were asked differently
What are the prevalence rates of psychotic disorders in 2007 according to NEMESIS-II?
- 8% has psychotic experiences
- 4% psychotic symtpoms
- 2-3% psychotic disorder
- 0.6-0.7% diagnoses schizophrenia
comorbidity between depression and anxiety
- Depression and anxiety have a high comorbidity
- Both are labeled “Internalizing disorders” or “Emotional disorders”
- Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder
- Response to the same treatments (antidepressants tackles both - clinical experience)
- Many transdiagnostic processes
What are examples of transdiagnostic factors?
- Genetics - share gene expression
- Brain, neurotransmitters
- Cognitive emotional learning - in many disorders
- Thinking (e.g., negative repetitive, intrusive) + ruminating
- Youth and upbringing
- Interpersonal processes
What is the overlap in symptoms of GAD and MDD?
- agitation
- irritability
- fatigue
- sleep problems
What does the medical model proposes?
- whole premise of DSM
- there is some kind of latent disease which causes the symptoms
- difficult to find in data and clinical practice
What does the network model propose?
No such a thing as a depression, rather the symptoms interact with each other and this interaction causes the presentation
How can we compare the medical and network model with an example?
Medical model: Symptoms are all caused by the underlying condition
- Example: HIV causes rash and fever. These two symptoms are independently caused by HIV.
- In mental disorders, symptoms are not independent of each other: sleep problems, for example, lead to more worrying
- You can have HIV without symptoms, but you cannot have depression without symptoms
- So, the network perspective states “symptoms cause each other”!
How is comorbidity differently portrayed by the medical and network model?
Picture 1 - medical model
- within the medical model the disorders co-occur together so we would have two separate disorders and they might both be present
Picture 2 - network model
- Disorders have ‘bridge’ symptoms that are shared by both disorders so the disorders are more interconnected
