L13 - Personality Disorders 2 Flashcards
1
Q
What is DBT?
A
- Dialectical Behaviour Therapy developed by marsha Linehan
- Based on CBT but adapted to meet specific needs of those who experience emotions very intensely
- Deals with harmful behaviours, powerful emotions and dysregulation and unstable relationships
- Places importance on relationship between client and therapist: relationship is meant to motivate change
2
Q
How does DBT differ from CBT?
A
- Focus on accepting who you are
- Trying to balance contradictory positions: balancing acceptance and change to accept the self as you are and to make positive changes in life
- As you learn to accept and regulate emotions, possible to change behaviour
3
Q
What are the 4 pillars of DBT?
A
Acceptance
- Mindfulness: non-judgemental awareness of the present moment
- Distress tolerance: learning to tolerate emotions in a crisis without making things worse
Change
- Emotion regulation: changing unwanted emotions, reducing vulnerability to emotions
- Interpersonal effectiveness: improving and maintaining relationships and self-respect
4
Q
What is evidence for DBT?
A
- Meta-analysis of 33 trials looking across disorder-specific outcomes and general outcomes including stand-alone designs: therapy vs control, and add on designs: treatment + therapy vs treatment
- Significant results, small/medium effect sizes across categories
- DBT and psychodynamic approaches more effective than control interventions
- No differences across treatments in retention
5
Q
What is Radical Open DBT?
A
- Transdiagnostic treatment that targets disorders characterised by excessive self-control
- Relatively new but evidence base is small
6
Q
What is the criteria for Antisocial Personality Disorder?
A
- Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15
- Failure to conform to social norms with respect to lawful behaviours
- Deceitfulness: repeated lying or conning
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness as indicated by repeated physical fights or assault
- Reckless disregard of safety of self or others
- Consistent irresponsibility
- Lack of remorse
- Occurrence of antisocial behaviour is not exclusively during the course of the schizophrenia or bipolar disorder
7
Q
Relationship between ASPD and age?
A
- Can only diagnose if age 18 or older
- Evidence of conduct disorder with onset before age 15
8
Q
Relationship between ASPD and crime?
A
- 47% of men in prison and 21% of women in prison qualify for a diagnosis of ASPD
- 70-80% of individuals meet criteria of ASPD, only 25-30% meet criteria for psychopathy
- Many clinicians use the PCL-R as it is a long research tradition and better predictor of criminal behaviour, violence and recidivism
9
Q
What is the successful psychopath?
A
- Those who do not display the interpersonal/affective symptoms
- 4% of a sample of corporate professional had a PCL-R score above the threshold
- Many held leadership positions
- Rated by colleagues as good communicators, strategic thinkers, not team players and poor management style
- Greater heart-rate reactivity and more conscientious
10
Q
What are gene-env causes?
A
- Twin and adoption studies indicate a moderate heritability for antisocial or criminal behaviour and ASPD
- Not sure what is inherited - could be broader personality traits e.g impulsivity, low anxiety and aggression
- Env factors could be abuse, parental conflict and neg peer influence
- Adopted-away children of bio parents with ASPD were more likely to develop ASPD if exposed to an adverse env within their adopted families
- More likely to show antisocial behaviour with presence of MAOA gene and childhood mistreatment
- Child with early ASPD behaviours can elicit behaviours in others
- Relative contributions of genes and env can change over time but they are bidirectional
11
Q
What are a study looking at negative emotion, recognition and empathy?
A
- Collected fMRI data from men in correctional facility and community volunteers with high, medium and low psychopathy traits
- FMRI scan while completing a self-perspective or other-perspective task show right hands and feet in painful and non-painful situations
- Self-perspective conditions: high PCL-R group showed typical response within brain networks involved for empathy for pain
- Other-perspective: High PCL-R showed atypical pattern of brain activation and effective connectivity = low empathy
- Correlated with interpersonal/affective factor and predicted neural response for pleasure
12
Q
What is fear conditioning and how does it relate to psychopathy?
A
- Like classical conditioning
- We learn to avoid criminal behaviour = associate it with punishment/fear
- Poor fear conditioning is a risk factor for crime because those who lack fear are less likely to avoid situations that would be punished for
13
Q
How to measure emotion processing and bodily reactions?
A
- Heart rate
- Skin conductance
- Startle reflex
- EEG
- Cortisol
- Eye gaze and fixation
14
Q
What is the startle reflex?
A
- Tend to blink when we startle
- Dysfunction in amygdala = reduced augmentation of startle reflex by visual threat primes
- Startle reflex is modulated by affective content, smaller startle responses is when we shown something pleasant and opposite for unpleasantness
- For psycho: adults process emotional stimuli in abnormal ways: very low reflex in positive compared to controls, higher than controls in neutrals, and lower in neg than controls (visual content of slide) (shows fearlessness as you do not recoil from unpleasant things)
15
Q
How to test fear conditioning?
A
- Ppts view 48 slides with 4 diff colours, 10 slides paired with loud, aversive noise
- 4 phases: habituation, acquisition, extinction e.g blue slide = unpleasant sound coming
- People learn the safety/fear slide during acquisition and this is seen through higher/lower skin conductance
- 42 young men were recruited from youth offensive service and underwent this = pattern of responses show more biological responses in fear and less skin conductance with learning in control BUT in young offenders, both resulted in lower skin conductance = higher psychopathic traits = not scared and do not pair punishment = can cause reoffending
