Lecture 10: Chapter 14 - Emotion in Clinical Psychology Flashcards
In early days of clin. psych., few categories for disorders existed. Would classify people as either having ______ or _______.
Psychosis or Neurosis
Describe Psychosis
- A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality
- Considered in past as more neurological problem
Describe Neurosis
- A relatively mild mental illness that is not caused by organic disease, involving symptoms of stress but not a radical loss of touch with reality
- Excessive and irrational anxiety or obsession
- Considered in past as more psychological problem
Describe the DSM diagnosis for MDD
Major Depressive Episode: either a depressed mood of a loss of interest and pleasure, persisting almost every day for at least 2 weeks
- Can also include feelings of worthlessness, agitation/inactivity, too much/little sleep, increased/decreased appetite, impaired concentration
What are the two ways a therapist can diagnose MDD?
- Talking with client, evaluate symptoms to determine diagnosis
- Ask client to fill questionnaire to diagnose disorder, can compare scores pre/post treatment more objectively
- MMPI – Minnesota Multiphasic Personality Inventory
- Beck Depression Inventory
- Hamilton Depression Rating Scale
Because of depression’s ____ nature, hard to determine whether treatment alleviated symptoms or if it went away on its own. Thus, we need to either compare treatment against either control, or another treatment
Episodic nature
Brumfiel (2013) examined behaviour of Japanese families after the earthquake that destroyed the Fukushima nuclear power plant. Initially people were energized and determined to cope with disaster, but over time as they were unable to return to normal lives, many became severely depressed. Such is similar to the ____ and _____ phases in stress responses.
Similar to resistance and exhaustion phases in stress responses
- People become especially vulnerable to depression from stress during exhaustion
What are the four types of depression?
- Anxious depression
- Melancholic depression
- Psychotic depression
- Atypical depression
_____ includes thought disorder similar to that observed in schizophrenia (type of depression)
Psychotic depression
____ includes anxiety as well as depression symptoms (type of depression)
Anxious depression
_____ includes severe depression, marked by lack of pleasure in anything (type of depression)
Melancholic depression
_____ is marked increased appetite and increased sleep
Atypical depression
- In contrast to most cases of depression, where people usually lose appetite and have insomnia
- People experience brief periods of enjoyment in response to positive events
Often times placing people into these depression categories helps narrow down treatment. T or F?
False, there’s too much variability in individual symptom profiles
Early hypothesis was that depression was due to a lack of either _____ or _____?
Norepinephrine or serotonin
- Early antidepressants increased the availability of serotonin, sometimes dopamine too at synapses (i.e. tricyclic antidepressants)
Main problem with the early hypothesis was _________?
Time course of drugs
- Drugs can enhance the activity at synapses within minutes/hours, but behavioural benefits generally do not emerge until at least 2 weeks later
Revised hypothesis was that the bombardment of synapses with NTs ______________________?
Reduces the number of receptors at synapses to alleviate symptoms
Main problem with revised hypothesis is that __________?
- Antidepressant drugs are ineffective for many people, especially those with mild/moderate depression
- These drugs affect the synapses just as much for people who do not respond beneficially to them
Most researchers have given up one finding a distinction between norepinephrine and serotonin type depression to target treatment. Thus, most researchers now try to relate depression to _________?
Altered neural circuits in the brain
- E.g. many studies indicate that depression is associated with decreased production of new neurons + synapses in hippocampus, impairing learning
- Anti-depressants, psychotherapy, or other
treatments that alleviate depression also increase
plasticity of hippocampus
DSM-5 makes a distinction between major depression and dysthymia: a condition in which _________?
Someone feels sad almost constantly for years at a time
Dysthymia is similar to melancholic depression, but different in that:
- Emphasis on sad mood rather than lack of pleasure
- Instead of lasting months, will last years
With respect to the causes of depression, stressful events create greater reactions in people _____________?
Predisposed to depression
- Nolen-Hoeksema & Morrow (1991) had college students fill our personality questionnaire that after a major earthquake in California
- Although virtually all students felt sad/depressed
shortly after damage, those already mildly depressed
before earthquake became more severely depressed
and remained depressed longer
- Although virtually all students felt sad/depressed
_____ factors are one possible basis for predisposition to depression
Genetic
- When an adopted children develops depression, depression is generally more common among their biological parents than their adoptive parents
- Comparisons of identical (monozygotic) and fraternal (dizygotic) twins show a moderate genetic influence
Whatever the genes facilitating depression may be, they appear to have multiple effects beyond depression. Major depression runs in the same families as ______ (7)
Alcohol/drug dependence
Antisocial personality disorders
Bulimia
Panic disorders
Migraine headaches
Attention deficit disorders
Binge eating
One study found that within Chinese women in China suffering from multiple episodes of severe depression, two genes increased the likelihood of depression by 15%. What does this suggest?
Suggests that different genes may promote depression by different biological mechanisms in different groups of people
Kendler, Kuhn, and Prescott (2004) had 1404 female adult twins (one reporting sexual abuse, one not) report levels of depression. What did they find? What do these results suggest?
- Found that both twins had higher risk of depression, highlighting environmental/familial factors increasing risk
- Only the abused twin had higher rate of depression, showing trauma further exacerbating symptoms
Children that have been subjected to emotional abuse, neglect, or sexual abuse have an increased risk of depression later in life
Emotions underlying depression is also based on the
Appraisals one makes about depression
- If you habitually feel depressed, you will more often believe you are helpless/hopeless and vice-versa
Learned helplessness is the _______?
Failure to try to improve one’s current situation, resulting from lack of control in a prior situation
Seligman & Maier (1967) had dogs harnessed in place on a floor that would produce electric shock a few seconds after a sound tone. Half the dogs learned to press a panel to avoid shock after tone, while the other half could do nothing to avoid shock. Dogs were later placed in new structure where they could avoid shock by jumping over hurdle to other side of room. What were the results?
Previously shock avoidance trained dogs learnt new paradigm, helpless dogs did not – acted as if the shock was unavoidable
________ _______ has been proposed as an explanation for human depression.
Learned helplessness
The revised theory of learned helplessness states that a total lack of success in some situation may or may not lead to feelings of depression, depending on how someone interprets the outcome (i.e. what attributions they make). What are the 3 types of attribution?
- Internal vs. External – attributing blame to internal vs. external causes
- Stable vs. Unstable – evaluating the attribution as permanent vs. temporary
- Specific vs Global – considering an attribution as applying to specific circumstances vs. relating to many/all situations
Attributions vary based on _______?
Success/failure
Attributions of successes usually follow ___
Facts
- E.g. attributing doing well on a test to studying hard, or the test being easy
Attributions of failures follow one’s _____?
Explanatory style: way of making attributions for their failures, especially when explanation is not obvious
With respect to attributions of failures following explanatory styles, what are the 2 types? Which is strongly associated with depression?
Optimistic style – e.g. blaming failure on lack of effort, implying you have the skills to succeed
Pessimistic style – e.g. blaming failure on lack of ability, implying failure is internal, stable, and global → strongly associated with depression
In addition to a pessimistic explanatory style, most depressed people have _______ attitudes with unrealistic beliefs about what they must become/accomplish to be satisfied
Dysfunctional
Perfectionism is common among people with depression but this correlation ______________?
Does not demonstrate cause and effect
- Depression might lead to dysfunctional attitudes, or dysfunctional attitudes might lead to depression, or something else might be responsible for both.
Although depression is linked to negative affect, the more prominent feature is lack of ______?
Enjoyment
- Psychologists disagree as to whether this is lack of pleasure or lack of motivation
- Describe the methods of Sloan, Strauss and Wisner’s (2001) study
- Had depressed + nondepressed women view series of pictures and reported their emotional responses while researchers observed their expressions
- Participants also asked to rate how well 12 pleasant +12 unpleasant words applied to themselves. Then asked to recall the 24 words
- Describe the findings of Sloan, Strauss and Wisner’s (2001) study
- Both women reacted about equally to sad pictures, but depressed people showed significantly less response to pleasant pictures
- Both groups recalled about the same number of unpleasant words, but depressed women recalled fewer of the pleasant words
- Describe the methods of Henriques and Davidson’s (2000) study
- Had depressed and nondepressed patients view words on computer screen, then complete second task as distraction
- Then asked participants on another set of trials to identify which words now presented had been on the original list
Two types of trials:- Asked to respond as accurately as possible, with no
rewards given - Asked to respond as accurately as possible, 10
cents per correct answer, no punishment for error
- Asked to respond as accurately as possible, with no
- Describe the findings of Henriques and Davidson’s (2000) study
- Logically best thing to do over time when rewarded without punishment is to say yes even when in doubt
- Nondepressed people would change strategy over time to do this, but not depressed people
Most studies, albeit not all, have shown decreased activity in the ____(major source of dopamine output) and decreased activity at one type of ____receptor in depressed people
Striatum, dopamine
People with depression have decreased levels of ________________?
Metabolic breakdown products of dopamine
Most drugs that stimulate dopamine synapses are not effective as an ________
Antidepressant
Most antidepressants work on other NT synapses
Most common treatments for depression are _______ and _______?
Antidepressants and psychotherapy
- Both equally effective, but not reliable
- Half of patients on either treatment show improvement, compared to 1/3 on placebo
- Combining both treatments improves response for some people, but does not greatly improve % of people who respond at all
- Effectiveness might be overstated, since null effects of treatments never published
The first antidepressants were found by accident when trying to treat _____. Drugs used seemed to increase activity at synapses using _____, ______, sometimes _______
Tuberculosis
Increase activity at synapses using serotonin, norepinephrine, sometimes dopamine
Most common psychotherapy used is ______ therapy: an approach that seeks to alter the explanatory styles and other dysfunctional cognitive biases that characterize disordered individuals
Cognitive therapy
- Try to suggest other interpretations of daily events/difficulties
- Invites client to consider other possibilities and draw the most reasonable conclusion, instead of presuming the worst
- Shown to be as effective as a stand-alone therapy as any other therapy for depression
What has been found to be responsible for much of the effectiveness of cognitive therapy?
- Its encouragement of behavioural activation (i.e. more activity of any kind)
- Depressed people lack motivation due to both a lack
of energy, and not expecting to enjoy it - Forcing someone to try something may make them
realise they enjoy it more than expected
- Depressed people lack motivation due to both a lack
What are the three ways to decrease risk of depression without professional help?
- Exercising consistently for 30-45 mins at least a few times per week
- People who exercise less likely to be depressed, and
depressed people are less likely to exercise - Maintaining regular sleep cycle helps alleviate depression symptoms
- Sleep difficulties in adolescence predict increased
chance of depression later
- Sleep difficulties in adolescence predict increased
- Eating seafood rich in omega-3 fatty acids is correlated with decreased probability of depression
Describe bipolar disorder
Mood disorder in which someone alternates between episodes of mania and depression
- Mania: state marked by relentless, vigorous activity
and extreme self-confidence
- May be enjoyable for a while, but can morph into
irritability if it feels like the rest of the world is slowing
you down or in your way
- Criteria for mania include impulsive, risky reward seeking behaviours
- E.g. gambling, unsafe sex, purchasing luxury items
one can’t afford, bad financial investments
Which aspect of bipolar disorder is most likely to cause harm?
Mania, as it damages oneself as well as one’s relationships with friends/family
When symptoms of mania are present but not extreme enough to cause problems in the person’s life such is referred to as _____
Hypomania
Bipolar disorder also involves disruption of normal responses to _____ stimuli
Rewarding
- Gruber and colleagues (2008) showed positive, negative, and neutral film clips to participants with hypomanic symptoms
- Increased manic predisposition = increased positive
emotion (and irritability) to clips
Gruber and Johnson (2009) found greater tendency towards _____ and _____(both high in appetitive motivation and behavioural activation) is a risk factor for mania
Enthusiasm and pride
People may show heightened risk of mania when their positive emotion is ________?
Insensitive to what is going on in their environment
- Positive emotion not on its own bad, context matters
Mania and Bipolar Disorders
Depression in bipolar disorder resembles ______ ______
Atypical depression
- Marked by low enjoyment, physical lethargy, and excessive sleep
- Opposite of mania’s constant movement, activity,
and sleeplessness
- Exceptions do exist, where individual alternate
between mania and agitated depression
First comes 1+ episodes of major depression, later changes to bipolar disorder diagnosis. Treatment also changes, with people with bipolar disorder generally responding best to either _____ _____ or certain ______ medications
Lithium salts or certain antiseizure medications
Defining feature of bipolar disorder is
Mood instability – swings from feeling very low to very high
- Malik et al. (2014) found hypomanic adults had about twice as many intrusive images than others over the following 6 days after watching a film about traumatic events
- Intrusive imagery one way to shift mood, in either
direction
- Intrusive imagery one way to shift mood, in either
Describe PTSD
Condition marked by flashbacks and nightmares about a traumatic event, avoidance of reminders of it, and an exaggerated startle reflex
Describe GAD
Disorder characterized by almost constant nervousness and a wide range of worries
- Worries make them irritable, restless, and fatigued
- Most with GAD qualify for additional mental disorder diagnoses
Describe panic disorder
Disorder characterized by repeated attacks of increased heart rate, rapid breathing, noticeable sweating, trembling, and chest pains
People with panic disorders have frequent nervous apprehension about the prospect of having another attack which often leads to _________
Agoraphobia: an excessive avoidance of public situations where a panic attack might be embarrassing
Panic disorders are most common in ____ than ___ (gender), most prevalent in _____ and ______ ______ (age)
Women than men
Adolescents and young adults
______ ____ is a disorder characterized by excessive fear of a particular object/situation
Specific phobia
- Most phobias pertain to things that are dangerous
(e.g. snakes, spiders, lightning, falling from great
height)
The defining feature for specific phobia disorder is __________?
That the fear is exaggerated and interferes with one’s life
Fear of open, public place:
Agoraphobia
Fear of public speaking:
Glossophobia
Fear of heights:
Acrophobia
Extreme anxiety about being with or observed by strangers:
Social Phobia
Fear of being alone:
Autophobia
Fear of spiders:
Arachnophobia
Fear of snakes:
Ophidiophobia
Fear of blood
Blood phobia
Describe how fear is characterized for specific phobias
- Fear occurs either in presence of object/situation or even the thought/reminder
- Fear are for evolutionarily dangerous phenomena primarily, not what is dangerous today
- Could also be that phobias are for things that are uncontrollable
- E.g. have more control over a car and tools than
snakes and spiders
- E.g. have more control over a car and tools than
The key characteristic of phobias is that they _____ _____
Dominate attention
Miltner et al. (2004) had normal and arachnophobic individuals find a mushroom among either pictures of flowers, or pictures of flowers and one picture of a spider
Arachnophobic individuals had a harder time finding the mushroom if a spider picture was present, but no issues without it
Having a painful experience is neither necessary nor sufficient for establishing a phobia. What supports such?
- John Watson believed classical conditioning was the cause of phobias
- Had “Little Albert” develop a phobia for white rats by
pairing the presence of the rat with a frightening loud
gong sound - Did not provide convincing explanation for acquiring
a phobia
- Had “Little Albert” develop a phobia for white rats by
- An identical twin of someone with a phobia has an elevated risk of also having a phobia regardless of whether or not the first twin can identify a frightening experience that started the phobia
- No apparent increased risk from experience beyond
genetic factors
- No apparent increased risk from experience beyond
For PTSD, traumatic experiences are _____
Necessary but not alone enough to elicit it
- The severity of trauma and the intensity of someone’s initial reaction are not good predictors of who will or will not develop PTSD
A better predictor than traumatic experiences for PTSD is
Emotional status before the trauma
- People who have had abusive/neglectful experiences in childhood, or who developed emotional difficulties for other reasons are more likely than others to develop PTSD
- PTSD victims have fewer than normal recollections of feeling in control over the events in their lives
Berntsen & Rubin, 2015 sought to find evidence of “pre-traumatic stress disorder” by giving questionnaires to soldiers before, during and after deployment to war zone in Afghanistan. What did they find?
Many soldiers experienced anxiety symptoms before deployment
- Reported disturbing dreams, intrusive images,
attempted to avoid any reminder of the events that
might happen
- Soliders with strongest “pre-trauma” had highest probability for PTSD after war exposure
Shows that not just the event, but predisposition affecting PTSD
With respect to the hereditary/environmental factors contributing to anxiety disorders, people with anxiety disorders are likely to have
Relatives with them as well
- Overlap of incidence of anxiety disorders higher for identical vs. fraternal twins
- Genetic influence not specific for a specific anxiety disorder, any anxiety disorder increases likelihood of any other
With respect to the hereditary/environmental factors contributing to anxiety disorders, no common gene is shown to cause a large or replicable effect. Thus, it could be _______ factors at play instead
Could be epigenetic factors at play instead, modulating transcription of genes from environmental factors (e.g. adding methyl/acetyl groups to DNA to block transcription)
Through what mechanism might a genetic predisposition act? No gene directly causes anxiety, thus, one possibility is for genes to act through
Changes in brain anatomy
- People with PTSD have smaller hippocampi than normal (responsible for controlling stress hormones and episodic memory)
- Gilbertson et al. (2002) evaluated the hippocampi of
one identical male twin with PTSD from war, and the
other without PTSD that had not been in battle
- Both twins had smaller hippocampi than average,
suggesting it was predisposition and not caused
by the trauma of war
- Gilbertson et al. (2002) evaluated the hippocampi of
Genes that regulate serotonin have major influences on the amygdala. People with the short form of the serotonin transporter gene (makes proteins to pull serotonin back into axon after release) make less transporters, so that serotonin lasts in synaptic cleft longer before being recycled. In general these people show:
- Increased responses to threat and increased attention to threatening stimuli, especially in social situations
- Show greater amygdala responses to photos of angry/fearful expressions
- Learn fear more quickly than average if a cue predicts shock/danger
People with short gene are thus more likely to
Develop anxiety disorders and have difficult social interactions
- Gene is not linked specifically to anxiety
- People with short form also shown bigger smiles
and more laughter in responses to amusement
- People with short form also shown bigger smiles
- Gene heightens emotional arousal of any type
- Gene heightens attention to cues that elicit emotion
Children that have been sexually abused or neglected are more likely than others to develop
Fear-related disorders and depression
For both identical and fraternal twins, the children of each twin had a risk of anxiety that depended much more on parent’s status than parent’s twin. What does this suggest?
If only genes mattered, parent and their twin should be equally correlated with risk of anxiety
What is the common treatment for anxiety disorders?
(CBT): Treatment focusing on reinterpreting/reappraising a situation, solving problems, and relaxation
For GAD, CBT will emphasize:
Identifying feelings of worry
Developing greater tolerance for uncertainty
Learning to solve problems constructively
Avoid ruminating on problems
For panic disorders, CBT may involve an emphasis on
reinterpreting physiological symptoms so they are perceived as less threatening and more tolerable
Specific phobias are commonly treated with ____therapy
Exposure
- A.k.a systematic desensitization – utilizing extinction in classical conditioning
- Client is exposed to the feared object/situation under controlled conditions that should minimize fear
- Often times to simulate “real” conditions, will use
VR
- Often times to simulate “real” conditions, will use
Drugs that relieve anxiety are known as
Anxiolytics (a.k.a. tranquilizers)
The most common class of anxiolytics are
Benzodiazepines (e.g. diazepam (Valium), chlordiazepoxide (Librium), and alprazolam (Xanax))
Anxiolytics facilitate the effectiveness of ____, main inhibitory NT in the nervous system
GABA
- Suppress activity in amygdala, decreasing response to threatening and emotional stimuli
- Suppresses other brain regions, leads to drowsiness, memory impairment, reduced emotional processing
Describe Obsessive-Compulsive Disorder
Obsessions: recurrent and persistent thoughts, impulses and intrusive images that cause distress
Compulsions: repetitive behaviours (e.g. hand washing, ordering) or repetitive mental acts (e.g. counting things, repeating words) that a person feels internal pressure to perform in response to obsessive thoughts
- Will feel distressed if prevented from doing the
compulsive act
- Completing the act does not fully relieve the distress
People with OCD are highly prone to feeling ___, and report stronger than average ____ ____
Disgust, guilt feelings
- FMRI findings show intense brain responses to any reminder of shame/guilt
- People with OCD believe that thinking about shameful act is as bad as doing it
Describe Antisocial Personality Disorder
Condition marked by deceitful, impulsive, and aggressive behaviour, with disregard for safety of self and others and lack of remorse
- Overlap with characteristics of psychopathy and
sociopathy
- Willingness to harm or manipulate other people, with
no concern for their well-being and no signs of
remorse
Those with Antisocial Personality Disorder possess empathic ____ but not _____ empathy
- Possess empathic accuracy but not emotional empathy
- Lack tendency to imitate sight of sad or frightened
face - Show relatively response to seeing someone suffer in
the amygdala and prefrontal cortex
- Lack tendency to imitate sight of sad or frightened
Disruption of emotions characterize many psychological disorders:
Borderline personality disorder: show extreme emotional volatility, impulsivity, poor emotional regulation skills
Autism: deficits in recognizing others’ emotional expressions
Schizophrenia: often show flat affect (low emotional expression) but report normal levels of subjective emotional experience
Alcohol: used often to regulate emotions
One theory is that disordered emotion stems in large part from __________?
Inadequate or improper emotion regulation
___ in particular seems to link with poor emotional regulation
Depression
- Show bias to be oversensitive to unpleasant and/or undersensitive to positive events
- Depressed people are less likely than others to look for away to reappraise situation in more positive way
- Also more likely to blame themselves, catastrophize (expect worst outcome), and ruminate on issue
Ruminating involves thinking repeatedly about unpleasant event without looking for solution, prolonging unpleasant emotional reaction. Compared to ____ , ____ are more likely to ruminate and also become depressed (gender)
men, women
- Relationship between rumination and depression is correlation not causation, directionality not clear
The role of of emotional regulation is complicated since it may be used also by depressed people
To remain sad
- Could be that sad people feel comfortable with a sad mood out of familiarity, or some people feel they deserve to be sad
How does emotion regulation influence panic disorder?
- People with panic disorder produce exaggerated responses to subtle signs of increased heart rate, faster breathing or other body indications of distress
- Enhancing rather than soothe their emotional
responses
- Enhancing rather than soothe their emotional
How does emotion regulation influence PTSD and BD?
Some people with PTSD or bipolar disorder fail to regulate responses to bad memories by self-distancing
