PSY1022 WEEK 6 ABNORM 2 Flashcards
ANXIETY DISORDERS
Most prevalent of all mental disorders. 29% of people will have one at some point in their life. Onset is earlier than for most other disorders (average age 11).
SOMATOFORM DISORDERS
Condition marked by physical symptoms that suggest an underlying medical illness, but that are actually psychological in origin. Freud called this “grande hysteria”
HYPOCHONDRIASIS
An individual’s continual preoccupation with the notion that he has a serious physical disease. Somatoform disorder.
GENERALISED ANXIETY DISORDER (GAD)
Continual feelings of worry, anxiety, physical tension, and irritability, across many areas of life functioning. 3% of the population. 60% of the day worrying, compared with 18% gen pop. ⅓ have it develop after major stressful event or lifestyle change. More likely to be female, middle-aged, widowed or divorce, poor.
Unpredictable events in childhood may predispose people to this.
Or may manifest later in life after major change.
PANIC ATTACK
Brief, intense episode of extreme fear characterised by sweating, dizziness, light-headedness, racing heartbeat, and feelings of impending death or going crazy. Often mistaken for heart attacks.
PANIC DISORDER
Repeated and unexpected panic attacks, along with persistent concerns about future attacks or a change in personal behaviour in an attempt to avoid them. Often develops in early adulthood. Most people develop agoraphobia.
SPECIFIC PHOBIAS
Intense fear of an object or situation that’s greatly out of proportion to its actual threat. Many disappear with ages.
AGORAPHOBIA
Fear of being in a place or situation from which escape is difficult or embarrassing, or in which help is unavailable in the event of a panic attack. Common misconception that it is a fear of crowds. Typically emerges midteens, and is usually a direct outgrowth of panic disorder. Malls, movie theatres, tunnels, bridges, or wide-open spaces.
SOCIAL PHOBIA
Marked fear of public appearances in which embarrassment or humiliation seems likely. Beyond stage fright. Can be speaking, swallowing, swimming, etc.
POST TRAUMATIC STRESS DISORDER (PTSD)
Marked emotional disturbance after experiencing or witnessing a severely stressful event. Event must be physically dangerous or life-threatening, either to oneself or someone else.
Manifests if person can’t make sense of the trauma.
Flashbacks. Efforts to avoid thoughts, feelings, places and conversations associated with the trauma, recurrent dreams of the trauma, increased arousal. Panic attacks. Nightmares. Difficult to diagnose.
OBSESSIVE-COMPULSIVE DISORDER
Condition marked by repeated and lengthy (at least one hour per day) immersion in obsessions, compulsions, or both. Usually centre on “unacceptable” thoughts eg fears of being dirty or killing others. Typically are disturbed by their thoughts and see them as irrational, but can’t make them stop. Also develop compulsions.
OBSESSION
Persistent idea, thought, or impulse that is unwanted and inappropriate, causing marked distress.
COMPULSION
Repetitive behaviour or mental act performed to reduce or prevent stress.
- Repeatedly checking locks, doors, etc.
- Arranging and rearranging objects.
- Washing and cleaning.
- Performing tasks in a set way.
- Touching or tapping objects.
- Hoarding.
LEARNING MODELS OF ANXIETY
Operant conditioning.
Also can acquire fears by observing others engage in fearful behaviours.
And fears can stem from information or misinformation from others.
CATASTROPHISING AND ANXIETY SENSITIVITY
People catastrophise when they predict terrible events, such as contracting a life threatening illness, from turning a door knob.
People with anxiety sensitivity have a fear of anxiety-related sensations (dizziness, heart racing, short of breath). Normal physical reactions get catastrophised and can lead to a panic attack.
ANXIETY: BIOLOGICAL INFLUENCES
Anxiety is genetically influenced. Biologically GAD and major depression same thing.
People with OCD twice as likely to inherit a specific overactive gene related to transport of seratonin.
OCD is malfuntion of caudate nucleus.
PSYCHOTHERAPY
A psychological intervention designed to help people resolve emotional, behavioural, and interpersonal problems and improve the quality of their lives.
Patients in are more likely to be women. Less likely to be from an ethnic group.
Better adjusted clients respond better. Also people with anxiety. Or temporary problems.
PARAPROFESSIONAL
Person with no professional training who provides a mental health service.
EFFECTIVE PSYCHOTHERAPIST
More likely to be:
- warm and direct
- positive working relationship with clients
- tend not to contradict clients
- select important topics to focus on in sessions
INSIGHT THERAPIES
Psychotherapies, including psychodynamic, humanistic, and group approaches, with the goal of expanding awareness or insight.
- negative is can’t rule out rival hypotheses.
PSYCHODYNAMIC THERAPIES
Three core beliefs:
- Abnormal behaviours stem from adverse childhood experiences.
- Strive to analyze: distressing thoughts and feelings clients avoid, wishes and fantasies, recurring themes and life patterns, significant past events, and therapeutic relationship.
- When clients achieve insight into previously unconscious material the causes and symptoms will become evident, often causing symptoms to disappear.
PSYCHOANALYSIS
One of the first forms of psychotherapy. Goal to decrease guilt and frustration and to make the unconscious conscious. - Free association - Interpretation - Dream analysis - Resistance - Transference - Working through
FREE ASSOCIATION
Technique in which clients express themselves without censorship of any sort.
RESISTANCE
Attempts to avoid confrontation and anxiety associated with uncovering previously repressed thoughts, emotions, and impulses.
TRANSFERENCE
Projecting intense, unrealistic feelings and expectations from the past onto the therapist.
INDIVIDUATION
The integration of opposing aspects of the personality into a harmonious “whole,” namely the self.
Jung.
INTERPERSONAL THERAPY (IPT)
Treatment what strengthens social skills and targets interpersonal problems, conflicts, and life transitions.
Collaborative undertaking between client and therapist. Analyst is participant observer.
Short term intervention (12 to 16 sessions).
Effective for depression, substance abuse, eating disorders.
Harry Stack Sullivan.
HUMANISTIC THERAPIES
Therapies that emphasise the development of human potential and the belief that human nature is basically positive.
Focus on the present.
Importance of assuming responsibility for decisions.
- reject interpretive techniques of psychoanalysis.
Carl Rogers.
PERSON-CENTERED THERAPY
Therapy centering on the client’s goals and ways of solving problems.
Carl Rogers.
Therapist must satisfy 3 conditions:
- must be an authentic, genuine person who reveals his or her own reactions to what the client is communicating.
- must express unconditional positive regard of all feelings the client expresses.
- must relate to clients with empathic understanding.
REFLECTION
Mirroring back the clients feelings.
Carl Rogers.
GESTALT THERAPY
Therapy that aims to integrate different and sometimes opposing aspects of personality into a unified sense of self.
Fritz Perls.
Two-chair technique (patient moves between). Allows synthesis of opposing sides.
GROUP THERAPY
Therapy that treats more than one person at a time.
Jacob Moreno.
Efficient, time-saving, less costly.
Research shows effective for a wide range of problems and about as helpful as individual treatments.
ALCOHOLICS ANONYMOUS
Twelve-Step, self-help program that provides social support for achieving sobriety.
Not supported by research.
CONTROLLED DRINKING
Drinking in moderation. Teach alcoholics to set limits and drink moderately. Opposite of AA. More supported by research.
RELAPSE PREVENTION (RP)
Assumes that many people with alcoholism will at some point experience a relapse. Teaches people not to feel ashamed, guilty, or discouraged. A lapse doesn’t equal relapse.
STRATEGIC FAMILY INTERVENTIONS
Family therapy approach designed to remove barriers to effective communication.
Families often scapegoat one family member as the “identified patient” with the problem. For therapist real source is dysfunction in whole family.
STRUCTURAL FAMILY THERAPY.
Treatment in which therapists deeply involve themselves in family activities to change how family members arrange and organise interactions.
Minuchin.
Research says no more effective than individual therapy.
DIRECTIVES
Strategic family therapy.
Planned tasks that family members carry out. Shift how family members solve problems and interact.
PARADOXICAL REQUESTS
Strategic family therapy.
Also called “reverse psychology”.
BEHAVIOUR THERAPIST
Therapist who focuses on specific behaviours, and current variables that maintain problematic thoughts, feelings, and behaviours.
Learning - classical, operant, and observational.
BEHAVIORAL ASSESSMENT
Used by behaviour therapists.
Emphasis on current, rather than past, behaviours. Establishes specific and measurable treatment goals.
Use direct observation, verbal descriptions, scores on tests, standardised interviews.
SYSTEMATIC DESENSITIZATION (SD)
Clients are taught to relax as they are gradually exposed to what they fear in a stepwise manner.
Joseph Wolpe. 1958.
Based on reciprocal inhibition. Can’t experience relaxation and anxiety at the same time. Also called counterconditioning.
Type of exposure therapy. Can occur in vivo “in real life”
EXPOSURE THERAPY
Therapy that confronts clients with what they fear with the goal of reducing the fear.
ANXIETY HIERARCHY
A “ladder”of situations that climbs from least to most anxiety provoking.
Client is taught to imagine the first scene, and relax. Moves only to the next scene when the client is relaxed with the first.
DISMANTLING
Research procedure for examining the effectiveness of isolated components of a larger treatment.
Behaviour therapists.
FLOODING THERAPIES
Start at the top of the anxiety hierarchy and expose clients to images of the stimuli they fear the most for prolonged periods, often for an hour or more.
Based on the idea that fears are maintained by avoidance.
Response prevention.
Contrast to SD.
Can be conducted in vivo.
RESPONSE PREVENTION
Technique in which therapists prevent clients from performing their typical avoidance behaviours. Was called ritual prevention (for OCD).
Research shows is effective for OCD.
PARTICIPANT MODELING
Technique in which the therapist first models a problematic situation and then guides the client through steps to cope with it unassisted.
Bandura.
Assertion training.
Behaviour rehearsal.
TOKEN ECONOMY
Method in which desirable behaviours are rewarded with tokens that clients can exchange for tangible rewards.
Operant conditioning.
AVERSION THERAPY
Treatment that uses punishment to decrease the frequency of undesirable behaviours.
Research provides mixed support.
COGNITIVE-BEHAVIOURAL THERAPIES
Treatments that attempt to replace maladaptive or irrational cognitions with more adaptive, rational cognitions.
Three core beliefs:
- cognitions are identifiable and measurable
- cognitions are the key players in both healthy and unhealthy pyschological functioning
- irrational beliefs or catastrophic thinking can be replaced by more rational and adaptive cognitions.
RATIONAL EMOTIVE BEHAVIOUR THERAPY (REBT)
Albert Ellis.
Focus on changing how we think and how we act.
A) Activating event (eg. grade of C on exam)
B) Beliefs (I did badly, I did well, etc).
C) Consequences (I suck, will do better next time)
D) Dispute irrational beliefs (with therapist)
E) Adopt more effective beliefs (with therapist)
COGNITIVE THERAPY
Aaron Beck.
Emphasises identifying and modifying distorted thoughts and long-held negative core beliefs. Greater emphasis on behavioural procedures than REBT.
STRESS INOCULATION TRAINING
Therapists teach clients to prepare for and to cope with future stressful life events.
Type of CBT.
Successful for medical and surgical procedures, public speaking, exams, anger problems.
Donald Meichenbaum.
THIRD WAVE THERAPIES
First - behavioural
Second - cognitive
Third - instead of trying to change maladaptive behaviours and negative thoughts, assist clients with accepting all aspects of their experience they’ve avoided or suppressed.
- includes acceptance and commitment therapy (ACT)
- dialectical behavoiur therapy (DBT)
META-ANALYSIS
Statistical method that helps researchers to interpret large bodies of psychological literature.
Pool the results of many studies.
DODO BIRD VERDICT
Alice in Wonderland Dodo “all have won, and all must have prizes”
Saul Rosenzweig. Different psychotherapies are the same, as all a roughly equivalent.
But, not everyone agrees.
Behavioral and cognitive-behavioral are clearly more effective than other treatments for children and adolescents. There are also better for anxiety disorders and OCD.
FACILITATED COMMUNICATION
Potentially harmful therapy.
A facilitator holds the hands of children with autism, etc, as they type messages on a keyboard.
Problem: false accusations of abuse.
SCARED STRAIGHT PROGRAMS
Potentially harmful therapy.
At-risk adolescents are exposed to the harsh realities of prison life to frighten them away from a life of crime.
Problem: worsening of conduct problems.
RECOVERED-MEMORY TECHNIQUES
Potentially harmful therapy.
Therapists use methods to recover memories, including prompting of memories, leading questions, hypnosis, and guided imagery.
Problem: production of false memories of trauma.
DISSOCIATIVE IDENTITY DISORDER (DID) ORIENTATED PSYCHOTHERAPY
Potentially harmful therapy.
Therapists use techniques that imply to clients that they harbour “alter” personalities. Therapists summon and interact with alters.
Problem: production of alters, creation of serious identity problems.
CRITICAL INCIDENT STRESS (CRISIS) DEBRIEFING
Potentially harmful therapy.
Shortly after a traumatic event, therapists urge group members to “process” their negative emotions, describe PTSD symptoms that members are likely to experience, and discourage members from discontinuing participation.
Problem: heightened risk for PTSD
DARE (DRUG ABUSE AND RESISTANCE EDUCATION) PROGRAMS
Potentially harmful therapy.
Police officers teach school children about the risks of drug use and social skills to resist peer pressure to try drugs.
Problem: increased intake of alcohol and other substances (such as cigarettes).
COERCIVE RESTRAINT THERAPIES
Potentially harmful therapy.
Therapists physically restrain children who have difficulty forming attachment to their parents. These therapies include rebirthing and holding therapy.
Problem: physical injuries, suffocation, death.
COMMON FACTORS IN PSYCHOTHERAPY
Jerome Frank.
Empathic listening, instilling hope, establishing a strong emotional bond with clients, providing a clear theoretical rationale for treatment, implementing techniques that offer new ways of thinking, feeling, and behaving.
Also shared by many forms of faith healing, religious conversation, etc.
SPECIFIC FACTORS
Factors that characterise only certain therapies. Include exposure, challenging irrational beliefs, and social skills training.
SCIENTIST-PRACTITIONER GAP
Refers to the sharp cleft between psychologists who view psychotherapy as more an art than a science, and those who belive that clinical practice should primarily reflect well-replicated scientific findings.
EMPIRICALLY SUPPORTED TREATMENT (EST)
Intervention for specific disorders supported by high-quality scientific evidence.
Research supported treatments.
- Behaviour and cognitive behaviour for depression, anxiety disorders, obesity, marital problems, sexual dysfunction, and alcohol problems. As effective as SSRIs for depression.
- Interpersonal for depression and bullimia.
- Acceptance-based approaches for borderline personality disorder.
SPONTANEOUS REMISSION
Clients recovery may have nothing to do with the treatment.
PLACEBO EFFECT
Can lead to significant symptom relief.
SELF-SERVING BIASES
Strong psychological pull to find value in a treatment.
REGRESSION TO THE MEAN
Extremes (good or bad) tend to resolve back to the middle (mean)
RETROSPECTIVE REWRITING OF THE PAST
We may believe we have improved even when we haven’t because we misremember our initial (pretreatment) level of adjustment as worse than it was.
PSYCHOPHARMATHERAPY
Use of medications to treat psychological problems.
ANTIANXIETY DRUGS
Anxiolytics.
- Benzodiazepines
- Busprione
- Beta blockers
BENZODIAZEPINES
Antianxiety medication.
Increase efficiency of GABA binding to receptor sites.
- Diazepam (Valium)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
Also used with anti psychotic medications, treat medication side effects, alcohol detox.
BUSPIRONE
Antianxiety medication.
Stabilizes serotonin levels.
Also used for depressive and anxiety states, aggression in people with brain injuries and dementia, sometimes used with antipsychotics.
BETA BLOCKERS
Antianxiety medication.
Compete with norepinephrine at receptor sites that control heart and muscle function, reduce rapid heartbeat, muscle tension.
- Atenolol (Tenormin)
- Propranolol (Inderal)
ANTIDEPRESSANTS
- Monoamine oxidase (MAO) inhibitors.
- Cyclic antidepressants
- SSRIs
MONOAMINE OXIDASE (MAO) INHIBITORS
Antidepressant
Inhibit the action of enzymes that metabolise norepinephrine and serotonin, inhibit dopamine.
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
Also used with panic and other anxiety disorders.
CYCLIC ANTIDEPRESSANTS
Antidepressant
Inhibit reuptake of norepinephrine and serotonin.
Also used for panic and other anxiety disorders, pain relief.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Antidepressant
Selectively inhibit reuptake of serotonin.
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Sertraline (Zoloft)
Also used for eating disorders, OCD, social phobia.
Increase the risk of suicidal thoughts in people under 18.
MOOD STABILIZERS
- Mineral salts
- Anticonvulsant medications
MINERAL SALTS
Mood stabilzer
Decrease noadrenaline, increase serotonin.
Lithium carbonate (Lithium)
Used for bipolar.
ANTICONVULSANT MEDICATIONS
Increases level of GABA, inhibits norepinephrine reuptake.
Used for bipolar.
ANTIPSYCHOTICS
- Conventional anti psychotics
- Serotonin-dopamine antagonists (atypical anti psychotics)
CONVENTIONAL ANTI PSYCHOTICS
Antipsychotic medication Block post synaptic dopamine receptors - Chlorpromaxine (Thorazine) - Haloperidol (Haldol) Also used for Tourette syndrome.
SEROTONIN-DOPAMINE ANTAGONISTS (ATYPICAL ANTIPSYCHOTICS)
Antipsychotic medication.
Block activity of both serotonin and/or dopamine, also affect norepinephrine, acetylcholine.
PSYCHOSTIMULANTS
Attention disorders.
Release norepinephrine, dopamine, serotonin in the frontall regions of the brain, where attention and behaviour are regulated.
- Methylphenidate (Ritalin, Concerta)
- Amphetamine (Adderall)
SIDE EFFECTS OF PSYCHOPHARMATHERAPY
Most have adverse reactions. Nausea, drowsiness, weakness, fatigue, imparied sexual performance. These are reversible.
But some older antipsychotics lead to tardive dyskinesia. Involuntary moving of muscles, including face. Not reversable.
POLYPHARMACY
Prescribing many medications. Sometimes five or more. Hazardous if not carefully monitored. Particular problem with the elderly.
ELECTROCONSVULSIVE THERAPY (ECT)
Patients receive brief electrical pulses to the brain that produce a seizure to treat serious psychological problems.
Used as a last resort for serious depression, bipolar disorder, schizophrenia, and severe catatonia.
Typically 6-10 treatments, 3x a week.
Done with muscle relaxant and anesthetic.
Around 80-90% improvement.
ECT MISCONCEPTIONS
- painful
- invariably produces long term memory loss
- personality changes
- brutal
- violent convulsions
TRANSCRANIAL STIMULATION
Surgeons implant a small electrical device under the skin near the breastbone to stimulate the vagus nerve to treat severe depression.
Increases blood brain flow.
Can also use magnets.
PSYCHOSURGERY
Brain surgery to treat psychological problems.
Used to be lobotomies.
Now involves creating small lesions on the amygdala or other part of the limbic system, such as the cingulate cortex.
ANXIETY RESPONSES
Subjective- emotional - tension and apprehension
Cognitive - worrisome thoughts, inability to cope.
Physiological - increased heart rate and blood pressure, muscle tension, rapid breathing, nausea, dry mouth, etc.
Behavioural - avoidance of situations, impaired task performance.
PHOBIAS
Intense irrational fear related to a category of
object or event. Experiences flight or fight
response.
Watson -phobias are acquired by classical conditioning.
Other views:
–
we’re genetically prepared, by evolution, to fear
certain classes of objects/events
–
phobias may exist differently in different cultures
–
Phobias can occur at different times of life
–
Most social phobias arise out of shyness
ACUTE STRESS DISORDER
Symptoms 3 days to 1 month after trauma. Dissociative symptoms, such as: - numbness - intrusive distressing memories - flashbacks, etc. May predict later development of PTSD.
PSYCHODYNAMIC THEORY OF ANXIETY
Anxiety occurs when unacceptable
impulses threaten to overwhelm the ego’s defences and explode into conscious actions the ego’s defence mechanisms kick in to deal with this in the form of anxiety disorder
ASSESSMENT
Process by which a mental health professional gathers and compiles information about a patient or client for the purposes of developing a treatment plan.
