PSYC 102 Midterm 2 Flashcards
5 Historical Perspectives of Mental Illness
Shifted by prevailing cultural conceptions, society’s beliefs shape interventions.
1. Demonic Model: attributed to evil spirits infesting the body, deemed possessed by demons, witches, needed to be punished, often diagnosed & treated in brutal ways: dunking, impaled at stake, exorcism
- Moral Treatment: Dorothea Dix, less brutal, calling for kindness, dignity, respect oriented, free roaming of halls, fresh air, freely interact with staff & other patients
- Medical Model: Mental illness viewed as caused by physical disorder requiring medical treatment, sent to asylums often overcrowded, understaffed. Also had barbaric treatments (bloodletting, frighten), efficacity explained by placebo effect
- Modern Era of Psychiatric Treatment: medication in mental hospitals that effectively treated disorders marked by a loss of contact with reality, able to function independently & some returned to their families
- Deinstitutionalization: with pharmaceutical treatments showing some efficacy, many patients we able to regain function ability & some returned to their families. (1)Releasing psychiatric patients in the community, some who couldn’t support themselves long term or didn’t have family had no choice but to live on the streets with (2)closing mental hospitals
3 Issues with Medical Model
- Justifies their behavior & lose control/responsibility of their “illness”
- Diagnoses can be molded to suit political, social & business goals
- Others benefit from their illness (ex. Pharmaceutical companies, healthcare workers)
6 Criteria for Abnormality + Problems
- Statistical Abnormality/Rarity: although rare/uncommon in population, doesn’t mean it is abnormal, not all pathological, many mental illnesses are common ex. Stamp collectors are rare but it is a normal hobby, depression is common but still abnormal
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Violation of Socially-Accepted Norms: social norms are often politically motivated, not only on the basis of normality, ex. Homosexuality, Drapetomania
-Maladaptive Behavior (harmful to self): maladaptive activities are deemed normal ex. Secondary Aging (drugs, extreme sports) - Impairment: interferes with people’s ability to function in everyday life, however some conditions can produce impairment but aren’t mental disorders (ex. laziness)
- Sujective Abnormality and/or Distress: subjective, to some it is normal to others not so much, not all disorders generate distress, sometimes even less (ex. Psychopathy)
- Biological Injury/Dysfunction/Abnormality: breakdowns/failures of physiological systems, not often visible to others (ex. schizophrenia), however some are acquired from experiences (ex. Phobias) and weak genetic predisposition to trigger them
- Family Resemblance View: mental disorders don’t all have one thing in common
Common Myths about Psychiatric Disorders
- Psychological Disorders are Incurable
- People with psychological disorders are violent & dangerous
-Previous violent behavior are the greatest predictors of future violence
-People with psychological disorders are more likely to be victims of violence - People with psychological disorders behave in strange & bizarre ways & are very different from normal people
DSM + 5 Purpose + 6 Criticisms + 4 Account for Cultural Diffs
Provides an exhaustive classification system for every possible mental disorder, a list of diagnostic criteria for each condition, and a set of decision rules for deciding how many of these criteria need to be met
Several Purposes:
1. Pinpoint psychological issue
2. Guide treatment choices
3. Allow clinicians to communicate
4. Please insurance companies who require a concrete diagnosis (Ex. Gender Dysphoria: needed for insurance but stigmatizes transgender)
5. Permit research via categorization
Criticisms:
* Assumes that people can reliably be placed in discontinuous (non-overlapping) diagnostic categories
* People often have comorbidities, unreliable, invalid
* Enormous overall between various disorders in symptoms, Reliance on categorical model: no-inbetween, kind not degree differing categories, dimensional model is better differ from normal functioning in degree, not kind, continuum with normality
* Szasc argues mental illness is a social construct, names given are no different than from the demonic model, stigmatizes
* 300+ disorders don’t meet criteria for validity
* Diagnostic criteria+decisions are based on primarily scientific findings & subjective committee decisions
* Medicalize normality: classify mild disturbances as pathological
Features
* Info on how differing cultural backgrounds can affect the content & expression of symptoms to prevent incorrect label merely because of behaviors culturally unfamiliar or unusual
* Warns about physical or medically induced conditions that simulate certain disorders (ex. substances, physical illnesses)
* Info concerning prevalence
* Biopsychosocial approach: acknowledges interplay of bio, psycho & socio influences
Why might some people develop mental disorders while others don’t?
Due to a combination/interaction of multiple genes & experiences/learning.
7 Mood Disorders
- Major depressive disorder: Chronic or recurrent state in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss and sleep difficulties
- Manic episode: Markedly inflated self-esteem or grandiosity, greatly decreased need for sleep, much more talkative than usual, racing thoughts, distractibility, increased activity level or agitation, and excessive involvement in pleasurable activities that can cause problems (like unprotected sex, excessive spending, reckless driving)
- Bipolar disorder I: Presence of one or more manic episodes
- Persistent depressive disorder (dysthymia): Low-level depression of at least two years’ duration; feelings of inadequacy, sadness, low energy, poor appetite, decreased pleasure and productivity, and hopelessness
- Hypomanic episode: A less intense and disruptive version of a manic episode; feelings of elation, grouchiness or irritability, distractability, and talkativeness
- Bipolar disorder II: Patients must experience at least one episode of major depression and one hypomanic episode
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Cyclothymic disorder: Moods alternate between numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Cyclothymia increases the risk of developing bipolar disorder.
8.** Postpartum depression**: A depressive episode that occurs within a month after childbirth in up to 15 percent of mothers. A much more serious condition, postpartum psychosis, occurs in about 1 or 2 per 1000 childbirths
Diagnostic Criteria for Major Depression
Major Depressive Episode: state of lingering depressed mood or diminished interest in pleasurable activities with symptoms that include weight loss & sleep difficulties
- 5+ of symptoms present during the same 2-week period & represent a change from previous functioning; at least 1 symptom is either (1) or (2) (Do not include symptoms that are clearly attributable to another medical condition)
1. Depressed mood MotD NED, indicated by either subjective report or observation made by others (In children & adolescents can be irritable mood)
2. Anhedonia, markedly diminished interest or pleasure in almost/all activities MotD NED, indicated by either subjective report or observation made by others
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite NED (In children, consider failure to make expected weight gain)
4. Insomnia or hypersomnia NED
5. Psychomotor agitation or retardation NED observable by others, not merely subjective report
6. Fatigue or loss of energy NED
7. Feelings of worthlessness or excessive or inappropriate guilt, maybe delusional, NED, not merely self-reproach or guilt about being sick
8. Diminished ability to think or concentrate, or indecisiveness, NED by subjective report or observed by others
9. Recurrent thoughts of death (not just a fear of dying), recurrent suicidal ideation without a specific plan - Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
- Episode is not attributable to the physiological effects of a substance or to another medical condition
- Occurrence of the major depressive episode is not better explained by specified & unspecified schizophrenia spectrum & other psychotic disorders
- There has never been a manic episode or a hypomanic episode
8 Factors Influencing Depression & Mood Related Disorders
- Genetic Vulnerability:
- Biological/Neurochemical Mechanisms: abnormal levels of serotonin, norepinephrine & low dopamine. Correlation with decreased hippocampal volume from neurogenesis suppression, problems in reward & stress response systems
- Behavioral Model: low rate of response-contingent positive reinforcement (trying things with no payoff>gives up, withdraw or continue to get sympathy)
- Cognitive Model/Factors: depression caused by negative schemas; beliefs & expectations, cognitive triad (self, world, future) causes learned helplessness. Cognitive Distortions: skewed ways of thinking, selective abstraction: negative conclusions based on isolated aspect of a situation, glasses filtering out all of life’s positive experiences, brings negative into focus, depressive realism: more accurate view of circumstances with mild dep. Those not depressed experience opposite illusory control.
- Learned Helplessness Lab: tendency to feel helpless in the face of event we can’t control, dogs restrained to shock machine gives up even when unrestrained, unrestrained easily jumps, Attribute failures to internal factors & successes to external factors. See failures due to stable global fixed personality factors
- Interpersonal Facotrs/Vicious Cycle: depressed people can be depressing to others, elicit hostility & rejection from others seek excessive reassurance, less positive reinforcement, find partners that reinforce negative self views (assortative mating), maintains worsens depression (graph)
- Life Events/Stress: lost or are about to lose something of much value, major life events, loss of self-worth, relationships, health, depression can set up negative life events
- Cultural Factors: depression predicted from size in difference between how we feel and how we want to feel (actual affect vs ideal affect), ex. value excitement over calm
Difficulties of Living with Depression
Empty, life slowed down, physically weak, no more pleasure from activities that used to, dark glasses, ruin appetite, chewed memory or concentration, lack of social confidence, fear of stigma, shame, repetitive think say negative things, irritable, hurt others, self-medication, isolation, no cure, be emotional authentic & genuine
Seasonal Affective Disorder + Treatment
Seasonal Affective Disorder (SAD): form of depression that follows a seasonal patterns, linked to circadian rhythms & melatonin usually during winter/rainy
Treatment: spending time in front of very bright lamps for 15-30 minutes each day during winter months, regular sleep & exercise
Bipolar Disorder DSM Criteria
Bipolar Disorder (manic depressive): 1+ manic episodes & periods of depression
Bipolar 1 Disorder: 1+ manic episode, symptoms cause social/occupational distress or impairment & not better accounted for by disorders on the Schizophrenic spectrum, depression not required
Manic Episode - DSM Criteria: distinct period lasting 1w MotD NED of abnormally & persistently elevated/expansive mood & increased goal-directed activity/energy, symptoms don’t meet criteria for a Mixed Episode, causes social/occupational impairment/hospitalization/psychotic features, not due to substance or medical condition, 3+ of following symptoms present to a significant degree
* Inflated self-esteem/grandiosity, involvement in activities that have high potential for “painful” consequences
* Increase in talking, pressure to keep talking, goal-directed activity or psychomotor agitation
* Flight of ideas or subjective experience that thoughts are racing
* Distractibility, as reported or observed
* Decreased need for sleep
Bipolar 2 Disorder: 1+ hypomanic episode & 1+ major depressive episode, never a manic or mixed episode
Hypomania: symptoms present for 4 days (not 7) doesn’t impair social or occupational functioning, require hospitalization, no psychosis
Major Risks Associated with Bipolar
High recurrence/lifelong, suicide, death, disability, exacerbated by non-complience of Bipolar patients
Schizophrenia Criteria
2+ symptoms present 1-month period for significant portion of time or less if successfully treated, 1 must be delusion, hallucination or disorganized speech, continuous signs of disturbance persist for at least 6 months, significant time level of functioning below level achieved prior to onset (work, interpersonal relations, self-care) not attributable to substance or other medical condition, most severe disabilities job, relationship
Positive (Adding) Symptoms:
* Delusions: strongly held false beliefs not bound by reality often involve being persecuted (paranoid schizophrenia) is a psychotic symptom (serious distortion of reality)
* Hallucinations: sensory perceptions occurring without stimuli mostly auditory, visual more substance abuse (ex. Could be all sense, Arguing, commenting on actions, command hallucinations=risk of violence,etc.)
* Disorganized Speech: frequent derailment or incoherence, associations b/w words weakened
* Grossly Disorganized or Catatonic Behavior: motor problems, resistance to complying with simple suggestions, holding body in bizarre or rigid postures, curling up in fetal position, laugh cry swear inappropriately
Negative (Taking Away) Symptoms: treatment resistant, pervasive+persistent more than positive symptoms,
- avolition (inability to initiate+persist in goal-directed activities)
- alogia (poverty of speech) + social withdrawal
- ‘flat affect’ diminished emotional expression
- anhedonia (lack of pleasure, motivation)
- neglect of personal hygiene
RIsks + Influences on Vulnerability to Schizophrenia
Not split personality, not by bad mothers, not by bad family. Severe disabilities in life, suicide, anxiety, depression, substance abuse, homelessness, health medical problems, lack of hygiene, social isolation
- Biological: Enlarged ventricles → disorder of brain deterioration, thought disorder. Increases in size of sulci (space b/w ridges of brain), decreases in size of temporal lobes, activation of amygdala+hippocampus, symmetry, frontal lobes less active
- Neurotransmitter Differences: Abnormalities in Dopamine Receptors: these sites respond uniquely to drugs designed to reduce psychotic symptoms and are associated with difficulties in attention, memory, and motivation, link to paranoia. Schizophrenia are less impaired when their symptoms are predominantly positive (adding) rather than negative (removing)
- Genetic Findings:
Diathesis-Stress Model
Mental disorders are a product of genetic vulnerability (diathesis) & stressors/psychosocial factors trigger it.
Panic Attack
Sudden overwhelming experience of terror or fright, develops quickly, peaks within minutes consisting of shaking, sweating, accelerated heart, numbness, chills, chest discomfort, etc. can occur in every anxiety disorder, some mood & eatings disorders.
Panic Disorder Criteria + Who Sick
Panic Disorder: recurrent unexpected panic attacks, concerns about panicking or change their behavior
Display 1 of following for 1 month following attack: persistent (1)concern/ (2)worrying of implications/consequences about having another attack, (3)significant change in one’s behavior
* With Agoraphobia: display fear of being in a place/situation where difficult or embarrassing to escape or obtain help during a panic attack, often avoided
Who Sick: 2%, late teen early 20s, good prognosis (good behavioral+drug treatment) correlated with history of fear of separation from a parent during childhood
Somatic Symptom Disorder +
Illness Anxiety Disorder
Somatic Symptom Disorder: anxieties about physical symptoms, medically verified or psychological, so intent they interfere with daily living
Illness Anxiety Disorder: idea they’re suffering from a serious undiagnosed illness that no reassurance can relieve their anxiety
Post-Traumatic Stress Disorder (PTSD) Criteria + Who Sick
Post-Traumatic Stress Disorder (PTSD): intense fear, helplessness, horror (disorganized/agitated behavior in children) resulting from the experience of an extremely traumatic event 3 months following
Symptoms present for >1 month, cause significant distress/impairment in social/occupational or other
* Persistent replaying of traumatic event (reliving, distress)
* Avoidance of stimuli associated
* Numbing responsiveness,
* increased autonomic arousal
Who Sick: 8%, 35-50% rape victims, military, help captive, lived through genocide
Anxiety Related Disorders
Most prevalent.
1. Panic Disorders
2. PTSD
3. OCD
4. Phobias
5. GAD
Obsessive-Compulsive Disorder (OCD)
Extreme o+c, no other identifiable disorders, not infatuation or perfectionism
Obsessions: unresistable intrusive repetitive inappropriate persistent thoughts, impulses/images not just real-life problems, attempts are made to ignore or suppress/neutralize with other thoughts/action, recognize they’re a product of their own mind, cause distress
Compulsions: excessive repetitive ritualistic behavior, compelled to perform according to self made rules, focused on preventing/reducing distress/preventing dreaded outcome, not realistically connected to what they’re designed to reduce/prevent, relieve shame/guilt
Who Sick: 2.5% F=M, late teens - early 20s, good prognosis, at least 1 hr per day immersed in o+c
Related to Tourette’s disorder: motor+vocal tics, twitching, facial grimacing, grunting, throat clearing
Phobias
Phobias: most common of all anxiety disorders 1/9
Social Anxiety Phobia: strong persistent fear of social/performance situations where embarrassment with severe physiological reactions may lead to panic attack
Specific Phobia: excessive persistent intense fear & anxiety cued by presence or anticipation of specific object/situation may culminate in a panic attack, restrict lives, create considerable distress
Widespread in childhood, usually disappear with age
Agoraphobia: most debilitating, onset mid-teens, usually direct outgrowth of panic disorder
Generalized Anxiety Disorder (GAD) + Who Sick + 3 Explanations
Excessive anxiety/fear related to many events/activities, multiple features of other anxiety disorders
**Who sick: ** 3%, 60% of day worrying compared with 18%, develops following a major stressful event, F>M, middle aged, widowed, divorced, poor, prone to self-medication
Learning Models: operant/reinforcements/punishments maintains fears, observations, misinfo/info
Ex. Socially awkward repeatedly experiences rejection/avoidance → social anxiety disorder
Catastrophizing: predicting terrible events despite their low probability
High levels of Anxiety Sensitivity: fear of anxiety-related sensations
Biological Influences: genes impact levels of neuroticism - tendency to be high strung & irritable, brain abnormalities
4 Dissociative Disorders
Dissociative Fugue: sudden unexpected travel far from home or workplace, loses memories of entire lives & sense of personal identity
Dissociative Identity Disorder (DID): coexistence in 1 person 2+ largely complete, usually very different personalities, with own name, memories, traits & physical mannerisms, extremely controversial & fad induced
F>M, 1-4500 alters, physiological differences
Dissociative Amnesia: sudden loss of memory for important personal info to extensive to be due to normal forgetting (ex. Memory loss of traumatic events)
Controversy: nontraumatic events have memory gaps, traumatized not motivated to recall upsetting events, other factors can explain in studies
Depersonalization Disorder: feeling detached from self, watching oneself form outside of one’s body
Experience multiple episodes of depersonalization, derealization, or both
Derealization, the sense that the external world is strange or unreal, often accompanies both depersonalization and panic attacks
DID Controversy
No conclusive evidence of existence, cause a response to early trauma (posttraumatic model) > compartmentalize identity to cope with intense emotional pain, or is it a consequence of social and cultural factors (sociocognitive model) popular media, therapists, shaped by societal shifts
Personality Disorders + Criteria
Least reliably diagnosed, usually comorbid with each other & other mental disorders, only a few extensively systematically reviewed
DSM: condition in which personality traits, appearing first in adolescence, are inflexible, stable, expressed in a wide variety of situations & lead to distress or impairment
Abnormal behavior depends on context
Antisocial Personality Disorder: physically & verbally abusive, destructive, frequently in trouble with the law, lack empathy & remorse, reckless & impulsive
Borderline Personality Disorder: intense extremes b/w positive & negative emotions, unstable sense of self, impulsivity & difficult social relationships
* Self-Destructive Quality: drug abuse, overeating, self-mutilation, manipulation, jump between unhealthy relationships.
* Who: 2% F>M
Psychopathic Personality (not formal or in DSM): superficial charm, dishonesty, manipulativeness, self-centredness & risk taking
* Who Sick: M>F, seek out people with this as friends or lovers, aren’t physically aggressive, higher risk for crime, aren’t psychotic but entirely rational, know actions are morally wrong just don’t care, populate jails, leadership positions
* Causes: correlation with deficit in fear, aren’t motivated to learn from punishment, underaroused seek out excitement when bored
Antisocial Personality Disorder: lengthy history of irresponsible and/or illegal actions
Borderline Personality Disorder Explanations
Childhood: Problems developing sense of self & bonding emotionally to others in childhood (ex. Cold unempathetic mother > can’t integrate difference perceptions of people+themselves, Tend to split people+experiences into all good or all bad > unstable experience)
Sociobiological Model: heritable tendency to overreact to stress, lifelong difficulties regulating emotions
Emotional Cascade Model: intense rumination about negative/emotional events may result in uncontrolled self-injurious actions, succeed in providing brief distraction, often fuel further bouts of rumination, creating a vicious cycle of problems with regulating emotions
Insanity Defense
Legal system assumes actions are freely chosen, scientific psychology assumes actions are determined by prior variables genetics + learning
Insanity/Mental Disorder Defense: used in courts of law, not psychologists, that an individual shouldn’t be held criminally responsible if they were not in their “right mind” (in Canada mental disorder) during the time of the crime, for those who lack free will
* **M’Naghten Rule: **insanity exists when person with mental disorder can’t tell right from wrong at time of crime or what they were doing at the time
* Outcomes: absolute discharge, conditional discharge, ordered to a mental institution
Automatism: one shouldn’t be held responsible if they had no control over their behavior (sleep walking, sustained physical blows, carbon monoxide poisoning, seizures)
Unfit to Stand Trial: because of mental disorder, defendant is incapable to communicate with lawyers, understand the legal proceedings or their consequences
Involuntary Commitment: placing some people with mental illnesses in a psychiatric hospital or other facility based on their potential danger to themselves or others, or their inability to care for themselves only formally approved by a judge, 2 psychiatrist or other physicians can place an emergency hold on patients for a brief period of time, patient is legally entitled to a judicial hearing after (impedes on civil liberties, can be misdiagnosed)
Insanity Defense Misconceptions
- Determination of qualifying for the mental disorder defense rests on a determination of a person’s mental state at the time of the crime, no current.
- Competence to stand trial bears on the defendant’s ability to assist in their own defense
- 1% of criminal trials, ¼ successful, usually delivered by judges not juries, juries aren’t fooled
- Acquitte spends close to 3 years in psych hospital, often longer than the length of criminal sentence, don’t go free
- Faking mental disorder appear low
Psychiatric Stigma
Stereotypical negative attitudes against people who have a mental illness label (devastation of being invisible, shameful, toxic makes situation unbearable).
Prevent people from seeking help, labels, stigmatizes.
3 Levels of Stigma + How to Reduce
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Self-Stigma (Internalized): negative feelings about self, maladaptive behavior, identity transformation, or stereotype endorsement resulting from an individual’s experiences, perceptions or anticipation of negative social reactions on the basis of their mental illness
* Perceived Stigma: individual’s beliefs about the attitudes of others to mental illness
* Reduce: (1)interventions that alter stigmatizing attitudes & beliefs (ex. Cognitive Behavioral Therapy), (2)improve skills for coping/improving/empowerment/help-seeking behavior -
Social Stigma (Public): social groups endorsing stereotypes about & acting against a stigmatized group, can lead to self-stigma
* Reduce: educate & dispel myths, increased contact with those living with mental illness -
Structural Stigma: policies & practices of institutions in positions of power, systematically restrict the rights & opportunities for people living with mental illnesses
* Reduce: contact-based training & education programs for medical students, police, counselors, etc.
4 Theories for Why Stigma Exists
Evolutionary Theories: naturally selected programs designed for disgust/avoidance of contamination from individuals & anger/punishment others who don’t reciprocate socially who display low social capital
Social Psychological Theories: individuals with mental illness prone to be categorized into on out-group, stigmatizing outgroup member provides a boost to self esteem of those in in-group
Terror Management Theory: thoughts of disorder & demise prime, inspires defensive & stigmatizing responses (how could that be me)
Perceptions of Dangerousness: media portrayals of individuals with mental illness emphasize a high potential for violence
Psychoanalysis/Pschodynamic Therapies + Crits
Psychoanalysis: first forms of psychotherapy, make the unconscious conscious by bringing to awareness previously repressed impulses, conflicts & memories, recovery of unconscious conflicts, motives & defenses through techniques of free association, transference, dream interpretation, Freud emphasized sexuality & aggression as roots of internal conflict that results in abnormal thoughts & behaviors
* Conscious: contains thoughts, feelings, images presently aware
* Preconscious: contains info you’re not presently thinking about, can be easily retrieved
* Unconscious: part of mind holding thoughts & memories about which person is unaware revealed via slips of tongue, dreams, psychoanalysis
Crits: understanding/insight on emotional history is not required to relieve psychological distress, to improve, one must practice new adaptive behaviors to engage in working through, difficult to falsify interpretations/transference/reaction, based on small samples unclear external validity non-systematic unreplicable uncontrolled
* Repressed Memories: unsettling events are usually more memorable, not repressed.
* Effectiveness: better than no treatment, less effective than CBT-don’t emphasize insight, not effective for psychotic disorders
3 Approahces & Beliefs of Psychodynamic Therapists
Causes of abnormal behaviors, including unconscious conflicts, wishes, and impulses, stem from traumatic or other adverse childhood experiences
Strive to analyze (a) distressing thoughts and feelings that clients avoid, (b) wishes and fantasies, (c) recurring themes and life patterns, (d) significant past events, and (e) the therapeutic relationship
Clients achieve insight into previously unconscious material, the causes and the significance of symptoms will become evident, often causing symptoms to disappear
Features of Modern Psychodynamic Therapies
- Free Association: clients spontaneously express their thoughts & feelings exactly as they occur, with as little censorship as possible, analyst studies free associations for clues about what is going on in the client’s unconsciousness
- Dream Analysis: clients encouraged & trained to remember dreams, therapist interprets symbolic meaning of them
- Interpretation: therapist attempts to explain the inner significance of the client’s thoughts, feelings, memories & behaviors. Analysts don’t analyze everything, look for patterns & don’t typically provide dramatic revelations
- Resistance: treatment brings up unconscious material that the client wishes to avoid, engaging in strategies for keeping the info out of conscious awareness (ex. Skipping sessions, draw blank), analysts make clients aware they’re unconsciously blocking efforts, how & what they’re resisting
- Transference: clients direct emotional experiences/feelings/expectations that they’re reliving toward the therapist, rather than OG person involved in experience. Provides a vehicle for clients to understand irrational demands of others as we indeed react to people in present lives in ways similar to people in our past
- Working Through: final stage, therapist helps client resolve issue(s) uncovered in therapy. Repeatedly address conflicts and resistance to achieving healthy behavioral patterns and help clients confront old and ineffective coping responses as they re-emerge in everyday life
Humanistic Therapies + Roger’s Person Centered Therapy
Humanistic Therapies: emphasizes development of human potential & the belief that human nature is basically positive, reject psychoanalysis, assuming responsibility for decisions, not attributing them to the past, living fully, finding meaning in the present.
* Effectiveness: can be falsified, strong alliance is helpful to success. 3 core aspects aren’t necessary and sufficient for improvement. Self help programs exist. Improvement than strong bond, the reverse.
Person (Client) Centered Therapy: emphasizes providing supportive emotional climate for clients, who play a major role in determining the pace & direction of therapy, not to be clever guide client nondirective
* Realize don’t always have to please others/win acceptance
* Respect own feelings & values
* Restructure self-concept to correspond better with reality
* Ultimately foster self-acceptance & personal growth
* Focus on the therapeutic alliance: emotional bond b/w therapist & client, along with agreement on goals & tasks of therapy
Effectiveness: studies show it is no more effective than no treatment or comparable to CBT: studies show it is no more effective than no treatment or comparable to CBT
3 Conditions for Safe Emotional Climate for Therapy
Genuine Acceptance: therapist should be honest & spontaneous, not phony or defensive, authentic, genuine, reveal own reactions
Unconditional Positive Regard: therapist shows complete non-judgemental acceptance of the client as a person
Empathy: therapist must provide accurate empathy for the person by way of reflection-mirroring back feelings
Psychoanalysis vs CBT
See Graph
Family Therapy
Family Therapy: systems approach, requires willing members
* Focus on dynamics, interactions & communication often used to help families deal with specific members who are highly dysfunctional (ex. Addictions, poor emotional control, schizophrenia/bipolar)
* Help family know how to react, to not perpetuate behavior by isolating, accepting blame
* Identify the family’s unhealthy communication patterns and its unsuccessful approaches to problem solving. Then, they invite family members to carry out planned tasks known as directives-shift how family members solve problems and interact. They often involve paradoxical requests, which many of us associate with the concept of “reverse psychology. Success when resistant uncooperative unit to intentionally produce thought, feeling or behavior that troubled them
* Strategic Family Intervention: remove barriers to effective communication
* Structural Family Therapy: therapist actively immerses themself in the everyday activities of the family to make changes in how they arrange and organize interactions
Effective: more than none, as effective as individual
Group Therapy
Group Therapy: share personal stories & experiences, bonding & support occurs 4-15 (8 ideal) with similar psychological problem, age, sex, less costly, efficient, time saving, as effective as individual treatments
Therapist’s Role: selecting participants, setting session goals & guidelines, initiate & maintain the therapeutic process, protect clients from harm, promote cohesiveness
Client’s Role: function as therapists for each other, describe problems, share coping strategies & trade viewpoints, provide acceptance & emotional support
Alcoholics Anonymous (AA): self-help program based on 12 steps that provides social support for achieving sobriety, sponsored/mentored by senior members, assumes alcoholism is a physical disease, never drink after entering treatment, no clear research on it treatment programs that encourage people with alcoholism to set limits, drink moderately, and reinforce their progress, teaching coping/tolerance skills can be effective
* Abstinence Violation: a slip can lead to continued drinking, thus removing stigma is imperative
Behavioral Therapies
Behavioral Therapy: all behaviors are learned and that behaviors can be changed. This form of therapy looks to identify and help change potentially self-destructive or unhealthy behaviors, current not history.
Classical + Operant Behavioral Therapies
Systematic Desensitization: used for treating phobias, classical conditioning taught to relax as they are gradually exposed to what they fear in a stepwise manner, earliest exposure therapy, counterconditioning pairing incompatible
* Reciprocal Inhibition: can’t experience 2 conflicting responses simultaneously (ex. Relaxed & anxious at the same time)
* Anxiety Hierarchy: identifying & imagining situations that climbs from least to most anxiety provoking, any anxiety at any point, process is intterupted & help return relax
* Effectiveness: measured using dismantling-examining effectiveness of isolated components of broader treatment, no single component of desensitization is essential can be variety of approaches, may fare no better than placebo
Flooding therapists jump right to 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 even several hours. Provokes anxiety repeatedly in the absence of actual negative consequences so that extinction of the fear can proceed
**Token Economy: **certain behaviors rewarded with tokens later exchanged for tangible rewards, crits: don’t generalize, impractical,
Aversion Therapy: punishment to decrease the frequency of undesirable behaviours crits: mixed, ethicality must be considered
Modeling Behavior Therapies
Modeling in Therapy: observing therapists that model positive behaviors, treating (although not curing) schizophrenia, autism, depression, attention-deficit/hyperactivity disorder (ADHD), and social anxiety
Participant Modeling: therapist models a calm encounter with the client’s feared object or situation, and then guides the client through the steps of the encounter until they can cope unassisted
Assertion Training: therapists teach clients to avoid extreme reactions to others’ unreasonable demands, such as submissiveness on the one hand and aggressiveness on the other hand. Assertiveness, the middle ground between these extremes, is the goal.
Behavioral Rehearsal: client engages in role-playing with a therapist to learn and practise new skills, offered coaching, feedback, encouraged to practice skills outside
CBT + 3 Waves + Effectiveness
Cognitive Behavioral Therapy: varied combinations of verbal interventions & behavior modification techniques to help change maladaptive patterns of thinking, no history, all current, considers all aspects of client (gender, race, socioeconomic, culture, sexual orientation), evaluates effectiveness throughout therapy, apply new coping skills
3 Core Assumptions: (a) Cognitions are identifiable and measurable; (b) cognitions are the key players in both healthy and unhealthy psychological functioning; and (c) irrational beliefs or catastrophic thinking, such as “I’m worthless and will never succeed at anything,” can be replaced by more rational and adaptive cognitions
Therapist’s Role: help clients become more aware of the thought, emotion, & behavior patterns that arise in their current lives, behavioral change results from the operation of basic principles of learning, especially classical conditioning, operant conditioning, and observational learning
Client’s Role: learn to identify their habitual dysfunctional tendencies (ex. Journals, diaries, schedules), then work on building more functional cognitive & behavioral habits
1st Wave - Behavioral Component: clients given exercises, guidance, practice in gaining skills they may be lacking, techniques including:
* Systematic monitoring of one’s behaviors, modeling, behavioral rehearsal
2nd Wave - Cognitive Component: clients given exercises & strats to track negative thoughts then build more functional cognitive habits
* Cognitive Restructuring: challenge negative thought patterns, question self-defeating beliefs, view situations in a different light
3rd Wave: assist clients with accepting all aspects of their experience that they’ve avoided or suppressed, eclectic-integrate many techniques+theories, behavioral activation-participation in reinforcing activities
Effectiveness:
* They’re more effective than no treatment or placebo treatment
* They’re at least as effective and in some cases more effective than psychodynamic and person-centred therapies, as drug therapies for depression.
* In general, CBT and behavioral treatments are about equally effective for most problems.
CBT Therapies
Rational Emotive Behavioral Therapy: assumes unhealthy people frequently engage in catastrophic thinking about their problems, therapists encourage clients to actively dispute (D) their irrational beliefs and adopt more effective (E) and rational beliefs to increase adaptive responses
Beck’s Cognitive Therapy: emphasizes identifying and modifying distorted thoughts and long-held negative core beliefs
Stress Inoculation Training (Vaccine): “inoculate” clients against an upcoming stressor by getting them to anticipate it and develop cognitive skills to minimize its harm
Ineffective Therapies Sometimes Appear Effective
- Spontaneous Remission: common many phys/psych disorders get better without treatment thus must be compared to untreated/waitlisted patients
- Placebo Effect: improvement due to the mere expectation of improvement
- Regression to the Mean: extreme scores tend to become less extreme with retesting. In cases of rock bottom, only improvement to the mean is possible, misinterpret the treatment as effective
- Self-Serving Biases: investment of time & money persuades that treatment is effective, overweighs evidence of efficacy while downplaying evidence of treatment failure
- Retrospective Rewriting of the Past: expectations of treatment efficacy color one’s memory, misremembering previous symptoms as worse than they actually were
Challenges to Determining Effectiveness of Therapy
- Severity of depression, more severe more effective
- Researchers may have financial or ideological interests
- Underlying unsolvable socio-cultural-economic factors
- Meta-analysis reveals psychotherapy works in alleviating human suffering
- Socioeconomic status, gender, race, ethnicity, and age typically have little or no bearing on the outcome of therapy
- Nonspecific Factors: cut across many/most therapies are responsible for improvement across diverse treatments, motivation to change, key ingredients (empathy, hope, strong emotional bond, social skills, offer new ways of thinking)
- Scientist-Practitioner Gap: b/w psychologists who view it as an art vs as scientific, ranking therapies is unreliable as they are subjective in nature, some are understudies
Costs Associated with Drug Treatments
Critics charge that psychologists don’t possess sufficient knowledge of the anatomy and physiology of the human body to adequately evaluate the intended effects and side effects of medications, one dose doesn’t fit all, harmful & overprescribed, concern of polypharmacy-prescribing many medications, are of little value in helping patients learn social skills, modify self-defeating behaviors, or cope with conflict
NTs
Monoamine Oxidase Inhibitors (MAOIs): inhibits degrading enzymes, increases concentrations of monoamine NTs, many side effects
“Cheese effect”, breaks down tyramine → surges of blood pressure that can lead to stroke for those who eat tyramine-rich foods
Tricyclic Antidepressants: blocks reuptake of serotonin & norepinephrine, safer than MOAIs
Selective Monoamine Reuptake Inhibitors (SSRIs): most well known used, overprescribed for other “disorders” with side effects worse than condition (self-esteem, fear of failure, excessive sensitivity to criticism)
Weight gain, sexual dysfunction or loss of interest
Atypical Antidepressants: heterogenous group of antidepressants with own unique actions
Bupropion: increasingly popular, favorable side effect profile, inhibitor of dopamine & norepinephrine reuptake
6 Non-Pharma Treatments
Cognitive-Behavioral Therapy (CBT): effective for mild-moderate depressions, combined with pharma for severe depression as only more effective than placebo by itself.
No effects on remission (returning to normal social functioning), suicidality or quality of life
Sleep Deprivation: brief improvement in 60%, REM deprivation produce more enduring effects, more effective in combo with antidepressants and/or light therapy
Electroconvulsive Therapy (ECT): electric currents pass through brain, triggering a brief seizure & changes in brain chemistry as last resort for severe or treatment resistant depression, bipolar, schizophrenia, severe catatonia
Not dangerous, patients happy to have received would receive again, less frightening, improvement rates high, isn’t a cure relapses, increases levels of serotonin, stimulates growth of hippocampus, not just placebo
Short term confusion, clouded memory, weigh benefit vs cost
Repetitive Transcranial Magnetic Stimulation (rTMS): large electromagnetic coil placed against scalp near the forehead, creates electric currents that stimulate nerve cells in regions involved in mood control & depression, few if any side effects
Exercise: high intensity aerobic or anaerobic forms as effective as pharma (although quicker) or psych therapies, have longer lasting effects
Psychosurgery: last resort for those with handful of conditions, radical, controversial, costs of impairing basic function+death outweighs benefits, historically punitive, precision improved, REB ensures ethics
Cyclothymia Criteria
Cyclothymia : chronic less severe form of bipolar disorder, mood alternate b/w hypomanic & depressive symptoms over 2 years, no evidence of mania, hypomania or major depression during this time, increases risk of developing bipolar disorder
Who Sick: 1% F=M, strong tendency to run in families, onset 18-22
Comorbidities: anxiety, substance use, migraine headaches, cardiovascular disease
Mood Patterns: mixed episode higher rates of suicide as high energy depressed state
Rapid Cycle: 4+ mood changes/cycles in a year
Bipolar Disorder Explanations
Genetics: Most genetically influenced of all mental disorders, 85% heritability from twin studies. Increased sensitivity of dopamine receptors, decreased serotonin boosts risk of bipolar disorder.
Brain Structures: Increased activity in emotion centers, less in planning
Stressful or Positive Life Events
Major Depression Who SIck + Gender+ Major Risks
Who Sick: onset 15-24, “Common cold of psych disorders, increasing” Women 10-25%> Men 5-12% will experience clinical depression at least once in their lives, theories
- Gender-related differences in physiology
- Sociocultural norms, men are generally more reluctant to seek treatment; and they’re more likely to regard depression as a weakness
- Alcoholism, higher incidence in men, might mask depression or self medication
- Gender-specific social factors & traumas
Major Risks: completed suicide in 8-15% with major depressive disorder, greater physical illnesses & decreased physical & social functioning, recurrent/chronic avg 5-6 times in a lifetime 6-12months
4 Mood Disorders
Medical Students’ Disease: condition where med students believe they’re experiencing the symptoms of a disease that they’re studying
Postpartum Depression: A depressive episode that occurs within a month after childbirth in up to 15 percent of mothers
Postpartum Psychosis: command hallucinations to kill the infant or delusions that the infant is possessed by an evil spirit
Premenstrual Dysphoric Disorder: Occurs in females during the final week before the onset of menses, with marked mood swings, irritability, anger, and anxiety
Persistent Depressive Disorder: Low-level depression of at least two years’ duration; feelings of inadequacy, sadness, low energy, poor appetite, decreased pleasure and productivity, and hopelessness
Disorder Validity Criteria
(1)distinguishes a particular diagnosis from other similar diagnoses, (2)predicts performance on lab tests (3)family history of psychiatric disorders (4)what happens to the individual overtime (5)response to treatment
Other Humanistic Therapies
Motivational Interviewing: one- to two-session procedure recognizes that many clients are ambivalent about changing long-standing behaviors and is geared toward clarifying and bringing forth their reasons for changing—and not changing—their live (exercise, diet, alcohol problems)
Gestalt Therapy (2 Chair): integrate different & sometimes opposing aspects of personality into a unified sense of self, key to personal growth is accepting responsibility for one’s feelings and maintaining contact with the here and now.
2 Chair Technique: client moves chair to chair, dialogue b/w conflicting aspects of personality for synthesis of both
Carl Rogers Diagram
Affection is conditional - need to feel worthy distort shortcomings - incogruent self concept - recurrent anxiety - defnesive beahvior protects self-concept - incongruent self concept - loop
7 Types Of Therapy
- Insight Therapies: psychodynamic
- Humanistic Therapies: Person Centered Therapy
- Family Therapy
- Group Therapy
- Cyber Therapy
- Behavioral Therapy: focuses on the present and the client’s current behavior, Behavioural therapy is grounded in the scientific method and based on learning principles.
- Cognitive Behavioral Therapy: addresses past experiences and how they contribute to current behavior, modify irrational and negative beliefs and distorted thoughts that contribute to unhealthy feelings and behaviours
Effectiveness of Therapies
- behavioural, psychodynamic, and person-centred approaches have found that all are more successful in helping clients compared with no treatment but no different from each other in their effects
- behavioural and cognitive-behavioural treatments are clearly more effective than other treatments for children and adolescents with behavioural problems + consistently outperform most other therapies for anxiety disorders, including phobias, panic disorder, and obsessive–compulsive disorder
- 5 to 10percent, become worse following psychotherapy
