Psych 2101 Flashcards
- What is a mental disorder?
A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning.
- What is classification?
Classification is “the act or process of dividing things into groups according to their type”(Cambridge dictionary)
Mental disorders, however, are classified by symptoms that meet specific “diagnostic criteria”.
- Why should we classify mental disorders?
Most medical disorders are classified by results of biological testing. * Ex. Diabetes and fasting glucose + glucose tolerance test
Mental disorders are classified by observable behaviours (signs) and self-reported feelings and thoughts (symptoms).
Who is emil kraepelin? (Defined 15 categories of mental disorders based on common patterns of symptoms, Most famous for the “Krapeliniandichotomy”: dementia praecox (schizophrenia) vs manic depression)
Why should mental disorders be classified at all?
It’s debatable, but there are some good reasons:
* Provides a common vocabulary across psychologists, psychiatrists, GPs, social workers, governments, etc.
* Provides a guide for treatment
* Can be used in legal settings → see if they are fit to stand trial or lesser sentencing
Some disadvantages:
* Stigma
* Changes self-concept (e.g., being “abnormal”)
* Insurance problems
- How do we classify mental disorders?
categorical approach
dimensional approach
transdiagnostic approach
what is the categorical approach
The categorical approach
Based on DSM-V or ICD-11 criteria
Diagnostic categories include disorders, subtypes, and changes overtime
There are 22 diagnostic categories in the dsm5
Limitations of the categorical approach
Including a disorder in the DSM or ICD makes people believe that the disorder is real
* A real category, different from others. → isolates people
* Ignores overlap between disorders.
* People classified with the same disorder may have few symptoms in common.
(eg internert gaming disorder)
Example of categories not matching reality → a platypus
what is the dimensional approach
The dimensional approach
* Not yes or no (i.e., you’ve got it or you don’t), but how much?
* Each i* Most mental disorders can be described along a number of symptom dimensions individual receives a score on several different ‘dimensions’ of psychopathology. This includes emotional symptoms (fear), cognitive symptoms (fear of losing control/dying/derealisation), and physical symptoms (sweating)
Example
* Hallucinations and delusions are distributed continuously in the population.
* Subclinical psychotic experiences (8%)
* Subclinical psychotic symptoms which are associated with a degree of distress and help-seeking behaviour but do not necessarily amount to clinical psychotic disorder (prevalence
around 4%).
* Psychotic disorder (3%)
Beck Depression Inventory is a dimensional approach
Minnesota Multiphasic Personality Inventory (MMPI)
First developed in 1943, updated in 1989, 2008, and 2018
* 10 ‘dimensions’ (clinical scales) of psychopathology along which people differ e.g., hypochondriasis (HS), depression (D), paranoia (PA), psychasthenia (PT), hypomania (MA), psychopathic deviate (PD) etc.
* Individual’s score on each dimension is compared to population norms
Millon Clinical Multiaxial Inventory
>20 dimensions
With loads of dimensions can defeat the purpose of the easy classification mechanism → plus no common communication between each group
Limitations of the Dimensional Approach
* No common vocabulary
* Unwieldly
* Implications for treatment?
* Knowing severity of disorder may not impact treatment plan.
* E.g., what’s the best way to treat someone who is high on hypochondriasis, but low on depression, but high on social introversion, but low on paranoia etc….
* Does a consistent pattern map on to a specific diagnostic category?
what is the transdiagnostic approach
The transdiagnostic approach
Very new approach (last 10 years)
National Institute of Mental Health’s (USA) Research Domain Criteria
Launched in 2009
Characteristics of RDoC:
* Holistic approach
* Understanding interaction between brain development, social factors, and lifespan to identify multiple dimensions that may produce mental illness.
* Study of biological processes and behavior that are part of interpersonal and sociocultural milieu
* From genes and cells to human behaviour
Not for immediate clinical use
Will take many years of research before it will influence classification
draw the RDoC diagram
draw the RDoC diagram
domains
- negative valence
- positive valence
- cognitive symptoms
- systems for social processes
- arousal/regulatory systems
-sensorimotor systems
environment:
circuits:
neural systems –> genes, moleculles, cells
behavioural dimensions –> physiology, behaviour, self reports
neurodevelopment
what is negative valence
- acute threat fear
- potential threat anxiety
- sustained threat
- loss
-frustrative non reward
what is positive valence
approach motivation
- reward valuation
- effort valuation
- expectancy
-action selection
initial responsiveness to reward
sustained responsiveness to reward
reward learning
habit
what is cognition?
attention
perception
- visual
-auditory
-olfactory
declarative memory
language behaviour
cognitive control
- goal selection, updating, representation, and maintenance
- response selection
- inhibition
-performance monitoring
working memory
- active maintenance
- flexible updating
- limited capacity
- interference control
what is HiTOP?
The hierarchical taxonomy of psychopathology (HiTOP) splits the world into internal and external
Advantages of Categorical
Common vocabulary, aids in communication
Provides a guide for treatment and prognosis
Advantages of Dimensional
Closer to reality?
Doesn’t require arbitrary distinctions between normality and abnormality
what is a categorical v dimensional approach
A categorical approach to assessment relies on diagnostic criteria to determine the presence or absence of disruptive or other abnormal behaviors (e.g., Diagnostic and Statistical Manual of Mental Disorders or DSM-IV, APA, 2000), whereas a dimensional approach places such behaviors on a continuum of frequency and/or severity (e.g., Child Behavior Checklist or CBCL, Achenbach & Edelbrock, 1983; Lavigne et al., 1996).
which approach does the dsm use?
categorical
what is a Taxometrics
Taxometrics is a statistical procedure for determining whether relationships among observables reflect the existence of a latent taxon (type, species, category, disease entity).
what is RDoC?
RDoC is a research framework for new approaches to investigating mental disorders. It integrates many levels of information (from genomics and circuits to behavior and self-reports) in order to explore basic dimensions of functioning that span the full range of human behavior from normal to abnormal.
“RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.”
Research domains encompass various fields of study that contribute to the advancement of knowledge and understanding in different areas. They provide specialized frameworks for conducting research and generating insights within specific disciplines.
- What are psychometrics?
- The branch of psychology dealing with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables
- Psyche = mind, metric = measure
- Psychometrics involves the measurement of directly unobservable mental constructs (e.g., intelligence, aptitude, personality, etc.) as opposed to directly observable physical constructs (e.g., height, weight, antibody levels, etc.)
What is a mental construct?
- Theoretical, intangible quality or trait.
- A psychological test aims to measure mental constructs (latent construct) by inferring an individual’s true score on the construct from their observed test score.
Aggressiveness
Emotional stability
Depression
Fear of vaccination
Intelligence
Beliefs in conspiracy
- Assumptions underlying psychometrics
- It is possible to measure psychological states and traits.
* Measurement – assigning values according to rules.
* Define the construct under study (“operationalization”)
* Sample from a universe of items thought to represent the construct.
* Developed rationally or empirically (good enough that its correlated) - Various methods of measuring aspects of the same thing can be useful.
* Format
* Multiple choice, true-false, essay, performance, verbal-nonverbal, behavioural observation, interview
* Administration
* Individual vs. group
* Timed
* Clinician administered versus self-report
* Scoring
* Cutoff vs. relative values (i.e., categorical versus dimensional) - Assessment can provide answers to some of life’s most momentous questions. Examples:
* Entry to UNSW?
* Competent to stand trial?
* Receive job or promotion?
* Many more…
* CAVEAT: Testing must be used appropriately by trained experts. - Error is part of the assessment process.
* Extraneous factors that influence test performance.
* Example:
* PSYC 2101 Final exam score = knowledge + noisy room
+ hungry + tired + drunk last night + COVID…. Etc.
True score + measurement error = observed score - Testing and assessment can be conducted in a fair and unbiased manner.
* Accommodations for test-takers with disabilities .
* Cultural Bias – very controversial with good reason. (Koori IQ test, 2003)
* If someone referred to you as “Binghi”, would it mean….
* a) you’re white
* b) like a brother
* c) you’re a baker
* d) you’ve got dough
* If you saw a gungibal, would you be looking at a….
* (a) soldier
* (b) policeman
* (c) centrelink officer
* (d) gunsmith
* The main point is to show non-Indigenous people two things: how the value of knowledge is culturally constructed; and what it is like to be assessed and graded on the basis of alien criteria.
(https://www.nesst.org.au/resource/koori-iq-test/)
what are the two types of measurement error?
Two types of measurement error
* Random error: unpredictable influences that vary from measurement to measurement. –> threats to reliability
* e.g. participant didn’t have their morning coffee or has the flu, examiner didn’t give clear instructions etc.
* Influences go in both directions —sometimes increasing a score and sometimes decreasing it
* Systematic error: biases that influence scores in a similar way across multiple measurements –> threats to validity
* e.g., using vocabulary as a measure of IQ in ESL participants
* Influences generally go in one direction —consistently increasing or decreasing a score
what is reliability?
Consistency of measurement
what is validity?
Accuracy of measurement
types of reliability
- Temporal stability
- Are the results of an assessment instrument stable over time?
- Test-retest reliability
- Inter-rater reliability
- Can raters agree on the scores of an instrument?
Can the two people collecting data get the same scores? - Inter-rater reliability
- Internal consistency reliability
- Are there positive correlations among items that are intended to measure the same construct?
- Cronbach’s alpha (α)
Test-retest Reliability
* Will taking the assessment again yield the same results?
* Administer a test once and then again later.
* Limitations: practice effects, fatigue, expensive
Inter-rater reliability
* Do two different raters yield the same results?
* Often used with subjectively-scored measures like coding written responses.
* Test is scored by two or more raters. Sets of scores are correlated with one another.
Internal consistency reliability
* Extent to which test items that propose to measure the same construct actually show similar scores
* Strong correlations between items within a scale
Internal consistency reliability
* To increase internal consistency reliability:
* Increase the number of items
* Remove items that are uncorrelated with many of the other items.
* To increase internal interrater reliability:
* Train and practice
* To increase test-retest reliability:
* Maintain standardized protocol
draw brunswik’s lens model
search it up pookie
what are 3 major sources of error?
- Reliability
- Validity
- Errors in use of method
types of validity
Content validity
* The degree to which the items adequately sample the mental construct in question
* e.g., Imagine 2 measures of general intelligence (IQ)
* Scale A only includes a vocabulary measure
* poor content validity
* Scale B includes measures of vocabulary, arithmetic, working memory, matrix reasoning, mental rotation, etc
* better content validity
* Fictitious example (don’t freak out ☺): 2101 final exam only has 3 questions and they are all on interrater reliability
Construct validity
* A scale is said to have high construct validity if:
1)It correlates with other tests purporting to measure the same construct (and hence they converge on measuring the same construct).
Convergent Validity
2)It does not correlate with other tests that do not purport to measure the same construct (and hence, their scores discriminate between different constructs).
Discriminant Validity → always have discriminant validity
Construct validity - convergent
* Demonstrated when a measure correlates highly with other measures with which it theoretically should correlate.
Criterion validity
* Degree to which the test is able to predict present or future performance on some real-world outcome (i.e., the criterion)
* Concurrent validity: Does test score accurately predict present scores on the criterion?
* i.e., the test and the criterion are assessed at the same time
* e.g. Predicting who has clinically-diagnosed major depression based on their score on the DASS
* Predictive validity: Does test score accurately predict future scores on the criterion?
* Predicting future convictions for crimes from a measure of self control
what is a mental disorder?
is abnormal and effects the way an individual functions
Associated with significant distress and impairment
what is not a disorder?
An acceptable or culturally approved response to a common stressor or loss (such as death of a loved one) is not a disorder
in regards to society, what is not a disorder?
Socially deviant behaviour and conflicts are primarily between the individual and society are NOT mental disorders unless the deviance or conflict results from a dysfunction in the individual
when was the dsm first published?
1952
when was the dsm5 published
2013
what year was homosexuality removed from the dsm?
1974
Revisions and updates of the DSM5
The removal of the DSM4 multi axial system → included:
Axis 1: clinical disorders
Axis 2: personality disorders or mental retardation (now know as learning disorders)
Axis 3: medical or physical conditions → affect or be affected by mental disorders
Axis 4: contributing environmental psychosocial factors
Axis 5: global assessment of functioning → a number between 0 and 100 indicating a persons level of functioning and their ability to engage in daily living
There was no scientific reason to separate these into different axis
DSM single axis
Notations for what would be under 4 and 5 (such as parent child relationship problems)
Combined 1-3 into a single axis
Helps to remove stigma from personality disorder diagnosis
DSM organisation
Developmental and lifespan considerations
Chapters and diagnostic categories
Childhood disorders outlined first → later in life
Contextual influence : gender and culture
Mental disorders are grouped together in the dsm5 according to the disorder (such as anxiety and depression)
Dsm provides detailed information about each mental disorder and their diagnostic criteria
Also provides cultural and sexual issues for the clinician to consider
Also includes differential diagnosis → other possibilities that need to be ruled out before labeling someone with a disorder
dsm advantages
Common language
Short hand communication
Guide treatment recommendations and access to funding
Benefits fo research
Research conducted on same phenomena
Prevalence morbidity and mortality rates
Normalising
DSM limitations and critiques
Arbitrary cut offs
What is considered normal v abnormal (abnormal is a relative context that changes over time)
Categorical classification
Borderline personality disorder → 256 distinct presentations
Post traumatic stress disorder → 636120 presentations
Dimensional or spectrum approach → puts people on a spectrum of the disorder and aids when categorically they dont ‘have’ the disorder
Diagnostic validity → how accurate is it at measuring what it says it will measure?
Do mental disorder exist the way they are outlined?
Inter rater reliability
Diagnoses are subjective and interpretative
National institute of mental health: Research domain criteria (RDoC) → abandoned dsm and used rdoc instead as it incorporates behavioural and neuroscience
Influence of the medical model
Viewed as having a disease
Reductionstic in its use of labels and numbers
Pharmaceutical influence
Experts with financial ties to the pharmaceutical industry
Implicates classification as it aligns with pharmaceutical companies and their medication options
Lowering an broadening of diagnostic thresholds
Meaning more people will be diagnosed with a mental disorder than they did before
E.g. major depressive disorder - bereavement exclusion removed → allows people who are clinically depressed for up to two months over the loss of a loved one to be diagnosed with major depressive disorder → benefits individuals as they get reimbursements for medications but also benefits pharmaceutical sectors as it broadens their customer scope
Western influences
Labeling and stigmatising
Can become internalised and effect the identity of the individual
It is crucial to use this CAREFULLY
What are the key features of BDP
Periods of mania alternate with periods of depression
Emotional rollercoaster: elation to despair to elation to despair…
“Manic depression” = old name for bipolar disorders
What is a manic episode definition according to the dsm?
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal- directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary)
3 or more of the following (4 if mood is only irritable):
Inflated self-esteem or grandiosity
Decreased need for sleep
Atypically talkative
Flight of ideas or subjective experience of racing thoughts
Distractibility as reported or observed
Increase in goal-directed activity (socially, at work, or sexually) or psychomotor agitation (purposeless non-goal-directed activity)
Excessive involvement of activities with a high potential for painful consequences (e.g., unrestrained buying sprees, sexual indiscretions, foolish business investments)
The mood disturbance is sufficiently severe to cause a marked impairment in social or occupational functioning OR necessitates hospitalization to prevent harm to self or others OR there are psychotic features
Not substance induced
What is a hypomanic episode definition according to the dsm5?
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
3 or more of the following (4 if mood is only irritable):
Inflated self-esteem or grandiosity
Decreased need for sleep
Atypically talkative
Flight of ideas or subjective experience of racing thoughts
Distractibility as reported or observed
Increase in goal-directed activity
Excessive involvement of activities with a high potential for painful consequences
The episode is NOT severe enough to cause a marked impairment in social or occupational functioning or necessitate hospitalization and there are NO psychotic features.
The disturbance in mood or functioning is unequivocal and observable by others
Not substance induced
What are the 3 main categories for bipolar disorders?
Bipolar I disorder: manic episodes (typically) alternate with major depressive episodes
Bipolar II disorder: hypomanic episodes alternate with major depressive episodes
Cyclothymia: hypomanic symptoms alternate with hypodepressive symptoms
What is bipolar I?
Diagnostic criteria: at least one manic episode
Over 90% of bipolar I patients have recurrent episodes
Manic episodes typically (but not necessarily) alternate with major depressive episodes
Manic symptoms can be psychotic
But typically not
Prevalence: ~ 0.5 to 1%
Typical age-of-onset: late teens, early 20s
Typical length of mood episode: 2-6 months (Angst and Sellaro, 2001)
‘Rapid cycling’ = 4 or more mood episodes (i.e., manic or major depressive) in previous 12 months
What is bipolar II?
Hypomanic episodes alternate with major depressive episodes
In contrast to bipolar I disorder, where a full-blown manic episode is necessary for diagnosis, but major depressive episodes - while common - are not necessary
Average length of mood episode tends shorter for bipolar II compared to bipolar I more likely to be rapid cycling
Approx. 15% of bipolar II patients transition to bipolar I
What is Cyclothymia?
Recurrent periods of hypomanic symptoms (which do not meet criteria for a hypomanic episode) alternating with hypodepressive symptoms (which do not meet criteria for a major depressive episode) over at least a 2 year period
Criteria for manic, hypomanic and major depressive episodes have never been met
Chronic, low-level symptoms
“Insidious onset, persistent course”
Personality disorder?
What are the causes of bipolar disorders?
Heritability
Bipolar disorder is highly heritable
Among the highest of any mental disorder
Around 1% of people have bipolar
If your twin has bipolar → your risk comes up to 45 to 75 %
Neurochemistry
Bipolar depression: low levels of the serotonin transporter
Mania: greater sensitivity to dopamine
But findings have been inconsistent…
Gave people speed → the dopamine → manic people have a great sensitivity to dopamine
Why do bipolar disorders cycle?
One theory…
Bipolar disorder caused by abnormal circadian rhythms (e.g., Harvey, 2008, AJP)
Observations:
Manic individuals tend to sleep very little; bipolar depressed individuals tend to sleep a lot
Sleep deprivation can improve mood in bipolar depressed patients; sleep deprivation can trigger mania
In healthy people, circadian rhythms (24 hours long) are set by zeitgebers (“time-givers”) such as light/dark cycles, meal times etc. In bipolar patients, CRs become detached from these zeitgebers
Key idea: bipolar patients have longer circadian cycles (i.e., in the order of weeks, rather than days)
Study to reset circadian rhythm → shine a bright light on bpd patients in the morning → WORKS
What are treatments for BPD
Mood stabilizers
Suppress swings between mania and depression
Primarily mania stabilizers; less effective against bipolar depression
Lithium: ‘gold standard’ Ancient treatment: alkali springs Mechanism of action unclear
Anticonvulsants (e.g., sodium valproate, blocks Na+ channels)
Antipsychotics are also used (e.g., olanzapine: dopamine antagonist)
CBT for bipolar disorders
Focus is on promoting stability and routine, and medication compliance
Help patient identify warning signs for imminent mood shifts
Not sleeping, feeling full of energy, thoughts racing, starting to get irritable or frustrated with others…
CBT for bipolar depression:
Behavioural activation, pleasant events scheduling → careful, we dont want to flip this into mania
CBT for mania:
Motivational interviewing – especially with regards to medication compliance (big problem!)
‘Urge surfing’ → acknowledge their urges and their consequences
What is ocd categorised under?
Obsessive compulsive and related disorders
What are the two main criteria for ocd?
Obsessions and compulsions
What are obsessions?
Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted and cause marked anxiety
The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them (i.e., by performing a compulsion)
Thoughts, images or impulses
Repetitive, intrusive, uncontrollable, distressing
Not just excessive worries about real life problems
Interpreted as strange or inappropriate
Compel the person to ignore or neutralize the obsessions in some way
What are compulsions?
Repetitive behaviors or mental acts that the individual performs in response to an obsession or according to rules
Aimed at reducing anxiety or preventing dreaded event; however, not connected in a realistic way with what they are designed to prevent or are clearly excessive
Repetitive overt behaviors or covert mental acts
Goals are usually to “undo” obsession, to prevent harm associated with obsession, or to alleviate anxiety
‘Rituals’
What are the 3 different types of obsessions
Repugnant obsessions
Contamination obsessions
Doubting obsessions → me with locks
What arent obsessions?
Obsessions
Preoccupation
Sexual fantasies (recurrent)
Everyday worries
Explain the sandra case
Cant make tea
Thinks theres broken glass
What is the prevalence of ocd?
2-3% lifetime prevalence,
F=M
What is the onset of ocd
mean age is 17 years old (international study by Brakoulias et al., 2014), but significant portion have childhood onset
May be important differences in childhood onset cases
What are the ocd symptom dimensions?
Heterogeneous disorder → every obsession and compulsion is different
4 commonly replicable symptom dimensions:
Obsessions about contamination and washing compulsions
Obsessions about responsibility for causing harm/making mistakes and checking compulsions
Obsessions about symmetry and ordering compulsions
Repugnant obsessional thoughts concerning sex, religion and violence along with mental compulsions and other covert ne
Biological model of ocd
High reactivity in the cortical striatal thalamic circuit
This is the area related to filtering out irrelevant information and preservation of behaviour
Psychological treatment for ocd exposure and response prevention (ERP)
Moderate symptom reduction between 55% and ⅔ of patients
Through repeated exposure to feared situations and thoughts without performing compulsions the pearson learns
Emotional response subsides
The feared event does not happen
It is safe and moral t let the thought go without responding with a compulsion
Pharmaco and erp: pre and post → the brain region activation changes in the cortical striatal thalamic circuit
What are assessments of ocd?
Self-report measures
Padua Inventory (Burns et al., 1996) and Padua Inventory - Washington State University Revision (PI-WSUR)
Obsessive-Compulsive Inventory Revised (Foa et al., 2002)
Interviewer measure
Yale-Brown Obsessive Compulsive Scale (YBOCS; Goodman et al., 1989)
Identifying obsessions
situations (e.g., locking a door, driving over bumps)
thoughts, images, impulses, e.g., unlucky numbers, thoughts of being contaminated
what are the disastrous consequences? (e.g., disease from touching contaminated object)
Identify avoidance patterns
situations or objects that are avoided, e.g., using kitchen knives, driving on busy street
Identify rituals
washing, cleaning, checking, attend to subtle rituals such as using a hand sanitizer
What are treatments for ocd?
SSRIs (fluvoxamine, sertraline, fluoxetine etc) found to be useful in OCD
Significant average symptom reduction of approx 40% in 50-60% ofsubjects
Majority relapse after discontinuation of SSRIs – addition of behaviour therapy is important
What is the basic cognitive behavioural model?
Obsessions, impulse, image, or doubt → maladaptive interpretation of intrusions → distress → compulsion, suppression, avoidance, reduced distress but no new learning → attentional bias toward OCD relevant stimuli → back to the start
EXPOSURE AND RESPONSE PREVENTION (ERP)
Moderate symptom reduction between 55% and 2/3 of patients (Ost et al., 2015)
Drop out of 19% (Ost et al., 2015)
Through repeated exposure to feared situations and thoughts the person learns:
Emotional response subsides (this happens more quickly over trials)
The feared event does not happen
It is safe and moral to let the thought go without responding with a compulsion
TIPS FOR EXPOSURE
Must experience anxiety/distress without seeking reassurance about obsessional concerns or doing compulsions
Patient should expect exposure to feel quite uncomfortable, and to accept it rather than fight it
Repeat exposure very soon
Massed exposure is much more effective than spaced
Intensive more effective than less intensive
THERAPIST BEHAVIOR DURING EXPOSURE TASKS PREDICTS HABITUATION AND CLINICAL OUTCOME (BENITO ET AL. 2021)
Pediatric OCD – 111 clients, 3 RCTs
Within exposure tasks, therapist behaviors and patient fear were coded continuously
More therapist behaviors that encourage approach—and less use of accommodation, unrelated talk, and externalizing language—predicted greater subsequent habituation during individual exposure tasks (exposurelevel), and also predicted improved patient clinical outcomes
Benito et al. (2021). Therapist Behavior During Exposure Tasks Predicts Habituation and Clinical Outcome in Three Randomized Controlled Trials for Pediatric OCD, Behavior Therapy,Volume 52, Issue 3, 2021, Pages 523- 538.
What three things are associated with motivation?
RATIONALE
Avoidance prevents expectancy violations Activate expectancies → short-term distress Goal is distress tolerance, not fear reduction Strengthen extinction learning & recall for long-term symptom remission
COLLABORATE
Collaboration is associated with better compliance with out-of- session exposures (Ong et al. 2022)
Use creativity & some modeling (banana in the hair)
VALUES
Link exposures explicitly w/ values. Why are you doing this exposure? What important thing will it allow you to do in your life?
(e.g., bookcase and daughter)
Why is variable exposures more beneficial instead of a hierarchy?
More life like → element of surprise
The stronger the mismatch between expectation of an aversive outcome and actual outcome, the more expectancies that are violated, the stronger the inhibitory retrieval (Wannemueller et al., 2019)
HOW TO DEEPEN EXTINCTION
Compound exposures:
Do exposures in as many places and contexts as possible (Craske et al., 2008, 2014)
Extinguish separately first then combine for additional trials (client in bar example, Lucifer tv example)
Variety of physical and psychological contexts (Craske et al., 2014, Jacoby & Abramowitz, 2016)
IMAGINAL EXPOSURE
When the obsession is a disturbing recurrent image, e.g., someone engaging in a repugnant sexual act
Ask client to write down everything about the image, with as much detail as possible
Ask him or her to re-read this script silently until emotion subsides, then read it aloud repeatedly
May be helpful for client to write key words over and over
TREATMENT OF OCD: COGNITIVE THERAPY
Rests on the cornerstone that 90+% of people experience intrusive thoughts
Interpretation of the intrusive thought is typically threatening (“I’m mad, bad, or dangerous”)
It is the anxiety from the appraisal that promotes compulsive behaviour
OCD-RELEVANT BELIEFS (OCCWG, 2005)
Over-importance of thoughts – This thought must mean I’m a violent person
Over-importance of thought control – I must be going crazy because I can’t control these thoughts
Overestimation of threat – I am more likely than other people to cause harm
Perfectionism- Even minor mistakes will lead to harm
Intolerance of Uncertainty – I need to be absolutely sure that I won’t hurt others
NORMALIZING ITS
Another quote from Turtles All The Way Down:
“Supposedly everyone has them,” she says. “You look out from over a
bridge or whatever and it occurs to you out of nowhere that you could just
jump. And then if you’re most people, you think, Well that was a weird
thought, and move on with your life. But some people the invasive can kind
of take over, crowding out all the other thoughts until it’s the only you’re
able to have, the thought you’re perpetually either thinking or distracting
yourself from.”
Foundation of treatment
Use intrusive thoughts reported by a non-clinical sample
Survey
CHALLENGING IMPORTANCE OF THOUGHTS
Behavioral experiment of alternating between letting thoughts ‘come and go’ vs. ‘fighting and dwelling’
Patients record overall anxiety and frequency of ITs
Patients predict results of experiment prior to beginning
Treating thoughts like pop up ads on the internet
Sushi train
THOUGHT ACTION FUSION (TAF; SHAFRAN & RACHMAN, 2004)
Likelihood - because I’ve had the thought it’s more likely to happen
Moral - the thought is as reprehensible as the action
CHALLENGING MORAL TAF
Continuum
normalization of ITs
List qualities of a good and bad person
Identification of a possible double standard
Any other ideas?
TARGET AND CONTENT OF THOUGHTS IS NOT RANDOM
Based on value system
Person/situation that is the most important to the individual
Intrusions become repetitive BECAUSE the person is sensitive, caring, etc.
And in the manifestation look for positive qualities– artist/vivid superstitious imagery example
FOCUS ON INTERPRETATION RATHER THAN CONTENT
In some cases, probability and cost may not be as useful
Sexual or Religious obsessions
People with OCD are less concerned about actual harm than about being RESPONSIBLE for harm (Mancini & Gangemi, 2004, 2011)
Challenging logic of obsession versus challenging patient’s beliefs about meaning of the obsessions - better to focus on meaning
Strangling children with cord
First try challenging the content – use probability and cost
Then try to challenge the meaning of obsession
ACCEPTANCE AND COMMITMENT THERAPY?
Twohig, Abramowitz et al., 2018, Behaviour Research and Therapy
ACT plus ERP and ERP alone were both highly effective for OCD with no difference in outcomes.
Metaphors: Swamp, passengers on the bus, chess board
ACT EXAMPLE (TWOHIG ET AL., 2015)
3 core beliefs of cognitive model
Core beliefs
Beliefs about ourselves, others, and the future. Cognitive triad of negative beliefs (aaron beck) → when you have negative beliefs about all of these facets. Core beliefs are made from early life experiences and life stressors. This give way from intermediate beliefs and assumptions
Intermediate beliefs and assumptions
Rigid conditional ‘rules for living’ if then conditional statements and rules
Play a large role in how we respond to stressors and go about living life
Automatic thoughts and images
Spontaneous thoughts or images
Distorted and consistent with core belief
Distortion in thinking (cognitive distortions)
Behavioural model
learning theory
Learning theory
Classical conditioning
Emotional responses can be classically conditioned in a similar way
Operant conditioning
A(antecedent) → b (behaviour) → c (consequence)
Negative reinforcement and the maintenance of anxiety
Behvaioural model
Social learning theory
People learn from one another, via observation, imitation and modeling
CBT
Challenge established thought patterns
Break learned and conditional behaviours that are maladaptive
Formulation
Explanation and conceptualisation of how difficulties have developed and are maintained
Hypothesis of the causes, precipitants and maintaining factors of a person’s difficulties
Longitudinal
Earlier experiences contribute to the development core beliefs → lead to disruptive assumptions and roles
Cross sectional
Focuses on here and now
Showcases how our thoughts → emotion → physical sensations → behaviour → thoughts
what are personality disorders?
Enduring pattern of inner experience and behaviour that deviate markedly from the
expectations of the individual’s culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to distress or impairment.
- 10% of population. 20-50% in clinical/mental health settings
- High comorbidity with other mental disorders
- Personality traits that deviate markedly from expectations of the individual’s culture, are pervasive and inflexible, has onset in adolescence or early adulthood, is stable over time, and leads to distress
or impairment. - More stable over time comparative to other mental disorders
- 10 Personality Disorders classified in the DSM-5
what approach is used to classify personality disorders?
currently the categorical approach is used however it is critised by its threesholds needed to meet the disorder. a new hybrid approach has been made
what is a personality?
Personality
* Characteristic manner of thinking, feeling, behaving, and relating to others across situations and contexts, that is relatively stable over time.
* Self-report measures; e.g., Five Factor Model (OCEAN)
* Predictive of life outcomes
explain how the dsm5 categorises personality disorders
Categorical approach in main text
* Hybrid model included under “Emerging Measures and Models”
10 personality disorders, clustered into 3 group
DSM-5: Personality Disorders
DSM-5 Main Text (Section II)
Still classified using the Categorical approach
* Qualitatively distinct clinical syndromes
General Personality Disorder Criteria
Personality disorders are an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of an individual’s culture. It is manifested in 2 or more of the following areas
Cognition
Affectivity
Interpersonal functioning
Impulse control
what are the 10 personality disorders?
Cluster a
Regarded as:
Odd
Eccentric
Paranoid → distrust
Schizoid →detachment from social relationships (lack of emotions)
Schizotypal →acute discomfort (close relationships, cognition, eccentric behaviour)
Cluster b
Regarded as:
Dramatic
Emotional
unpredictable
Antisocial →exploit, manipulate or violate the rights of others
Borderline → intense mood swings and feel uncertainty about how they see themselves
Histrionic →a chronic, enduring psychiatric condition characterized by a consistent pattern of pervasive attention-seeking behaviors and exaggerated emotional displays
Narcissistic →a mental health condition in which people have an unreasonably high sense of their own importance.
Cluster c
Regarded as:
Anxious
fearful
Avoidant →a mental health condition that involves chronic feelings of inadequacy and extreme sensitivity to criticism.
Dependent →a mental health condition that involves an excessive need to be taken care of by others
Obsessive compulsive →Be preoccupied with and insist on details, rules, lists, order and organization. Have perfectionism that interferes with completing tasks.
what is the hybrid model to classifying personality disorders and where can you find it?
- Hybrid model included under “Emerging Measures and Models”
Hybrid (Dimensional-Categorical) Model
A - Impairment in Personality functioning:
Sense of self - Identity and Self-direction
Interpersonal functioning - Empathy and Intimacy
Level of Personality Functioning Scale - Moderate impairment required for diagnosis
B - Pathological Personality Traits:
* Negative affectivity
* Detachment
* Antagonism
* Disinhibition
* Psychoticism
Hybrid Model Personality Disorder
Diagnoses:
* Antisocial
* Avoidant
* Borderline
* Narcissistic
* Obsessive-compulsive
* Schizotypal
* Personality Disorder – Trait Specified
Studied in DSM-5 field trials –? Sowed good test retest reliability
Unanimously approved by DSM-5 task force
However, more evidence needed to validate proposed new personality disorder model and establish clinical utility
Included the hybrid model in Section III of DSM-5:
* “Emerging measures and models”
what are the 3 P’s of personality disorder?
- Pervasive [inflexible]
- Pathological [distress or impairment]
- Persistent [stable]
what two categories can childhood disorders be broken down into?
internalising and externalising
childhood disorders overlap substantially, what is this called?
comorbidity
mental illnesses in adults usually start in
childhood
what is the statistics of adults with mental disorders preceded by childhood mental illness?
1 in 2
what is the importance of the multi method assessment of children?
to establish persistence across time and pervasiveness across setting
what is externalising in childhood illness?
UNDERCONTROLLED → affects people around them → more prevalent in boys
DSM-5 Externalising Disorders
Disruptive, impulse control, and conduct disorders
– Oppositional defiant disorder
– Conduct disorder
– Intermittent explosive disorder
– Pyromania
– Kleptomania
DSM-5 Neurodevelopmental Disorders
Attention-deficit/hyperactivity disorder
Autism spectrum disorder
Communication disorders
Global developmental delay
Intellectual disability (Intellectual Developmental Disorder)
Motor disorders
Specific learning disorders
what is internalising in childhood illness?
affects the child → more prevalent in girls
DSM-5 Internalising Disorders
Anxiety disorders
– Separation anxiety disorder
– Selective mutism
– Specific phobia
– Social anxiety disorder (social phobia)
– Panic disorder/ Panic attack
– Agoraphobia
– Generalised anxiety disorder
Depressive disorders
– Disruptive mood dysregulation disorder → anger outbursts
– Major depressive disorder
– Persistent depressive disorder (dysthymia)
what are the pathways to psychological services?
Observe problem behaviour
Discuss with GP/ specialist
Referral to mental health professional
Psychological assessment
what are the Assessment Methods for Children
Clinical interviews
– Clinical/ developmental history
– Diagnostic interview
Psychological tests (e.g., questionnaires, checklists)
– Self-report
– Rater measures
Behavioural observations (clinic, home, school)
– A-B-C analysis
Specialised testing
– IQ/ neuropsychological testing
– ASD, developmental delay
Third-Party Information
– Medical/school/legal records
– Prior psychological testing/reports
what are the Important Considerations for Children
Comprehensive assessment essential
– Gain knowledge about multiple settings (home, school, peer, other)
* Multi-reporter (child, parent, teacher, others)
– Multi-method
– Relevant developmental information
For younger children, observation and rater measures especially important
what is the pathway to treatment?
Diagnose
Diagnose the problem
Report
Prepare report with recommendations
Recommend
Identify evidence-based intervention(s)
Treatment
Treat or refer to specialist MH professional
3 core beliefs of cognitive model
Core beliefs
Beliefs about ourselves, others, and the future. Cognitive triad of negative beliefs (aaron beck) → when you have negative beliefs about all of these facets. Core beliefs are made from early life experiences and life stressors. This give way from intermediate beliefs and assumptions
Intermediate beliefs and assumptions
Rigid conditional ‘rules for living’ if then conditional statements and rules
Play a large role in how we respond to stressors and go about living life
Automatic thoughts and images
Spontaneous thoughts or images
Distorted and consistent with core belief
Distortion in thinking (cognitive distortions)
what is the behavioural model in terms of learning theory
Classical conditioning
Emotional responses can be classically conditioned in a similar way
Operant conditioning
A(antecedent) → b (behaviour) → c (consequence)
Negative reinforcement and the maintenance of anxiety
what is the behavioural model in terms of the social learning theory
Social learning theory
People learn from one another, via observation, imitation and modeling
CBT
Challenge established thought patterns
Break learned and conditional behaviours that are maladaptive
Formulation
Explanation and conceptualisation of how difficulties have developed and are maintained
Hypothesis of the causes, precipitants and maintaining factors of a person’s difficulties
Longitudinal
Earlier experiences contribute to the development core beliefs → lead to disruptive assumptions and roles
Cross sectional
Focuses on here and now
Showcases how our thoughts → emotion → physical sensations → behaviour → thoughts
what are personality disorders?
Personality
* Characteristic manner of thinking, feeling, behaving, and relating to others across situations and contexts, that is relatively stable over time.
* Self-report measures; e.g., Five Factor Model (OCEAN)
* Predictive of life outcomes
What is a Personality Disorder?
Personality Disorders
* Personality traits that deviate markedly from expectations of the individual’s culture, are pervasive and inflexible, has onset in adolescence or early adulthood, is stable over time, and leads to distress
or impairment.
* More stable over time comparative to other mental disorders
* 10 Personality Disorders classified in the DSM-5
Classification of personality disorders
Classification of Personality Disorders
Categorical Approach
DSM-III (1980)
* Eleven Personality Disorders on Axis II
* Three cluster groups (A- eccentric, b-dramatic/emotional, C-anxious or fearful)
Later DSM Revisions
* Ten Personality Disorders
* Multi-axial system removed (DSM-5) → helped to remove some stigma (that personality disorders are lesser than clinical disorders)
Limitations
* Arbitrary diagnostic threshold
* Extensive heterogeneity
* Misses the relational context
How else can we classify Personality Disorders?
DSM-5 revisions:
“Well-informed clinicians and researchers have suggested that variation
in psychiatric symptomatology may be better represented by dimensions
than by a set of categories, especially in the area of personality traits”
A research agenda for DSM-V. Washington: American Psychiatric Association; 2002. pp. 12
Personality Disorders are a difference of degree rather than kind
How else can we classify Personality Disorders?
Work Group for Personality and Personality Disorders
* Reviewed literature to explore dimensional approach
Prototype model not workable
Made a hybrid model
Hybrid (Dimensional-Categorical) Model
A - Impairment in Personality functioning:
Sense of self
* Identity and Self-direction
Interpersonal functioning
* Empathy and Intimacy
Level of Personality Functioning Scale
* Moderate impairment required for diagnosis
B - Pathological Personality Traits:
* Negative affectivity
* Detachment
* Antagonism
* Disinhibition
* Psychoticism
Hybrid Model Personality Disorder
Diagnoses:
* Antisocial
* Avoidant
* Borderline
* Narcissistic
* Obsessive-compulsive
* Schizotypal
* Personality Disorder – Trait Specified
Studied in DSM-5 field trials –? Sowed good test retest reliability
Unanimously approved by DSM-5 task force
However, more evidence needed to validate proposed new personality disorder model and establish clinical utility
Included the hybrid model in Section III of DSM-5:
* “Emerging measures and models”
Current DSM5 personality disorder
DSM-5: Personality Disorders
DSM-5 Main Text (Section II)
Still classified using the Categorical approach
* Qualitatively distinct clinical syndromes
General Personality Disorder Criteria
Personality disorders are an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of an individual’s culture. It is manifested in 2 or more of the following areas
Cognition
Affectivity
Interpersonal functioning
Impulse control
DSM-5 Main Text (Section II)
The 3 P’s:
* Pervasive [inflexible]
* Pathological [distress or impairment]
* Persistent [stable]
- Late adolescence or early adulthood (cant diagnose until after 18)
- 10 Personality Disorders organised into three clusters
Cluster a
Regarded as:
Odd
Eccentric
Paranoid → distrust
Schizoid →detachment from social relationships (lack of emotions)
Schizotypal →acute discomfort (close relationships, cognition, eccentric behaviour)
Cluster b
Regarded as:
Dramatic
Emotional
unpredictable
Antisocial →exploit, manipulate or violate the rights of others
Borderline → intense mood swings and feel uncertainty about how they see themselves
Histrionic →a chronic, enduring psychiatric condition characterized by a consistent pattern of pervasive attention-seeking behaviors and exaggerated emotional displays
Narcissistic →a mental health condition in which people have an unreasonably high sense of their own importance.
Cluster c
Regarded as:
Anxious
fearful
Avoidant →a mental health condition that involves chronic feelings of inadequacy and extreme sensitivity to criticism.
Dependent →a mental health condition that involves an excessive need to be taken care of by others
Obsessive compulsive →Be preoccupied with and insist on details, rules, lists, order and organization. Have perfectionism that interferes with completing tasks.
Why study childhood mental disorders?
Childhood disorders usually persist into adult disorders
What are the dimensions of child psychopathology?
EXTERNALISING/UNDERCONTROLLED → affects people around them → more prevalent in boys
INTERNALISING/ OVERCONTROLLED → affects the child → more prevalent in girls
What are internalising disorders?
DSM-5 Internalising Disorders
Anxiety disorders
– Separation anxiety disorder
– Selective mutism
– Specific phobia
– Social anxiety disorder (social phobia)
– Panic disorder/ Panic attack
– Agoraphobia
– Generalised anxiety disorder
Depressive disorders
– Disruptive mood dysregulation disorder → anger outbursts
– Major depressive disorder
– Persistent depressive disorder (dysthymia)
What are externalising disorders?
DSM-5 Externalising Disorders
Disruptive, impulse control, and conduct disorders
– Oppositional defiant disorder
– Conduct disorder
– Intermittent explosive disorder
– Pyromania
– Kleptomania
What are dsm5 Neurodevelopmental Disorders?
Attention-deficit/hyperactivity disorder
Autism spectrum disorder
Communication disorders
Global developmental delay
Intellectual disability (Intellectual Developmental Disorder)
Motor disorders
Specific learning disorders
What is assessment?
- Also called psychological testing
– Individualised - Used to measure and observe client’s behaviour
– Gives full picture of person’s strengths/limitations - Used to test hypotheses about a patient
- Wide variety of tests and assessments
- Informs diagnosis and treatment planning
What are assessment methods for children?
Clinical interviews
– Clinical/ developmental history
– Diagnostic interview
Psychological tests (e.g., questionnaires, checklists)
– Self-report
– Rater measures
Behavioural observations (clinic, home, school)
– A-B-C analysis
Assessment Methods (cont’d)
Specialised testing
– IQ/ neuropsychological testing
– ASD, developmental delay
Third-Party Information
– Medical/school/legal records
– Prior psychological testing/reports
Important Considerations for Children
Comprehensive assessment essential
– Gain knowledge about multiple settings (home, school, peer, other)
* Multi-reporter (child, parent, teacher, others)
– Multi-method
– Relevant developmental information
For younger children, observation and rater measures especially important
Draw the case conceptualisation diagram
Referral problem → initial working hypothesis → plan assessment based on hypothesis → conduct assessment → refine hypothesis and identify what additional info is needed → end of assessment: theory based on all data collected
What is the Pathway to Treatment?
Diagnose
Diagnose the problem
Report
Prepare report with recommendations
Recommend
Identify evidence-based intervention(s)
Treatment
Treat or refer to specialist MH professional
do childhood disorders overlap? if so what is this called?
YES comorbidity
how many adults with a diagnosable mental illness had a childhood mental illness?
1 in 2
what is the importance of the multi method assessment of children?
Importance of multi-method assessment of children to establish persistence across time and pervasiveness across setting
What are the key assumptions of personality?
Personality is stable over time
Personality influences behavior
There are a (finite) number of dimensions on which people can differ. These dimensions are referred as personality traits
What are hippocrates 4 humors?
Hippocrates’ 4 humors (temperaments)
Sanguine → blood → sociable, playful, carefree
Choleric → yellow bile → ambitious, restless, hot tempered
Melancholic → black bile → quiet, analytical, despondent
Phlegmatic → phlegm → calm, peaceful → lazy
how many personality traits are there?
Raymond Cattell used factor analysis to identify 16 ‘personality factors’
Developed the 16PF questionnaire →
Reserved → outgoing
Less intelligent → more intelligent
Affected by feelings → emotionally stable
Submissive → dominant
Serious → happy go lucky
Expedient → conscientious
Timid → venturesome
Tough minded → open minded
Trusting → suspicious
Practical → imaginative
Forthright → shrewd
Self assured → apprehensive
Conservative → experimenting
Group dependent → self sufficient
Uncontrolled → controlled
Relaxed → tense
What is Eysenck’s Personality Theory
Eysenck used factor analysis to reduce Cattell’s 16PF into 2 factors:
Extraversion/introversion
Emotionally unstable (neurotic) / Emotionally stable
Which mapped on to Hippocrates’ 4 humours →
Eysenck later included a 3rd factor: Psychoticism
Misnomer; refers to aggression, coldness, lack of empathy, manipulativeness
^^ meant to relate to psychopathy not psychoticism
What are the big 5 personality factors?
Big 5 personality factors
The dominant model currently
The Big 5 personality factors are:
Openness to experience (O)
inventive/curious vs.consistent/cautious
Conscientiousness (C)
efficient/organized vs. easy-going/careless
Extraversion (E)
outgoing/energetic vs.solitary/reserved
Agreeableness (A)
friendly/compassionate vs. analytical/detached
Neuroticism (N)
sensitive/nervous vs.secure/confident
What are Scales for measuring the Big 5
NEO-Personality Inventory Revised (NEO-PI-R)
240 questions (48 for each of the 5 factors)
5 point scale (Strongly Agree to Strongly Disagree)
Each factor is comprised of 6 ‘facets’ (sub-factors).
E.g., Extraversion is comprised of warmth, gregariousness, assertiveness, activity, excitement seeking, positive emotions
Reliability
Internal consistency ~ 0.9; Test-retest (1 week) ~ 0.9
Got good test retest reliability + split test reliability
Validity
Criterion validity: Conscientiousness predicts GPA of Uni students
Convergent validity: NEO-PI-R Extraversion score correlates highly
with Eysenck Extraversion score
Other scales are also used, e.g., Big Five Inventory; Five Factor PI
What are personality changes?
Personality Changes
Maturity principle: Increase in agreeableness and conscientiousness, decrease in neuroticism, over young adulthood (Roberts et al., 2006)
Major life events can lead to changes in personality (Bleidorn, Hopwood & Lucas, 2018)
Changes in personality over Covid-19, young adults showed disrupted maturity (Sutin et al., 2022)
Neuroticism can reduce through therapeutic intervention (Roberts et al., 2017)
Extroversion can be split into social vitality and social dominance
What is the heritability of the big 5?
Jang et al., (1996), J Personality
Gave the NEO-PI-R to 123 MZ (identical) twins and 127 DZ twins
All Big 5 factors were heritable: Openness and Extraversion were most heritable, Agreeableness the least
What is the Neurobiological correlates of the Big 5
De Young et al., (2010), Psychological Science
116 healthy adults underwent sMRI scanning
O → not significant
C → MFG (Middle frontal gyrus)
E → medial orbitofrontal (inhibition)
A → STS (superior temporal sulcus) (monitoring intentions of others)
N → lots, including amygdala (fear)
What is the dark triad?
The Dark Triad
Subclinical set of negative personality traits
Narcissism
Attention-seeking, arrogant vain, entitled
Psychopathy
Callous, insensitive, lacking in remorse, cynical
Machiavellianism
Manipulative, strategic, will flatter and lie t
- What are conduct disorders?
Conduct Disorder (CD), DSM-5 312.xx
* A repetitive and persistent pattern of behavior involving (3 or more):
– Aggression to people and animals (e.g., bullying, physical fights, weapon use, cruelty, forced sexual activity)
– Destruction of property (e.g., fire setting, other vandalism)
– Deceitfulness/ Theft (e.g., B&E, conning, shoplifting, forgery)
– Serious violation of rules (e.g., run away, truancy)
Children usually start with ODD and then it develops into a conduct disorder
- What causes conduct disorders?
Gerald pattersons coercion theory
Parent instruction → child defiance and anger → parent gets louder → child gets louder
(usually the parent gives in) → reinforces the child behaviour → child realises that if the child makes a big enough of an argument, they get what they want
ABI
- How can subtyping improve understanding of development course and prognosis?
Subtyping aims to achieve higher accuracy in the prediction of decisions that can improve the treatment
Subtypes include
Oppositional defiant disorder
Conduct disorder
Childhood onset subtype
Adolescent onset subtype
– Early onset (< age 10) is a risk factor for life-course persistent antisocial behaviour and impairment
What is odd?
Oppositional Defiant Disorder (ODD) DSM-5 313.81
* Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness involving (4 or more):
– Often loses temper
– Touchy, easily annoyed
– Angry, resentful
– Argumentative
– Defiant and noncompliant
– Deliberately annoys others
– Blames others for mistakes
– Spitefulness/ vindictiveness
Symptoms in bold → kids with these symptoms go onto internalising disorders (depression, anxiety)
Symptoms italised → kids go onto developing conduct disorders
The last one goes onto developing more serious conduct disorders
What is Antisocial Personality Disorder, DSM-5 301.7
Pervasive pattern of disregard for/ violation of others’ rights occurring since age 15 (3 or more):
– Repeated criminal behavior
– Repeated lying or conning of others
– Impulsivity or poor planning
– Irritability and aggressive behavior
– Reckless disregard for others’ safety
– Chronic Irresponsibility
– Lack of remorse
Evidence of CD (conduct disorder) before age 15 years
What are risk factors in the child?
Difficult temperament
Poor academic achievement
Genetic factors
Autonomic irregularities
Premature birth
Reward dominance
Thrill seeking
Low verbal intelligence
Cognitive biases
Impulsivity
What are risk factors in the environment?
Prenatal exposure to toxins
Poor neighbourhood quality
Violence exposure
Deviant peers
Family conflict
Dysfunctional parenting practices
Parental psychopathology
Low social support
Low socioeconomic status
Poor quality early childcare
Draw Patterson’s Coercive Cycle
Mother and child go to supermarket → child sees and asks for a lollipop → mum says no → child whinges → mum yells no → child yells back → mum gives in and buys the lollipop → child immediately quiets down
(negative reinforcement)
What is ABC analysis?
It is a direct observation tool
Antecedent
Behaviour
Consequence
Antecedent
Refers to:
Prompts, cues, stimuli, events or interactions that precede or come before a behaviour
Antecedents can be thought of as ‘triggers’
Can include things that contribute to or cause a behaviour
Important to understand antecedent
Helps gather more information about factors that make a behaviour more or less likely to occur
Questions to consider when gathering information about antecedents
When / Where / With whom does the behaviour occur?
What activities/events come before the behaviour?
Are there any other behaviours occurring before the ‘target’ behaviour?
When, where, with whom and in what circumstances is the behaviour LEAST likely to occur?
Behaviour
Refers to:
Observed behaviours - must be clearly seen and able to be described
Important to understand the purpose or function of behaviours
Behaviours can express information about unmet needs
Identifying behaviours to target
Behaviours of concern are those that put an individual or those around them at risk of harm
Behvaiours can often occur:
To address or bring attention to a currently unmet need
To allow for escape from an activity or situation
To obtain tangible items
For self-stimulation purposes
Consequence
Refers to:
The responses to the behaviour - what happened after the behaviour occurred?
Different types of consequences
Can be naturally occurring consequences or deliberately put in place as a response to behaviours
Consequences can impact the likelihood of behaviours occurring in the future
Pleasant consequences increase the likelihood of the behaviour occurring again (reinforcement)
Unpleasant consequences decrease the likelihood of the behaviour occurring again (punishment)
Understanding antecedents helps us to…
control behaviours and therefore consequences
Disruptive behaviours can be learnt
Children learn that certain behavours are followed by favourable consequences, while other behaviours are followed by unfavourable consequences
Reinforcement
When a behaviour is followed by a favourable consequence, it is more likely to happen again in the future
Punishment
When a behaviour is followed by an unfavourable consequence, it is less likely to occur again in the future
Reinforcement & Punishment can either be ‘Positive’ or ‘Negative’
Positive ADDING something to the situation
Negative REMOVING something from the situation
what is reinforcement?
can be used to increase behaviours
what is positive and negative reinforcement
POSITIVE REINFORCEMENT means we are adding a pleasant
consequence to increase a behaviour
NEGATIVE REINFORCEMENT = taking away an unpleasant
consequence to increase a behaviour
What is the coercive cycle?
Coercive Cycles reflects a push-pull between two parties (e.g., parent-child, teacherstudent)
Results in the escalation of behaviours before one party ‘gives in’ in some way
what is key to maintaining coercive cycles?
Negative Reinforcement Removing something unpleasant that increases the likelihood of a behaviour occurring again
- What is psychopathy?
- Psychopathy identifies special subpopulation of antisocial individuals at-risk for chronic, violent behaviour
