Psych 2101 Flashcards

Question

types of reliability

Answer 1

* 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

Answer 2

search it up pookie

Answer 3

* Reliability * Validity * Errors in use of method

Answer 4

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

Answer 5

is abnormal and effects the way an individual functions Associated with significant distress and impairment

Answer 6

An acceptable or culturally approved response to a common stressor or loss (such as death of a loved one) is not a disorder

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

Periods of mania alternate with periods of depression Emotional rollercoaster: elation to despair to elation to despair… “Manic depression” = old name for bipolar disorders

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

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?

Answer 19

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

Answer 20

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

Answer 21

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

Answer 22

Obsessive compulsive and related disorders

Answer 23

Obsessions and compulsions

Answer 24

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

Answer 25

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’

Answer 26

Repugnant obsessions Contamination obsessions Doubting obsessions → me with locks

Answer 27

Obsessions Preoccupation Sexual fantasies (recurrent) Everyday worries

Answer 28

Cant make tea Thinks theres broken glass

Answer 29

2-3% lifetime prevalence, F=M

Answer 30

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

Answer 31

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

Answer 32

High reactivity in the cortical striatal thalamic circuit This is the area related to filtering out irrelevant information and preservation of behaviour

Answer 33

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

Answer 34

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

Answer 35

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

Answer 36

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

Answer 37

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

Answer 38

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

Answer 39

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.

Answer 40

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)

Answer 41

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)

Answer 42

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)

Answer 43

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)

Answer 44

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

Answer 45

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

Answer 46

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

Answer 47

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

Answer 48

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

Answer 49

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

Answer 50

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.

Answer 51

* 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”

Answer 52

* Pervasive [inflexible] * Pathological [distress or impairment] * Persistent [stable]

Answer 53

internalising and externalising

Answer 54

comorbidity

Answer 55

to establish persistence across time and pervasiveness across setting

Answer 56

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

Answer 57

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)

Answer 58

Observe problem behaviour Discuss with GP/ specialist Referral to mental health professional Psychological assessment

Answer 59

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

Answer 60

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

Answer 61

Diagnose Diagnose the problem Report Prepare report with recommendations Recommend Identify evidence-based intervention(s) Treatment Treat or refer to specialist MH professional

Answer 62

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)

Answer 63

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

Answer 64

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

Answer 65

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

Answer 66

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”

Answer 67

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.

Answer 68

Childhood disorders usually persist into adult disorders

Answer 69

EXTERNALISING/UNDERCONTROLLED → affects people around them → more prevalent in boys INTERNALISING/ OVERCONTROLLED → affects the child → more prevalent in girls

Answer 70

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)

Answer 71

DSM-5 Externalising Disorders Disruptive, impulse control, and conduct disorders – Oppositional defiant disorder – Conduct disorder – Intermittent explosive disorder – Pyromania – Kleptomania

Answer 72

Attention-deficit/hyperactivity disorder Autism spectrum disorder Communication disorders Global developmental delay Intellectual disability (Intellectual Developmental Disorder) Motor disorders Specific learning disorders

Answer 73

* 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

Answer 74

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

Answer 75

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

Answer 76

Diagnose Diagnose the problem Report Prepare report with recommendations Recommend Identify evidence-based intervention(s) Treatment Treat or refer to specialist MH professional

Answer 77

YES comorbidity

Answer 78

Importance of multi-method assessment of children to establish persistence across time and pervasiveness across setting

Answer 79

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

Answer 80

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

Answer 81

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

Answer 82

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

Answer 83

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

Answer 84

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

Answer 85

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

Answer 86

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

Answer 87

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)

Answer 88

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

Answer 89

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

Answer 90

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

Answer 91

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

Answer 92

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

Answer 93

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

Answer 94

Difficult temperament Poor academic achievement Genetic factors Autonomic irregularities Premature birth Reward dominance Thrill seeking Low verbal intelligence Cognitive biases Impulsivity

Answer 95

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

Answer 96

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)

Answer 97

It is a direct observation tool Antecedent Behaviour Consequence

Answer 98

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?

Answer 99

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

Answer 100

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)

Answer 101

control behaviours and therefore consequences

Answer 102

Children learn that certain behavours are followed by favourable consequences, while other behaviours are followed by unfavourable consequences

Answer 103

When a behaviour is followed by a favourable consequence, it is more likely to happen again in the future

Answer 104

When a behaviour is followed by an unfavourable consequence, it is less likely to occur again in the future

Answer 105

Positive ADDING something to the situation Negative REMOVING something from the situation

Answer 106

can be used to increase behaviours

Answer 107

POSITIVE REINFORCEMENT means we are adding a pleasant consequence to increase a behaviour NEGATIVE REINFORCEMENT = taking away an unpleasant consequence to increase a behaviour

Answer 108

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

Answer 109

Negative Reinforcement Removing something unpleasant that increases the likelihood of a behaviour occurring again

Answer 110

* Psychopathy identifies special subpopulation of antisocial individuals at-risk for chronic, violent behaviour

Answer 111

* Extensive debate surrounds the core deficit and etiology of psychopathy

Answer 112

* Psychopathic individuals show pervasive emotional deficits attributed to brain differences, and thought to contribute to their chronic antisocial behaviour

Answer 113

* To date, treatment research poorly designed and carried out; evidence supports antisocial burnout in the absence of treatment

Answer 114

* The Mask of Sanity (1941) * Based on experiences with psychiatric patients * Narrowed psychopathy construct * Forms basis for modern conceptualisations Three main domains Positive Adjustment § Superficial charm and good “intelligence” § Absence of delusions/irrational thinking § Absence of nervousness or neuroses § Suicide rarely carried out Chronic Behavioral Deviance § Inadequately motivated antisocial behavior § Poor judgment / failure to learn from experience § Unreliability § Fantastic and uninviting behavior with/without drinking § Sex life impersonal, trivial, poorly integrated § Failure to follow any life plan Emotional-interpersonal deficits (THE MAIN ONE) – Untruthfulness and insincerity – Lack of remorse or shame – General poverty in major affective reactions – Pathological egocentricity and incapacity for love – Specific loss of insight – Unresponsiveness in general interpersonal relations

Answer 115

10% antisocial behaviour 1% psychopathic traits These individuals cause the government $460 billion

Answer 116

Antisocial personality disorder (50-60%) Psychopathy (16 - 25%) White collar ‘successful psychopaths’ (4% of corporates) 1% general population

Answer 117

Psychopaths are opportunistic criminals → no plans for the future → doesnt stay in one place for too long

Answer 118

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 before age 15 year

Answer 119

Early empirical study of psychopathy Developed the Psychopathy Checklist (PCL) and its derivatives – Original version published in 1980 (revised in 1991) – To address lack of objective psychopathy measures – Intended to capture the psychopathy construct described by Cleckley – Initially validated in relation to global and checklist measures of Cleckley psychopathy

Answer 120

Hare’s Psychopathy Checklist- Revised Semi-structured face-to-face interview covering education, employment, family, relationships, criminal history, substance use Supplemented by detailed review of institutional file material (because psychopaths lie, need files to cross check) Information used to score 20 items

Answer 121

Each item scored on a 3-point scale – 0 = item does not apply to individual – 1 = item applies to individual but only somewhat, or mixed evidence – 2 = item describes individual in most respects Item scores summed to generate total and factor scores – 30+ : psychopath – 21-29 : intermediate – < 20 : non-psychopath

Answer 122

psychopathy is split into 2 factors factor 1: interpersonal/effective 1. interpersonal facet - glibness/superficial charm - grandiose sense of worth pathological lying - conning/manipulative 2. affective facet - lack of remorse or guilt - shallow effect - callous/lack of empathy - failure to accept responsibility for own actions factor 2: chronic antisocial lifestyle 3. lifestyle facet - need for stimulation/proneness to boredom - parasitic lifestyle - lack of realistic long term goals - impulsivity - irresponsibility 4. antisocial facet - poor behavioural controls - early behavioural problems - juvenile delinquency - revocation of conditional release - criminal versatility

Answer 123

Used the prior test and revised it for children

Answer 124

CU Traits Lack of remorse or guilt Lack of concern for others’ feelings Lack of concern over poor performance at school Shallow or deficient emotions Conduct Disorder Aggression to people and animals (e.g., bullying, physical fights, weapon use, cruelty, forced sexual activity) Destruction of property (e.g., fire setting, vandalism) Deceitfulness/ Theft (e.g., B&E, conning, shoplifting, forgery) Serious violation of rules (e.g., run away, truancy) CU Traits & Outcomes Take home message: Children with CU/CP present with a “special” kind of antisocial behavior ^^ increase chances of becoming a psychopathic adult

Answer 125

Disproportionate criminal involvement § Versatile offenders Most severe and violent offenders § Predatory aggression (proactive → seeking out victims) Predictor of future violence and criminal involvement § General and violent recidivism § Nonviolent and violent infractions Attributed to unique causal factors Poor response to treatment

Answer 126

Less prevalent in women than men More sexual promiscuity (Grann, 2000), prostitution (Strachan, 1993), use of nonviolent sexual coercive tactics (Khan et al., 2017), & relational aggression Overlap with somatization, histrionic PD, borderline PD (Cale & Lilienfeld, 2002; Lilienfeld et al., 1986) Predictor of suicide-related behaviors (Kimonis et al., 2010) Mixed findings for greater violent and non-violent crime and recidivism Mixed findings for same causal factors as men Higher rates of childhood abuse, neglect, and trauma (Moreira et al., 2020) Research still lags far behind that on men and boys

Answer 127

Take home message: Children with CU traits show severe CPs regardless of coercive/inconsistent parenting Coercion cycle

Answer 128

^^ psychopaths dont have the negative emotional state “Unempathetic brains” Brain differences → amygdala (emotion) Brain Differences in CU Subtype of CP Amygdala → too active → conduct disorder → overreactive) Violent Adult Psychopaths Show Low Amygdala Volume Differences in how the brain acts and looks

Answer 129

After learning a behaviour is rewarded, struggle to re-learn same behaviour is punished PI (punishment insensitive → those in a healthy population) struggle to link consequence with own behaviour as the cause * Punishment cues less aversive People with psychopathy have a reduced startle response (dont respond to fear normally)

Answer 130

bottle neck (attention) → all they see is what they want → cant see consequences Goal driven behaviours

Answer 131

* Strong pessimistic opinions – ‘‘No clinical intervention will ever be helpful’’ and ‘‘no effective interventions yet exist for psychopaths’’ (Harris & Rice, 2006) – Largely based on one unconventional study that made patients worse (Harris et al., 1991) * Mainly poorly designed and carried out studies * Treatment effective in reducing re-offending in psychopathic juvenile offenders * Early intervention with children with callous-unemotional conduct problems promising

Answer 132

Parent Management Training (PMT) (AKA Behavioural Parent Training) * The most successful interventions for conduct problems * Based in social learning and behavior modification methods * Therapist teaches caregiver(s) skills to manage child’s problem behaviours Planned Ignoring Rule: Ignore minor misbehaviour. → behaviour gets worse before it gets better Look away Show no expression Say nothing to or about the child Catch the 1st positive child behaviour – use a “Do” skill. Reason: Helps child notice difference between your responses to positive and negative behaviour Although the ignored behaviour may get worse at first, consistent ignoring reduces attention seeking behaviour Examples: Child: (crashing into parent’s tower with a plane) “I crashed yours”. Parent: (looks away) “My plane flies in circles”. Child: “My plane goes high”. Parent: “Your plane flies really high. I love when you play gently with your toys.” Behavioural Targets for Strategic Attention and Planned Ignoring Praise when the child is doing the opposite of what you dont want them to do STRATEGICALLY ATTEND TO … Polite manners Playing gently with the toys Staying seated at the table Asking nicely Talking softly Sharing toys Trying even when it is hard SELECTIVELY IGNORE … Bossiness, demandingness, Banging toys on the table, Leaving seat during play, Whinging , Yelling, Snatching, Giving up in frustration Constance Hanf’s Intervention Developed clinical intervention to strengthen the parent-child relationship and achieve authoritative and “good enough” parenting * Teaching parents play therapy skills to build parentchild bond * Teaching parents firm limit setting to manage disruptive child behaviors Trained many leading world-scholars of parenting interventions Parent-Child Interaction Therapy * Behavioral family therapy focused on relationship building and establishing firm boundaries for children Goals are to: * Establish a more positive parent-child relationship * Decrease child behaviour problems and increase prosocial behaviours * Improve parenting skills * Foster optimal “authoritative” parenting style PCIT research outcomes: * Reduces children’s oppositional, noncompliant, aggressive, destructive behaviour * Calms children & improves selfregulation * Improves children’s self-esteem * Reduces parent’s stress levels * Improves family functioning and emotional well-being * Gains maintain years after PCIT ends * The most effective psychological intervention Who is PCIT for? Odd Cd Adhd Children from 2 - 7 PCIT as a Transdiagnostic Intervention Oppositional Defiant Disorder (ODD) Conduct Disorder (CD) Attention-Deficit/Hyperactivity Disorder (ADHD) Anxiety Disorders Developmental Disabilities Autism Spectrum Disorder (ASD) Depression Selective Mutism Social Inhibition Child Maltreatment & Trauma Foster Carers Domestic Violence Obesity How Does PCIT Work? Parent wearing bug-in ear device Therapist behind one-way mirror providing in-vivo coaching to parent in play with child Parent-child dyad involved in special therapeutic play Phases of PCIT Child Directed Interaction (CDI) 7+ weeks Focuses on rebuilding the relationship between parents and children Teaches parents to improve child behaviour using positive attention strategies Parent Directed Interaction (PDI) 7+ weeks Focuses on reducing ‘big’ behaviour problems like chronic non-compliance, aggression, and destructiveness Teaches parents to use safe, consistent, and powerful discipline and reward strategies “Do Skills” of Special Play FUndamental Principle: Follow the children lead DO * Praise * Reflect * Imitate * Describe * Enjoy Praise What? Complimenting child and their behaviours or creations How? * Labeled/specific (tell child exactly what you like) * Unlabeled * Enthusiastically Why? Increases self-esteem * Teaches children what behaviours you like * Increases behaviours you want to see again * Fosters positive, warm parent-child relationship * Makes parents & children feel good When? Following: Appropriate behaviour * New skill you’re trying to build * Any time, except after behaviour you don’t want to see again Reflect What? Repeating what child says How? Repeat, paraphrase, or elaborate on what the child says; can use synonyms of child’s words * Mustn’t change the meaning of what child said or interpret unstated ideas Why? * Increases self-esteem * Shows you’re listening, understand, are interested and care about what child says * Improves speech and conversational skills * Fosters positive, warm parent-child relationship When? Following: Appropriate talk * New verbal skill * Any time, except after talk you don’t want to hear again Imitate What? Copy what child is doing How? Follow the child’s lead Why? * Increases self-esteem * Let’s child lead * Communicates approval of child’s choices * Helps parents play at child’s level * Makes play more fun When? Following: Appropriate behaviour * Any time, except after behaviour you don’t want to see again Describe What? Say what child is doing How? Child is the subject, not toys or parent * Describes child’s ongoing or immediately completed (< 5 sec.) observable behaviour * Uses an action verb Why? Increases attention and concentration * Has a calming effect * Helps organise child’s thoughts about play * Shows child you’re interested; selfesteem * Models speech When? Following: Appropriate behaviour * New skill you want to encourage * Any time, except after behaviour you don’t want to see again Enjoy What? Act warm and happy How? Smiling * Laughing * Enthusiastic talk * Affectionate behaviour and talk * Eye contact * Facing, sitting close together When? Following: * Appropriate behaviour * Any time, except after behaviour you don’t want to see again Why? Increases self-esteem * Let’s child know you enjoy spending time together * Improves parent-child relationship * Makes child feel loved “Don’t Skills” during Special Play se DON’T * Give commands * Ask unnecessary questions * Criticise or be sarcastic “Don’t skills”: Don’t ask questions (during Special Play) Rule: Avoid Questions Questions call for your child to give an answer Reason: * Leads the conversation instead of following * Many questions are commands * Many questions require an answer * May seem like you are not listening or you disagree with the child Examples: That’s a yellow one, right? * What colour is this? * Are you going to use the yellow crayon? * Yellow? * Do you really want to use yellow? * Why are you drawing it all yellow? * Are you having fun? “Don’t skills”: Don’t criticise Rule: Avoid Criticism and Sarcasm (verbal and non-verbal) Expresses disapproval of your child Reason: Gives attention to negative behaviour * Causes angry feelings between parent and child * May lower the child’s selfesteem * Teaches child negative social behaviour Examples: “No” “Stop” “Don’t…” * That’s wrong * That wasn’t very smart * Don’t colour the sky pink * Stop it! * Your tower isn’t straight enough * No, sweetie, that’s not where it goes * Can you do anything right? * “Don’t skills”: Don’t give Commands (during Special Play) Rule: Avoid Commands Commands tell the child to do something Reason: Takes the lead away from the child * Can cause conflict * “Machine-gun” commands frustrate children Example: Indirect Will you hand me the paper? Can you tell me what animal this is? Direct Look at this Please tie your shoelace Dangerous Behaviour Rule: Stop the play for aggressive and destructive behaviours Reason: Aggressive and destructive behaviours cannot be ignored as they can be dangerous. Teaches natural consequences. Examples: Child: (hits parent) * Parent: (gathers toys) “special play is over because you hit me. I bet you can play more gently tomorrow.” Special Play: How Tos Purpose Strengthens caregiverchild relationship Opportunity to practice modeling and reinforcing good behaviours Planned ignoring addresses minor misbehaviour Special Play Tips Follow child’s lead Imitate what child does Reflect what child says Use lots of genuine praise Be enthusiastic and warm Keep to five minutes Practice daily => natural, effortless, automatic Distraction-free setting Examples of Activities Lego Blocks Play sets (e.g., food, farm, train) Dolls House Colouring Mr Potato Head Arts &Crafts (older kids) Lecture Summary Baumrind’s authoritative parenting style linked with optimal child outcomes Parent management training is most efficacious treatment for child conduct disorders, and is based in: Social learning theory Operant conditioning principles Attachment theory (PCIT and its counterparts) Key goal of behavior modification programs like PMT: Extinguish conditioned problem behavior by altering consequences (reinforcement, punishment) and strengthen parent-child relationship

Answer 133

The power of caregiver modeling & responding Albert Bandura Managing Problem Behaviour Why do child behaviours happen? Two key principles: Parent MODELLING of behaviours Parent REINFORCEMENT of behaviours Key Principle #1 What is parent modelling? Children imitate the behaviours they observe from important people in their lives Children were presented with models that did certain behaviours (aggressive to a doll) Children copied models Exposure to aggressive modelling → children learn to be aggressive and extend on it to do worse Key Principle #2 What is reinforcement? → increases the likelihood of behaviours (positive and negative) Coercive cycle

Answer 134

Diana Baumrind’s Parenting Styles Authoratitative (high demand, high response) OPTIMAL Authoritarian (high demand, low response) Permissive (low demand, high response) Uninvolved (low demand, low response) Demandingness (obedience) → responsiveness (how much are parents responding to children's needs) If youre in the middle of these domains → ‘good enough’ parenting Optimal Parenting Style: ”Warm but Firm” * Improved social competence

Answer 135

* The power of caregiver modeling & responding Albert Bandura Managing Problem Behaviour Why do child behaviours happen? Two key principles: Parent MODELLING of behaviours Parent REINFORCEMENT of behaviours Key Principle #1 What is parent modelling? Children imitate the behaviours they observe from important people in their lives Children were presented with models that did certain behaviours (aggressive to a doll) Children copied models Exposure to aggressive modelling → children learn to be aggressive and extend on it to do worse Key Principle #2 What is reinforcement? → increases the likelihood of behaviours (positive and negative) Coercive cycle

Answer 136

Parent Management Training (PMT) (AKA Behavioural Parent Training) * The most successful interventions for conduct problems * Based in social learning and behavior modification methods * Therapist teaches caregiver(s) skills to manage child’s problem behaviours Planned Ignoring Rule: Ignore minor misbehaviour. → behaviour gets worse before it gets better Look away Show no expression Say nothing to or about the child Catch the 1st positive child behaviour – use a “Do” skill. Reason: Helps child notice difference between your responses to positive and negative behaviour Although the ignored behaviour may get worse at first, consistent ignoring reduces attention seeking behaviour Examples: Child: (crashing into parent’s tower with a plane) “I crashed yours”. Parent: (looks away) “My plane flies in circles”. Child: “My plane goes high”. Parent: “Your plane flies really high. I love when you play gently with your toys.” Behavioural Targets for Strategic Attention and Planned Ignoring Praise when the child is doing the opposite of what you dont want them to do STRATEGICALLY ATTEND TO … Polite manners Playing gently with the toys Staying seated at the table Asking nicely Talking softly Sharing toys Trying even when it is hard SELECTIVELY IGNORE … Bossiness, demandingness, Banging toys on the table, Leaving seat during play, Whinging , Yelling, Snatching, Giving up in frustration Constance Hanf’s Intervention Developed clinical intervention to strengthen the parent-child relationship and achieve authoritative and “good enough” parenting * Teaching parents play therapy skills to build parentchild bond * Teaching parents firm limit setting to manage disruptive child behaviors Trained many leading world-scholars of parenting interventions Parent-Child Interaction Therapy * Behavioral family therapy focused on relationship building and establishing firm boundaries for children Goals are to: * Establish a more positive parent-child relationship * Decrease child behaviour problems and increase prosocial behaviours * Improve parenting skills * Foster optimal “authoritative” parenting style PCIT research outcomes: * Reduces children’s oppositional, noncompliant, aggressive, destructive behaviour * Calms children & improves selfregulation * Improves children’s self-esteem * Reduces parent’s stress levels * Improves family functioning and emotional well-being * Gains maintain years after PCIT ends * The most effective psychological intervention Who is PCIT for? Odd Cd Adhd Children from 2 - 7 PCIT as a Transdiagnostic Intervention Oppositional Defiant Disorder (ODD) Conduct Disorder (CD) Attention-Deficit/Hyperactivity Disorder (ADHD) Anxiety Disorders Developmental Disabilities Autism Spectrum Disorder (ASD) Depression Selective Mutism Social Inhibition Child Maltreatment & Trauma Foster Carers Domestic Violence Obesity How Does PCIT Work? Parent wearing bug-in ear device Therapist behind one-way mirror providing in-vivo coaching to parent in play with child Parent-child dyad involved in special therapeutic play Phases of PCIT Child Directed Interaction (CDI) 7+ weeks Focuses on rebuilding the relationship between parents and children Teaches parents to improve child behaviour using positive attention strategies Parent Directed Interaction (PDI) 7+ weeks Focuses on reducing ‘big’ behaviour problems like chronic non-compliance, aggression, and destructiveness Teaches parents to use safe, consistent, and powerful discipline and reward strategies “Do Skills” of Special Play FUndamental Principle: Follow the children lead DO * Praise * Reflect * Imitate * Describe * Enjoy Praise What? Complimenting child and their behaviours or creations How? * Labeled/specific (tell child exactly what you like) * Unlabeled * Enthusiastically Why? Increases self-esteem * Teaches children what behaviours you like * Increases behaviours you want to see again * Fosters positive, warm parent-child relationship * Makes parents & children feel good When? Following: Appropriate behaviour * New skill you’re trying to build * Any time, except after behaviour you don’t want to see again Reflect What? Repeating what child says How? Repeat, paraphrase, or elaborate on what the child says; can use synonyms of child’s words * Mustn’t change the meaning of what child said or interpret unstated ideas Why? * Increases self-esteem * Shows you’re listening, understand, are interested and care about what child says * Improves speech and conversational skills * Fosters positive, warm parent-child relationship When? Following: Appropriate talk * New verbal skill * Any time, except after talk you don’t want to hear again Imitate What? Copy what child is doing How? Follow the child’s lead Why? * Increases self-esteem * Let’s child lead * Communicates approval of child’s choices * Helps parents play at child’s level * Makes play more fun When? Following: Appropriate behaviour * Any time, except after behaviour you don’t want to see again Describe What? Say what child is doing How? Child is the subject, not toys or parent * Describes child’s ongoing or immediately completed (< 5 sec.) observable behaviour * Uses an action verb Why? Increases attention and concentration * Has a calming effect * Helps organise child’s thoughts about play * Shows child you’re interested; selfesteem * Models speech When? Following: Appropriate behaviour * New skill you want to encourage * Any time, except after behaviour you don’t want to see again Enjoy What? Act warm and happy How? Smiling * Laughing * Enthusiastic talk * Affectionate behaviour and talk * Eye contact * Facing, sitting close together When? Following: * Appropriate behaviour * Any time, except after behaviour you don’t want to see again Why? Increases self-esteem * Let’s child know you enjoy spending time together * Improves parent-child relationship * Makes child feel loved “Don’t Skills” during Special Play se DON’T * Give commands * Ask unnecessary questions * Criticise or be sarcastic “Don’t skills”: Don’t ask questions (during Special Play) Rule: Avoid Questions Questions call for your child to give an answer Reason: * Leads the conversation instead of following * Many questions are commands * Many questions require an answer * May seem like you are not listening or you disagree with the child Examples: That’s a yellow one, right? * What colour is this? * Are you going to use the yellow crayon? * Yellow? * Do you really want to use yellow? * Why are you drawing it all yellow? * Are you having fun? “Don’t skills”: Don’t criticise Rule: Avoid Criticism and Sarcasm (verbal and non-verbal) Expresses disapproval of your child Reason: Gives attention to negative behaviour * Causes angry feelings between parent and child * May lower the child’s selfesteem * Teaches child negative social behaviour Examples: “No” “Stop” “Don’t…” * That’s wrong * That wasn’t very smart * Don’t colour the sky pink * Stop it! * Your tower isn’t straight enough * No, sweetie, that’s not where it goes * Can you do anything right? * “Don’t skills”: Don’t give Commands (during Special Play) Rule: Avoid Commands Commands tell the child to do something Reason: Takes the lead away from the child * Can cause conflict * “Machine-gun” commands frustrate children Example: Indirect Will you hand me the paper? Can you tell me what animal this is? Direct Look at this Please tie your shoelace Dangerous Behaviour Rule: Stop the play for aggressive and destructive behaviours Reason: Aggressive and destructive behaviours cannot be ignored as they can be dangerous. Teaches natural consequences. Examples: Child: (hits parent) * Parent: (gathers toys) “special play is over because you hit me. I bet you can play more gently tomorrow.” Special Play: How Tos Purpose Strengthens caregiverchild relationship Opportunity to practice modeling and reinforcing good behaviours Planned ignoring addresses minor misbehaviour Special Play Tips Follow child’s lead Imitate what child does Reflect what child says Use lots of genuine praise Be enthusiastic and warm Keep to five minutes Practice daily => natural, effortless, automatic Distraction-free setting Examples of Activities Lego Blocks Play sets (e.g., food, farm, train) Dolls House Colouring Mr Potato Head Arts &Crafts (older kids)

Answer 137

Answer: Psychopathy is a personality disorder characterized by antisocial behavior, emotional-interpersonal deficits, and a lack of empathy or remorse. It often leads to chronic, violent behavior.

Answer 138

Answer: Psychopathy is commonly assessed using Robert Hare’s Psychopathy Checklist-Revised (PCL-R), which involves a semi-structured interview covering various aspects of life and a review of institutional records. The PCL-R includes 20 items scored on a scale from 0 to 2, with a score of 30+ indicating psychopathy.

Answer 139

Answer: The causes of psychopathy are not fully understood but involve a combination of genetic and neurobiological factors, particularly involving the amygdala, which affects emotional responses. Twin studies suggest a high heritability, especially in youth with callous-unemotional (CU) traits.

Answer 140

Answer: Treatment for psychopathy is challenging, with many experts pessimistic about its effectiveness. However, early intervention in children with CU traits shows promise in reducing re-offending, especially among juvenile offenders.

Answer 141

Answer: Hervey Cleckley was a psychiatrist who published The Mask of Sanity (1941) based on his work with psychiatric patients. He narrowed the psychopathy construct and introduced core domains that influence modern understandings of psychopathy.

Answer 142

Answer: The three main domains are: Positive Adjustment: Superficial charm, good intelligence, absence of delusions, low anxiety. Chronic Behavioral Deviance: Antisocial behavior, poor judgment, impulsivity, unreliable. Emotional-Interpersonal Deficits: Lack of empathy, remorse, or emotional depth—considered the core of psychopathy.

Answer 143

Answer: This core feature involves a lack of genuine emotional response, such as empathy or remorse, combined with egocentricity and shallow affect.

Answer 144

Answer: Approximately 1% of the general population shows psychopathic traits, with higher rates in certain groups like corporate executives (4%) and offenders (16–25%).

Answer 145

Answer: Criminal psychopaths often engage in violent or impulsive crimes, while "successful" psychopaths (often found in corporate settings) display manipulative, non-violent traits that allow them to avoid detection.

Answer 146

Answer: ASPD requires a pervasive disregard for others’ rights since age 15, evidenced by behaviors like repeated criminal acts, lying, impulsivity, aggression, and a lack of remorse.

Answer 147

Answer: CU traits, such as lack of remorse, empathy, and shallow emotions, are markers of severe antisocial behavior in youth. Children with CU traits are at higher risk for adult psychopathy.

Answer 148

Answer: CU traits are linked with early onset and severe conduct problems, proactive aggression, violent offending, and a high risk of recidivism.

Answer 149

Answer: Individuals with CU traits often struggle to associate consequences with their actions, showing reduced responsiveness to punishment and focused attention solely on goal-driven behaviors.

Answer 150

Answer: Psychopaths often show abnormalities in the amygdala, which affects emotional processing, resulting in reduced emotional responses such as fear.

Answer 151

Answer: Psychopathy is less prevalent in women and often includes relational aggression, somatization, and a history of trauma or abuse. There is mixed evidence on whether women with psychopathic traits engage in as much violent crime as men.

Answer 152

Answer: Conduct Disorder (CD) involves severe antisocial behaviors like aggression and theft, while Oppositional Defiant Disorder (ODD) includes defiant, angry behavior without the same level of violation of others' rights.

Answer 153

Answer: LPE is a subtype of CD in DSM-5, where individuals show traits like lack of empathy and shallow affect across multiple settings, making them more likely to develop severe conduct problems.

Answer 154

Answer: This pessimism stems from studies showing limited effectiveness of treatment in adults with psychopathy, with some studies even suggesting that certain treatments can increase recidivism.

Answer 155

Answer: Early intervention in children with CU traits has shown promise in reducing the development of full psychopathy and may prevent chronic offending.

Answer 156

Answer: Psychopathy is a unique subset of antisocial personality that poses significant challenges for treatment due to pervasive emotional deficits. There is ongoing debate about its causes and treatment, with some success seen in early interventions for at-risk youth.

Answer 157

Answer: Psychopathy is estimated to be 80% heritable, indicating a strong genetic component.

Answer 158

Answer: In adults, psychopathy is classified as a behavioral disorder, assessed by actions and past behaviors. In children, it is more affective, focusing on emotions and cognitive patterns.

Answer 159

Answer: The core deficit in psychopathy is debated. Theories suggest it may involve: Fearlessness and insensitivity to punishment Limited emotional response to distressing cues Attentional deficits Atypical associative learning Efforts to unify these perspectives are still limited.

Answer 160

Answer: The Psychopathy Checklist (PCL-R) is a tool developed by Robert Hare to assess psychopathy. It includes a 60-90 minute interview plus file review, covering 20 traits across affective, interpersonal, and behavioral symptom clusters.

Answer 161

Answer: Each trait is scored on a 3-point scale: 0: Trait does not apply 1: Trait applies somewhat 2: Trait definitely applies Scores range from 0 to 40, with a score of 30+ indicating psychopathy.

Answer 162

Answer: Exposure to death, threatened death, serious injury, or sexual violence, either directly, as a witness, or indirectly (e.g., learning about a close relative/friend experiencing a violent or accidental event), or through repeated exposure in a professional context.

Answer 163

Answer: PTSD diagnosis requires: Exposure to trauma. Intrusion symptoms (e.g., intrusive memories, nightmares, flashbacks). Avoidance of trauma-related stimuli. Negative alterations in cognition/mood (e.g., negative beliefs, feelings of alienation). Alterations in arousal or reactivity (e.g., irritability, hypervigilance). Symptoms must persist for over a month, cause significant distress, and not be due to another condition.

Answer 164

Answer: Lifetime prevalence is 7-8% in the general population, with higher rates in trauma-exposed individuals: 20.4% in women and 8.2% in men.

Answer 165

Answer: ASD occurs within 3 days to 1 month post-trauma, requiring 9 out of 14 symptoms across five categories (intrusions, mood, dissociation, avoidance, arousal). It is a controversial diagnosis with limited predictive accuracy for long-term PTSD.

Answer 166

Vulnerability factors: Gender, prior trauma, past psychiatric illness, history of abuse. Peritraumatic factors: Severity, type, life threat, proximity, and dissociation during trauma. Posttraumatic factors: Level of social support and safety post-trauma.

Answer 167

Answer: This theory (1947) explains PTSD symptoms through classical conditioning (association of trauma with fear) and operant conditioning (avoidance behaviors to reduce anxiety).

Answer 168

Answer: Proposed by Lang (1977) and adapted by Foa, Steketee, and Rothbaum, this theory suggests PTSD is linked to a "fear network" that is stable, broadly generalized, and easily triggered, causing conscious intrusions.

Answer 169

Answer: This model posits that trauma memories are poorly integrated, making them both difficult to recall and easily triggered, with negative appraisals of self, world, and trauma being central.

Answer 170

Answer: Psychological Debriefing is a single-session intervention originally for emergency personnel. It’s controversial because meta-analyses suggest it may hinder natural recovery and potentially worsen PTSD symptoms.

Answer 171

Answer: Psychological First Aid aims to enhance safety, calming, connectedness, self-efficacy, and hopefulness immediately after trauma. It is supported by limited research.

Answer 172

Answer: Pharmacological treatments are not first-line but include: Propranolol in the first few hours post-trauma, potentially reducing PTSD risk. Benzodiazepines, which may increase PTSD risk. Tricyclic antidepressants may help reduce arousal.

Answer 173

Prolonged Exposure Therapy: Encourages “reliving” traumatic events to reduce fear. Cognitive Processing Therapy: Focuses on changing unhelpful beliefs related to trauma. Eye Movement Desensitization and Reprocessing (EMDR): Combines exposure with eye movement to process trauma. Narrative Exposure Therapy: Involves creating a coherent trauma narrative.

Answer 174

Answer: Techniques include psychoeducation, imaginal exposure, in vivo exposure, cognitive restructuring, and relapse prevention.

Answer 175

Answer: Imaginal exposure involves “reliving” the trauma through memory to facilitate habituation, emotional processing, and cognitive change. It requires client consent, as symptoms may increase initially.

Answer 176

Answer: In vivo exposure gradually exposes the client to feared situations, helping reduce avoidance and facilitate cognitive changes.

Answer 177

Answer: Cognitive therapy identifies and challenges maladaptive thoughts related to trauma (e.g., “The world is dangerous”), helping to develop healthier beliefs.

Answer 178

Answer: Relapse prevention includes revisiting the intervention, preparing for future challenges, understanding the difference between lapse and relapse, and creating a plan for managing potential setbacks.

Answer 179

Answer: DSM-III, though many cases were classified as “not otherwise specified” (NOS) due to diagnostic limitations. Later DSM revisions aimed to reduce NOS diagnoses by revising criteria and identifying new disorders.

Answer 180

DSM-IV criteria included: Refusal to maintain minimally normal body weight (85% expected, BMI 17.5). Intense fear of gaining weight. Body image disturbance. Amenorrhea (absence of menstruation), which only applied to women. Subtypes: Restricting and binge-eating/purging types. DSM-5 removed amenorrhea and specified weight severity thresholds.

Answer 181

DSM-IV criteria: Binge eating (large amount in a short time) with lack of control. Inappropriate compensatory behaviors. Binge/compensatory behavior 2X/week for 3 months. Self-evaluation heavily influenced by weight/shape. DSM-5 adjusted the frequency of binging/compensatory behavior to 1X/week.

Answer 182

Binge eating episodes involve: Eating large amounts in a discrete period with loss of control. Associated symptoms (e.g., rapid eating, eating when not hungry, feeling guilty). Bingeing 1X/week for 3 months, without compensatory behaviors.

Answer 183

For individuals not meeting full criteria for AN, BN, or BED, includes conditions like purging disorder and night eating syndrome.

Answer 184

Point prevalence: Cases at a given time. Lifetime prevalence: Cases at any time in life (most commonly reported). Incidence: New cases over a specific time period. Prevalence Order: Higher in binge eating, followed by bulimia, then anorexia.

Answer 185

Social comparison: Upward: Comparing to someone "better" (often worsens self-view). Downward: Comparing to someone "worse" (may boost self-esteem). Media Influence: Media alone isn’t solely responsible. Other factors like peer influences (body-type idealization, “fat talk”) and family pressures (parents’ weight concerns) are significant. Cultural Variations: Different cultures value different body types; for instance, African American and Hispanic Americans may internalize the thin ideal less, while in some Chinese cultures, there is a form of non-fat-phobic AN.

Answer 186

Issues with self-esteem, identity, and perfectionism are common, with eating disorders often reflecting attempts at control. Escape Theory: Eating disorders may serve as a way to escape aversive self-awareness.

Answer 187

Genetics: Higher risk if a family member has an ED, with stronger concordance in MZ twins. Neuroendocrine Dysfunction: The hypothalamus regulates hunger, while serotonin imbalances can link to impulsivity and binge eating.

Answer 188

10. Cognitive-Behavioral Therapy (CBT) for BN Stage 1: Introduce CBT model, stabilize eating behaviors. Stage 2: Eliminate dieting behaviors and confront fear foods. Stage 3: Focus on maintenance and relapse prevention. Success rate: 60%, effective for 5-6 years, and works quickly. 11. Interpersonal Psychotherapy (IPT) for BN Focuses on interpersonal relationships rather than ED symptoms. Areas addressed: Interpersonal disputes, role transitions, grief, deficits. Success rate: 70% over 12 months but slower improvement. CBT vs. IPT: CBT is often preferred for severe cases due to faster symptom reduction, while IPT may be effective for less severe cases.

Answer 189

12. Initial Goal: Weight restoration. 13. Family-Based Therapy (FBT) – “Maudsley Approach” Phase 1: Parents lead weight restoration. Phase 2: Gradual return of eating control to the child. Phase 3: Help child establish a healthy identity. 15-20 sessions over a year, outpatient. 14. Other Approaches Cognitive-Behavioral Therapy for AN involves addressing ambivalence or resistance. Motivational Interviewing: Helps clients recognize the need for change.

Answer 190

15. Effectiveness of Medications SSRIs may help in bulimia but not particularly effective for anorexia. Pharmacotherapy generally not successful as standalone treatment for EDs; usually, medication is combined with other therapeutic methods.

Answer 191

Answer: Binet and Simon (1905) defined intelligence as the ability to judge well, understand well, and reason well.

Answer 192

Answer: Wechsler (1939) defined intelligence as the aggregate capacity of the individual to act purposefully, think rationally, and deal effectively with the environment.

Answer 193

Answer: Linda Gottfredson and other experts (1997) described intelligence as the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly, and learn from experience. It is broader than academic skills, reflecting a deeper capability to understand and make sense of the surroundings.

Answer 194

Answer: Alfred Binet is considered the father of intelligence testing. He created the Binet-Simon test, which was designed to measure a person's cognitive abilities and identify children who might need special education.

Answer 195

Answer: Lewis Terman adapted the Binet-Simon test for use in America and invented the concept of the Intelligence Quotient (IQ).

Answer 196

Answer: Charles Spearman contributed to intelligence theory by using statistics to measure intelligence in terms of general intelligence (g) and specific intelligences (s). His work laid the foundation for modern IQ tests.

Answer 197

Answer: David Wechsler attempted to create an intelligence scale that could provide the best estimate of an individual’s intelligence, focusing on a more comprehensive assessment of intellectual functioning.

Answer 198

Answer: Raymond Cattell differentiated between fluid intelligence (the ability to process information) and crystallized intelligence (the facts we know). He argued that fluid intelligence declines with age, while crystallized intelligence remains stable.

Answer 199

Answer: Howard Gardner proposed the theory of multiple intelligences, emphasizing that intelligence includes a variety of types such as musical, linguistic, logical-mathematical, spatial, bodily-kinesthetic, interpersonal, intrapersonal, and naturalistic intelligences.

Answer 200

Answer: Robert Sternberg introduced the concept of successful intelligence, which includes problem-solving ability, and practical intelligence, which refers to "street smarts" or the ability to navigate real-world challenges.

Answer 201

Answer: Carol Dweck is known for her research on growth mindset vs fixed mindset, emphasizing how individuals' beliefs about their intelligence can influence their motivation and achievement.

Answer 202

Answer: Alan and Nadeen Kaufman focused on intelligence testing that considers the broader social context and the individual undergoing the test, emphasizing the importance of the testing environment.

Answer 203

Answer: Emotional intelligence refers to the ability to recognize, understand, and manage emotions. It was developed by Peter Salovey and John Mayer.

Answer 204

Answer: The two popular intelligence tests are the Stanford-Binet 5 (SB-5) and the Wechsler Adult Intelligence Scale IV (WAIS-IV).

Answer 205

Answer: Intelligence test scores are standardized with a mean score of 100 and a standard deviation of 15. This means that 68% of people score between 85 and 115, and 95% score between 70 and 130.

Answer 206

Answer: Reliability refers to the consistency of the test results across different times and raters. Validity refers to the accuracy of the test, specifically whether it measures what it purports to measure.

Answer 207

Answer: Intelligence tests are generally highly reliable, with high concurrent validity (the ability to correlate with other measures of intelligence), but they often have poor predictive validity (the ability to predict future success or outcomes).

Answer 208

Answer: Controversies include the limited scope of IQ tests, which fail to measure multiple intelligences such as emotional, creative, and practical intelligences. There are also concerns about the misuse of IQ tests in educational, forensic, and employment settings, as well as their use to justify claims about genetic differences between groups.

Answer 209

Answer: Intelligence tests can help identify children who may benefit from extra education, track efforts to address social disadvantages, and assist in selecting candidates for employment, especially when used as part of a broader evaluation.

Answer 210

Answer: Test bias refers to the unfairness or prejudice in an intelligence test that results in a disproportionate effect on one group compared to another, potentially leading to inaccurate or misleading conclusions about intelligence.

Answer 211

Answer: The key question is whether the differences in test scores reflect true differences in intelligence or are simply due to biased testing.

Answer 212

Answer: Test bias is a concern because many assessments influence important decisions, such as entry into gifted programs, job placements, and forensic evaluations, and bias could unfairly disadvantage one group over another.

Answer 213

Answer: Test bias is related to validity (accuracy of measurement) because a biased test may not measure intelligence equally across different groups, leading to differential validity (inconsistent accuracy across groups).

Answer 214

Answer: Differential validity occurs when a test or assessment is valid for one subgroup (e.g., middle-class individuals) but not for another subgroup (e.g., lower-class individuals), resulting in unfair conclusions.

Answer 215

Answer: Bias can be assessed in terms of: Predictive validity: Does the test predict future performance differently for different groups? Construct validity: Does the test measure the same construct for all groups?

Answer 216

Answer: Predictive validity refers to whether a test accurately predicts future outcomes (e.g., academic or career success) for different groups. Bias is present if the test leads to incorrect predictions for a particular group.

Answer 217

Answer: Construct validity concerns whether the test measures the same underlying construct (e.g., intelligence) in the same way for different groups. Bias in construct validity occurs if the test measures different things for different groups.

Answer 218

Answer: Methods to measure bias in construct validity include: (In)consistency in factor analysis: Whether different groups group variables the same way. (In)consistency in rank ordering of difficulty: Whether the difficulty ranking of items differs between groups. (In)consistency of convergent/discriminant validity: Whether the test correlates appropriately with related measures and does not correlate with unrelated measures.

Answer 219

Answer: Factor analysis is a statistical method used to identify the underlying dimensions (factors) that explain the interrelationships among variables. Bias may be indicated if different groups group variables differently during factor analysis.

Answer 220

Answer: Rank ordering of difficulty refers to arranging test items based on their average difficulty. If different groups rank the items differently, it suggests a bias in the test for those groups.

Answer 221

Answer: Convergent validity refers to the degree to which a test correlates with other measures of the same construct. Inconsistent convergent validity across groups can indicate construct bias.

Answer 222

Answer: The Bell Curve argues that IQ tests are an accurate measure of intelligence, predicting school and career success, and that racial differences in IQ are likely due to genetics rather than environmental factors. It claims that educational interventions have little effect on IQ or racial differences.

Answer 223

Answer: The two main explanations are: Differences are due to a gene-environment interaction (e.g., access to education and socioeconomic status). Differences are due to biased tests.

Answer 224

Answer: "Culture-free" intelligence tests aim to eliminate cultural biases, often using nonverbal tests like Raven's Matrices. However, they are controversial because they may still be culturally biased, as some logical patterns used in these tests may be more familiar to certain cultures than others.

Answer 225

Answer: Nonverbal tests like Raven’s Matrices rely on matrix logic, which may be familiar in some cultures but not in others, making them not truly culture-free.

Answer 226

Answer: The problem is that intelligence is often defined in terms of adaptive behavior within a particular culture. Therefore, a test that is free from cultural influence may no longer be an accurate measure of intelligence, as it might not predict intelligence well in any culture.

Answer 227

Answer: Western cultures tend to view intelligence as a means for individuals to categorize and rationally debate. Eastern cultures see intelligence as recognizing contradictions, understanding complexity, and playing social roles. African cultures combine cognitive skills with social responsibility, emphasizing qualities like respect and responsibility.

Answer 228

Answer: Among the Luo people, intelligence includes: Rieko (academic intelligence), Luoro (social qualities like respect and responsibility), Paro (practical thinking), and Winjo (comprehension).

Answer 229

Answer: Elena Grigorenko notes that while mindlessly applying the same tests across cultures is undesirable, there is still a desire to compare intelligence across cultures using a standard measure, which must be balanced with assessing people within their own cultural context.

Answer 230

Answer: The challenge is that intelligence, when defined as adaptive behavior, is influenced by culture. Therefore, a truly culture-free test would likely fail to predict intelligence in any culture effectively.

Answer 231

Answer: The intelligence heritability debate concerns the relative contribution of genetic versus environmental factors in determining intelligence. It questions whether intelligence is primarily inherited (genetics) or shaped by environmental influences such as education and socio-economic status.

Answer 232

Answer: Twin studies traditionally concluded that about 70% of the variance in intelligence is heritable. However, newer studies show that in high socio-economic status (SES) contexts, this figure holds, but in low SES contexts, genetics accounts for only 8% of the variance, suggesting a stronger role for the environment in lower SES groups.

Answer 233

Answer: Genetic sequencing studies have found that genome-wide sequences explain about 4% of the variance in intelligence. This figure increases to 10% when years of education are also considered, indicating that both genetic factors and educational experiences contribute to intelligence.

Answer 234

Answer: Both nature (genetics) and nurture (environmental factors like education and socio-economic status) play important roles in shaping intelligence. The balance between these factors is central to understanding individual differences in intelligence.

Answer 235

Answer: The Mozart Effect suggests that listening to classical music can temporarily boost performance on certain tasks. However, research shows that this effect is not long-lasting, and there is no evidence that it leads to long-term improvements in intelligence.

Answer 236

Answer: Research, including a study by Sala and Gobet (2017), indicates that music training does not improve cognitive skills such as fluid intelligence, memory, phonological processing, spatial ability, or cognitive control. Additionally, it has no significant impact on academic achievement.

Answer 237

Answer: Studies show that chess training improves memory skills in chess players, but these benefits do not transfer to other areas of cognitive functioning. Additionally, there is a lack of appropriate control groups in many studies, making it difficult to draw firm conclusions about its impact on intelligence.

Answer 238

Answer: Working memory training (WMT) involves exercises designed to improve the capacity of working memory. Some studies, such as Jaeggi et al. (2008), suggest that training can improve performance on working memory tasks, which may translate to improvements in fluid intelligence. However, other studies, such as Chein and Morrison (2010) and Redick et al. (2013), found no significant improvements in fluid intelligence as a result of WMT.

Answer 239

Answer: Jaeggi et al. (2008) found that participants who underwent dual n-back training showed improvement in n-back task performance, and their fluid intelligence scores also increased after training, suggesting a positive effect of working memory training on intelligence.

Answer 240

Answer: Chein and Morrison (2010) found that although working memory training led to improvements in working memory performance, it did not result in any significant changes in fluid intelligence, suggesting that working memory training may not transfer to broader cognitive abilities.

Answer 241

Answer: Redick et al. (2013) found that while participants improved in the tasks directly related to the training (like dual n-back and visual search tasks), there was no improvement in fluid intelligence or other cognitive abilities after three weeks of working memory training.

Answer 242

Answer: Harrison et al. (2013) found that working memory training (whether complex-span, simple-span, or visual search training) improved performance on the trained tasks, but it did not lead to substantial improvements in broader cognitive abilities or intelligence.

Answer 243

Answer: According to Simons et al. (2016), "brain training" interventions improve performance on the trained tasks, but there is limited evidence that such training improves related tasks or transfers to other areas of cognitive functioning. Furthermore, little evidence exists to suggest that brain training improves real-world cognitive performance.

Answer 244

Answer: Physical exercise has been shown to positively influence cognitive abilities in both children and adults. A meta-analysis published in 2012 found that a single bout of intense exercise, particularly if followed by a short delay before cognitive tests, has a small but reliable positive effect on cognitive performance.

Answer 245

Answer: Hogan et al. (2013) found that performing moderate-intensity exercise for 15 minutes before completing a 2-back task resulted in quicker reaction times, especially for older adults, compared to a control group that did not exercise.

Answer 246

Answer: The meta-analysis showed that short bouts of intense exercise can improve cognitive performance, with the strongest effects occurring when there is a short delay before cognitive testing. However, exercise lasting less than 20 minutes may have a negative effect, while exercise lasting longer than 20 minutes generally yields positive results.

Answer 247

Answer: Based on current research, the most promising advice would be to engage in regular physical exercise, as it has been shown to have a positive impact on cognitive performance. While other interventions like working memory training or music training have limited evidence for improving general intelligence, exercise is a well-supported method for enhancing cognitive abilities. Additionally, a balanced environment that promotes both genetic and environmental factors, such as a high-quality education, can contribute to better cognitive outcomes.

Answer 248

A1. Dementia is a progressive disorder that affects cognitive functioning and worsens over time, impacting daily activities. It is not considered a normal part of aging.

Answer 249

A2. Dementia can have a young onset (typically in a person’s 40s or 50s), often influenced by genetic factors. Late-onset dementia usually occurs after age 65 and has some genetic influence but not necessarily a requirement.

Answer 250

A3. Cognitive decline progresses along a continuum: cognitively normal → mild cognitive impairment (MCI) → major neurocognitive disorder (dementia). This progression can vary by individual and may stabilize temporarily.

Answer 251

A4. Mild cognitive impairment (MCI) involves a modest cognitive decline without interfering with complex daily activities. In contrast, dementia involves significant cognitive decline that impairs daily functioning.

Answer 252

A5. Mild neurocognitive disorder (NCD) involves modest cognitive decline without impacting independence in daily activities, while major NCD (dementia) involves substantial cognitive decline that requires assistance with daily activities.

Answer 253

A6. Diagnosis requires meeting the criteria for major or mild NCD, with an insidious onset and gradual progression of cognitive impairment in one or more domains. Genetic evidence of Alzheimer’s, either through family history or testing, is also a factor, with no mixed etiology.

Answer 254

A7. Diagnostic tools include neuropsychological tests (e.g., MMSE, MoCA), medical history, physical and neurological assessments, psychiatric evaluations, blood tests, and brain imaging.

Answer 255

A8. Dementia types include Alzheimer’s (60-80%), Lewy body dementia (5-10%), vascular dementia (5-10%), and frontotemporal dementia (5-10%). Mixed dementia can also occur from multiple causes.

Answer 256

A9. Risk Factors: Smoking, sedentary lifestyle, poor sleep quality. Protective Factors: Cognitive engagement, social engagement, regular exercise.

Answer 257

A10. High blood pressure, especially in midlife, is a significant risk factor for later dementia. It can lead to vascular damage, affecting brain health and contributing to cognitive decline.

Answer 258

A11. The meta-analysis, with over 28,000 participants, showed that antihypertensive treatment reduced the odds of dementia by around 13% compared to placebo, particularly for those with elevated baseline blood pressure.

Answer 259

A12. The FINGER trial showed that a 2-year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring) could reduce cognitive decline compared to general health advice, suggesting lifestyle interventions can help prevent dementia.

Answer 260

A13. In Australia, it is estimated that the number of people with dementia will increase to over 1 million by 2058.

Answer 261

Answer: Five or more symptoms must be present within a two-week period, representing a change from previous functioning. At least one symptom is either a depressed mood most of the day or markedly decreased interest in almost all activities (anhedonia).

Answer 262

Answer: Symptoms include: Depressed mood most of the day, nearly every day. Decreased interest or pleasure in activities. Significant weight change or change in appetite. Insomnia or hypersomnia. Psychomotor agitation or retardation. Fatigue or loss of energy. Feelings of worthlessness or excessive guilt. Diminished ability to think or concentrate. Suicidal ideation or plans.

Answer 263

Answer: The symptoms must not be due to the effects of a substance or another medical condition.

Answer 264

Answer: The 12-month prevalence is 10%. Lifetime prevalence is 22.9% for females and 15.1% for males.

Answer 265

Answer: MDD is less prevalent in individuals aged 60 and over.

Answer 266

Answer: The mean age of onset is 26.2 years, with data suggesting that the onset age is decreasing. Early onset is associated with more frequent, but shorter, depressive episodes.

Answer 267

Answer: PDD involves a depressed mood for most of the day, more days than not, for at least two years, with symptoms generally being less severe but more chronic than MDD.

Answer 268

Answer: It is 0.5% for PDD and 1.5% for chronic major depressive disorder in the U.S.

Answer 269

Answer: Family studies show that relatives of patients with mood disorders often have earlier onset and recurrent episodes. Twin studies indicate a higher likelihood of depression in identical twins than fraternal twins, with higher heritability in women.

Answer 270

Answer: Lower levels of serotonin are implicated in mood disorders, as serotonin helps regulate emotional responses. The "permissive hypothesis" suggests that when serotonin is low, other neurotransmitters may become dysregulated, contributing to mood disturbances.

Answer 271

Answer: This theory suggests that depression may develop when people believe they have no control over reinforcements in their life, leading to learned helplessness. This concept was originally based on animal studies by Seligman in the 1970s.

Answer 272

Answer: The ABC model stands for Activating event, Belief/interpretation, and Consequential emotion. The model helps clients understand the relationship between events and their emotions by examining and modifying their thoughts.

Answer 273

Answer: Evidence-based psychotherapy, such as Cognitive Behavioral Therapy (CBT), is the first-line treatment for mild to moderate depression.

Answer 274

Answer: SSRIs specifically inhibit serotonin reuptake, increasing its availability in the brain. They are preferred due to similar efficacy as older drugs but with fewer side effects.

Answer 275

Answer: Behavioral Activation aims to increase positive reinforcement and activity levels by scheduling pleasurable and mastery-related activities, addressing the inactivity cycle that can maintain depression.

Answer 276

Answer: The prodrome, or 'ultra-high risk' phase, is an early stage where a person can feel an episode beginning internally but shows no external signs. Examples include heightened anxiety before a panic attack or subtle auditory experiences like whispers before a psychotic break.

Answer 277

Answer: Schizophrenia symptoms are grouped into: Positive symptoms: delusions and hallucinations. Disorganized symptoms: disorganized speech, affect, and behavior. Negative symptoms: avolition, alogia, and anhedonia.

Answer 278

Answer: Positive: Hearing voices (hallucinations). Disorganized: Speaking in fragmented or incoherent sentences. Negative: Loss of motivation (avolition).

Answer 279

Answer: First-rank symptoms are distinctive signs commonly associated with schizophrenia. Examples include: Third-person auditory hallucinations. Audible thoughts (hearing one’s thoughts spoken aloud). Delusions of thought broadcast (belief that others can hear one's thoughts).

Answer 280

Answer: Increased dopamine can enhance the sense of reward from minor stimuli, making insignificant details (e.g., birds chirping, numbers, or the time) appear highly relevant. This can lead to delusions of reference, where individuals believe these stimuli hold a special, personal significance.

Answer 281

Answer: A delusion of reference is the false belief that everyday events or objects have a special significance directed at the person. For example, someone might believe a song on the radio is specifically conveying a message to them.

Answer 282

Answer: Schizophrenic individuals typically have increased dopamine production and dopamine receptors. This excess can contribute to symptoms like delusions, hallucinations, and aberrant salience. Dopamine is involved in rewarding experiences and prediction errors, and its hyperactivity can lead to abnormal significance being assigned to neutral or irrelevant events.

Answer 283

Answer: Amphetamines are dopamine agonists, meaning they increase dopamine levels. Studies show that amphetamines can increase the risk of developing schizophrenia and can produce psychotic symptoms similar to those found in schizophrenia, such as paranoid delusions.

Answer 284

Answer: The dopamine hypothesis suggests that psychotic symptoms of schizophrenia are caused by hyperactivity in the dopaminergic system. Evidence for this includes the fact that antipsychotic medications block dopamine (D2) receptors, and dopamine agonists (e.g., amphetamines) can induce psychosis-like symptoms.

Answer 285

Answer: First-rank symptoms (FRS) include experiences like audible thoughts, voices commenting on actions, and delusions of control. These symptoms are considered characteristic of schizophrenia. A hyperactive dopamine system may contribute to these symptoms, with the brain misattributing internal thoughts or actions as external influences due to dopamine's role in salience detection.

Answer 286

Answer: "Aberrant salience" refers to the hyperactive dopamine system assigning disproportionate importance to neutral events or self-generated actions. This results in seemingly ordinary things becoming highly significant, contributing to delusions of reference or control, and misperceptions of one’s own thoughts or actions as being externally controlled.

Answer 287

Answer: Typical antipsychotics, such as chlorpromazine, block dopamine receptors to alleviate psychotic symptoms. Atypical antipsychotics, like clozapine, also block dopamine receptors but additionally act on serotonin receptors. Atypicals are more effective in treating negative symptoms but have side effects such as weight gain and sedation.

Answer 288

Answer: Side effects include extra-pyramidal symptoms (e.g., tardive dyskinesia), agranulocytosis (a dangerous loss of white blood cells), weight gain, and sedative effects. Long-term use can worsen negative symptoms like anhedonia or cognitive dysfunction.

Answer 289

Answer: CBT for negative symptoms focuses on behavioral activation and scheduling activities to enhance engagement in life. Techniques like thought challenging are used to help patients cope with apathy and lack of motivation.

Answer 290

Answer: CBT for auditory hallucinations aims to reduce distress by altering the patient's response to the voices. It doesn’t deny the presence of the voices but teaches patients how to manage their emotional reactions and avoid triggers that exacerbate hallucinations.

Answer 291

Answer: CBT has been shown to reduce compliance with command hallucinations, decrease distress, and lower levels of depression by challenging beliefs about the absolute power of the voices.

Answer 292

In psychodynamic therapy, the therapist takes a back seat, asking questions that help the patient reach conclusions independently. In contrast, CBT is very direct; the therapist is in control, guiding the patient through specific tasks without room for disagreement.

Answer 293

It focuses on tapping into the unconscious to address unresolved conflicts.

Answer 294

CBT emphasizes structure and control, with the therapist directly guiding the patient and ensuring they understand their actions and goals.

Answer 295

Psychoanalytic: Unconscious conflicts cause psychopathology. Humanistic: Conditions of worth impact mental health. Family Therapy: Family dysfunction leads to psychopathology. Behavioral: Learned responses to stimuli cause issues. Cognitive: Thoughts influence emotions and behavior.

Answer 296

The theoretical cause of psychopathology (e.g., unconscious conflicts, learned behaviors) influences therapy techniques and therapist-patient dynamics.

Answer 297

Mental disorders result from unresolved unconscious conflicts between the Id, Ego, and Superego.

Answer 298

Denial: Refusing to accept reality. Dissociation: Removing oneself from reality. Projection: Attributing unacceptable qualities to others. Reaction Formation: Acting opposite to unacceptable feelings

Answer 299

The goal is to reduce defenses and gain insight into hidden intrapsychic conflicts using techniques like free association and dream analysis.

Answer 300

Psychological problems arise from faulty learning.

Answer 301

Behavior modification and exposure therapy are commonly used, based on principles of operant and classical conditioning.

Answer 302

Behavior increases if it is rewarded or helps escape a negative consequence and decreases if punished or positive consequences are removed.

Answer 303

Exposure therapy involves gradually exposing clients to feared stimuli to reduce fear. Types include in vivo exposure, imaginal exposure, flooding, and graded exposure.

Answer 304

For social anxiety, exposure therapy could involve placing the client in social situations to reduce anxiety over time.

Answer 305

Distress results from maladaptive thought patterns and automatic negative thoughts.

Answer 306

The goal is to reduce distress by helping patients adopt more realistic and helpful thoughts.

Answer 307

Techniques include collaborative empiricism, Socratic questioning, and cognitive restructuring.

Answer 308

CBT combines cognitive restructuring with behavioral techniques, such as exposure, to facilitate cognitive change through experience.

Answer 309

For social anxiety, a client may test the belief that people will notice and react to their blushing by observing reactions when their therapist wears noticeable blush.

Answer 310

It assumes humans have an inherent drive for self-actualization and are inherently good.

Answer 311

Conditions include empathic understanding, unconditional positive regard, and congruence.

Answer 312

It combines research and clinical practice, with clinical psychologists using scientific evidence to inform treatment.

Answer 313

It ensures treatments are effective, ethical, and up-to-date, based on empirical evidence rather than solely on clinical opinion.

Answer 314

Efficacy research tests interventions under controlled conditions, while effectiveness research assesses how interventions work in real-world settings.

Answer 315

Factors include treatment complexity, training needs, cost, time commitment, and safety, all of which affect how widely a treatment can be implemented.

Answer 316

Clinicians use meta-analyses and expert reviews, such as those from the APA Division 12 Task Force, to stay informed on effective treatments.