Psychotherapy research Flashcards
Eysenck
Summarized 24 studies from 1920 to 1950 and concluded that the effects of psychotherapy are small or nonexistent. He had a no therapy control group vs eclectic psychotherapy vs psychoanalytic psychotherapy.
He was challenged on methodological grounds. His patients may not have been equivalent in terms of severity across groups. And no therapy group got medical treatment.
Smith, Glass, and Miller/Meta-analysis
First to apply meta analysis to psychotherapy outcome research and their results contradicted Eysenck’s finding.
Effect size
In meta analysis you combine results of multiple studies using an effect size. Usually involves subtracting the mean outcome score of the txt group from mean outcome score of control group and dividing difference by standard deviation of control group.
Smith, Glass, Miller
Conducted meta-analysis consisting of 475 outcome studies between 1941 and 1976 and found a mean effect size of .85. This suggests that the average client at the end of therapy is better off than 80% of those that did not receive therapy. Effect size for psychotherapy research is the same or higher than those for medical and education interventions and support claim that psychotherapy is generally efficacious.
Meta analyses have not found any one type of therapy to be better than other. However, some evidence that CBT is better for some disorders such as panic, phobias, and compulsions. This suggests that positive change in therapy is not due to any one particular technique but instead to factors that are common across all therapies including catharsis, positive therapeutic relationship, behavioral regulation, and cognitive learning and mastery.
Howard and his colleagues/ dose dependent effect
Relationship between treatment length and outcome levels off at 26 sessions. 75% of patients improved after 26 sessions but only 85% improved at 52 sessions. This is the dose dependent effect.
Phase model
Benefits of treatment vary depending on number of session. Three stages:
1) remoralization: client feelings of hopelessness and desperation respond quickly to therapy and happens during first few sessions
2) remediation: focus on symptoms that brought client to therapy; symptomatic relief is about 16 sessions
3) rehabilitation: focuses on unlearning maladaptive behaviors and establishing new ways; number of sessions depends on type and severity of problems.
Well being first phase, symptom outcomes second phase and life functioning outcomes third phase
Efficacy
Clinical trials
Effectiveness
Correlational or quasi-experimental in nature; best for assessing clinical utility that is determining generalizability, feasibility, and cost-effectiveness
Utilization of mental health services
Differ by race/ethnicity, type of treatment setting, and type of problem; smaller proportion of African Americans receive mental health services compared to whites but they are over represented in emergency services and inpatient psychiatric care settings. Asian American are underrepresented in inpatient and outpatient settings. Smaller proportion of African Americans and Hispanics receive treatment for depression compared to white, but African Americans are more likely to receive treatment for drug use.
Premature termination rates
50% of minorities drop out after first session. But only 30% of whites drop out. In community mental health services, African Americans had higher dropout rate than whites, Asians had lower rate, and Hispanics had similar rate to whites
Effects of therapist client matching
Inconclusive results; recent meta analysis indicated that therapist matching had a small effect but not significant effect on number of sessions attended.
Ppl with a strong association with their culture are more likely to prefer ethnically similar counselor. Other factors may be more important than race - education, similares in values and worldview
Older adults
Respond to treatment just as well as young people but slower progress; most common disorders include anxiety, severe cognitive impairment , and depression in this order; behavioral and environmental treatments well-established for behavioral problems associated with dementia; memory and cognitive training probably efficacious for dementia; cbt and brief psychodynamic probably efficacious for depression
Interventions for victims of spousal/partner abuse
Women more likely to be victims when they are younger, heterosexual, American Indian/Alaskan native (followed by African American), income less than 10,000. Income singles best predictor of abuse.
Goals of txt should focus on safety and increasing self-esteem, self-empowerment and control
Important for clinicians to self-monitor to avoid vicarious trauma
Often separate interventions for victims and perpetrators but Mack states that conjoint couples therapy may be appropriate if abuse is expression (occurs as result of emotion, mutual, shows remorse) vs instrumental (on purpose, unprovoked, unilateral).
Treatment manuals
Designed to standardize psychotherapeutic treatment; con is that it can oversimplify treatment and techniques; pro is that is can help disseminate evidence based treatments
Placebo effect
Different in psych. Refers to the nonspecific (common factors) of treatment; actually results in substantial improvements. Some say not an appropriate comparison group; when compared placebo to no treatment or waitlist, effect size of .67 but .48 when compare to an actual therapy.
Diagnostic overshadowing
Attribute Sxs to some other condition instead of what it is originally supposed to be.
Alloplastic vs autoplastic interventions
Alloplastic is make changes to environment so it accommodates the individual and autoplastic is make changes to individual so he/she can fit to the environment
Therapist distress
Suicidal statements most distressing client behavior; lack of therapeutic success most stress aspect of work; confidential most common legal issue
Psychiatric hospitalizations
Women more likely to have MH disorder than men in all age groups but men more likely to be hospitalized because they are more likely to show acting out behaviors which are a bigger concern to society whereas women are more likely to show anxiety and depression.
Psychiatric inpatients
Widowed less likely, married intermediate, and never married highest chance. Many whites but minorities are overrepresented. Most likely between 25-44; schizophrenia most likely diagnosis for less than 65. Those 65 or older, it is organic disorder followed by affective disorder. Women more likely to be outpatient. Whites majority of admissions to inpatient and outpatient.
African Americans
Emphasize group welfare over individual needs; focus on family including extended family. Church is considered important part of family; family roles are flexible; may exhibit health cultural paranoia
American Indians and Alaskan natives
Exhibit spiritual and holistic orientation; emphasis on extended family and tribe; strong sense of cooperation and generosity; time in terms of personal and seasonal rhythms; want therapist that helps reaffirm cultural values, adopt collaborative, problem solving approach; incorporate elders, medicine people and other healers;
Network therapy
Incorporates family and community members; use with American Indians and Alaskan natives
Asian Americans
Important to be aware of country of origina and acculturation status; place grater emphasis on group vs individual; adhere to hierarchical family structure and traditional gender roles; emphasize harmony; value restraint of strong emotions that might otherwise disrupt peace and harmony; prefer a directives, structure, goal-oriented approaches that focuses on alleviating specific sxs; emphasize formalism in therapy; the function of shame and obligation in Asian cultures is to reinforce adherence to prescribed roles; recognize that modesty and self-deprecation are not necessarily signs of low self-esteem; establishing credibility and competence early in therapy; may express mental health issues as somatic complaints; focus more on behaviors than emotions
Hispanic/Latino Americans
Emphasize family welfare; interdependence is healthy; discussing intimate details with a stranger is highly unacceptable, problems should be handled with family; adapt concrete approach to life; often attribute control of life’s events to luck, supernatural, acts of god, etc.
Recommended to be active and directive and to adopt a multimodal approach; recommends family therapy; other guidelines include: adopt personalismo; aware that such families are patriarchal; consider impact of religion; may express mh problems as somatic complaints.
Sexual minorities
Experience more psych issues due to discrimination and prejudice;
Internalized homophobia is when they accept society’s negative evaluations of them; this results in low self-esteem, self-doubt, self-hatred, sense of powerlessness; can be addressed in therapy
Important issue is coming out. Has benefits. Males more likely to complete coming out milestones earlier than women except in age at which they come out. Ppl these days more likely to come out earlier.
Cultural competence
Consists of awareness of assumptions, knowledge of world views of culturally diverse clients, skills to use techniques appropriate for certain clients
Credibility and giving are two important processes when working with diverse clients
Indigenous healing
Culture specific ways of dealing with human problems and distress. (E.g., curanderismo)
Acculturation
Degree to which a diverse member accepts and adheres to new culture.
Integration: has aspects of both cultures
Assimilation: person accepts main culture while relinquishing his
Separation: person withdraws from dominant culture
Marginalization: person identifies with neither culture
6 categories of acculturation: assimilated, fused, blended bicultural, alternating bicultural, separated, marginal.
Worldview
How a person perceives his own relationship to nature, other people, institutions, so on.
Determined by two factors: locus of control and locus of responsibility
White therapist likely to have internal locus of control and responsibility and misinterpret client who is black and has external locus due to racial oppression.
Minorities most likely to be IC ER due to oppression
Cultural encapsulation
Bad thing. When therapists define everyone’s reality according to their own.
Emic
Emic approach involves an attempt to see things through the eyes of the members of that culture
Étic
Viewing people from different cultures as essentially the same. Traditional psychological theories reflect an etic approach
High vs low context communication
High communication is grounded to the situation, depends on group understanding, relies heavily on nonverbal cues, and is slow to change. Low context relies on the explicit, verbal part of the message, less unifying, can change rapidly and easily.
Many diverse groups have high context communication.
Consequences of oppression
Internalized oppression is acting out against the system. Conceptual incarceration is assimilation. Split-self syndrome is seeing good and bad aspects of the self with the bad being the African American identity.
African Americans may display two survival mechanisms: 1) playing it cool and 2) Uncle Tom syndrome which is passivity.
Culture vs functional paranoia
Two forms of nondisclosure by african American clients; cultural paranoia is healthy and is when they do not disclose to white therapist due to fear; functional is unhealthy and when they do not disclose to anyone. 4 types:
1) intercultural nonparanoiac discloser (low functional and low cultural)
2) functional paranoiac (high function and low cultural)
3) healthy cultural paranoiac (low functional and high cultural)
4) confluente paranoiac (high functional and high cultura) doesn’t disclose to anyone due to racism and pathology. For this kind, the therapist should be the same race and culture but not necessary for others
Sexual stigma
Society’s negative regard for any nonheterosexual
Heterosexism
Cultural ideologies that define sexual minorities as deviant
Sexual prejudice
Negative attitudes that are based on sexual orientation
Racial cultural identity development model
5 stages: 1) conformity is preference for dominant culture and deprecating views of own culture
2) dissonance is confusion and conflict over the contradictory appreciating and depreciating attitudes that one has toward the self. These clients are likely to prefer minority therapist and see their problems as being due to racial/cultural identity problems
3) resistance and immersion is actively reject dominant culture. Prefer therapist from same race and see problems as being due to oppression
4) introspection are people who are uncertain about rigidity of beliefs held in stage 3. Prefer same race therapist but open to therapists with same world view
5) integrative awareness people experience a sense of self fulfillment with regard to cultural identity. Clients in this stage place greater emphasis on similar world view
Black Racial (Nigresence) Identity Development Model
5 stages:
1) Pre-encounter: racial identity and race have low salience in this stage. Usually prefer white therapist
2) encounter: exposure to a race event or series of events lead to greater racial awareness and leads to interest in developing black identity. Likely to prefer therapist of same race
3) immersion-emersion: race and racial identity have high salience. In immersion substage client has rage towards whites. Emersion substage, intense emotions subside but still rejects white culture.
4) internalization: race continues to have high salience. People in this stage have adopted one of three identities 1) pro black non racist, 2) a biculturist orientation, 3) multiculatirst orientation - integrates black with two or more cultures; ppl may exhibit healthy cultural paranoia
White racial identity development model (helms)
Hás two stages: abandoning racism and developing a nonracist white identity
6 statuses:
Contact status: obliviousness and denial
Disintegration: suppression of information and ambivalence
Reintegration: selective perception and negative out-group distortion
Pseudo-independence: selective perception and reshaping reality
Immersion-emersion: hypervigilence and reshaping
Autonomy: flexibility and complexity
Parallel interaction: patient and therapist have similar views of racial/cultural identity
Progressive interaction: when level of understanding of race in therapist and one step beyond client. This is most effective type.
Regressive interaction: clients level of understanding is higher
Crossed interaction: therapist and client report opposite info. opposite interactions about race.
Homosexual identity development model
Four stages:
Sensitization/feeling different: in middle school feel different
Self-recognition/identity confusion: they realize they are attracted to same sex, leads to turmoil and confusion
Identity assumption: INdivildiual becomes more aware of homosexuality
Commitment/ identity integration: publicly disclose homosexuality
Diagnostic uncertainty
Use other specified disorder when therapist want to indicate reason why deviates from disorder.
Use unspecified disorder when therapist does not want to indicate reason
DSM 5
Cross-cutting measures level 1 and 2; disorder specific severity measures;
Outline for cultural Formulation
Guidelines for assessing four factors: 1) clien’ts cultural identity 2) clients’ currrent conceptualization of distress; 3) psychosocial factors and and cultural factors that impact the client’s vulnerability; 4) cultural factors relevant to relationship between client and therapist
Intellectual disability
Need to meet 3 criteria:
1) deficits in intellectual functions
2) deficits in adaptive functioning (social, communication, independent living)
3) onset of intellectual and adaptive problems during the developmental period
4 severity levels
Etiology: 30% of cases unknown and low birth weight is strongest predictor; 15-20% environmental factors (like autism); 30% chromosomal changes (like Down syndrome)
Autism spectrum disorder
Must meet the following criteria:
1) persistent deficits in social communications and interactions across multiple contexts
2) restricted, repetitive patterns of behaviors, interests, and activities
3) symptoms during early developmental period
4) impairment in social, occupational, and other areas of functioning
Social problems apparent by about 12 months; poor prognosisl
Etiology: rapid head growth during first year of life; brain abnormalities ie amygdala, and cerebellum, neurotransmitter abnormalities, and some genetic component.
ADHD
Onset prior to 12 years, inattention or hyperactivity for at least 6 months, present in at least two settings, interferes with social, occupational, or academic functioning, requires at least 6 symptoms.
Combined presentation is when 6 symptoms in each category.
Typically test lower on IQ tests though they are usually average or above average. Exhibit academic difficulties and may also have social problems.
Adults with adhd tend to have low self-esteem, poor health outcomes, and education and occupational achievement.
Prevalence: 5% among children and 2.5% among adults. More common among males 2.1 ratio in children and 1.6 to 1 in adults. Combined subtype more common in males and inattentive subtype more common among females.
Etiology: there is a genetic component. Brain abnormalities include lower than normal activity and smaller size in caudate nucleus globus pallidus, and prefrontal cortex.
Behavioral disinhibition hypothesis: adhd is inability to regulate behavior or attention.
Stimulants work in about 75% of cases. Parent training and teacher training also commonly used.
In MTA study, compared med alone, behavioral txt alone, combine, and community care. Meds and behavioral txt were superior but benefits did not persist at 3 and 8 year follow ups.
Specific learning disorder
Presence of at least one characteristic sxs for at least 6 months; academic skills below what is expected for that age, began during school years, results in functional impairment
20 to 30% of children with learning disorder also have adhd.
One third of children with learning disorder have psychological problems as an adult.
More common in males
Etiology: cerebellar vestibular dysfunction, hemispheric abnormalities, exposure to toxins
Tourette’s disorder
At least one vocal tic or motor tics, persisted for more than one year, began prior to 18
Associated sxs is obsessive and compulsive. Many with this disorder also have OCD
Etiology: elevated levels of dopamine and super sensitivity of dopamine receptors in caudate nucleus
Txt: CBIT, haloperidol and pimozide; works for 80% but has intolerable side effects. SSSRI to alleviate ocd; clonodine (blood pressure), desipramine (antidepressant) to treat adhd.
Behavioral pediatrics, disclosure
Good to disclose; disclosure in early stages of cancer associated with better coping
Medical procedures
Multicomponent cognitive behavioral interventions useful for reducing children’s anxiety about medical procedures and the pain they cause. Based on stress inoculation model. Involves providing child with information about the procedure and using techniques to help child cope
Hospitalization
Children between ages of 1-4 has the most negative reactions to hospitalization due to child’s separation from family. This lead to increased visitation hours in hospitals
Physical disabilities
Risk for psychopathology greatest among children with a major neurological disorder (3 x higher)
School adjustment
CNS irradiation and intrathecal chemotherapy associated with impaired neurocognitive functioning and higher rate of learning disability.
Compliance
Noncompliance with medical regimens common among children and adolescents. Particular problem among adolescent and linked to concerns about peer acceptance, reduced conformity to rules, questioning credibility of HCP, reduced parental supervision.
Delusional disorder
Presence of one ore more delusions for at least one month.
Erotomanic- person believes that another is in love with him or her Grandiose: Jealous Persecutory Jealous Somatic Mixed Unspecified
Schizophrenia
At least two active phase sxs with at least one of them being hallucinations, delusions, or disorganized speech for at least one month. Continuous signs of the disorder for at least 6 months. And significant impairment in functioning.
SUD is common with rate of tobacco disorder being particularly high
Prevalence: 0.3-0.7% with rate slightly lower for females
Culture: findings that higher rate in african Americans is actually due to misdiagnosis and because that population is more likely to experience hallucinations and delusions due to depression and other disorder.
WHO international pilot study of schizophrenia compared patients with schizo in non western world to those in western world and found that those in non-western wold more likely to exibit acute set of sxs, a shorter clinical course, and a complete remission.
Onset between late teens and early 30s with peak in early to mid 20s for males and late 20s for females. Complete remission is rare.
Good prognosis associated with a good premorbid functioning, an acute and late onset, female, presence of a precipitating event, briefer duration of active phase sxs, insight into illness, family history of a mood disorder and no family history of schizo.
Concordance rates: 10% biological sibling, 17% fraternal twin, identical twin 48%, child of two parents with it 46%
Brain abnormalities: enlarged ventricles, smaller hippocampus, amygdala, and globus pallidus, lower activity in prefrontal cortex.
Treatment: traditional first generation antipsychotics (haloperidol fluphenazine) they eliminate positive sxs. They have severe side effects, mainly tardive dyskinesia
Atypical second general drugs are clozapine and risperidone. Can reduce both positive and negative sxs and less chance to develop TD.
Drugs are most effective when combined with psychosocial interventions like CBT.
Family interventions are beneficial when they target high levels of expressed emotion which has been linked to rehospitalization and relapse. This is when there is hostility towards patient or overprotective ness.
Dopamine hypohthesis
Early theory suggesting schizophrenia due to excess dopamine or overly sensitive dopamine receptors. Now revised to say that dopamine levels depending on sxs and that there are other neurotransmitters involved.
Schizophreniform disorder
Same diagnostic criteria as schizophrenia except present for at least one month but less than 6 months and impaired functioning may occur but not required.
Brief psychotic disorder
Often follows exposure to an overwhelming stressor. Presence of one of four sxs but one has to be delusions.
Schizoaffective disorder
Concurrent sxs of schizophrenia and a major depressive or manic episode with a period of at least two weeks with the mood sxs.
Bipolar 1
One manic episode that lasts at least a week. May include one or more episodes of hipomania and major depression
Comorbid with SUD and anxiety. 15 more likely to commit suicide compared to general population.
12 month prevalence is 0.6%. Slightly more common in males 1.1 to 1.
Genetics most consistently linked to bipolar disorders. 67 to 100% for identical twins. 20% for fraternal.
Lithium effective in 60 to 90% of cases. Compliance is a frequent problems. Think thy feel better stop, side effects, or are unwilling to give up high of manic episodes. For people that don’t respond to lithium or have rapid cycling or dysphoric mania, anti-seizure drug may be effective. For those experiencing acute mania, antipsychotic drug. Antidepressant may also be used but if combined with mood stablizer, may trigger a manic episode…. Risk greater with SSRIs than TCAs.
Compliance is enhanced when combined with psychotherapy (CBT, FFT interpersonal and social rhythm therapy).
Bipolar 2
At least one hypomanic (less severe and lasts for at least 4 days) and one major depressive episode. Not severe enough to cause impairment
Cyclothymic disorder
Numerous periods of hypomania but does not meet criteria to meet hypomanic epidsode and depression that does not meet criteria. Lasts for at least 2 years
Disruptive mood dysregulation disorder
Severe recurrent temper outbursts and usually occur three times per week on average. In between temper outbursts, the individual is mostly irritable. This has to last at least 12 months and between when individual is 6 to 18 years old but sxs have to exists before 10 years old.
Major depressive disorder
At least 5 sxs
Associated with sleep issues by 40 to 60% of outpatients: early morning awakening, reduced stage 3 and stage 4 (slow wave) sleep, decreased REM latency, increased duration of REM sleep early in night.
7% 12 month prevalence; people 18-29 3x more likely to have this compared to ppl 60 or older; at adolescence, females 1.5 to 3x more likely to have this compared to males.
Peak age is in mid 20s; might be precipitated by severe stressor but then related to number of depressive episodes.
Very genetic; 50% for identical twins and 20% for fraternal. Neuroticism and depression have same genetic predisposition which is why both are associated.
Catecholamine hypothesis: deficiency in norepinephrine
Indolamine hypothesis: deficiency in serotonina;
Elevated levels of cortisol which cause shrinkage in hippocampus.
Treatment: TCA, SSRIs, MAOI, SNRI
Study comparing IPT, CBT, TCA…. All three similarly effective but TCA better for severe depression
ECT side effective can be reduced by administering it unilaterally to right non dominant hemisphere.
Peripartum onset
Depression during or up to 4 weeks after pregnancy.
Behavioral theory of depression
Low rate of response contingent reinforcement
Learned helplessness model
Result of prior exposure to uncontrollable negative events along with attributing those events to internal, stable, and global factors. More recent model says it is just about hopelessness without attributions.
Depressive cognitive triad
Negative views of self, the world, and the future.
Suicide factors
Age: 45-54 most common with 45-54 most common for females and over 75 for males
Gender: males four times more likely but women more likely to attempt
Race/ethnicity: highest for whites except American Indian
Marital status: divorced, widowed, single, married
Suicidal thoughts and behaviors: most people have a previous attempt (60-80%)
Early warning signs: making preparations for dying, threading self-harm, talking about suicide etc
Life stress: big stressors like rejection by a loved one, living alone; among adolescents usually preceded by interpersonal conflict.
Psychiatric disorders; most have a mental disorder like bipolar or major depression. Most likely to occur within 3 months after depressive sxs begin to improve. Suicide risk when depression comorbid with SUD, conduct disorder, or ADHD.
Personality correlates: hopelessness and perfectionism
Biological correlates: low levels of serotonin and 5-HIAA (serotonin metabolite)
Separation anxiety disorder
At least 3 sxs including fear of being alone, excessive distress when separated, somatic sxs when separated; must last for 4 weeks in children and adolescents or 6 months in adults
May manifest as school refusal ages 5-7, 10-11, 14-16
Usually in children that come for warm, close family but precipites by life stressor like death of a pet.
Systematic desensitization or for older kids, cognitive approaches
Specific phobia
At least 6 months
Due to abnormal levels of serotonin, norepinephrine, and GABA.
Two factor theory attributes phobias to avoidance conditioning which involves both classical condition and operant conditioning.
Exposure with response prevention
Cognitive self control for treating children who are afraid of dark.
Social anxiety disorder
At least 6 months;
Linked to behavioral inhibition, a temperament trait. Also associated with certain information processing biases.
Exposure with response prevention; ssri, snri, or beta blocker propranolol
Panic disorder
Recurrent panic attacks with at least one attack followed by at least one month of worrying about having another panic attack.
Need at least 4 sxs to diagnose panic attack; have to rule out some medical conditions like hyperthyroidism, hypoglycemia, cardiac arrhythmia
2 to 3% 12 month prevalence with females more likely to be diagnosed. Prepubertal children rarely receive this diagnosis.
Panic control therapy appropriate also medications like imipramine or other TCAs, ssri, snri, and benzo but meds along has a high relapse rate 30-70% when discontinuing med
Agoraphobia
Marked fear or anxiety about at least two of these: using public transportation, being in enclose spade, being in open space, being in line or part of a crowd, or being outside of the home alone. Lasts at least 6 months
Txt: in vivo exposure with response prevention
Not sure if graded or intense exposure is better but some indication that intensive exposure has better long term effects
GAD
Excessive worry for at least 6 months has to include at least 3 sxs related to anxiety and worry such as easily fatigued, sleep disturbances
Over 50% of people with an anxiety disorder have at least one other anxiety disorder.
GAD has highest comorbidity with 90% of people also having MDD, PDD then SUD, phobia, or social anxiety disorder
CBT or for many a combination of CBT and pharmacotherapy.
OCD
Obsessions (can include repeated doubts about ones actions) and/or compulsions (can include mental acts)
1.2% 12 month prevalence rate
Equally common among males and females but because age of onset is earlier for males, it is more prevalent in males
Caused by low levels of serotonin; overactive right caudate nucleus, other areas include orbitofrontal cortex and cingulate cortex.
Combination of exposure with response prevention and TCA or ssri but antidepressants associated with high risk for relapse when stopping drug.
Body dysmorphic disorder
Preoccupation with with a defect or flaw in appearance
Reactive attachment disorder
Inhibited or emotionally withdrawn behavior toward adult caregiver. Child must receive diagnosis before 5 and after 9 months.
PTSD
One intrusion sxs, persistent avoidance, two sxs related to negative changes in cognition and mood, 2 sxs related to change in arousal and reactivity.
Txt is comprehensive CBT. Sometimes SSRI prescribed to target comorbid depression or anxiety. High rate of relapse when drug discontinued.
Cognitive incident stress debriefing does not work. It may actually worsen sxs. EMDR has soem effects but may be due to exposure and other non specific factors rather than eye movement.
Acute stress disorder
Sxs from 3 days to one month
Adjustment disorder
Onset within three months of psychosocial stress but must terminate within 6 months after end of stressor or its consequences
DID
Important to consider cultural aspects when diagnosing bc this is acceptable in some cultures.
Dissociative amnesia
Localized amnesia and selective most common. Also, generalized, continuous, and systematized
Conversion disorder
Disturbances in voluntary motor or sensory functioning but does not match neurological or other medical condition.
Factitious disorder vs malingering
Fakes for no reward vs fakes for reward
Anorexia nervosa
Half of individuals with this disorder also have an anxiety disorder and the anxiety disorder usually comes before the eating disorder. Depression also common but can occur before or during the eating disorder.
Associated with higher than normal levels of serotonin and food restriction lowers that level which is rewarding.
Tend to be perfectionists
Some studies point to family problems as contributors but others do not.
Cbt and family therapy are recommended. However, families with high expressed emotion have greater relapse and parent should be seen separately.
Bulimia nervosa
Binge eating and compensatory behaviors that occur at least once a week for 3 months.
Often associated with anxiety disorder or depression that precedes bulimia; depression most common among ppl with builimia.
Onset is usually during or after period of dieting
Low levels of serotonin and endogenous opioid beta endorphin
Treatment includes nutritional counseling and cbt. Antidepressants like imipramine and fluoxetine can help reduce binge eating but cbt has lower relapse rate.
Difference from anorexia is that these ppl are not underweight, no severe restrictions, and often aware that there’s a problem.
Enuresis
Wetting the bed after 5 yrs old twice a week for 3 or more months
Txt bell and pad… effective 80% of cases; 1/3 of children relapse within 6 months best when combined with behavioral rehearsal or over correction
Imipramine also helps reduce bedwetting 85% of cases but has poor long term efficacy. Desmopressin another drug that is a antidiuretic hormone but also not good for long term
Encoures is
Once a month for 3 months and child must be at least 4
Insomnia
Dissatisfaction with sleep quality or quantity; 3 nights a week for 3 months
Txt is cbt-i which includes sleep hygiene, stimulus control, relaxation training, cognitive therapy
Narcolepsy
Lapses into sleep or daytime naps 3x per week for 3 months. Includes cataplexy (loss of muscle tone), hypocretin defiency, or a rapid eye movement latency
Cataplexy triggered by strong emotions so they try to control emotions
Many have hypnogogic or hypnopompic hallucinations.
Non rapid eye movement sleep arousal disorders
Involves incomplete awakening like sleep terrors or sleepwalking. Usually during stages 3 and 4
Erectile dysfunction
Must be present for at least 6 months
If no erection during REM sleep then this suggests and organic cause.
If psychological, then use CBT. Viagra often commonly prescribed.
Genito-pelvic pain/penetration disorder
Persisted for 6 months, usually result from physical or sexual abuse.
Premature ejaculation
Ejaculate within one min or before person desire it…. Use sex therapy to treat. Techniques include sensate focus… start and stop and squeeze techniques for PE. PE is linked to low serotonin levels and SSRIs have been found to be effective.
Gender dysphoria
Different for children and adults. In children need to be present at least 6 months and require 6 sxs while adults require 2 sxs.
Rate of persistence depends on natal gender. Natal males 2.2-30% and natal females 12-50%
Paraphilic disorders
Cause distress or impairment to self or harm to others.
Frotteuristic - sexual arousal from touching or rubbing a non consenting adult
Transvestic disorder- cross dressing for sexual arousal. Mostly male disorder and most men say they are heterosexual.
Use cbt. Covert sensitization - aversive conditioning in imagination
Orgasmic reconditioning- replace unacceptable fantasy with more acceptable one while masturbating
Depoprovera reduces this behavior but returns when stopping drug.
Conduct disorder
Moffitt life-course persistent type (attributes to combination of neurological impairments like verbal skills, memory, executive functioning) vs adolescence limited type
PBT is txt or multisystemic treatment that targets family, school, community, individual etc.
Substance use disorders
At least 2 sxs for 12 months from four groups: impaired control, social impairment, risky use, pharmacological criteria
Etiology: Conger’s tension-reduction hypothesis - people drink to reduce tension and form an addiction. Addiction is the result of negative reinforcement.
Marlatt and Gordon say that addictive behaviors are an overlearned, maladaptive habit pattern.
Biopsychosocial models suggest that it is an interaction between physical, psychological, and sociocultural factors.
Txt/relapse: cbt (motivational interviewing, relapse prevention training, contingency management). Family and couple therapy, 12 step programs. Naltrexone and disulfiram for AUD, nicotine replace, e cig, and antidepressant buproprione for TUD.
Marlatt and Gordon
Addiction is an overlearned, maladaptive habit pattern. Also propose that relapse reaction is the abstinence violation effect which involves blame, guilt, depression, anxiety which lead to increased susceptibility to alcohol consumption. Potential for relapse is reduced when ppl see it as a mistake resulting from controllable external factors.
Relapse prevention therapy
Helps identify circumstances that increases individuals chances for relapse and involves using cbt techniques to prevent future lapses and or how cope better if individual does relapse.
Tobacco use disorder
Ppl how smoke have 3 to 4 times higher chance of having myocardial infarction, cardiac arrest, or smoke. But after 1 to 5 yers of quitting, risk is same as non smoker
Hard for smokers to quit… fear of failure and for women, fear of gaining weight average gain is 5 to 6 lbs first few months postcessation
Person continues to crave nicotine for months or years after quitting
Most successful quitters tend to be male, over 35, no smoking at home or work, be married or living with partner, have a college education, started smoking at later age, low nicotine dependency, and was able to quit for at least 5 days in prior attempts to quit.
Smoking cessation intervention
Support from clinicians
Nicotine replacement
Multicomponente behavior therapy (skills training, relapse prevention, stimulus control, and rapid smoking)
Substance induced disorders
Involves intoxication, withdrawal, and substance/mediation induced mental disorders. For the latter, sxs must have emerged within one month of substance intoxication or withdrawal or of taking a medication.
Alcohol withdrawal
Autonomic hyperactivity, hand tremor, sinsominia, nausea or vomiting, transient illusions or hallucination, anxiety, psychomotor agitation, generalized tonic clônic seizures.
Korsakoff syndrome
Anterograde and retrograde amnesia and confabulation to make up for memory loss. has been linked to thiamine deficiency.
Alcohol induced sleep disorder
Insomnia type in usually from intoxication or withdrawal
When resulting from withdrawal involves severe disruption in sleep continuity from vivid dreams.
Opioid withdrawal
Dysphoric mood, nausea or vomiting, muscle aches, lacrimation, runny nose, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, insomnia
Tobacco withdrawal
Irritability, anger, impaired concentration, increased appetite, restlessness, depressed mood, insomnia
Delirium
Disturbance in attention and awareness that develops over a short period of time and fluctuates throughout the day and usually gets worse in evening and at night. Must be due to medical condition, substance intoxication or withdrawal, or exposure to a toxin.
5 groups of people who are at highest risk: older people, drug dependence, people with decreased cerebral reserve (dementia, stroke, HIV), post cardiotomy patients, burn patients
Treat underlying cause and agitation behaviors; haloperidol and other antipsychotics may help.
Alzheimer’s
Difficult to diagnose, not until after death doing a biopsy and seeing amyloid plaques and tangles especially in hippocampus, amygdala, and entorhinal cortex)
Probably diagnosis when evidence of causitive genetic mutation. Other possible. Also have to differentiate between major and mild neurocognitive disorder (less marked decline in functioning from previous functioning level and does not interfere with individual independence in daily activities)
Most common cause of dementia
3 stages:
Stage 1 : anterograde amnesia
Stage 2: retrograde amnesia
Stage 3: major deterioration in intellectual functioning; urinary and fecal incontinence, limb rigidity
Abnormalities in chromosomes 1, 14, 21, and with abnormality on chromosome 19 being associated with late onset
Abnormal levels of acetylcholine (involved in formation of memories)
Group therapy, behavioral techniques and antipsychotic medications to reduce agitation, antidepressants to relieve depression, environmental manipulation and meds to improve memory and cognition. Cholinesterase inhibitors
Infection from major or mild neurocognitive disorder
HIV can cause this and there are 6 stages.
Paranoid personality disorder
Paranoid person
Schizoid personality disorder
Person that prefers to be alone and does not want close relationships with others; emotional coldness and detachment
Schizotypal personality disorder
Social and interpersonal deficits plus eccentricities in cognition, perception, and behavior. May express desire for close personal contact but have few friends and prefer being alone.
Antisocial personality disorder
Must be at least 18 with sxs since 15 and history of conduct disorder before 15. Sxs become less severe as you get older
BPD
Commonly diagnosed in individuals 19-34. And by 40, 75% don’t meet all criteria. Impulsive sxs most quickly to resolve with affective sxs most chronic.
According to linehan, emotion dysregulation is core feature of disorder, result fo excessive emotional vulnerability and inability to modulate strong emotions and exposure to an invalidating environment. Others say problems with mother child and separation individual stage.
DBT
CBT combined with rogerian thinking that patient needs to be accepted in order ot make changes. It involves group skills training, individual therapy to strengthen motivation and newly acquired skills, and coaching outside of therapy.
Histrionic
Emotionality and attention seeking
Narcissistic
Grandiosity, need for admiration, and lack of empathy
Avoidant PD
Social anxiety x10
Dependent PD
Need to be taken care of, clinging behavior and a fear of separation
OCPD
Fixated with orderliness and perfectionism. Does not involve true obsessions and compulsions like OCD
Genotype vs phenotype
Genotype refers to genetic make up. Phenotype refers to observed characteristics
Bronfenbrenner’s ecological model
5 environmental systems:
1) microsystem (face to face relationships)
2) mesosystem (components of microsystem interact such as family factors influence on child’s behavior at school)
3) exosystem (parent’s work place, school board, local industry, mass media)
4) macrosystem (cultural beliefs, economic system, politics)
5) chromosystem (environmental events that occur over lifespan and impact the individual depending on his or her developmental stage and life circumstance such as immediate and long term effects of a change in family structure or SES)
Rutter’s indicators
The more risk factors the worse the outcomes for children. Rutter identified 6 indicators:
Severe marital discord, low SES, overcrowding or large family size, parental criminality, maternal psychopathology, place of the child outside the home.
Niche-picking
Children seek out experiences that are consistent with their genetic predisposition. For example extroverted children will seek out socially stimulating activities. Also called active genotype environment correlation vs passive vs evocative. Active becomes more important as children become more independent
Critical periods vs sensitive periods
Critical periods are specific predetermined periods of time during biological maturation when an organism is particularly sensitive to particular stimuli that can have a postive or negative effect. (When ducks are born, the 3 days after is a critical period because they are finding an object to imprint) Humans have some critical periods for physical development but less certain they exist for other things.
Sensitive periods are longer and more flexible and not tied as closely to chronological age or maturational age. Humans more likely to have this like language acquisition and attachment.
PKU or phenylketonuria
Recessive gene inheritance. When you lack the enzyme phenylalanine found in milk, eggs, bread etc so if you start a diet early than you avoid severe intellectual disabilities
Down syndrome
Disorder due to chromosomal abnormality. Extra chromosome 21
Increased susceptibility to Alzheimer’s, leukemia, and heart defects.
Klinefelter syndrome
Also chromosomal abnormality; abnormality in number of sex chromosomes. Occurs in males and due to presences of 2 or more Xs along with Y. Results in small penis/testes, develops breasts, limited sexual interest, often sterile and may have learning disabilities.
Turner syndrome
Occurs in female when there is only one X chromosome. Have certain physical features like webbed neck, droopy eyelids, and short. May exhibit cognitive deficits.
Fetal alcohol spectrum disorder
Exposure to teratogens during the embryonic stage is most likely to cause the most damage.
FAS is the most severe of them. Results when mother drinks every day or most days especially during second half of first trimester. Cognitive problems, behavioral problems like adhd, retarded physical growth, facial anomalies etc.
Also alcohol related neurodevelopment disorder and alcohol related birth defects.
Areas of brain most likely to be impacted include corpus callosum, hippocampus, hypothalamus, cerebellum, basal ganglia, and frontal lobes.
Cocaine
Use by a pregnant women associated with still birth and spontaneous abortion. Infants that are born are at high risk of SIDS, seizures, low birth weight, reduced head circumference, tremors, hard to smooth, high pitched cry, development delays. Cognitive and behavioral problems may persist unto early school years.
Malnutrition
Miscarriage, low birth weight, stillbirth, intellectual disability, suppression of immune system, etc. serious malnutrition during in third trimester (especially protein deficiency) is particularly bad for developing brain. Lack of folic acid can result in spina bifida
Brain development
Only 25% of its adult weight at birth then by age 2 80% of adult weight. Less about addition of new neurons but more about the connections between neurons and formation of glial cells. Brain full weight by age 16. Synaptic pruning occurs to rid of unused connections.
Cerebral cortex
Almost completely undeveloped at birth.
Responsible for high level cognitive functions like language, spatial skills, and complex motor activities. During first few months, primary motor and sensory areas develop while prefrontal cortex continues to mature until early or mid 20s
After 30, the brain begins to shrink and it becomes worse after 60. Starts with prefrontal lobes, parietal, temporal then occiptal lobes. But brain does engage in NEUROGENSIS develop new neural connections and neurons in hippocampus and possibly other areas
NEUROGENSIS
See other card. Brain creates no synaptic connections and neurons.
Early reflexes (Babinski and Moro (startle))
Unlearned responses to stimuli in environment.
Babinski toes fan out and upward when soles of feet are tickled
Moro flings arms and legs outward then in in response to loud noise or sudden loss of physical support.
Perception in newborns
Techniques used to study newborns depends on age:
Sucking 1 to 4 months
Reaching 12 weeks or later
Head turning 5.5 to 12 months
Heart and respiration all ages
Habituation vs dishabituation
Vision
Least well developed at birth. They see 20ft where as adult sees 200ft but vision basically normal by 6 months.
Babies first sensitive to kinetic cues, binocular cues, then pictorial cues.
Babies 2 to 5 days prefer faces and by 2 months prefer mother’s face. They also like black and white and then more complex things as they grow older.
Auditory localization
Ability to orient to direction of a sound is evident shortly after birth. It disappears 2 to 4 months then comes back and continues to improve
By 3 months infants can distinguish between voices and prefers mothers voice.
Pain
Newborns experience pain.
Full term newborns who experience painful medical procedure exhibited heightened responsivity to pain later infancy while preterm infants who did had lower reactivity.
Physical maturation in adolescents
Bad when teens perceive themselves to be different for their peers.
In boys, early maturing has some good things, more popular, more athletic, but more likely to be depressed and use drugs. Late maturing less popular, exhibit more attention seeeking behaviors, less confident, more depression
For girls, early maturing unpopular, poor self concept, more likely to engage in precocious sex and drug use, low academic achievement, more depression and eating disorders. For late maturing, dissatisfied with physical appears but superior academic achievement.
Visual changes
Around age 40, adults begin to experience presbyopia (in ability to focus on close objects) and after 65, most experience visual changes that interfere with daily activities.
Sexual activity in late adulthood
Older people can be just as sexually active as younger people but overall there is a decline in number of ppl who are sexually active as they get older.
Older people cite two reasons for not being sexually active: health problems in males or not having a partner
A larger proportion of older adults say their sex life is physical or emotionally better, with more males than females saying this.
Adaptation part of Piaget’s theory of cognitive development (assimilation and accommodation)
When children encounter new information that doesn’t match their understanding, they will undergo an process of adaptation using two processes:
Assimilation is the incorporation of new knowledge into existing schemas and accommodation in when you modify schemas to fit new knowledge.
So child gets new toy and tries to understand it by assimilating and then once she understands it’s unique properties will accommodate it.
Piaget’s four stages of cognitive development
Invariant and universal
Sensorimotor stage
Birth to 2 years has 6 sub stages - a child learns about objects and other people through the sensory information they provide.
Main accomplishments is establishment of object permanence developed in substage 4 in 8 to 12 months. Deferred imitation (copy another person’s behavior at a later time). Understanding of causality. And make believe play.
Object permanence
Child understand object exists even when it is not there.
Preoperational stage
2 to 7 years- symbolic (semiotic) function.. permits child to learn through the use of language, mental images, and other symbols. Because of this, these children engage in more symbolic play (e.g. adopting roles of other people and using objects) and can solve problems mentally
This stage is limited by:
1) precausal (transductive) reasoning - incomplete understanding of cause and effect. Two manifestations of precausal reasoning:
A) magical thinking - the belief that thinking about something will cause it to occur
B) animism - attributing human qualities to inanimate objects
2) egocentrism - unable to imagine another person’s POV
3) Do not recognize that actions can be reversed. They focus on the most central features (noticeable) of an object. They are unable to understand that if you change one dimension of an object, it doesn’t mean you change other dimensions. For example, if you pour water from fat glass to skinny tall glass, they think there is more water in tall glass.
Concrete operational stage (7 to 11 or 12 years)
Capable of mental operations (logical rules for transforming or manipulating information)
Children develop conservation in this stage- involves improving in irreversibility and decentration. These things develop gradually with conservation of numbering first, then liquid, length, weight, and displacement volume.
Horizontal decalage- gradual acquisition of conservation abilities
Formal operational stage
11 or 12 and older
Can think abstractly and engage in hypothetical-deductive reasoning which is ability to form competing hypotheses about a problem and strategies for testing those hypothesis.
There is also renewed egocentrism
Adolescent egocentrism: characteristics include personal fable (one is unique and rules don’t apply to them) and imaginary audience (always center of attention)
information processing theories
Compare functioning of computer programs to human mind. INvolve increasing processing capacity and efficiency.
Cognitive process are similar in all stages of development but differ in terms of their extent. For example, improvements in memory are due to larger memory capacity.
Focus on development within specific cognitive domains like attention, memory…
Also task specific
Vygotsky’s sociocultural theory
Placed greater emphasis on social and cultural factors on cognitive development. All learning is socially mediated… development is first interpersonal and then intrapersonal (when child internalizes what she has learned).
Development is facilitated when instruction and other environmental demands fall within the child’s zone of proximal development.
This means that it is a level just beyond the level at which the child can function independently but can be reached if more experienced person provides scaffolding.
Memory strategies
Children by 9 to 10 consistently use memory strategies starting with rehearsal, organization, then elaboration. Memory differences between different age groups is related to improvements in meta cognition and meta memory.
Preschool age children memory strategies but in an ineffective way. Early elementary school aged children use memory strategies in somewhat more effective way but are often distracted by other information.
Childhood infantile amnesia
Adults are able to recall very few things before age 3 ot 4. This is because children at that age have not yet developed the brain structures needed for memory especially prefrontal lobes. Another explanation is that children that age do not have the language skills to encode memory.
Reminiscence bump: recall memory from adolescence and young adulthood. Some explanations is that 1) larger proportion of novel experiences during those years 2) encoding of information is most efficient during this period and 3) person developed personal sense of identity during those years.
Effects of age on memory
Increasing age greater impact on explicit memory as opposed to implicit.
Older adult more declines in recent long-term (secondary) memory followed by working memory.
Episodic memory more affected
Healthy adults benefit from training memory. Memory decline less apparent on familiar tasks.
Nativist approach to language acquisition
Chomsky - universal patterns of language and biological mechanisms.
Research showing that children from all cultures pass through same stages of language development. Also that children learn the basics of language from 4-6 regardless of the complexity of the native language.
We have a language acquisition device that allows us to learn language just by being exposed to it.
Semantic bootstrapping
Refers to child’s use of his or her knowledge of the meaning of words to infer their syntactical category like noun, verb, etc.
Syntactic bootstrapping
Child’s use of syntactical knowledge to infer the meaning of the word.
Like “this is rel” then rel must be an object.
Phonemes vs morphemes
Phonemes are smallest units of sound in a language like b p v th.
Morphemes is smallest units of sound that convey meaning like do, go, ed, ing, un.
Stages of language acquisition
Crying: three types of cry (hunger, angry, and pain). Mom’s respond most to pain. By 1 to 2 months, also a fussy cry. If parents consistently respond to cry during first few months, then that is associated with less crying in later years and greater reliance on communication using gestures, facial expressions, etc.
Cooing and babbling: at 6 to 8 weeks, children begin to coo - mainly vowels
At 4 months, they babble, which is repition of simple consonant and vowel sounds (bi bi bi). Babble includes vowels from all languages. But by 9 to 14 months, repertoire of sounds is specific to native language.
Ecolalia and expressive jargon: at 9 months of age, imitate adult speech sounds and words without understanding their meaning (ecolalia) and use expressive jargon which is they say a bunch not stuff that sounds like sentences but have no meaning.
First words: 13 months of age, understand about 50 words. Speak first word by 10 to 15 months and by 18 months, speak about 50 words.
First words: most often nominals
From 1 to 2 years, they use single words to indicate who phrases combined with gestures or intonation…
Telegraphic speech: 18 to 24 months, use telegraphic speech whic Hsu stringing twos or more words together to make a sentence “i stuck”
Vocabulary growth: at 18 months, rapid growth in vocabulary. Fasted rate from 30 to 36 months. At 36 months, 1000 words and 3 to 4 word sentences.
Grammatically correct sentences: 2.5 to 5 years sentences increase in complexity.
Metalinguistic awareness: gain ability to reflect on language. For example, recognize that they can use language in humorous ways.
Under extension vs over extension
Under extension is when child applies a word too narrowly. Like dish is only her toy dish.
Over extension is when a child applies the word more generally. Like all 4 legged animals are dogs.
Bilingualism
Do as well or even better than monolingual children on tests measuring language and cognitive skills.
Better cognitive flexibility, working memory,cognitive complexity, analytical reasoning, attentive control, metalinguistic awareness.
Bilingual education
High quality bilingual programs as good or better than English immersion programs.
Behavioral inhibition
Biological contribution and relatively stable throughout life. And related to physicological reactivity. Level of inhibition can be influenced by parent-child rearing practices. Warm and supportive parents decrease it.
Goodness of fit model
Children with easy or hard temperaments tend to have poor or good adjustments in young adulthood. But this is not perfect. Goodness of fit model predicts that it is the degree of match between parent’s behavior né child’s temperament.
Freud’s stages of psychosexual development
Oral stage (birth to 1 year) mouth is focus of sensation and stimulation. Weaning is primary conflict. Anal stage (1-3 yrs) control of bodily waste; conflict from toilet training Phallic stage (3-6 years); focus on genitals and conflict is Oedipal conflict. Development of the superego. Latency stage (6-12) libidinal energy is diffuse. Developing social skills Genital stage (12 or more years) libido centered on genitals. Sexual desire combined with affection to produce mature sexual relationships.
Erikson’s theory of psychosocial development
8 stages;
1) basic trust - positive relationship with primary caregiver leads to sense of trust
2) autonomy: sense of self or autonomy develops out of positive interactions caregivers
3) Initiative vs guilt: positive family relationships lead to setting goals and devising and carrying out plans.
4) industry vs inferiority: focus on neighborhood and school. To avoid feelings of inferiority, must master certain social and academic skills.
5) identify vs role confusions: peers are dominant social influence; positive outcomes is sense of personal identity
6) Intimacy vs isolation: establish intimate bonds of love and friendship
7) generativity: focus on the people one lives or works with. Commitment to well-being of future generations.
8) ego integrity: social influence broadens to include all of humankind. Development of wisdom and sense of integrity.
Parenting styles
Four styles:
authoritative is high demand low responsivity
Authoritarian is high demand and high responsivity (this is the best)
Permissive is low demand and high responsivity
Rejecting-neglecting is low demand and low responsivity (associated with juvenile delinquency)
Maternal depression
Increases children’s risk for emotional and behavioral problems. More chronic symptoms result in mother being less sensitive and engaged which leads to worse child outcomes
Associated with signs of physiological distress in infants by 3 months; associated with higher passive noncompliance, higher aggression; poor cognitive linguistic performance; insecure attachment.
Gender identity
Refers to the sense of being boy or girl. Usually developed by age 3. By 3, can label themselves as boy or girl, can label others, and know what behaviors are appropriate for each gender.
Kohlberg’s cognitive development theory as it pertains to gender identity
Involves sequence of stages:
By 2 to 3 establish gender identity.
Soon after, children realize that gender is stable over time (gender stability)
By 6, children realize that gender is constant across situations (gender constancy)
Bem’s gender schema theory
Children develop boy and girl schemas as a result of sociocultural experiences. Schemas then determine how child sees the world.
Combination of social learning and kohlbergs cognitive development theory
Androgyny
Gender identity greater impact on self-esteem than biological sex.
Combines male and female characteristics and preferences
Androgyny and to a lesser extend masculinity were associated with higher self-esteem.
Androgyny also associated with greater flexibility in dealing with difficult situations, higher life satisfaction, and greater comfort with ones sexuality.
Four identity statuses
Reflect the degree to which the individual has experienced or is experiencing an identity crisis and is committed to an identity.
D (identity diffusion): adolescents has not yet experienced an identity crisis and not yet committed to an identity
F (identity foreclosure): have not experienced a crisis by have adopted an identity imposed by same sex parent or other person.
M (identity moratorium): has an identity crisis and is exploring other identities. Stage that teen expresses confusion, rebellion, discontent
A (identity achievement): resolved the identity crisis by exploring differing identities and committing to one.
Gilligan’s relational crisis
11 to 12 years, girls experience this crisis in response to social pressures to be a perfect good woman. As a result they disconnect from themselves. They experience a loss of voice when they realize that women’s opinions aren ot highly valued.
Results in drop in academic achievement, low self-esteem, increased vulnerability to MH issues.
Kubler-Ross 5 stages of grief
1) denial and isolation (no this isn’t happening to me)
2) anger (why me)
3) bargaining (yes me but not until my grandchild is born)
4) depression (yes me)
5) acceptance (my time has come and that’s alright)
Contact comfort
Baby’s attachment is due in part to contact comfort. Support by research with monkeys that prefer the cloth mother. Supported by learning theory.
Bowlby’s internal working model
Bowlby said that in first year of life (critical period), infants form attachment with mother that helps ensure their survival and both infant and mother have a biological predisposition to doing this. The infant goes through four stages of attachment (preattachment, attachment in the making, clear cut attachment, and formation of recriprocal relationships).
So after going through these stages, infant forms an internal working model which is a mental representation of self and others that influences child’s future relationships.
Signs of attachment
Social referencing: by 6 months of age, infants look to caregiver to determine how to respond
Separation anxiety: severe distress when child separated from caregiver. Begins 6 to 8 month then peaks at 14 to 18 months then declines.
Stranger anxiety: by 8 to 10 months, very anxious and fearful in presence of stranger, especially when caregiver not nearby or when caregiver responds negatively to stranger. Continues to age 2 then diminishes.
Patterns of attachment (ainsworth)
Secure attachment: baby explores while mother in room then becomes mildly distressed when mother leaves but then seeks mother quickly when she returns.
Insecure (anxious/ambivalent) attachment: baby alternatives being clinging and resisting mother, becomes very disturbed when mother leaves, and is ambivalent when mother returns (may become angry and resist mother). These mothers are often moody and inconsistent (warm sometimes and indifferent at other times).
Insecure anxious avoidant: avoidant baby interacts very little with mother, shows little distress when she leaves, and avoids or ignores her when she returns. These mothers are usually inpatient and unresponsive or provide too much stimulation.
Disorganized/disoriented attachment: child is fearful of caregiver, shows confusion, or other disorganized behaviors (eg. greeting mother when she returns but then turning away from her. 80% of infants mistreated by caregivers show this attachment. Have increased risk for hostile, aggressive behavior, low self esteem and low academic achievement in childhood.
Adult Attachment interview
Relationship between parent’s own attachment experiences and attachment of their children
Autonomous: parents give coherent descriptions of their relationships with their parents on interview. These tend to have children with secure attachment.
Dismissing: parents give a positive description but don’t have evidence to support it or have some contradicting memories. Their children tend to be avoidant.
Preoccupied: give angry description or confused. Their children tend to have a resistant/ambivalent attachment.
Patterson’s coercive family interaction model
Posits that a) children learn aggressive behaviors from parents who rarely reinforce pro social behaviors, use harsh discipline, and reward aggressive behavior with attention and approval; b) aggressive-parent child interactions escalate.
Parents use coercive forms of discipline: family has high levels of stress, have certain personality characteristics, child has difficult temperament;
Social cognitive factors to aggression
Posits that aggressive children differ from less aggressive ones in a) their self-efficacy beliefs (it is easy to perform aggressive acts but difficult to inhibit them); b) beliefs that aggressive acts will be followed by positive outcomes and c) they show little regret or remorse from committing aggressive acts.
Hostile attribution bias: interpret acts of others as being intentionally hostile
Heteronomous morality (Piaget)
Children 7 to 10 years old. They believe that rules are set by authority figures and are unalterable.
The greater the negative consequences, the worse the act is… used to determine if an act is right or wrong… along with whether a rule has been violated.
Autonomous morality (piaget)
11 years old. View rules are arbitrary and alterable when ppl who are governed by them agree to change them.
When judging act, focus more on intention of the actor rather than on consequences.
Kohlberg’s levels of moral development
Preconventional morality: punishment/obedience orientation: the goodness or badness of an act depends on its consequences. Act to avoid punishment
Instrumental hedonism: act to get reward
Conventional morality: transition at age 10 to 11; good girl good boy orientation: the right act is the one that is approved by others.
Law and order orientation: judgments are based on rules and laws established by authority figures.
Postconventional morality: transition late adolescent to adulthood; morality of contract, individual rights, and democratically accepted laws: right actions are those that are consistent with democratically determined laws which can be changed if interfere with basic human rights.
Morality of individual principles of conscience: right and wrong based on self-chosen universally applicable ethical principles.
Diminished capacity to parent (divorce)
Many parents experience a diminished capacity to parent following divorce. For mothers who have custody, they often monitor children less, more impatient, uncommunicative, less warm and consistent, more authoritarian. Experience lower income and feel lonely.
Custodial fathers have similar problems but often adjust more quickly than custodial mothers.
Non custodial fathers become more permissive; their visits decline in number after the first few months.
Effects of divorce
Child’s age: children who are in preschool experience greater negative outcomes initially than older children. But later on, older children experience worse outcomes than younger children.
In general, the effects of divorce on children are most profound during the first year after divorce.
Sleeper effect: girls who were in preschool or elementary school during time of divorce, do not show negative consequences until adolescence. As young adults, at higher risk for depression and anxiety about betrayal and abandonment in romantic relationships, more likely to see a psychologically unstable partner, and getting divorced themselves.
Adjustment is better when children have frequent reliable contacts with non custodial parent but lack of parental conflict after divorce is more important than contact with non custodial parent.
It is parental conflict, rather than divorce, that increases worse outcomes for children.
Remarriage
Children in intact families have better outcomes than children in stable family with a stepparent. But this difference has small effect size .17. This is even lower when controlling for factors such as SES, child adjustment problems before remarriage, etc.
Remarriage leads to worse outcomes in children who are 9 years or older. Research on gender and remarriage is inconsistent.
Stepfathers are often less engaged than real fathers. Authoritative parenting style by stepparent leads to better outcomes.
Effects of maternal employment
Benefits outweighs the costs, especially for older children. In lower SES families, sons of working mothers have higher cognitive scores compared to sons in higher SES families.
Maternal employment most likely to have a negative effect for boys if it is combined with poor child monitoring and supervision.
Gay or lesbian parent
Research shows that it is more about the quality of the parent-child relationship than the sexual orientation of the parents. Children of gay and lesbian parents do just as well and parents skills of gay and lesbian parents is similar or even superior.
Child sexual abuse
No clear consensus on differences between gender. Some studies say it more heavily impacts girls vs boys. Effects less severe when abuse committed by stranger vs family member or familiar person.
Sibling relationships
Middle school childhood marked by conflict/closeness among siblings. Sibling rivalry most intense during these years when sibligings 1.5 to 3 years apart, same gender, and parents provide inconsistent discipline. In later adulthood, those who were close get even closer. Those who were hostile become even more hostile.
Rejected and neglected children
Rejected-aggressive: impulsive, hostile, hyperactive, difficulty regulating negative emotions.
Rejected withdrawn children: more likely to be bullied, have high social anxiety
Neglected children: like to be alone, rarely engage in disruptive behavior. Do not report being particularly lonely or unhappy.
Rejected children have worse outcomes. Express greater loneliness and peer dissatisfaction.
Socioemotional selectivity theory
Motivational process underlying the changes in quality and quantity of our friendships. Determined by how we see time as limited or unlimited. If unlimited, we have knowledge oriented goals and focus on making new and more friends.
If limited, we focus on emotion based goals so focus on forming close friendships and are selective of our partners.
Generally, as we grow older, we see time as being more limited.
Empty nest
Marital satisfaction increases when children leave the home
Self fulfilling prophecy (rosenthal) effect
Teachers expectations about a student can influence their academic achievement due to differences in how teacher behaviors towards student
Teacher feedback
There are differences in how teachers provide feedback to male and female students. Female students are more criticized about intellectual ability and praised about their dependent behaviors, effort, cooperation. Male students are more criticized for inattention, failure to do work neatly, but praised for intellectual abilities.
This may help account academic gaps in gender.
Compensatory preschool programs
Like head start for economically disadvantaged children. Initial iq gains diminish but long term rewards are great. These children are more likely to attend college, less likely to drop out, repeat a grade, better attitude towards school, reduced pregnancy and drug use and delinquency.
Montessori method
Learning stems from sense perception. Child-centered; learning is experiential and children advance at their own pace.
Classical conditioning
Pavlov… bell plus meat power = dog salivating. After a while bell = dog salivating.
Unconditioned stimulus and unconditioned response
Unconditioned stimulus is meat power and unconditioned response is salivating
Conditioned stimulus and conditioned response
Conditioned stimulus is bell and condition response is salivation after it is paired with conditioned stimulus.
Classical extinction
When you keep showing Cs and cr without us eventually the pairing will decay.
Spontaneous recovery
Seems extinction has occurred but then tehre is a weak CR. Learning is never lost but merely inhibited.
Experimental neurosis
If you try to do stimulus discrimination with two things that are too similar, it can cause this which results in aggression, restlessness, agitation
Stimulus discrimination
The opposite of stimulus generalization. To do this, you need to present cs with us lots of times and similar things to cs without us lots of times.
Higher order conditioning
When you pair a cs to cr then you introduce a second neutral stimulus so you do cs, ns, then cr until ns becomes another cs.
Blocking vs overshadowing
When you present cs and ns at the same time, ns will not be paired with cr.
Overshadowing is when you present two ns at the same time and both cause cr. But, when presented separately, only one will cause CR.
Reciprocal inhibition
If a response that does not produce anxiety is paired with thing that produces anxiety then there is a complete or partial suppression of anxiety response and original pairing is weakened
Systematic desensitization
A hierarchy of anxiety provoking things paired with relaxation.
Has four stages:
1) relaxation training
2) construct anxiety hierarchy
3) desensitization in imagination
4) in vivo desensitization
Dismantling strategy
Trying to figure out which aspect of systematic desensitization is effective. Turns out is not the pairing with incompatible response or the gradual hierarchy parts. It’s the pairing of a cs without a us repeatedly which leads to extinction.
In vivo aversion therapy
Pair an aversive stimulus with CS. For example nausea inducting drug to help target alcohol addiction. Has high rate of relapse and limited generalizability. Works best when aversive stimulus is closet to CS. Also works best with booster sessions.
