Test 1 Flashcards
A historical procedure in which a section of the skull is removed to allow spirits to flee the body
-Trephination
The study of environmental modification of gene expression rather than alteration of the gene itself
-Epigenetics
How past vulnerabilities interact w/ current environmental pressures to produce psychopathology
-Diathesis-Stress
The presence of two or more disorders co-occurring in the same person
-Comorbidity
Saying whatever comes to mind without censoring thoughts in order to know unconscious material
-Free Association
When a client reacts to the therapist as if he or she is an important figure from childhood
-Transference
Evaluating the antecedents and consequences of a behavior to help modify problematic behavior
-Functional Analysis
The ability to endure or overcome difficulties in living
-Resilience
A cluster of behavioral, emotional, and/or cognitive symptoms
-Syndrome
An experiment that involves pre-determined groups, such as gender or those with vs. without a DO
-Quasi-Experiment
The extent to which the results of a study can be generalized to people who were not in the study
-External Validity
The ability of a diagnostic instrument to get the same result with repeated use
-Reliability
A study where participants and experimenters do not know who is in which comparison group
-Double-Blind Design
A common finding that all therapy techniques are equally effective
-Dodo Bird Effect
A perspective that therapies are equally effective because therapists & clients try things until they work
-Goldilocks Effect
4 D’s of Abnormal Behavior
- Deviant
- Dysfunctional
- Dangerous
- Distress
- Don’t need all four to be diagnosed, but having majority is seeked
- All four exist on a spectrum
Deviant
-Occurs infrequently in person’s culture
Dysfunctional
- Interferes with person’s ability to maintain:
- Relationships (get with and hold friends, romantic partners, family)
- Jobs (get a job, hold it, keep it)
- Life (hygiene, finances, cook for yourself)
- Relationships (get with and hold friends, romantic partners, family)
Dangerous
-Physically harmful to the person or others
Distress
- Causes the person or others psychological pain
- Required for all disorders
- For most, causes the person themselves pain, not others
4 Ancient Humours
- Blood:
- Ancient name: Sanguine
- Characteristics: Courageous, hopeful, amorous
- Ex: Picture of two people really close
- Blood:
- Yellow Bile:
- Ancient name: Choleric
- Characteristics: Easily angered, bad tempered
- Ex: Picture of domestic violence
- Yellow Bile:
- Black Bile:
- Ancient name: Melancholic
- Characteristics: Despondent, sleepless, irritable
- Ex: Picture of sleeping person
- Black Bile:
- Phlegm:
- Ancient name: Phlegmatic
- Characteristics: Calm, unemotional
- Ex: Picture of person playing music
- Phlegm:
Views and treatments for psychopathology from the Stone Age
- Where the work of evil spirits began
- (1) Trephination - a spirit has become trapped inside of you, and you need to release it; boring hold into skull to release it (ex: roll down windows top hope wasp flies out)
- (2) Exorcism - ritualistic set of behaviors (particular steps) that are meant to allow you to connect with spiritual world
- Anneliese Michel (1975) (today would probably be diagnosed with encephalitis and schizophrenia)
- Abnormal behavior as “the birth of a healer”
- Shamanism
- Depression, bipolar, schizophrenia, OCD
Views and treatments for psychopathology from Ancient Greece/Romans
-500 B.C. to 500 A.D.
- Hippocrates → illness had natural causes
- Imbalance of the four fluids, or humours
- Must “rebalance” humours
Views and treatments for psychopathology from the Middle Ages
- 500-1350 A.D.
- Church rejects scientific forms of investigation
- Abnormality is the conflict between good and evil
- Abnormal behavior increases
- Mass madness common, e.g,.
- (1) Tarantism (dancing uncontrollably due to spider bite)
- (2) Lycanthropy (people think they become an animal, like werewolves; people think they have it; animal part has overcome you)
- Revival of demonological treatments (things like exorcism, torture, to make the body too uncomfortable for the demon to possess)
Views and treatments for psychopathology from the Renaissance
- 1400-170 A.D.
- Religious shrines devoted to humane and loving treatment
- Physician Johann Weyer
- Mine was susceptible to sickness, like the body
-Rise of asylums to care for mentally ill
- Why do asylums fail?
- Economic downturn in society → decline in facility funding → decline in recovery rates and increase in admittance rates → facility overcrowding → enhanced prejudice against facility patients
What is moral treatment? How did it differ from earlier asylum conditions? What time period was it emphasized in?
- Moral Treatment: Care that emphasized moral guidance and humane and respectful techniques
- Difference between asylums and moral treatment: ?
- Emphasized in 19th century
What is mass madness? When was it most common?
- Groups of individuals afflicted at the same time with the same disorder or abnormal behaviors
- Includes tarantism and lycanthropy
- Most common when high levels of fear and panic exist, believing they’re “taken over”; eating substances such as fungi on food that led to odd beliefs and visions; during last half of Middle Ages
What is Tarantism and Lycanthropy?
- Tarantism: dancing uncontrollably due to spider bite; individuals became victims of a tarantula’s “spirit” after being bitten
- Lycanthropy: people think they become an animal, like werewolves; people think they have it; animal part has overcome you; belief that a person has been transformed into a demonic animal, such as a werewolf
Two competing perspectives on psychopathology in the early 20th century?
- (1) Somatogenic Perspective
- Abnormal functioning has PHYSICAL causes
- Untreated syphilis leads to general paresis
- Kraepelin - 2 forms of mental illness:
- Manic Depression (today, bipolar disorder)
- Dementia Praecox (today, schizophrenia)
- Kraepelin - 2 forms of mental illness:
- Untreated syphilis leads to general paresis
- Abnormal functioning has PHYSICAL causes
- (2) Psychogenic Perspective
- Abnormal functioning has PSYCHOLOGICAL causes
- Mesmer → hypnosis
- Freud → the talking cure, outpatient
- Abnormal functioning has PSYCHOLOGICAL causes
Important people to know?
- Hippocrates
- Philippe Pinel
- Dorothea Dix
- Kraepelin
Hippocrates - Contributions?
-Said illness had NATURAL causes
- He came up with the 4 humours
- Said illness was imbalance of the 4 fluids, or humours
- Must “rebalance” humours
Philippe Pinel - Contributions?
- (France)
- Said instead of just giving them basic needs, he said we need to interact with them as human beings, show them care, and they’ll get better; give them tasks; moral treatment
- Worked with Tuke (England) who had friends die with mental illness; said they should open their own moral treatment place
Dorothea Dix - Contributions?
- Boston school teacher; nurse
- Advocated for treatment centers for mental illness, for state mental hospitals; used her connections and was influential
Kraepelin - Contribution?
-Said fatigue causes mental dysfunction
- Said there were 2 forms of mental illness
- (1) Manic Depression (today, bipolar disorder)
- (2) Dementia Praecox (today, schizophrenia)
-Termed “syndrome” - Said we’re gonna know a disorder not by common symptoms, but common patterns of symptoms
According to Freud, what is fixation? How does it help explain psychopathology?
-The failure to “pass” developmental stage
- Stuck in that psychosexual stage, then causes problems in life adaptation
- Oral (0-1) - mouth: biting, sucking, eating, chewing; psychopathology = addictions
- Anal (1-3) - holding and witholing feces; psychopathology = control, OCD
- Phallic (3-6) - primary sex organs, oedipus/electra complex; psychopathology = deviance, sexual dysfunction
According to Freud, what are the 3 core parts of the mind? What guides them?
- Id
- Guided by the Pleasure Principle → What you want to do (instincts)
- Creates (ex: kid likes to build legos)
- Destroys (ex: kid likes to destroy legos)
- Ego
- Guided by the Reality Principle → What you can do (reality)
- Plans
- Compromises (how can I get what I want and still be good)
- Superego
- Guided by the Morality Principle → What you shouldn’t do (morality)
- Punishes (when doing bad things, or even thinking it)
-Unconscious nature is big part
Defense Mechanisms?
- Respression: (a.k.a. denial) push desire out of awareness (“I’m not drunk”)
- Projection: blame another person for having desire (“You’re hungover”)
- Displacement: redirect desire to appropriate object (boss calls me out, and I’m mad and want to yell at her but can’t. Go home and yell at husband.)
- Reaction Formation: behave opposite of desire (“I feel awesome”’ ex: want to stab boss, but at Christmas, buy them an iPhone)
- Ex: For all, except displacement: Have fun night, get really drunk, and are hungover the next day.
What are the 4 steps common to many psychodynamic therapies?
- (1) Use of projective techniques to learn unconscious drives
- Free association
- Transference
- Dreams
- (2) Therapist’s interpretation of the meaning of your actions/struggles
- (3) Working through resistance
- (4) Catharsis of internal conflict
- Goal: Understand and accept unconscious conflicts and defense mechanisms at play
Which model informed the first DSM?
- Psychodynamic Model
- 1st and second
Which model increasingly informs the DSM now?
-Biological model; a medical perspective
From the biological model, problems in what 3 aspects of the body produce psychopathology?
- (1) Brain anatomy
- (2) Brain chemistry
- (3) Genes
Core functions of left and right hemisphere?
- Left: language, analytic thinking, details
- Right: influenced by emotion, intuition, the big picture
Core functions cerebral cortex?
- Awareness
- Attention
Core functions frontal lobe?
-Planning, organization, decision making
Core functions of forebrain?
- Limbic system → Regulation
- Hippocampus: memory
- Amygdala: emotion
How does the brain’s structure differ in terms of complexity and adaptability?
- Brain becomes more complicated from inner to outer
- Subcortical = less complex
- Cortex = more complex
-Adaptability?
What is the difference between genotype and phenotype? How do methyl and histones modify gene expression?
- Genotype: Your inherited genetic composition (can live in you, but can be dormant)
- Phenotype: How your genotype is expressed/activated
- Methyl: ON/OFF Gene switch - Determines which genes turn on and off (Is it built or torn down?)
- Histones: Dimension/Volume - Determines how much of the gene is expressed (How big is it built?)
4 Types of Distorted Thinking?
- (1) Ellis’s Rational Restructuring
- Interpretation of event’s meaning causes distress – not the event itself (the belief causes the emotion, not the event that actually caused the emotion)
- (2) Beck’s Depression Therapy
- Challenge thoughts
- (1) Self: I am worthless
- (2) Future: I never will be good
- (3) World: Everyone hates me
- Ex: I’m bad, it’ll always be that way, and everyone knows about it- Assertiveness training (ex: Yeah, I’m bad, but it won’t always be that way)
- (3) Systematic Desensitization
- (1) Learn relaxation skills
- (2) Construct a fear hierarchy
- (3) Confront feared situation
- (4) Token Economy
- Positive reinforcement for desired change in behavior (reward them for good behavior)
What are the 3 areas of distorted thinking for Beck?
- Beck’s Depression Therapy
- Challenge thoughts
- (1) Self: I am worthless
- (2) Future: I never will be good
- (3) World: Everyone hates me
- Assertiveness training
- Challenge thoughts
Roger’s therapy is called _____? How are conditions of worth problematic? What are 3 components of a supportive climate?
-Client-centered therapy
- Conditions of worth are problematic because they create anxiety and depression; health depends on unconditional positive regard
- I’m good IF I do or am “X”… (people think they’re only good IF…; Rogers tries to get rid of this
- 3 components of a supportive climate:
- (1) Unconditional positive regard
- (2) Accurate empathy
- (3) Genuineness
- ”The good life is a process, not a state of being. It is a direction, not a destination.”
- Cycle: Increased self-awareness → increased self-acceptance → increased self-expression → reduced defensiveness → increased openness
T. Szasz’ critique of abnormality?
-Psychological disorders are a way society enforces cultural norms and maintains existing distribution of power
From the sociocultural model, psychopathology is often caused by ____ and ____.
- Prejudice and discrimination
- Lack of power, choice, material resources
- Traditional therapies often LESS effective for underrepresented groups
- Culturally sensitive therapies
- Consciousness raising
- Empowerment
What are the 2 dimensions of the family circumplex that help explain psychopathology?
- (1) Enmeshed-Disengaged
- Enmeshed = know too much
- Disengaged = don’t know much
- (2) Rigid-Chaotic
- Rigid = specific rules that need to be followed
- Chaos = no structure
-Family circumplex helps make up family system? (Abnormal family functioning leads to abnormal behavior)
What is triangulation?
- Avoid talking one-on-one
- Team up against one another
- Triangulation helps make up family system? (Abnormal family functioning leads to abnormal behavior)
With respect to the models, which are deterministic? Which emphasize free will? Which have strong research report?
- Deterministic Models:
- Psychodynamic?
- Humanistic-Existential?
- Emphasize Free Will:
- Humanistic-Existential Model
- Strong Research Report:
- Biological Model
- CBT
What is the median age of onset for DOs? How does the age of onset of anxiety and depression differ?
- Median age onset = 14
- Age of onset for anxiety = 11
- Age of onset for depression (mood DOs) = 30
- Scientists propose anxiety and mood DOs are not separate; being so anxious wears down the body and mind, and when older, person can no longer hold it under control, which turns into depression (mood DO)
- Anxiety leads to depression
Based on the lecture, anxiety is especially comorbid with what two DOs?
- Anxiety and depression
- Anxiety and bipolar
- Anxiety and substance use (?)
What is substance use comorbid with?
-Almost everything else
When people have comorbid DOs, the DOs tend to be ____ in severity and more ____ to treat.
- Higher rates of severity
- Lower rates of recovery; difficult to treat?
Common risk factors?
-Risk factors: characteristics (personal or environmental) that precede the development of a disorder
- Fixed: (mostly) assigned at birth
- (1) Gender (for most disorders, women at greater risk)
- (2) Race and Ethnicity
- (3) Neuroticism (strongly, genetically informed)
- Dynamic: (can change over time)
- (4) Age (if not diagnosed with ADHD by age 40, probably don’t have it)
- (5) Socioeconomic Status (SES) (lower economic status = higher risk)
- (6) Quality and Quantity of Social Relationships (few people in life and low support quality = higher risk factor)
- (7) Locus of Control (what happened to you and how you influenced it; internal: I control my destiny; external: they control my destiny; if you have an external locus of control = higher risk)
- (8) Childhood Trauma
What are the 3 types of ACEs? How are they related to having a DO?
-ACE = Adverse Childhood Experiences
- (1) Abuse: emotional, physical, and sexual
- (2) Neglect: emotional and physical
- (3) Household Dysfunction: mental disorder, incarceration, divorce, and substance use (other family members in household did these things, not you)
-Environments of childhood trauma influence behavior and epigenetics
Common protective factors?
- Protective Factors: characteristics (personal or environmental) associated with lower rates of having a DO
- (1) Social Support (counter-example: co-rumination - talk with friend about how much life sucks, and they do the same)
- (2) Extraversion (counter-example: Narcissistic DO - people who are especially extraverted)
- (3) Financial Wealth (counter-example: Eating DOs - grow up with money, food is seen differently)
- (4) Intelligence (counter-example: bipolar DO - people who have manic episodes tend to be smarter; intelligence → greater sense of yourself, discern something is wrong sooner, and get help sooner)
- (5) Hardiness → i.e., transformational coping - if someone breaks up with me, I could think negatively OR be like “Now, I get to ask out this other person I’ve liked for a while”
- (6) U.S. Cultural Power Groups → e.g., being male and white
Civil Commitment
- No crime, but found unstable
- A danger to oneself/others
- Forced to receive treatment in mental institution
Criminal Commitment
- Charged with a crime and found to be unstable
- Forced to receive treatment in mental institution
Not Guilty by Reason of Insanity
- Mentally unstable at time of crime
- M’Naghten rule: mental disorder prevented person from knowing right from wrong
- Guilty by Mentally Ill: Acknowledgement that mental disorder was involved, but you are still responsible for actions
Mentally Incompetent
- Mentally unstable at time of trial
- Person does not understand charges and is unable to help lawyers prepare defense
- Forced to receive treatment in mental institution until capable of standing trial
Therapeutic ethics of dual relationships, sexual relationships, and maintaining and breaking confidentiality?
- Dual Relationships - Must avoid dual relationships
- Cannot be therapist and friend, business partner, lover, etc.
- (Discussion of sexual relationships discussed right below)
- Cannot be therapist and friend, business partner, lover, etc.
-Sexual Relationships - No sexual relationship until 2 years after therapy ends (if a person calls you to ask you to be their therapist, you set an appointment, and they never show up, then the two year mark starts the day they called you
- Maintaining and Breaking Confidentiality: Must adhere to confidentiality (HIPPA)
- Who is the client?
- Legal obligation to inform when danger to self or others
- Can’t tell law officers about things done in the past (ex: killed someone), but yes, if the patient talks about doing it in future (ex: they are planning to kill someone)
The Two Types of Clinical Interviews
- Unstructured:
- Open-ended questions
- Tailored to the client
- Unreliable (no way to compare clients because its tailored around client)
- Unstructured:
- Structured
- Protocol instructions in the If-then format
- Same for all clients- E.g. Structured clinical interview for DSM
- 1-2 hours
- Enhanced reliability
- E.g. Structured clinical interview for DSM
- Structured
3 Types of Clinical Observations
- Systematic Observations of Behavior:
- (1) Naturalistic: e.g., at home, school, job
- (2) Controlled: e.g., in therapy room, experiment
- (3) Self-Monitoring: e.g., mood and behavior ratings throughout day
How do projective tests work? What are the common tests reviewed in lecture?
- Ambiguous stimuli evokes unconscious
- Developed from psychodynamic approach
- Overall, poor reliability and validity for clinical use (can’t be reliable if two different researchers come up with different answers/conclusions)
- Excellent when used as ice breakers to generate conversation
- Ex: Rorschach inkblot
- Location: What part of image (blank space, whole image, detail of image) that the interpretation comes from
- Determinants: What aspect of the image (color, texture) that the interpretation focuses on
- Content: The interpretation itself
- Other Examples?:
- Thematic Apperception Test (TAT) - Images we looked at and analyzed in class
- Sentence Completion - “I wish ____________”
- Draw a Person (DAP)
- Placement of Figure:
- Right = future; left = past
- Lower left = depression; upper right = suppress past
- Face
- Big head = desire to be smart
- Large eyes or ears = paranoid
- Missing parts = identity confusion
- Legs and Feet
- Confidence vs. insecurity
- Age
- Younger = infantilism
- Placement of Figure:
MMPI-2. - What two types of scales are measured? How are the results typically presented and assessed?
- Personality Clinical Test
- Minnesota Multiphasic Personality Inventory
- 550 self-statements: “true,” “false,” or “cannot say”
- Two types of scales:
- (1) Self-Report
- Physical concerns
- Mood
- Attitudes toward religion, sex, and social activities
- Psychological symptoms
- (2) Behavior (Do you respond consistently?)
- Careless responding
- Lying, manipulation
- (1) Self-Report
- Score range from 0 to 120 for ten scales
- Above 70 = of concern
- Graphed to create a “profile”
What are the common psychophysiological tests? How do they help assess psychopathology?
- Physiological response as a sign of stress/anxiety
- Electrocardiogram → heart rate
- Galvanic Skin Conductance → sweat gland activity
- Electroencephalogram (EEG) → brain electrical activity
- Polygraph (lie detector) - no longer used in court because people likely to commit crimes, pass them, and regular people who wouldn’t are so nervous that they don’t pass
What are the 4 common neuroimaging tests?
- (1) Computerized Axial Tomography (CT)
- Uses x-rays to identify structural abnormalities; uses iodine
- Can detect brain tumors and other abnormalities (enlarged ventricles; hollow spaces, which is related to schizophrenia)
- (2) Magnetic Resonance Imaging (MRI)
- Can produce high-resolution images of brain structure
- Can detect tumors, blood clots, and other abnormalities
- Uses big cylindrical magnet
- (3) Functional MRI (fMRI)
- Asses brain structure and function as well as metabolic changes
- Asses how brain is working
- (4) Positron Emission Tomography (PET)
- Invasive way to assess brain structure and functioning
- Can identify seizure activity and even brain sites activated by psychoactive drugs
What do you do in the Bender Visual-Motor Gestalt Test? What kind of test is it?
- To help assess people with ADHD
- Given sheet of paper with 9 images, given blank sheet and told to draw them. You get to see their hand-eye coordination. Bad at first, but see if after treatment, it gets better
- Tests immediate memory, spatial perception, and perceptual-motor coordination
-Neuropsychological Test
The most common way to assess overall functioning with the DSM-5? Areas of functioning it assesses?
-World h=Health Organization Disability Assessment Schedule (WHO-DAS 2.0)
- Areas of functioning:
- Cognition - understanding and communicating
- Mobility - moving and getting around
- Self-Care - hygiene, dressing, eating, and staying alone
- Getting Along - interacting with other people
- Life Activities - domestic responsibilities, leisure, work, and school
- Participation - joining in community activities
What are the core ways that diagnosing can cause harm?
- (1) Misdiagnosis
- Reliance on clinical judgement
- Ex: bipolar disorder sometimes gets misdiagnosed as schizophrenia
- (2) Labeling and Stigma
- Diagnosis may be a self-fulfilling prophecy
What are the 3 steps of systematic desensitization therapy? What model does it come from?
-Typically used to treat stress and phobia
- Traditional ERPT
- 10-20 sessions
- (1) Learn relaxation skills
- (2) Construct a fear hierarchy
- (3) Confront feared situation
- 10-20 sessions
-Model: Cognitive Behavioral Model
The ABCDE’s of Ellis’ Rational Emotive Restructuring therapy. What model does it come from?
-Typically used to treat mood and anxiety issues
- Problem: ABCs:
- A = Activating Event - Fail Exam
- B = Distorted Belief - I’m stupid; I will fail this course
- C = Emotional Consequence of Belief - Depression
- Solution: DEs
- D = Dispute Belief - You can still pass this course; You are skilled, wise in other things
- E = Evaluate Emotional Consequences - Less depressed
-Model: Cognitive Behavioral Model
4 Common Factors of Treatment Effectiveness? Which 2 factors are most responsible for treatment effectiveness?
- (1) Extra Therapeutic Factors
- Client factors
- Illness course factors
- Social/cultural factors
- (2) Expectancy
- Client believes in therapy/therapist
- (3) Therapeutic Relationship
- Client-therapist alliance
- Empathy, positive regard (Rogers)
- (4) Technique
- Factors unique to approach
-2 Factors Most Responsible: Client factors (part of extra therapeutic factors) & Relationship factors (therapeutic relationship)
3 Things Therapists Can Do to Enhance the Effectiveness of Treatment?
- (1) Choose therapy that matches client’s theory of change
- Activates expectancy (placebo) effects
- (2) Invite and use extra-therapeutic factors
- Social support network, culture, motivation factors
- (3) Use active listening to build rapport and a supportive relationship
- (1) Paraphrase with attention to emotion
- (2) Don’t problem-solve soon
- (3) If disagree or disapprove of client, try to be non judgemental, be accepting, and respectful
