Unit 1 Flashcards
Chapters 1-4
criteria for abnormal behavior
the four D’s (deviance, distress, dysfunction, and danger)
deviance
- behavior that is unexpected in its cultural context or behaviors that are rare
- not doing the societal norm of behavior
- can think about it as not statistically normal
distress
- individual is suffering/unhappy and wants to be rid of the behavior
- people are not aware of problems that their behaviors may create from themselves and others
dysfunction
- the behavior prevents normal daily functioning
- if they were left on their own, they would not be okay
danger
- behavior is careless, hostile, or confused consistently
- place themselves and others at risk
prehistoric abnormal behavior approach
- theory: caused by evil spirits
- treatment: trephination (drilling holes in the head to let the evil spirits out)
ancient China abnormal behavior approach
- theory: imbalance on Yin/Yang
- treatment: diet and lifestyle changes to restore balance
ancient Greece and Rome abnormal behavior approach
- 500 BCE to 500 AD
- theory: imbalance of natural forces (blood, phlegm, black bile, yellow bile)
- treatment: rebalance the natural forces through diet, lifestyle change, temperature, exercise, celibacy or bleeding
middle ages abnormal behavior approach
- about 500 to 1350
- theory: possessed by evil spirits/Satan’s influence (church was in control)
- treatment: drive out the evil spirits via exorcisms (usually included torture)
renaissance abnormal behavior approach
- about 1400 to 1700
- theory: mental disorders are like medical illnesses
- treatment: create asylums/mental hospitals (lock people up) because there was no effective cure, very inhumane
20th century abnormal behavior approach
- mutual influence of body and mind
- somatogenic hypothesis: physical issue cause psychological disorder
- psychogenic hypothesis: psychological issue causes physical disorder
- treatment: antipsychotic medication
- effects: deinstitutionalization and insufficient funds for resources
biopsychosocial approach
- biological: emphasis on biological processes like genetics
- psychological: emphasis on psychological factors such as early childhood experiences and self-concept
- social: emphasis on interpersonal relationships and social environments
capgras delusion
- when looking at something and it goes to the temporal lobe where it is identified, then goes to the amygdala where you keep emotions, but the relationship between the temporal lobe and amygdala is cut off so emotions aren’t associated with the recognition of an image/person/place
- lack of emotional response causes thinking people are not who they look like
- biological contribution: no connection between temporal lobe and amygdala
- psychological contribution: no emotional response to known people
- social contribution: disturbs relationships with others
cerebral cortex
- responsible for the higher level processes of the human brain, including language, memory, reasoning, thought, learning, decision-making, emotion, intelligence, and personality
- includes: precentral gyrus, central sulcus, postcentral gyrus, parietal lobe, occipital lobe, temporal lobe, and frontal lobe
limbic system
- processes and regulates emotion and memory while also dealing with sexual stimulation and learning
- includes: cingulate gyrus, olfactory bulb, amygdala, hippocampus, mammillary body, hypothalamus, fornix, and thalamus
modern abnormal behavior approach
- biopsychosocial approach: attribute the cause of abnormality to an interaction of genetic, biological, developmental, emotional, behavioral, cognitive, social, and societal influences
- vulnerability stress approach: individuals’ vulnerabilities and life events vary, interaction of these variables may precipitate psychological disorders
evidence based treatments
research supported recommendations for treating specific disorders
case studies
- detailed description of a person’s life and psychological problems
- values: opens the way for discovery, helps other therapists/clinicians, can support or challenge theories
- limitations: biased observer, subjective evidence, little basis for generalization
correlational studies
- a research procedure used to determine the ‘co-relationship’ between variables
- values: easily reproducible, uses variables, observes participants and applies statistical tests
- limitations: does not explain variable relationships, does not do causality
- examples: epidemiological and longitudinal studies
experimental studies
- research procedures in which a variable is manipulated and the manipulation’s effect on another variable is observed
- factors: independent and dependent variable, confound variables, control group, random assignment, blind design, double blind design
quasi-experimental studies
designs that fail to include key elements of a pure experiment and intermix elements of experimental and correlational studies
meta-analysis
statistical analysis of a collection of independent studies to see treatment success, to filter out bad studies, scale for all the remaining studies and have a clear message of what the body of studies tells you
presenting problem
why the person has come for help
clinical description
unique combination of behaviors, thoughts, and feelings that make up a disorder
course of a disorder
the characteristic pattern of how a disorder progresses
prognosis
anticipated course of a disorder
prevalence
how many people in the population as a whole have the disorder at a particular point in time
incidence
the number of new cases of a disorder occurring in a population over a specific period of time
etiology
the cause, set of causes, or manner of causation of a disease or condition
treatment
procedure to change abnormal behavior into more normal behavior
outcome
results of treatment, intervention, or experiment
comorbid
having more than one disorder at the same time
differential diagnosis
distinguishing among disorders that have symptoms in common
equifinality
number of different developmental routes lead to the same psychological disorder
multifinality
when individuals have experienced a number of similar developmental variables but have different clinical outcomes
biological model
- abnormal behavior is an illness brought on by malfunction of parts of an organism, usually in the brain
- structural injuries can cause dysfunctional diseases (ie Phineas Gage)
- biochemical causes can cause abnormalities
- treatment: drug therapy, brain stimulation, and psychosurgery
important neurotransmitters
acetylcholine, norepinephrine, GABA, serotonin, dopamine, glutamate, and endorphins
acetylcholine
- one of the first neurotransmitters to be discovered and the most common
- in motor neurons and muscles
- used for memory (ie Alzheimer’s)
norepinephrine
- important for bodily and psychological arousal (ie cocaine)
- used for bipolar disorder
GABA
- main inhibitory neurotransmitter in restraining some behaviors
- used for anxiety
serotonin
- regulation of sleep and wakefulness
- important in mood disorders
- hallucinogens stimulate it
dopamine
- pleasurable emotions
- causes addiction and withdrawals
- can be used for schizophrenia and Parkinson’s
glutamate
- major excitatory neurotransmitter
- enhances action potentials
- important for learning and memory
- important in rewiring the brain
endorphins
- disrupt pain messages
- causes placebo effect
- addiction and withdrawal
agonists
- enhance the action of the specific neurotransmitters
- increase how much the neurotransmitter is made, so there is more inside each vesicle
- can block reuptake of neurotransmitters
- can mimic a particular neurotransmitter, binding to that neurotransmitter’s postsynaptic receptors and either activate them or increase the neurotransmitter’s effects
antagonists
- block the action of specific neurotransmitters
- can decrease the release of neurotransmitters, so there are fewer inside each vesicle
- can help destroy neurotransmitters in the synapse
- can mimic a particular neurotransmitter, binding to that neurotransmitter’s postsynaptic receptors enough to block the neurotransmitter binding
central executive network
- high order cognition and attentional tasks
- prefrontal cortex
- think CEO or project manager
salience network
- monitoring critical external and internal states
- discrepancies –> activate central executive
- looking for errors and reporting to CEO
default/intrinsic network
- interacting areas involved in internal activity (no external stimulation)
- becomes less active when other networks involving external stimuli are activated
- some disorders involve problems with turning this network on and off
other brain networks
visual processing, auditory processing, sensorimotor processing, and attentional processing
are the multiple biological subsystems coordinated?
yes
nervous system
- central nervous system: brain and spinal cord
- peripheral nervous system: somatic and autonomic (sympathetic and parasympathetic)
endocrine system
- works with neurons to control growth, sex, heart rate, temperature, and stress
- hypothalamus stimulates the pituitary gland, which stimulates other glands, which release hormones into the bloodstream
genes
the unit of heredity that helps determine the characteristics of an organism; blueprints for building a person
alleles
genes come in different ‘flavors’ and can mutate over time
gene expression
- genes only affect some things in your body if they are turned on or off at the right time
- genes must be activated in a complex pattern to carry out the plan
- can be affected by environmental factors
epigenetics
- environment is seen as layered over genetics
- genes themselves may not be changed by the environment but instructions for gene expression can be coded and passed down
behavioral genetics
- study of how genes and the environment interact to influence psychological activity
- twins studies and adoption studies are common
- psychological disorders are polygenic (influenced by many genes)
psychodynamic model
- the theoretical perspective that sees all human functioning as being shaped by dynamic (interacting) psychological forces and explains people’s behavior by reference to unconscious internal conflicts
- includes the id, ego, and superego
- unconscious conflict –> anxiety
- defense mechanism used to protect from anxiety
- includes the psychosexual stages of development: oral, anal, phallic, latency, and genital
- disorders occur when the developmental task for the particular stage is not resolved and the person becomes stuck at that stage
psychodynamic model treatment
- talking cure: to gain insight into unresolved unconscious conflicts then work through the now conscious conflicts until resolved
- free association: patient describes any thought, feeling, or image that comes to mine, even if it seems unimportant
- therapist interpretation: interpret resistance, transference, and dreams
the id
- according to Freud, the psychological force that produces instinctual needs, drives, and impulses
- operates by pleasure principles (emotional)
- devil on your shoulder
the ego
- according to Freud, the psychological force that employs reason and operates in accordance with the reality principle
- practical and rational
- uses defense mechanisms to control id impulses
- reality
the superego
- according to Freud, the psychological force that represents a person’s values and ideals
- operates by morality principle
- angel on your shoulder
behaviorist model
- focuses on how our environment molds us
- approaches: classical conditioning, operant condition, and social learning
classical conditioning
- process of learning by temporal association in which two events that repeatedly occur close together in time become fused in a person’s mind and produce the same response
- can develop dysfunctional associations (phobias)
- automatic response
- therapy: extinction and counterconditioning (have to face the things you fear)
operant conditioning
- process of learning in which individuals come to behave in certain ways as a result of experiencing consequences of one kind or another whenever they perform the behavior
- reinforcement and punishment
- negative reinforcement can maintain dysfunctional behavior by escape and avoidance learning
- treatment: programs to reinforce desired behavior and extinguish undesirable behaviors (skill development)
social learning
- learning from others, relationships, and mimicking
- observational learning and modeling
- treatment: therapist modeling new behaviors and demonstrating new association or contingencies involved
cognitive model
- help people become aware of their automatic (lack of awareness) thoughts
- people’s thoughts are the most immediate and powerful influences on their behavior
types: causal attributions (attribute a behavior to a certain cause), control beliefs (people believe that they either can or cannot effect the things in their lives), and dysfunctional assumptions (usually automatic and don’t know we have them)
cognitive model treatment
- traditional: becoming aware of automatic thinking, challenging the logic of evidence for automatic thoughts, developing alternative ways of thinking
- new wave: mindfulness, awareness of thoughts, thoughts are just thoughts no need to react, accept thoughts rather than challenge them
- cognitive behavioral therapy: combine behavioral and cognitive techniques
- exposure therapy: interaction in which fearful people are repeatedly exposed to the object or situation they dread
humanistic model
- humans thrive for self-actualization (fulfill their potential), to grow and develop, and to be authentic
- disorders come from pressure to conform to others’ expectations and values
humanistic model treatment
- client centered therapy: made by Carl Rogers, provides therapeutic environment for individual growth, provides unconditional positive regard, accurate empathy, and genuineness (congruence)
- Gestalt therapy: opening and guide to self recognition and acceptance but challenge the clients to achieve goals and demand the clients stay in the here and now
existential model
- reality of the human condition is that we are born and die alone, free to choose our lives, responsible for our own choices, and death is certain
- believe that life is meaningful
- disorders come from existential anxiety
existential model treatment
finding meaning in one’s life, therapist facilitates person’s search for it
sociocultural model
- focus on a larger unit rather than the individual
- roots of psychological disorder are within the person’s relationships, family, or group rather than themself
sociocultural model treatment
interpersonal, family, or group therapies of different kinds or culture and gender sensitive therapy
process of collecting information in treatment
- start with the presenting problem
- mental status exam
- the funnel approach
- personal and family history
- physiological factors
- psychological factors
- sociocultural factors
presenting problem
what the person comes in with and is seeking help for
mental status exam
- appearance and behavior: attire, posture, expressions, appearance, overt behavior
- thought processes: rate of speech, continuity of speech, and content of speech
- mood and affect: predominant feeling state of individual and hot it affects what the individual says
- intellectual functioning: type of vocab and use of metaphors
- sensorium: awareness of surroundings in terms of person, time, and place
symptoms and history
- physical or mental features that indicate a disorder
- previous disorders or features that a person experiences
- does your family have a past of disorders or features
- how much do they interfere with the client’s ability to function
- how do they cope with stressful situations
physiological and neurophysiological factors
- physical/mental conditions
- drug and alcohol use that cause symptoms
- deficits in intellectual and cognitive functioning causing symptoms
funnel approach
start with broad questions then narrow down to the problem and finally zero in on the specific issue/conflict
structured clinical interviews
- prepared questions, specific questions, standard set of questions
- pros: wouldn’t leave anything out, can be more consistent and more standardized, and do reliability checks
- con: no questions for what’s important, confirmation bias
unstructured clinical interviews
- open ended and can follow leads and explore topics
- pros: open-ended questions so client can express feelings, welcoming, and empowering
- cons: client can leave things out because they do not know what to talk about
symptom questionnaires
list of questions with yes or no answers concerning depression, anxiety, and hostility
objective psychological tests
personality tests: individuals go through a long list of statements and choose which applies to them, reliable and valid test, cannot be solely used, has cultural limitations
projective psychological tests
clients interpret vague stimuli or follow open ended questions, because it is so general people project aspects of their personality into it
brain imaging and neuropsychological tests
measures brain structure and activity directly, looks at visual perception, memory and visual-motor coordination
diagnosis
does clients syndrome match a known psychological disorder (DSM 5)
syndrome
- certain symptoms that regularly occur together and follow a particular course
- classification systems of diagnosis are based on this
diagnostic and statistical manual of the american psychiatric association (DSM)
- first published in 1952, second version in 1968: had low reliability, not very influential, based on psychoanalytic theory, issue of validity
- version 3 in 1980, revised in 1987, version 4 in 1994, revised in 2000: was system of prototypes, a specific behavioral criteria for diagnosis, including duration, and reliability was improved by excluded validity as differential diagnosis was difficult need dimensional perspectives, cultural issues
- version 5 in 2013: had dimensional approach, personality disorder will be revised and childhood disorders were revised
research domain criteria (RDoC)
- new approach to developing a classification system for psychiatric disorders through a research based process
- starts with identifying normal range of functioning across multiple levels
international classification of diseases (ICD)
by world health org (WHO), had mental disorders and diseases
dimensional perspective/approach
- rating of how severe a client’s symptoms are and how dysfunctional the client is
- suggests symptoms may be present in normal as well as in ill (provides a cut off for diagnosis)
anxiety
- future oriented worry about future danger or misfortune
- expectations of negative events or that positive events won’t happen
- bodily tension
- normal emotional state but with adaptive functions
- brain predicts the immediate future based on recognizing past events
fear
- present oriented immediate fear or flight response to danger or threat
- strong avoidance/escapist tendencies
- abrupt activation of sympathetic nervous system
- normal emotional state
neuroscience of fear
- initiated by hypothalamus and cascades to endocrine system
- stressor -> amygdala -> hypothalamus -> sympathetic nervous system and adrenal cortical system -> pituitary gland -> adrenal gland -> changes in internal organs and muscles
neuroscience of anxiety
issues in areas of the brain that regulate fear system (prefrontal cortex, amygdala, hippocampus)
anxiety disorders
- pervasive and persistent symptoms of anxiety and fear
- excessive avoidance and escapist tendencies
- avoidance causes clinically significant distress and impairment
anxiety disorder brain networks
- individuals have overactivity in salience and underactivity in executive control and intrinsic
- intrinsic network: internal processing (self-inspection, emotional regulation, future planning)
salience: detects error, conflict and need for change in cognitive control
executive control: increased cognitive control
generalized anxiety disorder (GAD)
- excessive anxiety and worry
- difficulty in controlling the worry
- restlessness or feeling on edge
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension and sleep disturbances
- runs in the family
what percent of the general population meet the criteria for GAD?
4%
what is the ratio of females to males with GAD?
2:1
when does GAD onset?
beginning in early adulthood
psychodynamic GAD theory
- id based: neurotic (stems from insecurities, urges, and fear of losing control)
- ego based: realistic (actual threat to physical safety)
- superego based: moral (uncertainty about moral decisions)
humanistic GAD theory
- condition of worth: rules that govern behavior, values, and beliefs and if broken expect rejection or disapproval
- lack of authenticity and congruence (not a balance between real self and ideal self)
- people do not look at themselves honestly and acceptingly
- unable to fulfill their potential
existential GAD theory
- realities of the human condition: freedom, responsibility, loneliness, and certainty of death
- angst: negative feeling arising from experience of human freedom and responsibility
cognitive GAD theory
- focus on threat or lack of control
- caused by maladaptive assumptions
- guided by irrational beliefs that lead to inappropriate reactions, think it is best to assume the worst
- metacognitive: worry about worrying, start to believe they are going crazy with worry
- avoidance: worrying reduces bodily arousal
- intolerance of uncertainty: people cannot tolerate the knowledge that negative events may occur
biological GAD theory
- reduced GABA activity
- less inhibition of areas involved in fear response
- variety of mechanisms
- GABA receptors dense in prefrontal cortex, amygdala, and hippocampus
- antianxiety drugs increase GABA and serotonin is also involved
- having close relatives with this disorder leads to you having a higher chance of having it
GAD treatment
- cognitive behavioral (most effective): mindfulness, exposure, becoming aware of automatic thoughts, rational-emotive therapy (point-out irrational assumptions then suggest appropriate assumptions and apply them)
- biological approach: antianxiety drugs, relaxation training, and biofeedback
- humanistic approach: client-based
- psychodynamic approach: free association and therapist interpretation of transference, resistance, and dreams
panic attack
- periodic, short burst of panic that occurs suddenly, reaches a peak, and gradually passes
- abrupt experience of intense fear or discomfort
- accompanied by several physical symptoms (ie breathlessness, chest pains)
- often presents as a heart attack
panic disorder
- experience of unexpected and repeated panic attacks
- develop anxiety, worry, or fear about having another attack or its implications
- causes dysfunctional change to thinking or behaviors
- symptoms and concern about another attack persists for 1 month or more
agoraphobia
- fear or avoidance of situations/events associated with panic
- can have panic disorder with or without agoraphobia
- afraid of being in public spaces or situations where escape is difficult or unavailable
- has genetic component
- treatment: get person farther and farther from safe space (exposure) or use of support groups and home based self-help programs
biological component of panic disorder
- flight or fight response poorly regulated
- dysregulation of norepinephrine, especially in locus coeruleus (synthesizes norepinephrine)
- affects limbic system
- runs in families, seen in parent/child and twin studies
what percent of the general public meet the panic disorder criteria?
3.5%
what fraction of people with panic disorder are female?
2/3
when does panic disorder onset?
between 25 and 29 years old
biological treatment of panic disorder
- tricyclic antidepressants: increase level of norepinephrine, serotonin, and other neurotransmitters; imipramine is preferred treatment
- selective serotonin reuptake inhibitors: increases level of of serotonin; prozac and paxil is preferred
- benzodiazepines: suppress the central nervous system and influences functioning of GABA, norepinephrine, and serotonin neurotransmitter systems; valium and xanax preferred
cognitive component of panic disorder
- extra sensitive to body sensation that makes them spiral out of control
- negative misinterpretation of physiological events
- exaggerated thoughts about the worst possible outcome
- display avoidance/safety behaviors to control bodily sensations
cognitive treatment of panic disorder
- cognitive behavior therapy: identify the exaggerated cognitions about changes in bodily sensations, use breathing/relaxation exercises, systematic desensitization
- challenge client by using relaxation and breathing exercises while experience panic symptoms
- best for long term outcome
phobias
- persistent and unreasonable fears of particular objects, activities, or situations
- want to avoid the situation or even thoughts about the situation
- sufferers know its out of proportion but their response is out of their control
what percent of the general public meet the criteria for phobias?
11%
at what age range is the onset of a phobia?
15 to 20 years old
types of phobia disorders
agoraphobia, specific phobias, and social anxiety disorder
specific phobias
- fear of specific objects, places, or situations
- main categories: animal, nature/environment, situational, blood/injection/injury, other
- they will try to avoid what they fear at any cost
social anxiety disorder
- severe persistent and irrational anxiety about social or performance situations in which they may face embarrassment
- interferes greatly with ones life
- cognitive: believe that their social disaster in their head will occur and overestimate how poorly things go in their social interaction and dread most social situations which leads to avoidance and safety behaviors
causes of phobias
- direct conditioning: traumatic event, anxiety about recurrence, avoidance/escape to relieve anxiety(negative reinforcement) maintains phobia (operant conditioning)
- modeling: seeing someone else have a traumatic experience
information transmission: being warned repeatedly about something
psychodynamic approach to phobias
- unconscious anxiety displace onto phobic object, often symbolic
- treatment: developing insight into the hidden conflict
behavioral treatment of phobias
- systematic desensitization: learn to relax while gradually facing the object or situations they fear
- modeling: therapist confronts fear while patient observes
- flooding: people will stop fearing is exposed to object repeatedly
cognitive behavioral treatment of phobias
help clients identify and challenge negative exaggerated thought about feared situations
biological treatment of phobias
reduce symptoms of anxiety generally so that they do not arise in the fear situation through drugs
social anxiety disorder treatment
- needs to reduce social fear and provide training in social skills
- fear is reduced through the use of medication, exposure therapy, and challenging maladaptive beliefs
- social skills are improved by using modeling, role-playing rehearsing, feedback and reinforcement, group therapy
obsessive compulsive disorder (OCD)
- obsessions and compulsions feel excessive or unreasonable, cause distress, take up time, and interfere with daily function
- client recognizes that their behaviors are unreasonable
- causes anxiety if unable to perform behaviors
obsessions
persistent intrusive thoughts, images, ideas, or impulses that cause distress
compulsions
repetitive behaviors or mental acts that the person feels they must perform
what percent of people will develop OCD at some point?
1-3%
is there gender or ethnic differences in OCD?
no
biological approach to OCD
- dysfunction in the circuit of the brain regulating primitive impulses
- hyperactive brain circuit for impulses
- impulse arise in the frontal cortex, are filtered in the caudate nucleus, then act as if the impulses reach the thalamus
- impulses don’t turn off in OCD
- deficiencies in serotonin, possible glutamate, GABA, and dopamine
psychodynamic approach to OCD
- obsessions and compulsions symbolize unconscious conflicts
- conflicts create anxiety, id impulses and ego defense mechanisms act out
- deal with conflict indirectly by symptoms
cognitive behavioral approach to OCD
- most people have intrusive thoughts and rigid, ritualistic behavior when distressed
- blame themselves for thoughts and expect terrible things to happen
- OCD is when you can’t turn off intrusive thoughts
- may be generally anxious or depressed, tend to be more rigid, moralistic thinking, and believe they should be able to turn off intrusive thoughts
- OCD maintained by operant conditioning
- compulsive behavior reduces anxiety
biological treatment for OCD
- antianxiety drugs not effective
- SSRIs more effective and target serotonin
- only helps 50%
psychodynamic treatment for OCD
- insight therapy: leading to appropriate expression of impulses
- not very effective
cognitive behavioral treatment for OCD
- exposure therapy: exposure to obsessive thoughts and prevent compulsive behavior (exposure and response prevention)
- modeling
OCD related disorders
- hoarding
- hair pulling (trichotillomania)
- skin picking (excoriation)
- body dysmorphic disorder (BDD)
