Unit 12 (Chapters 13 & 14) Flashcards
1
Q
Symptom
A
A physical or mental feature that may be regarded as an indication of a particular condition or psychological disorder. A symptom does not constitue the disorder itself.
2
Q
Syndrome
A
A cluster of physical or mental symptoms that are typical of a particular condition or psychological disorder that tend to occur simultaneously.
3
Q
Prevalence
A
How widespread a disorder is.
4
Q
Point prevalence
A
Percentage of people in a given population who have a given psychological disorder at a particular point in time.
5
Q
Lifetime prevalence
A
Percentage of people in a certain population who will have a given psychological disorder at any point in their lives.
Generally, in Canada, about 40%.
6
Q
DSM-5 definition of a psychological disorder
A
- Clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
- Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved
one, is not a psychological disorder. - Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not psychological disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
- How much disturbance before it’s considered “clinically significant”?
- Line around “common stressor or loss” is fuzzy.
- Socially acceptable behaviour varies across time and cultures (ex: in 1970s, homosexuality was a disorder)
7
Q
Cultural variations in disorders and diagnoses
A
- Psychological disorders are largely a cultural construct
- Cultural beliefs and values play a role in determining whether a particular set of symptoms is a disorder or variation in “normal” behaviour
8
Q
Attention deficit/hyperactivity disorder (ADHD)
A
Disorder that involves impulsivity, hyperactivity (e.g., fidgeting, inability to sit still), and difficulty shifting attentional focus.
- Most common psychological disorder in children
- Twice as common in boys
- 4% of adults
- May relate to deficiency in brain areas related to attention and executive function (prefrontal cortex; related to impulse control, attention, decision-making).
9
Q
ADHD controversies
A
- Increased diagnosis & treatment. Growing awareness? Better diagnostic practices? Overdiagnosis & cultural obsession with academic performance? (Mismatch betweed ADHD and kids being kids and unable to focus.)
- Is there too much emphasis on individual interventions instead of structural societal changes?
- More opportunities for play, accommodation for range of temperaments & behaviours. Depriving children of “rough and tumble play” in academic settings makes it harder for them to thrive in.
- Labels carry stigma, can contribute to social exclusion, stereotyping, discrimination, shift in self-concept & potential for self-fulfilling prophecies. Once a label is applied, all subsequent behaviour is interpreted through that lens.
- Pharmacological treatments may pose risk of side-effects: ADHD treated with stimulant methylphenidate (activated inhibitory circuits that enable impulse control), which can be addictive and pose long-term side effects.
10
Q
Clinical assessment
A
Procedure for gathering the information to evaluate an individual’s psychological functioning and to determine
whether a clinical diagnosis is warranted.
The initial diagnosis of a patient may change!!!
11
Q
Clinical interview
A
Interview in which a clinician asks the patient to describe their problems and concerns.
- Usually the first step in assessment
- More open-ended
The initial diagnosis of a patient may change!!!
12
Q
Self-report measures
A
Standardized clinical assessment consisting of fixed set of questions that a patient answers.
- More structured
The initial diagnosis of a patient may change!!!
13
Q
Projective tests
A
A form of clinical assessment in which a person responds to unstructured or ambiguous stimuli; it is thought that responses reveal unconscious wishes and conflicts.
- Usefulness and validity of some of these tests have been called into question, but some still remain in use.
E.g., Rorschach Inkblot Test
14
Q
Diathesis-stress model
A
A model of clinical disorders suggesting that certain factors provide a susceptibility for a disorder that will manifest as symptoms only in certain circumstances (under certain levels of
stress).
- Diatheses and stressors vary in their origin and form. It’s not necessarily genetics: it can be ways of thinking, early life conditions, and pre-natal conditions.
15
Q
Anxiety
A
Feeling of intense worry, nervousness, or unease. Involves anticipation of danger (not equal to fear, which is more focused on the present).
- Maladaptive exaggeration of what is normally a useful response (we need some anxiety to avoid doing risky, stupid things).
- Most prevalent of all psychological disorders
- Typically, aware that anxiety is irrational, but unable to control it (doesn’t impair people’s ability to think realistically).
16
Q
Common causes of anxiety disorders
A
- High degree of comorbidity among the different anxiety-related disorders (they often coocur).
- Genetic component: concordance rate 5 times higher for identical twins than for fraternal twins or ordinary siblings (related to heretibility studies)
- Two types of risk factors involved: general and specific risk factors
17
Q
Concordance rate
A
Probability that a person with a particular familial relationship to a patient has the same disorder as patient.
18
Q
Comorbidity
A
Occurrence of two or more disorders in a single individual at a given point in time.
19
Q
Specific phobia
A
A pronounced fear of or anxiety about a particular object or situation (e.g., spiders, snakes, heights, blood, flying). The subject typically has some realistic potential for harm.
- May have significant impact on the life of a person as they develop elaborate strategies to avoid the object or situation.
- Women twice as likely as men to have a specific phobia, although rates vary by phobia
- Scope of a phobia may increase over time (generalization)
20
Q
Potential causes and predisposing factors of specific phobias
A
Classical conditioning:
- Learning: ~40% of people with phobias report a traumatic situation where they first acquired the fear (ex: bitten by a dog)
- Fear may then become generalized (ex: to all dogs)
Observational learning
- May develop phobias through observation & imitation
- Preparedness: may be biologically predisposed to form connections between certain stimuli (e.g., spiders, snakes) that have historically posed a threat & fear
- Ex: Monkeys fearing snakes after seeing a videos of another monkey scared of a snake.
21
Q
Social anxiety disorder
A
An anxiety disorder characterized by extreme fear of being watched, evaluated, and judged by others.
- Typically emerges in childhood or adolescence
- Places individuals at increased risk for depression and substance abuse
- Women and men are equally affected
Ex: Not being able to eat in restaurants.
22
Q
Panic disorder
A
Anxiety disorder characterized by repeated panic attacks & debilitating fear of future attacks.
- More common in women than men
23
Q
Panic attack
A
Sudden episode of intense, uncontrollable anxiety & autonomic arousal in the absence of real threat.
- Bodily symptoms: laboured breathing, choking, dizziness, tingling hands and feet, sweating, trembling, heart palpitations, chest pain, nausea.
- Symptoms can be really unsettling, and are sometimes even compared to having a heart attack or even dying.
24
Q
Agoraphobia
A
Fear of being in situations in which help might not be available or escape might be difficult or embarrassing.
- Common outcome of panic disorder, as one may fear having a panic attach in public places.
E.g., fear of being outside of home or other designated “safe” places, using
public transportation, standing in line or in a crowd.
25
Potential causes and predisposing factors of panic disorder
- Often manifests after major stressor: in children, more common following experience of parental loss or separation
- Biological explanation: may be due to disturbance in certain neuropeptides involved in regulating arousal, as panic attacks can be induced artificially.
- Cognitive theories: interpretation of physiological arousal as catastrophic (more prone to interpreting bodily symptoms as negative, for example a heart attack, which leads to anxiety, and then more physiological symptoms, then the vicious cycle continues).
26
Generalized anxiety disorder (GAD)
Anxiety disorder characterized by continuous, pervasive, and difficult-to-control anxiety that is not correlated with particular objects or situations.
- Bodily symptoms: muscle tension, headaches, elevated heart rate, diarrhea, breathing difficulty.
- Cognitive symptoms: feelings of inadequacy, difficulty concentrating and making decisions, sleep disturbances
- Twice as common in women as men
27
Potential causes and predisposing factors of generalized anxiety disorder
- Decreased inhibition of amygdala reactivity by prefrontal cortex
- Hypervigilance for threat observed in many individuals who experienced unpredictable, traumatic experiences in early life (stressors)
- Other research shows that hypervigilance for threat predates onset of GAD
- Cognitive perspective: worrying as a coping strategy for anxiety (avoid intense emotional reactions brought on by worrying about only one thing)
- Cultural explanation: generalized anxiety has sharply increased in Western societies. May be due to less stable relationships, or rapidly changing social norms.
28
Obsessive-compulsive disorder (OCD)
An anxiety disorder that manifests itself through obsessions and compulsion. Could be both or only one of the two.
- People with this disorder are usually aware of their obsessions and compulsions but are unable to control them.
29
Obsession
A recurrent unwanted or disturbing thought. Typically stems from everyday worries.
30
Compulsion
A ritualistic action performed to control an obsession; the efforts to ward off the anxiety caused by the obsession.
## Footnote
Ex: Hand-washing, rearranging things, listing things out loud...
31
Potential causes and predisposing factors of obsessive-compulsive disorder
- Has been observed following brain damage due to injury, disease, poisons, difficult births, pre-natal traumas.
- Parts of the frontal lobe, limbic system, and basal ganglia implicated—circuit that controls voluntary actions
- Theory that damage to these areas may impede ability to experience a sense of “closure” after completing an action
32
Post-traumatic stress disorder
Psychological disorder triggered by an event that involves actual or threatened death, serious injury, or sexual violence. Must last one month or longer, or else accute stress disorder.
- Women are more likely to be diagnosed than men (might be because they are more subjected to traumatic events).
Pattern involves:
- Dissociation (numbness)
- Intrusive symptoms (recurrent nightmares and waking flashbacks)
- Arousal symptoms (high state of readiness to guard against harm)
- Avoidance symptoms (avoiding thoughts, activities, people, and places that relate to the trauma)
- Negative alterations in cognition and mood (anger, loss of pleasure, survivor’s guilt)
33
Potential causes and predisposing factors of post-traumatic stress disorder
- Smaller hippocampal volume (also cause by chronic stress and trauma). Cause or effect (or both)?
- Variation in emotion regulation ability (tendency to ruminate)
- Lack of social support. E.g., people reporting low social support in 6 mos before 9/11 twice as likely to be subsequently diagnosed with PTSD.
**Trauma does not necessarily lead to to PTSD: less than 10% will develop PTSD.**
34
Anxiety disorders
- Specific phobias
- Social anxiety disorder
- Panic disorder
- Agoraphobia
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
35
Mood-related disorders
- Major depressive disorder
- Bipolar disorder
36
Mood disorders
Psychological
disorders characterized by
emotional extremes.
37
Major depressive disorder
Mood disorder characterized by prolonged feelings of
sadness, worthlessness, emptiness, and anhedonia. Commonly known as depression.
- Other symptoms: fatigue, changes in sleep & appetite, difficulty concentrating, feelings of guilt, recurrent thoughts of death or suicide.
- Symptoms must cause significant disruption persist without remission for at least 2 weeks.
- **Hallmark symptom is anhedonia.** Decreased sensitivity to reward may be a predisposing factor (can be seen before onset of MDD).
38
Anhedonia
Diminished interest or pleasure in nearly all of the activities that usually provide pleasure, that one once found rewarding (e.g., eating, spending time with friends, sex).
39
Prevalence of major depressive disorder
- "Common cold” of psychological disorders (most heard of).
- Lifetime prevalence 7-15% for men and 20-25% for women (may be due to factors like body image). Gender differences in prevalence emerge in teenage years.
- Frequently recurrent symptoms, more severe as they reoccur.
- One of the leading causes of disability worldwide; damaging, debilitating at a personal and social level.
40
Potential explanations and predisposing factors of major depressive disorder
Cognitive factors:
- Rumination = continuously focusing on emotional pain without active problem-solving
- Explanatory style = cognitive style that determines how individuals explain adverse events
- Internal: blaming oneself (“it’s my fault”)
- Global: generalizing problem to all aspects of life (“everything is ruined”)
- Stable: believing problem is unchangeable (“it will always be like this”)
Social & environmental factors:
- Stressful experiences interact with individual predisposition factors (diathesis-stress model)
Biological factors:
- Serotonin long-considered key player in mood regulation, but precise role is debated.
- Selective serotonin reuptake inhibitors (SSRIs) effective for treating depression (effective for anxiety as well). BUT: delayed effects, takes time to improve symptoms.
- Cortisol-induced inhibition of growth processes, brain shrinkage (stress also leads to shrinkage, so do SSRIs help with this?)
- Reward deficit—dopamine, opioids. Some antidepressants target dopamine neurotransmission.
- Heighted inflammation (diseases leading to depression, ex: cancer).
Evolutionary explanations:
- Dysregulation of an adaptive process. When coping with certain challenges, it may have been useful to withdraw oneself and conserve resources. Depression may be this ability, gone awry.
41
Selective serotonin reuptake inhibitors (SSRIs)
Prevent serotonin from being reabsorbed too quickly; cause a delay. Used to treat major depressive disorder. May also be effective to treat anxiety.
42
Bipolar disorder
Mood-related disorder characterized by both manic (excited, euphoric, expansive, and energetic) episodes and depressive episodes.
- Episodes can vary in length & may be mixed (although more rare)
- Lifetime prevalence: 4 percent. Almost always recurrent.
43
Various states of bipolar disorder
- Mania = state of high excitement and energy often characterized by racing thoughts, a feeling of invincibility or omnipotence, and a lack of boundaries or inhibitions. Leads to very reckless behaviour due to sense of invincibility.
- Hypomania = a mild form of mania marked by high spirits, happiness, self-confidence, and a high level of nervous energy. Not as intense as mania.
- Acute mania = occurs when feelings of invincibility are replaced by terror as a person loses their grip on reality. Severe manic episodes happen in this state.
44
Prevalence and risk factors of suicide
Worldwide, 800,000 people die each year by suicide
- Many more attempts
- In nearly every country, males are more likely than females to die of suicide, whereas females are more likely attempt suicide but survive. May be due to the methods used (guns vs pills).
An estimated 90% of people who die by suicide had a psychological disorder at the time of death.
- Bipolar most common: Highest risk when recovery from depressive episode begins, as heightened impulsivity may increase suicide risk. When in depressive state, lack motivation.
45
Suicide risk factors
1. Ideation regarding suicide
2. Substance abuse
3. **P**urposeless-ness
4. **A**nger
5. **T**rapped feelings
6. **H**opelessness
7. **W**ithdrawing from significant others
8. **A**nxiety
9. **R**ecklessness
10. **M**ood shifts
## Footnote
Mnemonic for key risk factors for suicidal behaviour is "PATH WARM".
46
Schizophrenia
Psychological disorder characterized by a loss of contact with reality and pronounced disturbance in thinking, perceptions, emotion, and actions.
- Lifetime prevalence: ~1%
- Emerges ealier in men than in women.
Symptoms:
- Delusions
- Hallucinations
- Disorganized speech
- Movement disorders
## Footnote
**Not equal to dissociative identidy disorder.
47
Positive symtoms
Behaviours that are not present in healthy people.
48
Negative symptoms
Absence of behaviors usually seen in healthy people. Flattening or cessation of behavioural responses.
49
Delusions (positive symptoms)
False, unrealistic beliefs that are rigidly maintained despite overwhelming contradictory evidence—for example:
- Grandiosity: Believing one is greatly important
- Persecution: Believing one is being singled out for punishment
- Delusions of reference: Believing one is the object of neutral environmental events
- Delusions of being controlled
- Thoughts are being broadcast
Might stem from a failure to mentally seperate voluntary and involuntary actions.
50
Hallucinatons (positive symptoms)
Unrealistic perceptions: sensory experiences, such as sights and sounds, that happen in the absence of any true sensory input.
- Auditory hallucinations in the form of voices are most common.
51
Disorganized behaviour (positive symptoms)
Unnusual actions that are not usually seen in healthy individuals—e.g:
o Dressing peculiarly (ex: multiple layers of clothes on a hot day)
o Frenzied, haphazard behaviour
o Nonsensical speech ("word salad")
o Menacing behaviour
52
Negative symptoms of schizophrenia
- Catatonic behaviour
- Flattened affect, reduction of drives and drive satisfaction, anhedonia
- Social withdrawal
53
Dopamine hypothesis
Schizophrenia arises from an abnormally high level of activity in
brain circuits that are sensitive to the neurotransmitter dopamine.
Supporting evidence:
- Amphetamines (which promote dopamine neurotransmission) may provoke schizophrenic symptoms
- Typical antipsychotics (which block dopamine neurotransmission) alleviate positive symptoms (but not negative symptoms)
54
Potential causes and predisposing factors of schizophrenia
- Dopamine hypothesis
- More recent research has shown that general dopamine excess is not the sole cause of schizophrenia, but that dopamine imbalance is involved (hyper/hypoactivity in some brain areas)
- Other neurotransmitters play role—e.g., newer antipsychotic medications target serotonin as well
- Enlarged ventricles due to reduced brain volume
- Reduced volume especially in frontal and temporal lobes
- Loss of gray matter in prefrontal regions that support working memory
- Some brain differences may precede schizophrenia, serving as a diathesis (or is this caused by schizophrenia?)
- Concordance rates are three times higher for
monozygotic twins than dizygotic twins. Determining which genes are involved has been difficult and nonconclusive.
- Prenatal risk factors: maternal ill health during pregnancy, infection, flu, malnutrition
- Birth complications like oxygen deprivation
- Psychosocial risk factors: low socioeconomic status, higher social stress
55
Catatonic behaviour
Standing or sitting “frozen” for hours on end, sometimes in unusual postures.
56
Developmental model of schizophrenia
- Genetic predisposition
- Early environmental disruptions to brain development
- Neurodevelopmental abnormalities at adolescence
- Stressful life experiences
- Onset of schizophrenia
- Stressful effects of the disorder
- Continued neural degeneration and chronic schizophrenia
57
Personality disorders
- Antisocial personality disorder
- Dissociative identity disorder
58
Personality disorders
Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or
impairment.
- Sometimes difficult to differentiate personality disorders from 1) pronounced but “normal” variation in personality traits, and 2) other forms of mental illness (e.g., schizophrenia).
- 3 clusters: A, B, and, C
59
Personality disorder clusters
- Cluster A: Odd or eccentric behavior
Paranoid, schizoid, schizotypal
- Cluster B: Dramatic or emotional behavior
Antisocial, borderline, histrionic, narcissistic
- Cluster C: Anxious or fearful behavior
Avoidant, dependent, obsessive-compulsive
## Footnote
No need to know all 10 personality disorders, just able to distinguish between clusters.
60
Antisocial personality disorder
- Diagnosed in adults, but symptoms must be present since earlier in life (must show longstanding pattern of disregard for others)
- Often seen in psychopaths, but not in all ciminals, as they are still able to show empathy for friends and family.
- If individual has a high level of intelligence, it might come off as charming, competent, etc.
Individuals with this personality disorder:
- Violate or disregard the rights of others, show lack of empathy and remorse
- Lie or manipulate
- Are often impulsive and reckless
61
Potential causes of antisocial personality disorder
- Little autonomic nervous system arousal in anticipation
of aversive events (deficit in fearfulness, which contributes to deficit in empathy)
- Lower volume & reduced activation in frontal lobe regions (important for impulse-control, decision-making, and empathy)
62
Dissociative identity disorder
Psychological disorder characterized by presence of multiple distinct personality states within the same person.
- Previously, multiple personality disorder.
- Spike in diagnosis frequency in 1990s following several
high-profile cases (e.g., Sybil). Provoked skepticism.
63
Dissociative identity disorder controversies
- The debate does not center on whether DID exists but rather on how common this disorder is and how it comes into being.
- Posttraumatic model: Symptoms arise when a child dissociates in order to cope with serious trauma.
- Sociocognitive model: Symptoms arise when a client responds to a therapist’s suggestions and to widespread cultural conceptions of DID.
64
Historical treatments
- Prior to 20th c.: common belief that psychological disorders caused by possession. Treatments: trephination (drilling holes in skulls), prayer, purge potions, flogging patients.
- 1897: general paresis discovered to be consequence of syphilis. Paved the way for medical approach to treatment of psychological disorders (thinking that they could have biological causes).
65
Psychoanalysis
Method of therapy, developed by Sigmund Freud, for uncovering unconscious conflicts, often rooted in childhood, that contribute to clinical symptoms.
Techniques:
- Free association
- Dream analysis
- Transference analysis
Important contributions:
- Insight that social and developmental factors profoundly affect psychological functioning.
- Talk therapy as a useful method for working through issues.
66
Free association
Encourage patient to say whatever comes to mind without censoring themselves.
- Issue of resistance, reluctance, self-consorship
67
Transference analysis
Interpretation of the way the patient’s feelings, expectations, and behaviours towards the therapist may reflect patterns from their significant relationships.
- This may be done by replaying old emotional patterns with the therapist instead.
68
Psychoanalysis v.s. modern psychodynamic approaches
Scope:
- Psychoanalysis: strong emphasis on the unconscious mind, focusing on deep-rooted repressed conflicts, often rooted in childhood
- Psychodynamic approach: Considers the unconscious important but gives more weight to conscious thoughts and emotions; emphasizes current relationships, self-concept, and coping with present challenges
Approach:
- Psychoanalysis: intensive, long-term
- Psychodynamic approach: less intensive, more time limited (not as many sessions; few months instead of a year)
69
Humanistic perspective
- Emphasis on people’s inherent potential for self-fulfillment & personal growth
- Regarded psychoanalysis and psychodynamic approaches as too concerned with basic urges, tension reduction, and the past
- Instead, focused on the search for meaning, self-actualization in the here-and-now
- Client-centered therapy
70
Client-centered therapy
The therapist’s genuineness, unconditional positive regard,
and empathic understanding are crucial to therapeutic success.
- Seeks to help clients bridge the gap between their self-concept and ideal self by accepting themselves as they are.
71
Behavioural approaches
A family of therapeutic approaches based on the idea that problematic behaviors are the result of learning. Treatments are drawn from the principles of learning theory & behaviour change:
- Classical conditioning
- Operant conditioning
- Modeling
72
Behavioural approaches: exposure techniques
- Behavioural techniques designed to remove the anxiety connected to a feared stimulus through repeated exposure
- Systematic desensitization
- Helpful with phobias
- In vivo exposure: the individual is exposed to the stimulus in the real world or through interactive programs
73
Systematic desensitization
Progressive exposure to feared stimulus combined with periods relaxation.
## Footnote
Ex: Teaching a child fearing dogs breathing techniques ad creating a fear hierarchy.
74
Behavioural approaches: token economies
A behavioral therapy technique based on operant conditioning in which patients’ positive behaviors are reinforced with tokens that they can exchange for desirable items.
- Reinforcement can be gradually adjusted (shaping).
## Footnote
Ex: Useful for a child with ADHD, give them a token for raising their hand, staying seated, etc.
75
Behavioural approaches: modelling
- Behavioural therapy technique based on observational learning, in which patients learn new skills or change their behavior by watching and imitating another person (e.g., the therapist).
- Vicarious reinforcement
76
Vicarious reinforcement
A form of modeling in which the learner becomes more likely to perform a behavior after observing someone else being rewarded for it.
## Footnote
Ex: The therapist acts as a model to show the patient struggling with social anxiety how to start a conversation.
77
Clinical psychology
The assessment and treatment of psychological disorders.
78
Abnormal psychology
Seeks to characterize the nature and origins of psychological disorders.
79
Biopsychosocial model
A way of understanding what makes people healthy by recognizing that biology, psychology, and social context all combine to shape health outcomes.
80
Trauma- and stressor-related disorders
Psychological disorders that are triggered by an event that involves actual or threatened death, serious injury, or sexual violation.
81
Explanatory style
How a person explains why bad things happen to them.
82
Civil commitment law
Laws that specify when people can be hospitalized “committed” against their will for mental treatment.
83
Not guilty by reason of insanity
A modern legal concept that holds that people are not responsible for criminal behaviour if at the time of the behaviour they had a mental disorder that left them substantially unable either to understand what they were doing wrong or to behave as they knew they should.
##Footnote##
May lead to criminal commitment.
84
Austin’s spectrum disorder
A disorder usually diagnosed in young children, and characterized by a wide range of developmental problems, including persistent deficits in social communication/interaction and restricted or repetitive patterns of behaviour or interest.
85
Historical treatments
Prior to 20th c.: common belief that psychological disorders caused by possession.
Treatments: trephination, prayer, purge potions, flogging patients
1897: general paresis discovered to be consequence of syphilis
- Paved the way for medical approach to treatment of psychological disorders
86
Psychoanalysis
Method of therapy, developed by Sigmund Freud, for uncovering unconscious conflicts, often rooted in childhood, that contribute to clinical symptoms
Techniques:
- Free association
- Dream analysis
- Transference analysis
87
Free association
Encourage patient to say whatever comes to mind without
censoring themselves
- Issue of resistance, reluctance, self-sensorship.
88
Transference analysis
Interpretation of the way the patient’s feelings, expectations, and behaviours towards the therapist may reflect patterns from their significant relationships.
- Replaying old emotional pattern with the therapist instead.
89
Important contributions of psychoanalysis
Insight that social and developmental factors profoundly affect psychological functioning.
- Talk therapy as a useful method for working through issues
90
Psychoanalysis VS modern psychodynamic approach
Scope:
- Psychoanalysis: strong emphasis on the unconscious mind, focusing on deep-rooted repressed conflicts, often rooted in childhood
- Psychodynamic approach: Considers the unconscious important but gives more weight to conscious thoughts and emotions; emphasizes current relationships, self-concept, and coping with present challenges
Approach:
- Psychoanalysis: intensive, long-term
- Psychodynamic approach: less intensive, more time limited (not as many sessions, over a few months instead of a year)
91
Humanistic perspective
- Emphasis on people’s inherent potential for self-fulfillment & personal growth
- Regarded psychoanalysis and psychodynamic approaches as too concerned with basic urges, tension reduction, and the past
- Instead, focused on the search for meaning, self-actualization in the here-and-now
- Client-centered therapy
- Maslov
92
Client-centered therapy
The therapist’s genuineness, unconditional positive regard, and empathic understanding are crucial to therapeutic success (try to really understand the client).
- Seeks to help clients bridge the gap between their self-concept and ideal self by accepting themselves as they are.
93
Behavioural approaches: exposure techniques
- Helpful with phobias
- Behavioural techniques designed to remove the anxiety connected to a feared stimulus through repeated exposure
- Systematic desensitization
94
Systematic desensitization
Progressive exposure to feared stimulus
combined with periods relaxation.
## Footnote
Ex: Teaching a child fearing dogs breathing techniques and creating a fear hierarchy.
95
Behavioural approaches: token economies
A behavioral therapy technique based on operant conditioning in which patients’ positive behaviors are reinforced with tokens that they can exchange for desirable items.
- Reinforcement can be gradually adjusted (shaping)
## Footnote
Ex: Useful for a child with ADHD; give them a token for raising their hand, staying seated, etc.
96
Behavioural approaches: modelling
Behavioural therapy technique based on observational learning, in which patients learn new skills or change their behavior by watching and imitating another person (e.g., the therapist).
- Vicarious reinforcement
## Footnote
Ex: Therapist acts as a model to show patient struggling with soxial anxiety how to start a conversation.
97
Vicarious reinforcement
A form of modeling in which the learner becomes more likely to perform a behavior after observing someone else being rewarded for it.
98
Cognitive approaches
A family of therapeutic approaches based on the idea that maladaptive behaviors arise due to maladaptive ways of thinking.
- Treatment focuses on changing thought patterns to produce more adaptive behavioral and emotional responses.
99
Cognitive approaches: the ABC model
Assumes that beliefs, intermediate cognitive proceses, (B) link activating events (A) and consequences (C). If a client’s beliefs are irrational, they will lead to negative consequences.
100
Aaron Beck's cognitive therapy
Approach that aims to change patient’s habitual modes of dysfunctional thinking.
Negative cognitive triad:
- Viewing oneself as inadequate, unworthy, or incapable
- Viewing the world as hostile, unfair, or overwhelming
- Believing the future is bleak and that things won’t improve
101
Aaron Beck's cognitive therapy: distorted thought processes and examples
Dysfunctional beliefs are supported by distorted thought processes:
**- All-or-nothing thinking:** "If I don’t get a perfect grade on the exam, I might as well have failed."
**- Overgeneralization:** "I fail at everything I do."
**- Disqualifying the positive:** "Doing well on the exam was just a fluke."
**- Emotional reasoning:** "I feel like a failure, therefore I must be one."
102
Cognitive reconstructuring
Therapist confronts clients with their maladaptive beliefs and offers more constructive ways of thinking.
## Footnote
Kind of like adapting a growth mindset!
103
Aaron Beck's cognitive therapy: examples of cognitive restructuring
**- All-or-nothing thinking antidote:** "Even though this grade is not perfect, it’s still a significant accomplishment."
**- Overgeneralization antidote:** "This one setback doesn’t mean I fail at everything. I’ve succeeded in many other areas and can succeed again."
**- Disqualifying the positive antidote:** "I studied hard. My preparation and effort contributed to my success."
**- Emotional reasoning antidote:** "Feeling like a failure doesn’t mean I am one. Emotions aren’t always accurate reflections of reality."
104
Cognitive-behavioural therapy
Hybrid form of therapy focused on changing both maladaptive thoughts (habitual interpretations of the world) & behaviours.
General principles of CBT:
- Present-focused (here-and-now)
- Concerned with identifying and solving problems that clients wish to address (create a concrete plan to address the issue).
- Sessions are highly structured, with assigned homework.
- Goals are transparent, set collaboratively, progress is openly discussed (therapist and client work together).
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Third wave therapies
Do not attempt to directly modify thoughts or behaviours themselves, but rather modify the hold thoughts have on us (i.e. change the way we relate to our thoughts and feelings).
## Footnote
E.g., Acceptance and Commitment Therapy
- Aims to help clients to achieve greater awareness and acceptance of thoughts and feelings ("it's just a thought, not a reality")
- Emphasizes that they can commit to pursuing valued goals despite unwanted thoughts and feelings
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Limitations of survey reserch (effectiveness of therapy)
- Potential differences in people who responded to the survey and those who did not (social desirability bias may step in here)
**- Regression to the mean:** Extreme scores tend to move closer to the mean over time, which complicates the interpretation of changes in clients’ symptoms. Ex: did the therapy help them get better or just time?
- People may feel the need to justify spending their time and money on therapy by reporting benefits (what does
this remind you of?)
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Randomized control trials
- Compare treatment group against control
- Random assignment is crucial so both groups are comparable after the intervention
**- Wait-list control condition:** a control condition in which patients receive delayed treatment rather than no treatment.
- If the groups differ after one is given therapy and before the other is, we can assume the difference arose as a result of the therapy
- BUT... placebo effect comes into play (is it the idea of therapy or therapy itself that actually works?)
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Double-blind, placebo-controlled randomized trials
- Placebo effect can be circumvented by giving one group the real therapy and the other group a sham therapy (e.g., inert pills)
**- Double-blind study** = study in which participants are assigned to experimental conditions while keeping both the participants and researchers unaware of who is assigned to which group.
- Not always possible (Ps or Rs might be able to guess what they recieve/from what group the person they're treating comes from)
- May be more constructive to conduct non-blinded trials in which various active treatments are compared
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"Dodo bird verdict"
Conclusion that all major forms of psychotherapy are equally effective.
Criticisms:
- Some approaches may be more effective for specific conditions. Ex: behavioural therapy might be better for specific phobias and anxiety but not personality disorders.
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Common factors underlying therapy effectiveness
The apparently comparable effects of different forms of therapy may be explained by the common factors they share:
- Establishing a strong relationship with the patient (therapeutic alliance)
- Offering new ways of thinking
- Instilling hope
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Therapeutic alliance
The bond (rapport) between client andtherapist, characterized by emotional connection, trust, collaborative approach.
- May be the most important ingredient in effective psychotherapy, even when medication is the primary treatment (especially if the client is feeling socially isolated due to their disorder).
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Inspiring new ways of thinking
Therapy inspires new ways of thinking by teaching clients to understand:
- their role in repetitive interpersonal conflicts **(psychoanalysis)**
- conflicting goals and how they follow a path towards reconciling them **(humanistic)**
- what triggers their anxiety and how to develop confidence to interact normally with the object(s) of their anxiety **(behavioural)**
- the powerful role of automatic thoughts **(cognitive)**
- that psychological disorders are just as treatable and no more shameful than any other medical problem **(biological)**
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Fostering hope
Therapy inspires hope by allowing clients to share their
problems and learn that symptoms are understandable, rather common, and treatable. Hope is very important, and may be the key to helping people improve.
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Subsyndromal disorders
Versions of psychological disorders that do not meet the DSM-5 criteria for diagnosis but that may cause significant problems.
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Cultural competence
An understanding of how client's beliefs, values, and expectations for therapy are shaped by their cultural background.
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Culturally appropriate therapy
Therapy that is conducted in a manner that is sensitive to the client's cultural background and expectations.
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Psychogenic
Resulting from some other psychological cause rather than the product of organic damage to the nervous system.
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Ego psychology
A school of psychodynamic though that emphasizes the skills and adaptive capacities of the ego.
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Interpersonal therapy
A form of therapy focused on helping patients understand how they interact with others and then learn better ways of interacting and communicating.
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Motivational interviewing
A brief, nonconfrontational, client-centered intervention designed to change problematic behaviour (such as alcohol or drug use) by drawing out a person's goals, reducing ambivalence, and clarifying discrepancies between how individuals are actually living and how they say they would like to live.
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Gestalt therapy
A form of humanistic therapy aimed at helping individuals become aware of and then integrate disparate aspects of themselves into a coherent whole by increasing their self-awareness and self-acceptance.
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Contingency management
A behavioural therapy in which certain behvaiours are reliably followed by well-defined consequences.
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Group therapy
A form of therapy in which two or more patients meet with one or more therapists at a time.
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Psychotropic medications
Drugs that control, or at least moderate, the symptoms of some psychological disorders.
