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o cultural universality:

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disorders and their manifestation same regardless of culture, similar ethology, symptomalogy and course of illness for specific disorders

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cultural relativism:

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abnormality and abnormal behavior defined and determined by culture and worldviews

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eisenberg (1977) i.e. cultural relativism

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disease is a basic dysfunction in biological systems or psychological systems. Illness is a person's reaction to this dysfunction in terms of experienced states of discontinuity and role performance. •distinguish between a disease and an illness •dysfunction = root cause for mental illness •disease cultural invariant → common process in many countries, disease is culturally universal. •Illness: how we react to the dysfunction/disease •Infected with the flu virus = disease, the way we respond to it is our illness behavior

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Sociopolitical and Cultural Limitations

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-cultural relativism -cultural universality

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determining abnormality

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-distress -deviance -dysfunction -dangerousness

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Distress:

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(physical or psychological pain)-experienced pain and suffering usually motivating person to seek help even here there can be important individual and cultural differences -Major differences in symptomatology to major depression across countries.

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Deviance:

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unusual or rare experiences which usually are distressing. At times, not distressing as with paranoia. •Paranoia →believe others are out to get them cause them harm

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Dysfunction:

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(gap between potential and performance) how person functions in critical and important roles

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Dangerousness:

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responsible for assessing dangerousness (harm to self and others) and for protecting intending victims. Difficult to predict violence, use past behavior.

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Surgeon General: definition of abnormal behavior

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Abnormal behavior departs from some norm and harms the affected individual or others obut what norm? there is still ambiguity

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DSM V: Definition of abnormality

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• "A behavioral or psychological syndrome (cluster/pattern of symptoms that reflect psychobiological dysfunction) or pattern that reflects an underlying psychobiological dysfunction that is associated with distress (i.e. a painful symptom)or disability (i.e. impairment in one or more important areas of functioning)) and is not merely an expectable response to common stressors or loses. symptoms vs. community functioning as outcome for mental health services -determine whether mental health services are needed. Focus on symptomatology associated with distress and whether or not a person is functioning well in their community. -reduce distress and help the person function better.

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strupp and Hadley's (1977)

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three vantage points for judging mental health: deviant with respect to the following vantage points. o Society o The individual o The mental health perspective •when something is abnormal there must be convergence between these three vantage points

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integrated definitions

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•Some people can be classified abnormal, under one of the above practical definitions, but not necessarily all the definitions. -distress -deviance -dysfunction -dangerousness

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the frequency and burden of Mental Disorders

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-prevalence -lifetime prevalence -incidence

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prevalence

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of a disorder indicates the percentage of people in a population who suffer from a disorder at a given point in time

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lifetime prevalence

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refers to the percentage of people in the population who have had a disorder at some point in their life.

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incidence

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refers to the onset or occurrence of a given disorder over some period of time.

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stereotypes about the mentally disturbed

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-easily recognizable -inherited -incurable -weak-willed -never contribute anything of worth -unstable and potentially dangerous

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Easily recognizable (stereotypes about the mentally disturbed)

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oeasily recognized as deviant most of time. The mentally disturbed do not have symptoms, no clear distinction between normal and abnormal. •The mentally disturbed are able to control themselves.

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Inherited (stereotypes about the mentally disturbed)

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oDisorder due to inheritance: evidence for schizophrenia, mental retardation, bipolar disorders. Heredity may make certain people more vulnerable but environmental factors are very important. •combination of heredity and environmental factors

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incurable: (stereotypes about the mentally disturbed)

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¾'s of those hospitalized for mental disorders recover sufficiently to lead productive lives

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weak willed: (stereotypes about the mentally disturbed)

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this stereotype ignores the fact that mental health problems are the result of major traumas, disordered learning histories, and biological vulnerabilities that are difficult to change or control without formal treatment

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Never Contribute anything of worth :(stereotypes about the mentally disturbed)

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never contribute to society because they cannot be cured Notion of cure is itself a myth

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Unstable and potentially dangerous: (stereotypes about the mentally disturbed)

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a large majority of mental patients are not violent or out of control.

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Moral Treatment Movement (The Reform Movement18th and 19th century)

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emphasized humane treatment of mental patients involving hygienic conditions, humanitarian care by staff and rest and non-stressful living environments. • first half of 19th century (1800-1860) moral treatment was the preferred approach-involved emphasizing regular habits and activities and conducting self in moral and proper manner -not punished but ignored when they behaved in an abnormal way.

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The Reform Movement18th and 19th century

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• first half of 19th century (1800-1860) moral treatment was the preferred approach-involved emphasizing regular habits and activities and conducting self in moral and proper manner o not punished but ignored when they behaved in an abnormal way. • By the second half of the 19th century hospitals had become overcrowded, treatment was inadequate. Mentally disturbed seen as organically caused and incurable. o less treatment more a site to keep the mentally disturbed away from the normal populace. o poor and immigrants overly represented in the mental hospitals o for example, Worcester state hospital 1830-1870 the average stay was 1 year by 1950 the average stay was 5 years o major changes and shift in psychiatric care in 1950's and 60's due to three developments: • psycjotropic medication controlled symptoms, patients could function in their communities, some could hold jobs • Maxwell Jones introduced the concept of therapeutic community in England and Scotland. Assumed therapeutic potential rests with patients and staff aimed to empower patients allowed people to control their lives regular meetings held daily allowed staff and patients to govern their own unit, make decisions. • Decentralization (and localization)of services in which patients would be assigned to wards for a particular city or regions. Staff could network with community in providing aftercare and residents would be with their neighbors. Exception: hospital for the criminally insane.

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contemporary trends in abnormal psychology

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-the drug revolution -prescription privileges for psychologists -managed health care -appreciation for research

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The drug revolution: contemporary trends in abnormal psychology

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-1950's: Rapidly and dramatically decreased or eliminated symptoms -deinstututionalization

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prescription privileges for psychologists: contemporary trends in abnormal psychology

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•Prescription privileges for psychologists

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Managed health care: contemporary trends in abnormal psychology

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industrialization of health care has created major changes in the mental health professions. -Only reimbursed for treatments that have evidence that shows that the practice you are using is effective with the patients you're treating

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Appreciation for Research: contemporary trends in abnormal psychology

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-Evidence Based-Practices -decade of the brain

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Evidence Based Practices (EBP's)

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mental health refer to the development and use of only those psychological and medical interventions that have garnered some scientific basis or evidence that they are effective in treating a particular disorder • Essentially, effective psychological treatment involves three essential processes: -applying the best available research evidence in the selection and application of treatments -using clinical expertise that encompasess a number of competencies that have been found to promote positive therapeutic outcomes -being responsive to the patient's characteristics, cultures and personal preferences. • Psychotherapies and treatments that satisfy rigorous research criteria such as those involved in randomized clinical trials (RCT's) are referred to as empirically supported treatments (EST's) or empirically validated treatments (EVT's).

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Diversity/multicultural psychology :contemporary trends in abnormal psychology

answer

-Cultural, social, gender, religious, sexual orientation variations that may affect a patient's response to treatment -culture, race, ethnicity, gender, age, Socio economic status to understand and treat abnormality -cultural sensitivity, knowledge of diversity, culturally relevant therapy -social conditioning, cultural values and influences. Sociopolitical influences and bias (research and diagnosis) • when you are forced to use your second language you come across as more pathological than you actually are. Service provider cannot speak your home/primary language.

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Positive Psychology: contemporary trends in abnormal psychology

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-psychologists should consider assets, strengths and optimal human functioning -seeks balance: study, develop and understand positive human qualities that build thriving individuals, families and communities

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known as the decade of the brain

answer

2000-2010

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neurons

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nerve cells that transmit messages throughout the body

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dendrites

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receive signasls from other neurons

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axons

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send signals to other neurons

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synapse

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gap between axon of sending neuron and dendrites of receiving neuron

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neurotransmitters

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chemicals involved in transmissions of neural impulses.

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genotype

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genetic makeup

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phenotype

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obsevable physical and behavioral characteristics

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criticisms of biological models:

answer

• do not account for abnormal behavior if biological causes are found (i.e. phobias) -phobias do not have any genetic influence, they are primarily learned -phobias based on conditioning and modeling → see a person react to a stimulus in a dramatic way may lead to developing a phobia • ignore environmental societal cultural influence Diathesis stress theory •biochemical changes may occur because of environmental forces -i.e. colleague with fast flushing response eliminated this by splashing cold water on their face, conditioning •May foster helplessness by eliminating personal responsibility for well-being -prevents the person from exerting control over their problems

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Diathesis stress theory-

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a predisposition or a vulnerability to develop illness/ disorder (diathesis) is inherited and may or may not be activated by environmental factors. -just because a person inherits a disposition to develop something doesn't mean they actually will, depends on environmental factors such as stress

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psychodynamic models:

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early learning experiences set up whether you become vulnerable to a disorder

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psychodynamic models:

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o adult disorders arise from childhood traumas or anxieties o childhood-based anxieties re unconscious and are repressed through defense mechanisms because they are threatening to face. • Person can over utilize/over rely on defense mechanisms • these defense mechanisms become pathological • they are threatened they project that on another person → now they feel threatened by that person • over reliance on defense mechanisms, usually related to the symptom that is associated with that disorder.

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Personality Structure

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-Id -ego -superego -instincts

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Id:

answer

present from birth, it operats on the pleasure principle. Impuslive , pleasure-seeking aspect of being immediate gratification of instinctual needs. -Dominant aspect of one's personality

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Ego

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Realistic, rational part of the mind. It operates on reality principle: awareness of environmental demands, plus need to adjust behavior to meet these demands

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superego:

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moral judgements/moralistic considerations involve conscience and ego ideal -moral and ethical decisions -regulate and control a persons behavior

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instincts

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give rise to thoughts and actions and fuel their expression •dominant human (needs) instincts: sex and aggression

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defense mechanisms

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-repression -reaction formation -projection -rationalization -displacement -undoing -regression denial

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defense mechanisms

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•We all use these, they become a problem when we over use them •all are done unconsciously →not aware you are doing this

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denial

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the second most featured/used defense mechanism

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Criticisms of Psychodynamic Models

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•samples that Freud used were narrow in scope and types of individuals examined -limited set of disorders examined •the methods that he used to formulate his theory rrelied too heavily on anecital or case study approaches •Theories on female sexuality and personality seen as grounded in sexist and biased interpretations of female behavior. Such theories have little support empirically and neglect the important impact of sociocultural factors. •Psychoanalytic theory has limited application in that it seems most appropriate for well-deducated, verbal clients from middle class or upper class backgrounds.

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Repression (Defense Mechanisms)

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(repressed memory → memory is forgotten) (prevention of impulse or conflict from becoming conscious)

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Reaction Formation (Defense Mechanisms)

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(negating unacceptable impulses by doing the exact opposite)

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Projection (Defense Mechanism)

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(attributing the unacceptable to others)

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Rationalization (Defense Mechanism)

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(rational, intellectual justification for behavior that masks the true feelings and impulses) (over intellectualizing why you'd do it-not taking responsibility)

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Displacement (Defense Mechanism)

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(directing unacceptable impulses toward less threatening object - kick the wall)

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Undoing (Defense Mechanism)

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(engagement in rituals to correct a transgression - hit someone and dust him off)

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Regression(Defense Mechanism)

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(return to an earlier developmental stage, usually the stage at which person was fixated)

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denial (defense mechanism)

answer

(aware of it but you are not accepting the full meaning of the event →denying the full impact or meaning of what you are experiencing)

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Classical cnditioning:

answer

associative learning, what is paired with what? -Learning principle in which involuntary responses to stimuli are learned through association

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unconditioned stimulus (UCS):

answer

elicits an unconditioned response

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unconditioned response (UCR):

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The unlearned response made to an unconditioned stimulus

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conditioned Stimulus (CS):

answer

neutral stimulus aquires some properties of another stimulus with which it was paired

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Conditioned Response (CR):

answer

the learned response made to a previously neutral stimulus that has acquired some properties if another stimulus with which it was paired

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classical conditioning example

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UCS→ Loud noise, UCR → startled

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Operant conditioning:

answer

voluntary behaviors are controlled by the consequences that follow them

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Positive:

answer

the stimulus was applied → positive reinforcement -i.e. clapping -usually applied stimulus are reinforcement

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negative

answer

take away a stimulus -takes away an aversion stimulus → negative reinforcement -i.e. nagging wife, husband leaves no more nagging -i.e. procrastination → get pizza with friends anxiety goes down thus from now on every time you study you want to get a pizza thus this is negative reinforcement

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positive reinforcement

answer

-apply stimulus -increases behavior/response

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negative reinforcement

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-remove stimulus -increases behavior/response

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positive punishment

answer

-apply stimulus -decreases behavior/response

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negative punishment

answer

-remove stimulus -decreases behavior/response

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shaping:

answer

reinforcement of successive approximation to the desired behavior. Shaping is needed to learn complex tasks on which the acquisition of the basic components of the tasks are reinforced. -Reinforcement of successive approximations of the desired behavior -we reinforce anything that moves the person towards the behavior we want them to perform

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operant conditioning

answer

-positive reinforcement -negative reinforcement -positive punishment -negative punishment -shaping

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Operant conditioning

answer

you must operate on the environment to learn

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Operant Conditioning in Psychopathology

answer

•Maladaptive behaviors linked to environmental reinforcers -Positive: pleasurable, peak feelings (i.e. drug use) -Negative: escape/avoidance (i.e. procrastination) •Early behaviorists saw "inner life" as unscientific -Thoughts were considered useless by behaviorists because we cannot see thoughts •Today behavioral therapists acknowledge that internal mental life affects acquisition and treatment of disorders •We usually learn through observation, watching from others -Symbolically observing someone learn those behaviors through language and modeling

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The Observational Learning Model

answer

•Behaviors are acquired by watching someone else perform those behaviors -modeling

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modeling

answer

Learning by observing models and later imitating them (also called vicarious conditioning)

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Observational Learning in Psychopathology

answer

•Four effects of observational learning -New behaviors may be acquired by watching a model •i.e. new behaviors such as phobias -a model may elicit behaviors in an observer by providing cues -behaviors formerly inhibited due to negative reactions may occur after observing a model -If observer sees a behavior by a model result in aversive consequences, the behavior may

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Observational learning

answer

learning is the most common way we learn. •how fast we learn and whether we learn something or not depends about what we are thinking about the situation -thoughts can cause/maintain a disorder

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cognitive models:

answer

-conscious thought mediates or modifies a person's emotional state and/or behavior in response to a stimulus -people can only take so much punishment → eventually they tune out and are not focused on the task at hand -schemas -Irrational/Maladaptive Assumptions and Thoughts

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schemas (cognitive models)

answer

sets of underlying assumptions influenced by experiences, values, and perceived capabilities

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Irrational/Maladaptive Assumptions and Thoughts (cognitive models)

answer

-aaron beck -albert elis

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BECK Irrational/Maladaptive Assumptions and Thoughts (cognitive models)

answer

people engage in rigid, inflexible, and automatic interpretations of events -rigid schemas they apply in determining the world → people get more depressed and maintain their depression -cognitive content is organized along three levels: 1. Most accessible and least stable cognitions, voluntary thoughts 2. Automatic thoughts that occur spontaneously, triggered by circumstances 3. **underlying assumptions about oneself and one's world • cognitive models are diverse.

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ELIS Irrational/Maladaptive Assumptions and Thoughts (cognitive models)

answer

psychological problems produced by irrational thought patterns stemming individual's belief system -unpleasant emotional responses result from one's unrealistic and irrational thoughts about an event, not the event itself -Irrational thinking operates from dogmatic, absolutist "shoulds," "musts," and "oughts" that cause human misery as "musturbatory activities."

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Ellis's A-B-C- Theory of Personality

answer

•Ellis challenges catastrophic interpretations of the person's life → you are imposing irrational thinking making it more unpleasant •First step-Ellis challenges this belief and disputes irrational belief •second step - substitute irrational belief with rational beliefs -rational thinking leads to adaptive types of emotional reactions •focuses on the rationality of some of the beliefs we have •challenges the absolute nature of your belief •if you buy into that irrational belief you'll be miserable

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Cognitive Approaches to Therapy

answer

•highly specific learning experiences to teach clients to: -Monitor negative, automatic thoughts •over learned behaviors → cognitions , we think less about them -Recognize the connections between cognition, affect and behavior •creates emotional responses and behaviors that are maladaptive -examine evidence for or against distorted automatic thoughts -substitute reality-oriented interpretations •rational/adaptive beliefs →lead to behavior change on the patient -identify and alter beliefs that predispose them to distort their experiences •at risk situations/at risk circumstances. Identify trigger situations that urges them to i.e. drink, use drugs etc.

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Criticisms of Cognitive Models:

answer

•Skinner: cognitions are NOT observable, so they cannot form the foundation of empiricism •Human behavior is more than thoughts and beliefs -we cannot assume what we think/believe will affect our behavior in an exact way •Therapist, as teacher, expert, authority figure is direct and confrontational and may intimidate client and misidentify the disorder. -Patient may think they have a belief they do not have if their therapist suggests it.

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Dimension Three (Third approach): Social factors:

answer

-Social relational models

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Social relational models: Dimension Three (Third approach): Social factors

answer

social isolation, poor social support and lack of intimacy related to pathology

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Social-Relational Treatment Approaches (social factors)

answer

couples therapy group therapy

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FAMILY THERAPY (social factors)

answer

family system is dysfunctional and the actual client, the "identified patient" (IP) manifests the family's symptoms. The IP problems allow family members to avoid dealing with maladaptive relationships. Changes in IP threatens equilibrium of system such that there is resistance to change. Therapist must modify family relationships.

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GROUP THERAPY Social-Relational Treatment Approaches (social factors)

answer

wide range of formats, theoretical perspectives and purposes -commonalities of group therapy: social situation and social support- reduces isolation, interpersonal responses in real-life context, and the development of new communication and social skills -Little Research on effectiveness

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Dimension four: Sociocultural factors

answer

-gender factors -socioeconomic class -race/ethnicity: multicultural models of psychotherapy

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GENDER FACTORS Dimension four: Sociocultural factors

answer

sex differences in life stress, certain mental health disorders and response to treatment

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SOCIOECONOMIC CLASS Dimension four: Sociocultural factors

answer

social class differences in life stress, vulnerability to pathology and treatment experience

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race/ethnicity: multicultural models of psychotherapy Dimension four: Sociocultural factors

answer

oInferiority model- basic inadequacies oDeficient model: cultural deprivation oMulticultural Model - contextualizing behavior

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Cultural Competence in Mental Health Care

answer

•Aspects of cultural competence -cognitive competencies -affective competencies -role competencies

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Cultural Competence in Mental Health Care affective competence

answer

emotionally understand what the patient is going through

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Cultural Competence in Mental Health Care role competence

answer

how do you carry out roles that are meaningful to different cultures? •Difficult , ability of the clinician to carry out roles that are effective and functional in that person's culture. •i.e. police trained, slovaks get out of car and walk to police car when pulled over because that is what is done in their

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State of discontinuity:

answer

• difference from how we typically feel and how we feel now -disrupts their performance in certain roles in their lives → can't go to school or work etc. -people respond/react to illness varies. •some people wallow in their illness others behave normal/close to their normal or typical behavior -culture affects illness but NOT disease

question

statistical deviation

answer

based on relative frequency, abnormality defined as deviation from normative or average frequency -deviations from ideal mental health as defined by some theory or school of thought

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Abnormality:

answer

statistically deviant. More frequent or less frequent than we would typically expect.

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Defining abnormal behavior

answer

making inferences about the effect someone's behavior has on us or on other people. People have very different ideas of what is abnormal.

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What is abnormal Psychology?

answer

•Scientific study aimed at describing, explaining, predicting, and treating strange or unusual behavior -This strange behavior makes it difficult for a person to function in a culture or society -Predicting→ is this person dangerous to themselves or others? •uses psychodiagnosis: attempts to describe, assess, and systematically draw inferences about psychological disorders -predict what the person may do and how they might respond to treatment •Therapy: systematic intervention aimed at modifying clients behavioral, emotional and/or cognitive state.

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Construct validation

answer

involves assembling evidence about what a test really means. This is done by showing the relationship between a test and other tests and measures. •We hypothesize what a test measures. •i.e. anxiety --> self report measures correlate with measures of observers, physiological symptoms •test the hypothesis that underlies the measure

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The assessment of abnormal behavior (development of measures)

answer

-rational method -empirical method

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Rational method: (development of measures)

answer

develop a measure to assess individual variation on a specific trait or attribute versus the empirical approach in which scores in measure distinguish individuals who share a particular attribute or characteristic from those who do not share this characteristic. -items go together, obvious what is being measured by the investigator

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empirical method (development of measures)

answer

approach the only criteria for item inclusion is that it can distinguish the criterion group from the control group. Used to identify individuals who are likely to be sociopaths, juvenile delinquents, actors, professional sports athletes, good sales people, sorority members. -Identify clinically depressed individuals, through consensual method identify 50 individuals who are depressed and give them a list of items/test to measure depression. The measures used to separate/distinguish between criterion groups. -i.e. MMPI --> Minnesota Multiphasic Personality Inventory used to distinguish between criterion groups, such as normal peope and those with mental disorders. Those with mental disorders are put into subgroups by mental disorder. -Adaptable used for other aspects of a person, characteristics a person has -did this item differentiate between the control group and the criterion group. The item an be totally unrelated such as True or false Lincoln was a better president than Washington.

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Observations:

answer

systematic monitoring and documentation of how the person behaves. Varies in terms of specificity of behavior from molecular to global which is associated with the level of interference required from the observer. •problems w/ observations: validity of observations when patient is from another culture

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Adapters: (observations)

answer

molecular measures that predict how the person behaves/ feels in the situation → nervous men scratch while women play with their hair

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reactivity: (observations)

answer

knowledge or awareness of being observed affect's person's behavior. •i.e. Hawthorne → turned up lights to make workers more productive. Wasn't really the lights, it was reactivity → workers knew they were being observed and watched by management so production went up

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interviews

answer

most commonly used technique of assessment in clinical psychology. Affected by professional discipline and theoretical orientation. Psychoanalysts emphasize early childhood experiences but cognitive behaviorists emphasize current thinking processes.

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standardization (interviews)

answer

degree of structure determined by the relative presence (structured) or absence of specific data and information procedures (i.e. questions, probes) that must be followed.

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errors of interviews

answer

a)working relationship: information exchange blocked if relationship is problematic b)faulty information from interviewee c) faulty interpretation from interviewer due to theoretical, professional or cultural orientation •information can be misinterpreted by the person giving the interviews

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projective personality tests

answer

-Rorschach technique (ink blots) -Thematic Appreciation Test (TAT) -Sentence completion

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Projective personality tests:

answer

ambiguous stimulus such that person projects personal motives, needs and conflicts into the stimulus.

question

Rorschach technique (inkblots)

answer

personality, dispositions, conflicts and needs •Look at where in the blot the person is looking. Is the person looking at the whole blot or just a part? •it's how you use the object/the whole blot, appearance of texture •focus on minor details/ versus larger picture •projections of thoughts/feelings/ideas •no right or wrong answer it is how you use the blot •answers are coded

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Thematic Appreciation Test, TAT (pictures):

answer

assesses interpersonal conflicts and needs. •What is the person thinking, doing, feeling, what are they like? •projections → how they perceive the world, what kinds of issues are being reflected? Achievement need → need to do things, achieve something, accomplish something can project about the environment •Multiple TAT pictures are used to assess interpersonal conflicts/needs.

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Sentence completion tests:

answer

relationship themes and conflicts •i.e. I feel happiest when ____________ she boiled up when_________. when my mother came home. I ___________.

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Self Report Inventories:

answer

•Test taker answers specific written questions or selects specific responses from a list of alternatives •Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2) •Beck Depresion Inventory -21 items focus on depression

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Intelligence Tests

answer

•primary functions: -obtain intelligence quotient (IQ) or estimate of current level of cognitive functioning -assess intellectual deteioation in psychotic disorders •secondary function: -provide clinical data •Wechsler scales and Stanford-binet scales

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Tests for cognitive impairment

answer

Detect and assess organicity (damage or deterioration in the central nervous system) Bender-Gestalt Visual-Motor Test Halstead-Reitan Neuropsychological Test Battery Luria-Nebraska Neuropsychological Battery

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Neurological tests

answer

brain dysfunctions due to structural damage or biochemical/physiological processes or functioning. CAT PET EEG MRI

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Computerized axial tomography (CAT scan)

answer

X-rays and computer used to map out brain structure.

question

Positron emission tomography (PET) scan

answer

A radioactive substance is injected into bloodstream and is detected as it metabolizes in the brain.

question

Electroencephalogram (EEG)

answer

Assesses electrical activity as marker of brain processing.

question

Magnetic resonance imaging (MRI)

answer

A magnetic field is induced around the patient and assessment is made with the use of radio waves. A computer processes and maps out a very clear picture of the brain's structure. -MOST EXPENSIVE

question

disorders

answer

lie on a continuum with normality at one end, due to dissatisfaction with the categorical model •dimensional ratings: "none" to "severe" -could affect what insurance does and does not cover. Does this person have a problem or not?

question

Objections to classification and Labeling

answer

•A label can lead to overgeneralizations, stigmas and stereotypes. •labels can change your behavior. A label may lead others to treat a person differently. •A label may lead those who are labeled to believe that they indeed possess such characteristics. Affect's one's identity and self-perception. Social anxiety research. •a label may not provide the precise, functional information that is needed. DSM symptom-oriented.

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A label can lead to overgeneralizations, stigmas and stereotypes.

answer

Rosenhan's study (1973). "Sane in Insane places" -Rosenhan created pseudo-patients, the pseudo patients were trained to mimic and look psychotic. -students trained to mimic symptoms. All pseudo-patients were committed against their will → involuntarily committed. As soon as the pseudo patients were committed were told to act normal at the state hospital, they stopped behaving in a psychotic manner. How long will it take the professional staff to notice this? Hypothesis- was 5 days. They were told to say- I am alright now can I be released? Students were not released until Rosenhan intervened and asked for his students to be released. • once they had a label these pseudo-patients were not released. • the behavior that was exhibited was seen as pathologically. • even people who were professional trained did not recognize these patients were actually sane

question

labels can change your behavior. A label may lead others to treat a person differently. Rosenthal and Jacobson's (1968) study:

answer

o randomly selected third graders, gave teachers a list of students who were high potential and on the verge of an intellectual spurt. o intelligence testing of all children in the grade. At the end of the year the kids were tested again and the randomly selected children labeled high potential had statistically significant higher IQ scores. o teachers did not perceive they treated the kids differently → however they found teachers did treat the kids differently, gave high potential students more time to generate a response, higher expectations pushed the students more, made more eye contact. o positive stereotype but shows the power of a label and can affect how a person behaves towards you!

question

diagnostic and statistical manual of mental disorders

answer

DSM-5

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DSM-5 (combines Axes I,II and III of DSM IV)

answer

Clinical syndromes and other conditions, personality disorders and mental retardation and general medical conditions (now known as another medical condition in DSM-5) are now combined

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DSM V

answer

in DSM IV psychosocial stressors and environmental problems now known as Psychosocial and contextual factors --> formerly axis IV in DSM IV

question

DSM V

answer

axis V general assessment of function (GAF) in DSM IV. known as disability in DSM V

question

comorbidity

answer

the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder.

question

anxiety

answer

feelings of fear, apprehension and tenseness

question

Anxiety disorders

answer

meet one of these criteria: •Anxiety itself is a major disturbance •Anxiety is manifested only in particular situation •Anxiety results from attempt to master other symptoms -Person cannot control other symptoms and develop an anxiety disorder

question

Panic attacks:

answer

:one system that can occur in all four types of anxiety disorders. Intense fear, fear of losing control of the mind or body, with somatic symptoms (i.e. intense heart pounding), can occur in all types of anxiety disorders, episodic -have never killed a person but many people who experienced a panic attack have said they thought they were going to die

question

Four types of anxiety disorders:

answer

1. Panic disorder 2. Generalized anxiety disorder 3. Phobias 4. Agoraphobia

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phobias (types of phobias)

answer

-social phobias (social anxiety disorder) -specific phobias -agoraphobia

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Agoraphobia (types of phobias)

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fear of being in a public place without help, fear of panic symptoms, anxiety over these symptoms can result in people being house-bound. •DSM-5: Endorsement of fears from 2 or more situations now required, six month duration of symptoms Usually it is more than 2 situations → market, work, school etc •Lifetime prevalence: 3.5% for males, 7% for females •panic attacks precede agoraphobia, but relationship unclear, clear precipitating event in 75% of those surveyed in one nationwide survey •catastrophic thoughts of losing control, becoming ill, and other extreme outcomes often associated with agoraphobia

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social phobias/social anxiety disorder:

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fear of being scrutinized/examined, fear of negative evaluation from others •one subcategory: performance (fear of public speaking) •another more general sub category: or other types --> generalized social anxiety disorder -social anxiety disorder → high prevalence rates •Lifetime prevalence rates: 11.1 percent for males, 15.5% for females •annual prevalence rate: 8.7% annually •women twice as likely to have a social phobia, but men are more likely to seek treatment. Why? Women more emotional think this is just how they are and do not need treatment! Role → men initiate conversation.

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Specific phobias(types of phobias)

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irrational fear to object or situation • In DSM-5 , five specifiers: 1. Animals 2. Natural environmental (such as thunder) 3. Blood injection/ injury (such as needle phobics) → usually associated with fainting 4. Situational (such as elevators) 5. Others (such as choking)

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Etiology of phobias: perspectives

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-psychodynamic -behavioral classical conditioning observational learning -cognitive behavioral -biological

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Etiology of phobias: Psychodynamic perspective

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displaced sexual or aggressive conflict, phobic stimulus or situation has symbolic significance of real conflict that is threatening the person. Little Hans's fear that a horse would bite him represents his castration anxiety over Oedipal conflict with his father.

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Etiology of phobias: behavioral perspective

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•classical conditioning: conditioned emotional responses, some research and clinical support for conditioned learning in that most phobic patients report conditioning experiences as perceived cause •observational learning: negative information and modeling are major factors accounting for childhood fears. Probably depends on if the model and observed situation can elicit a strong vicarious emotional response. Ollendick and King (1991) found that modeling (56%) accounted for childhood fears more than direct conditioning experiences (36%).

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Etiology of phobias: cognitive behavioral

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negative thoughts and overestimates of unpleasant future events in those with phobias, may be consequence of phobias rather than cause.

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Etiology of phobias: biological perspective

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genetic predisposition for fear reactions but depends on the type of phobia with specific phobias having less of a genetic contribution than either agoraphobia or social phobias. Some evidence that individuals may inherit the disposition to develop phobias •due to having usually high autonomic nervous system (ANS) reactivity - more likely to respond more intensively to external and internal stimuli, more easily aroused and more difficulty in habituating to stimuli.

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Ollendick and King (1991)

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ound that modeling (56%) accounted for childhood fears more than direct conditioning experiences (36%). -behvaioral perspective -observational learning

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treatment of phobias

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-biochemical treatments -behavioral treatments

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treatment of phobias: biochemical treatments

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many new drugs, benzodiazepines, SSRI's most commonly used drugs to treat phobias. Effective but effects •confounded with exposure effects with the feared stimulus.

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treatment of phobias: behavioral treatments

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most effective approaches usually involves combination of the following: -exposure therapy -systematic desensization -cognitive restructuring -modeling therapy

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treatment of phobias: behavioral treatments Exposure therapy

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gradually introduce contact with feared situation, extincton •most people do not want to try this approach since they have been avoiding the stimulus their whole life

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treatment of phobias: behavioral treatments systematic desensization:

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relaxation (incompatible response to anxiety) while imagining increasingly anxiety-provoking situations in stimulus hierarchy •cue word paired with relaxation •method 1: progressive muscle relaxation •method 2: autogenic training → generate strange images people don't think about, relax, strange suggestions get people more relaxed, paired with a cue word •Example of systematic desensization goal for Rachel →agoraphobia, the goal was for Rachel to get to the mailbox, get to the store and then get back to work (hierarchy) progressive 10 steps. Step 1 relax/walk towards the door (imagery → imagine her turning towards the door, trained in progressive muscle relaxation, ask patient how anxious they are 1-10, anything above a 5 we cannot proceed to the next step) after a 2nd week Rachel was able to get to 2nd hierarchy and drive to therapy

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treatment of phobias: behavioral treatments Cognitive restructuring

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challenges catastrophic thinking and self-focus •Client imagines going out the door, think about why this is terrible, challenging catastrophic thinking (this is terrible, I am going to die) •instead substitute thinking that is more positive --> (everything is fine, I am going to be ok) •break self-focus, shift towards coping statements (such as I can handle this) •i.e example of coping statement for patient scared of spiders: even if it hurts me (the spider bites me) I am not going to die

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treatment of phobias: behavioral treatments Modeling therapy:

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model should be similar to patient in characteristics •Modeling is very powerful, but the model must be someone the patient identifies with •example: a patient who is scared of shots, show the scared patient a model getting a shot. •model must have characteristics the patient wants to emulate /can emulate

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Panic Disorder

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•Severe and frightening episodes of apprehension and feelings of impending doom -Person fears they are going to die •DSM-5 : recurrent unexpected panic attacks, plus at least one month of apprehension over having another attack, person is expecting they will have another panic attack-avoiding things they believe will trigger a panic attack (walking on eggs) •somatic symptoms: breathlessness, sweating, choking, nausea, heart palpitations •May lead to agoraphobia: anxiety about leaving one's home -panic disorder and agoraphobia are unlinked in DSMM-5 •lifetime prevalence: 3.5%, twice as common in women as in men

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Generalized Anxiety Disorder (GAD)

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•persistent high levels of anxiety and excessive worry over major and minor life circumstances (more persistent, less intense than panic disorder) •DSM-5 symptoms must be present for at least three months •somatic symptoms: heart palpitations, muscle tension, restlessness, trembling, sleep difficulties, poor concentration, persistent apprehension nervousness •most have co-morbid disorders: 2/3 of people with GAD have depression, substance abuse, or phobia oco morbid→ having more than one disorder •worldwide: most frequently diagnosed symptom anxiety disorder •lifetime prevalence: 5%, twice as common in women as in men

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Ethiology of panic disorder and GAD

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-psychodynamic -cognitive behavioral -social/sociocultural -biological

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Ethiology of panic disorder and GAD Psychodynamic:

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anxiety over sexual and aggressive impulses that cannot be controlled by defense mechanisms

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Ethiology of panic disorder and GAD cognitive bahavioral:

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negative thoughts or overattention to bodily sensations serve as internal triggers for panic attacks •over attention to bodily sensations

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Ethiology of panic disorder and GAD social/sociocultural:

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stressful childhood involving separation anxiety, family, conflict poverty, pejudice, trauma and other environmental stressors •put them at risk for panic disorders and GAD but these are life stressors and may not be specific to GAD and panic disorders

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Ethiology of panic disorder and GAD Biological perspective:

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•Panic disorder associated with oxygen mis-regulation resulting from dysfunction in the brain, erroneous messages that oxygen is insufficient that elicits hyperventalization and fears of suffocation •disturbances in or lack of serotomin 5-HT1A receptors •genetic studies: higher concordance rates for MZ than DZ twins for panic disorder, less support for genetics in GAD (see textbook)

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Treatments of Panic disorder and GAD

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-biochemical treatment -Cognitive-behavioral treatment

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Treatments of Panic disorder and GAD Biochemical treatment

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•Antidepressants(tricyclic antidepressants and selective serotomin Reuptae Inhibitors (SSRI's)) and antianxiety medications (i.e. benzodizepines); relapse after stopping drug therapy quite common, unclear if due p placebo effects which can approach 75% success rate in clinical trials •Benziodiazepines (Valium and Librium) useful in GAD but can cause tolerance and dependence addictive, not the first choice, if they must be used they are used in conjunction with another form of treatment, usually therapy

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Cognitive-behavioral treatment of Panic disorder

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• Educate about panic symptoms (a lot of patients have misinformation- educate about symptoms, explain a panic attack cannot kill them ) • Restructure catastrophic thinking (train people to challenge the thinking that this is terrible, introduce coping statements→ reassuring self statements practiced by the patient), • Self-induce physiological symptoms (i.e. have people hyperventilate, have patients use coping statements and relaxation exercises), self-controlled exposure, substitute coping statements, • identify high risk information (what really stresses you, what are signs that you are worried? Use dreams to identify high risk situations→ dreams not used in a psychodynamic way) • Higher success rates in behavioral treatments than medication, 8-% of people treated wit panic disorders with cognitive behavioral treatments were panic free

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cognitive-behavioral treatment of GAD:

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focus on worrisome thoughts, discriminate between realistic and irrational worries, challenge irrational and catastrophic beliefs underlying worry, substitute coping and problem solving thoughts and use of relaxation to counter somatic symptoms • looking at rational versus irrational worries • what should you be really thinking abut versus what is irrational that you don't need to be thinking about • train people to behave in ways that are incompatible with the behavior we want to present. For example, you don't see someone running and eating a doughnut at the same time. • For excessive worriers, like GAD we teach them how to relax → progressive muscle relaxations. Train them how to relax, this cuts anxiety they experience from GAD.

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Obsessive-Compulsive Disorder • obsessions:

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Intrusive, repetitive thoughts or images that produce anxiety. - Most common obsessions (for children and adolescents)→ dirt, germs, disease, death, danger to self or loved ones - Most common obsessions (for adults) → bodily wastes, secretions, dirt, germs, environmental contamination

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Obsessive-Compulsive Disorder • compulsions:

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the need to perform acts or to dwell in thoughts to reduce anxiety. -Most common compulsions: (for children and adolescents)→ excessive or ritualized washing, repeating rituals, checking behaviors -driven by negative reinforcement -in a given year, 1% of US population has OCD. No gender differences, but less common in African Americans and Mexican Americans.

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Etiology of OCD

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-biological -psychodynamic cognitive and behavioral -social and sociocultural

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Etiology of OCD o Biological:

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increased metabolic activity in the frontal lobe of left hemisphere suggests deregulation of the orbital-frontal caudate circuit (alerts rest of the brain when something is wrong) In OCD, it is weakened, and disturbing thoughts may leak through. Response to medication also suggests serotonin deficiency.

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Etiology of OCD Psychodynamic:

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Attempts to fend off anal sadistic (antisocial), anal libidinous (pleasurable soiling) and genital (masturbatory) impulses. The obsession is a less threatening substitute or replacement for the original conflict.

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Etiology of OCD Cognitive and behavioral:

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Obsessive-compulsive behaviors develop to reduce anxiety. The individual does not trust own memories and judgment and makes attempts to determine if they did something "correctly" . The uncertainty leads to rituals. Person is subject to disconformatory bias, probability bias, and morality bias

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Etiology of OCD Social and sociocultural:

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Overly critical parenting and adverse environments may be related to development of OCD. More common among the young and those who are divorced, separated, or unemployed. Less likely to be diagnosed in AfAm and HisAm than Whites.

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Treatment of OCD:

answer

-biochemical treatments behavioral treatments

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Treatment of OCD: Biochemical treatments

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•SSRI's to increase available serotonin (only 60-80% respond to these) •Benzodiazepines less effective with OCD than other anxiety disorders •Clomipramine (tricyclic antidepressant)in small dosages are taken by some Asian Americans and whites due to metabolic differences •once medication is stopped the anxiety goes back up, we try to wean the person off the medication as psychotherapy becomes more effective

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Treatment of OCD: Behavioral treatments:

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•Combination of exposure (flooding or gradual exposure) and response prevention is the treatment of choice •Reduces anxiety that drives compulsions and obsessions

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dissociative Disorders :

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Disorders in which person's identity, consciousness or memory are significantly altered -Dissociation example: tune a person out, mom asks are you listening to me •most are rare, but reports of dissociative identity disorder in United States have increased (now estimated that 5% of adult psychiatric unit patients have dissociative identity disorder)

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dissociative amnesia:

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partial or total loss of personal information (due to traumatic event) -localized amnesia -dissociative fugue

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Types of amnesia: Localized-

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- memory loss for a short time (most common type)

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dissociative figure-amnesia

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plus travel , usually incomplete change of identity , recovery usually abrupt and complete (now DSM-5 specifier)

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DEPERSONALIZATION/ DEREALIZATION DOSPRDER:

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feelings of unreality and perceptual distortion of self or environment. Things feel strange or surreal. Most common form of dissociative disorder

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Dissociative identity disorder (multi personality disorder) :

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formerly multiple personality disorder characteristics: •two or more independent personalities exist in one person, core set of symptoms (Gleaves 1996)-amnesia, lack of personal memory of childhood and/or daily events, chronic depersonalization, alteration of identity, experience of possession with a new identity, and may be observable by others or self-reported •one personality as evident at a time, usually there is amnesia in personality that is not present, but one personality may have awareness of other personalities •often opposite personalities that reflect different mood and attentional states that are often in conflict or unacceptable to the person. •More prevalent in women in the United States

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Diagnostic controversy: Dissociative identity disorder (multi personality disorder)

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-great increases in diagnosis (one clinician reported 130 cases) -Rare outside United States and Canada -Base rate for dissociation experiences may be high, which clinicians misinterpret as a dissociative identity disorder -hard to separate faking from real behavior -dissicosiative experiences/ experiences that seem like dissociation are so common

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Etiology of dissociative disorders:

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-psychodyamic -biological behavioral

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Etiology of dissociative disorders: psychodynamic perspective:

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-capcity to dissociate needed when repression not totally effective, need to split off the disturbing experience -exposure to severe long term, stress that usually is inescapable such as physical or sexual abuse -walling of experience essentially is a protective mechanism-allows person to function under very difficult conditions

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Etiology of dissociative disorders: Biological Perspective (mostly on DID)

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o activation or inhibition of certain brain regions (hippocampus region-involves memory) o differences in temporal lobe activity-seizures often alter consciousness o Decreased brain volume in amygdala and hippocampus - may affect coding of information

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Etiology of dissociative disorders: Behavioral perspective:

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indirect avoidance of stress -Socio-cognitive model: rule-governed/goal directed experiences and displays created, legitimatized and maintained by social reinforcement •Rule-governed experiences→ many different roles/rigid roles → over learned/ over rehearsed roles, different roles seen as different personalities -Iatrogenic: created by the therapeutic situation •Under these conditions people are very likely to be influenced: One source of information, unsure of situation/what you're supposed to be doing, cant escape the situation→ high anxiety , deprived sensory conditions, authority figure

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Treatments of dissociative disorders:

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•medications treat accompanying anxiety or depression •survivors of childhood sexual abuse who have dissociated are often treated with psycho-education, use of group resources and cognitive social skills training -normalization → powerful tool of group therapy, the idea that you're not the only one •amnesia and fugue (usually spontaneously reunite): -supportive counseling -treat depression and stress •depersonalization disorder (slower spontaneous remission) -alleviate feelings of anxiety, depression, fear of going insane -occasionally behavioral therapy (reinforcement of appropriate responses) •support the person, allow them to recover with time, treat symptoms.

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Treatments of dissociative disorders: •Dissociative identity disorder (DID):

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-Controversial treatments, not always successful -Hypnosis: •personalities introduce selves to patient and recall traumatic experiences/ memories, different personalities explain how they are related to the trauma •therapist suggests personalities served a purpose but now alternative coping strategies will be more effective •integrate personalities it is hard for the different personalities to interact o psychotherapy •work on safety issues, stabilization, symptom reduction •identifying and working through traumatic memories and experiences •integrate personalities •current treatment focus on different personalities as symptoms and addressing the stress and/or trauma that created these symptoms rather than working for personality integration •common feature of most therapies is emphasis on having client work through or cope with stress or trauma that precipitated the dissociative experience

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Somatic Symptom and Related Disorders

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-(Complex) Somatic symptom disorder -Illness anxiety disorder -functional neurological symptom disorder

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Somatic Symptom and Related Disorders Complex) Somatic symptom disorder

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-formerly, seomatization disorder and pain disorder in DSM-IV -No identifiable medical condition -characterized by excessive distress over somatic symptoms, accompanied but high levels of health related anxiety, maladaptive thoughts, feelings and behaviors present for six months -two subtypes: Somatization or Pain features

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Somatic Symptom and Related Disorders Illness anxiety disorder

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-formerly known as hypochondriasis in DSM-IV -high health anxiety about preoccupation with and oversensitivity to normal variations in bodily functions or sensations for at least six months -so somatic symptoms -cognitive disorder-believe they have a serious illness or are dying. •misuse of the emergency room, come in with normal bodily functions

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Somatic Symptom and Related Disorders functional neurological symptom disorder

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-aka conversion disorder -Motor, sensory, or seizure-like symptoms incongruent with recognized neurological or medical disorder -Onset of symptoms often related to traumas or other stressors -example: Cambodian refugees from the Vietnam War → came to United States had functional neurological symptom disorder → psychic blindness. Symptoms with no identifiable medical cause.

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Treatment: Somatic Symptom Disorders

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-biological -psychological -cognitive-behavioral

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Treatment: Somatic Symptom Disorders biological

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antidepressants (SSRI's) effective, opioids and increases in physical activity (conversion disorder)

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Treatment: Somatic Symptom Disorders psychological

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focus on developing better social relationships to counter reliance on "sick role" -may have to do with the stress. Stress can affect physiology → stress makes you feel sick -stress management training

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Treatment: Somatic Symptom Disorders cognitive-behavioral

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CBT is most promising intervention. Focus on a)relaxation training tor educe arousal and anxiety b) connecting stress to bodily sensations c) correcting cognitive distortions, catastrophic thinking, and misinterpretations d) reinforcing social contact e) confirming non-physical nature of problems •major hurdle: get the patient to except there is no physical problem causing their symptoms, just that stress is causing the problem

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stressor:

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external event or situation that places a physical or psychological demand on a person i.e. carry this table up the stairs by yourself → stress about the physical demand i.e. come to my office and tell me what a great professor I am → psychological demands

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stress:

answer

internal response to a stressor

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Life change model (Holmes and Holmes)

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all life events (large or small, positive or negative) an cause stress in a person- cumulative impact of life changes o Hypothesized that greater life change units produce greater chance of illness. Measured stress with the social Readhustment rating scale and stress potential values are called Life Change Units (LCU's) o fond relationship between LCU level and likelihood of illness • 150-199 (37% ill) • 200-299 (51% ill) • more than 300 (80% ill) o only undesirable changes had negative effects o research tends to be correlatonal and retrospective in nature

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Acute Stress disorder and Post Traumatic stress disorder

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•ASD and PTSD formerly types of anxiety disorders in DSM IV •Acute stress disorder: 8 or more symptomsasociated with stress disorders that last more than two days but less than thirty days occurring within four weeks of the event •post traumatic stress disorder: symptoms last more than 30 days •separate PTSD criteria added for children age 6 or younger

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diagnosis of acute and post—traumatic stress disorder:

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•develops un response to a specific traumatic event experienced directly, witnessed or experienced indirectly •re-experiencing terror of event, intrusive dreams and memories •avoiding stimuli associated with trauma (i.e. thoughts, sensations, events, situations) •alterations in mood and cognitions associated with event (i.e. emotional numbing, self-blame, anhedonia → the inability to experience pleasure) → emotional withdrawal •heightened autonomic arousal- hyper vigilance, startle reactions. concentration problems, sleep disturbance, irritable and aggressive behavior

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characteristics of clinical research

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-potential for self correction -hypothesizing relationships -operational definitions -reliability and validity of measures and observations -base rates -statistical vs. clinical significance

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operational definitions (characteristics of clinical research )

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Researchers are accountable for how they define a variable in terms of how it is measured and assessed. (i.e. the operations used to define a variable) Special challenges in operationalizing and classifying mental health disorders -what criteria are we using to define who has and does not have a disorder. inclusion/exclusion prnciples. -if we are doing a clinical trial who qualifies to be a participant and who should not participate? -does the person really have this disorder? •i.e. autism. Do these people actually have autism or were they misdiagnosed/ included in a study when they shouldn't have been. •i.e compulsive shopping! What is compulsive shopping? No included in the DMS V because it is too difficult to decide what is and what is not compulsive shopping.

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base rates (characteristics of clinical research )

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the rates of natural occurrence of phenomena in the population studies -if the rate is so low, it is hard to diagnosis it -mental health practitioners are charged to predict if and when a person will become violent → violence is so low, how can we predict it -if base rates are too high they can be mistakngly identified as casuing a disorder! •i.e mom was thinking of me and I called. She thinks her thinking of me caused me to call→ this is a mistake since there is such a high base rate. -Suicide → we try to predict sucide at UC Davis but the rate of suicides is very low -false positives → let's over predict suicide and violence. But then you'd be labeling a bunch of people as suicidial or violent when they actually aren't. •over prediciting is not the solution many times.

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Statistical vs. clinical significance (characteristics of clinical research )

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statistical significance: the likelihood that a relationship could be due to chance alone •if you ran this treatment study over and over again → the effect we found is reliable, we will find the same results each time •in clinical research we must show a treatment is statistically significant, show it out performs a control treatment to determine if somethings is statistically significant •use statistical tests clinical significance: whether a statistically significant finding has any practical relevance in a clinical setting •must be clinically significant •difference must be large enough to have relevance in their life •is the finding of clinical relevance? Is the effect so large it actually makes an effect in people's lives?

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2 major methods of clinical significance:

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1. social comparison: did you decrease the problem to the point where people who have the problem cannot be differentiated from people who do not have the problem . Did the treatment move the treated group to the point where they are no longer distinguishable from a group who do not have this problem? 2. Subjective evaluation: the favored method by clinicians. People who observe your behavior a lot are asked to evaluate if there is a difference. Observors of the behavior are surveyed. From pre-test to post -test will these observers provide findings that you've changed for the better? if there is a significant change we are confident that these changes are clinically important.

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the placebo group (experiments)

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:controls for expectations that treatment will work. In drug trials, the placebo is a sugar pill (inert drug). In psychotherapy research, the placebo condition is an intervention in which minimal behavior change is expected.

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Additional concerns in clinical research

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-blind design -double blind design -hawthorne effect -external validity -internal validity

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blind designs (Additional concerns in clinical research )

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researchers do not know purpose of research study. Controls for experimenter bias

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double blind design (Additional concerns in clinical research )

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neither subjects nor the researchers know which experimental confitions the participants are in. Controls for experimentor and participant bias. •contaminantion → participants speak to each other about the different conditions -therapists, patients and asessors can all be kept blind → triple blind study

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Parents Television Council (2007) correlational study: Correlation

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relationship between violent TV programs abd aggressive behavior •more violen children → watch more violent TV •watching violent TV causes violence •there could be many different reasons

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Sanders and Giolas (1991) correlational study: Correlation

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relationship between childhood abuse and dissociation (disturbance in their memory, identity, unsure of who they are/where they are →location/time). •Found that children who dissociated a lot had a more extensive history of childhood abuse •abuse was causing dissociation •what else could be happening? Third variable childhood difficult temperament → abuse → dissociation unpredictable/chaotic parenting styles →abuse →dissociation

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Analogue Study

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•Stimulate real situation under controlled conditions, usually done because real-life conditions are difficult to study or difficult to control conditions in real life •limitations → give insight about a behavior but its not the same in real life. Assess ablility to do something but not how things would occur in real life. Performance in real life is different than your ability. •give insight into behavior but only an aprroximate of real life. Simulations often test's people's capacities and not actual behavior or performance. (i.e. practice versus a real game/race in sports) -Example: Binge drinking→ bar lab where students could go in and drink. They controlled conditions measured how much people drank •Does stress lead to more drinking? Threat of shock did not increase drinking. A beautiful women will come into the room soon → led to a lot of drinking •social anxiety vs. physical anxiety to see how it affected drinking

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Single Participant Studies Idiographic approach:

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in depth study of one person, valuable for clinical work. Idioraphic approach emphasizes the uniqueness of individuals and their unique qualities such that anin-depth examination can only do justice to describing that person.

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Single Participant Studies Case study:

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Clinical data on one person or small number of people.

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Single Participant Studies Single-participant experiment:

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Person's own behavior acts as own control condition. Person subjected to intervention and then no-intervention condition •example: autistic child given communication skills treatment -intervention increased the child's social interaction -social skills program works for this one autistic child -when the social skills tratment is taken away the interactions the child has decreased almost to zero. -this child is their own control → provide the treatment, taking the treatment away •cannot withdraw treatment that would be detrimental to the paient if removed -i.e. someone who is suicidal •this design is difficult if someone is looking at a skill set → how to drive, you learned the skill-learned how to drive or learning to shot a basketball

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Biological Research Strategies

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-genetics and epigenetics -genetic linkage studies -the endophenotype concept -other concepts in biological research

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Biological Research Strategies genetics and epigenetics

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how the environment affects or "programs" gene expressions. Identifying the impact of environmental stressors during certain critcal periods in child development

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Biological Research Strategies genetic linkage studies

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determine whether a disorder follows a genetic pattern

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Biological Research Strategies the endophenotype concept

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biological indicators that provide information on the genes involved in the disorder o associated with the disorder o heritable o manifested in an individual regardless if whether the disorder is present o found in a higher rate among non-affected family members than the general population

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Biological Research Strategies other concepts in biological research

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i. iatorgenic effects ii. penetrance iii.pathognomic iv.Biological challenge tests:

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Biological Research Strategies other concepts in biological research i. iatorgenic effects

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unintended changes (side effects) in behavior due to treatment. •for example: hypnosis by therapist may create memories among patients

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Biological Research Strategies other concepts in biological research ii. penetrance

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degree to which genetic characteristics is seen in people carrying a gene associated with it. Usually partial or incomlete penetrance.

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Biological Research Strategies other concepts in biological research iii.pathognomic

answer

degree to which symptom is specific to a disorder. Most people with mental disorders have poor family relations, low self-esteem and poor social skills. These are not pathognomnic symptoms but indeterminate conditions, Problem of "fallacy of etiological specificity" → you only study one disorder at a time. Something can be a predictor for a wide variety of disorders!

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Biological Research Strategies other concepts in biological research iv.Biological challenge tests:

answer

Monitor behavior change after presentation of a specific chemical or nutrient. -i.e. fast flushing response → lack an enzyme that metabolize alcohol •70% Asians have fast flushing response along with 60-70% of native Americans •people who are embarrassed have lower rates of drinking -biology interacting with the environment -can you condition this physiological response? Yes it appears so. -something biological can be affected by the environment and by learning , conditioning in this example.

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other forms of research

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•Survey research: including epidemiological research -Self-report survey research -Sampling issues, are the measures valid -social desirability → motivated to report in a way that makes them appear desirable to society/societal standards •people will under report on things that are undesirable such as substance abuse, alcohol, drugs etc. -Paradoxical reports: prevention programs → people become more comfortable with researchers, the program, start reporting accurately, looks like an increase in usage, negative effect or impression of program -Longitudinal vs. cross-sectional research •Historical (Archival Research) •Twin Studies (genetic linkage) •Treatment Outcome studies-effectiveness vs. change mechanism research -Focuses on the changes -must consider relapse rates •Treatment Process studies: examine processes between therapist and client that result in certain outcomes -Examines relationship between doctor and patient→ bedside manner -started in psychotherapy are now being applied in medicine •Program Evaluation: accountability of social change programs. -i.e the DARE program, is not as successful as we'd think. Many of these programs do not have an effect on behavior. -prigram failure → program is not effective because intervention was never implemented in the first place. Program never has a chance to have its optimal effect, administered incorrectly.

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Other forms of research:

answer

•Survey Research (including epidemiological research) •Longitudinal vs. Cross-sectional Research •Historical (Archival) Research •Twin Studies (Genetic Linkage) •Treatment Outcome Studies - Effectiveness vs. Change Mechanism Research •Treatment Process Studies - Examine processes between therapist and client that result in certain outcomes. •Program Evaluation - Accountability of social change programs.

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Historical perspectives on abnormal behavior:

answer

a. prehistoric and ancient beliefs b. naturalistic explanations (Greco-Roman Thought) c. Reversion to supplemental explanations (Middle Ages) d. the Rise of Humanism (Renaissance) e. The Reform movement (18th and 19th centuries)

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Historical perspectives on abnormal behavior: prehistoric and ancient beliefs

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-no distinction between mental and physical disorders -abnormal behaviors attributed to evil spirits -demonology, victim held partially responsible -trephining treatment, skull chipped to allow evil spirit to leave -exorcism

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Historical perspectives on abnormal behavior: naturalistic explanations (Greco-Roman Thought)

answer

-Hipocrates questioned these beliefs and suggested more rational and scientific explanations for mental disorders 3 categories of entail illness: mania, melancholia, and phrenitis -relied heavily on observation -brain seen as central organ -brain pathology the disease of the brain, heredity and environment were also important

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Historical perspectives on abnormal behavior: Reversion to supplemental explanations (Middle Ages)

answer

scientific inquiry, the attempt to understand, classify and explain/control nature Dark ages: heresy and punishment, conflict with science and the church , illness a result of supernatural forces, illness was a punishment for sin Mass Madness: group hysteria(people exhibit the same symptoms) --> stress and fear are associated with mass outbreaks! witchcraft: Martin Luther, pope/church challenged, papal bull to exterminate witches, peculiar actions seen as witchcraft

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Historical perspectives on abnormal behavior: the Rise of Humanism (Renaissance)

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humanism --> emphasizes human welfare mentally ill seen as sick not possessed

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Causes: Early Viewpoints

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-biological or organic viewpoint -psychological viewpoint these two schools of thought emerged. Most people tended to combine elements of both the above schools of thought

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Causes: Early Viewpoints -biological or organic viewpoint

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mental disorders are the result of physiological damage syndromes-symptoms that occur regularly in clusters each cluster of symptoms represented a mental disorder with its own cause, course and outcome

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Causes: Early Viewpoints -psychological viewpoint

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emotional basis for mental health certain types of emotional disorders were not associated with any organic disease in the patient

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integrating mental health and health

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managed health care- the industrialization of health care, large organizations in the private decor control the delivery of services businesses determine reimbursable diagnoses, number of psychology sessions, other restrictions psychologists asked to justify their use of therapies by empirical methods

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the human brain

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-forebrain -midbrain -hindbrain

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forebrain

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control all the higher mental functions associated with juan consciousness, learning, speech, thought and memory

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midbrain

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involved in higher vision and hearing -contro of sleep, alertness and pain

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hindbrain

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manufactores serotonin heart rate, sleep and respiration

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biology-based treatment techniques

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psychopharmacology-study of the effects of drugs on the mind and on behavior (medication/drug therapy) electroconvulsive therapy- application of electric voltage to the brain to induce convulsions psychosurgery - brain surgery performed for the purpose of correcting a severe mental disorder

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psychosexual stages (freuds psychodynamic theory)

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in psychodynamic theory the sequence of stages- oral, anal, phalic, latency and genital -through which human personality develops

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classical conditioning in psychopathology

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watson-recognized the importance of associative learning in the explanation of abnormal behavior showed that the acquisition of a phobia could be explained by classical conditioning

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criticisms of behavioral models

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-it often neglects or places low importance on the inner determinants of behavior -behaviorists extension to human beings of results obtained from animal studies -mechanistic

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humanistic perspective

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the optimistic viewpoint that people are born with the ability to fulfill their potential and that abnormal behavior results from disharmony between the person's potential and his or her self concept

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self-actualization humanistic perspective

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an inherent tendency to strive toward the realization of one's full potential

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development of abnormal behavior in the humanistic perspective

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people left unencumbered would develop into fully functioning people (rogers) society imposes conditions of worth

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person centered therapy humanistic perspective

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humans need unconditional positive regard therapists create conditions that allow people to grow and fulfill their potential therapist attitude matters need a strong positive regard. the therapist must believe in the client's strengths

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existential approach humanistic perspective

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a set of attitudes that has many commonalities with humanism but is less optimistic. focusing on: i. human alienation in an increasingly technological and impersonal world ii. the individual int he context of the human condition iii. responsibility to others and to oneself

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criticisms of humanistic and extinsential approaches

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-can only be applied to a small population -not suited to scientific or experimental investigation -hinder empirical study -does not work well with severely disturbed clients

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social factors: family systems model

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model that assumes the behavior of one family member directly affects the entire family system

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social factors: family, couples and group perspectives

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-other people influence behavior -family systems model -personality development is ruled by attributes of the family -abnormal behavior in the individual is the symptom of an unhealthy family dynamic -focus on family not the individual

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couples therapy (social factors)

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a treatment aimed ta helping couples understand and clarify their communications, role relationships, needs and unrealistic and unmet expectations

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criticisms of social-relational models

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-research not rigorous in design lack components such as control groups etc -culture variation -family system models have unpleasant consequences

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criticisms of the multicultural model

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-critics argue "a disorder is a disorder" regardless of cultural context -lack of empirical validation

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the experimental group

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participants exposed to the experiment or intervention

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the control group

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participants are treated in ways that are very similar to the experimental group, but they do not receive an intervention or receive less of independent variable.

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the control group

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i. no treatment ii. treatment as usual iii.attention placebo

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the control group Treatment as usual:

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using informal support systems → support groups, counseling

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the control group No treatment:

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person comes in at beginniing of study and at end. Is evaluated w/o receiving additional treatments -the placebo group / attention placebo → i.e. education about phobias from a therapist •i.e. sugar pill versus actual medication/drug

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Hawthorne Effect (concern in clinical research)

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-people change their behavior because they know they are being watched i.e. changing lights and productivity

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external validity

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can your results apply/be generalized to the entire population -can results apply to the community outside of Davis i.e. sample is only from Davis

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internal validity

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-methods -design of experiment -participants -unbiased you measure what you intend to measure

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correlation coefficent (r)

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ranges from -1 to 1 shows relationship (positive or negative) strength of relationship

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reliability

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the degree to which a procedure or test yields the same results repeatedly under the same circumstances

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validity

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the extent to which a test or procedure actually preforms the function it was designed to perform

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test-retest reliability

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determines whether a measure yields the same results when given to an individual at two different points in time

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internal consistency (reliability)

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various parts of a measure yield similar or consistent results

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interrater reliability

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consistency of responses when different raters administer the measure

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cultural competance in mental health cognitive competence

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diversity related educational courses to build skills

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predictive validity

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the ability of a test or measure to predict or foretell how a person will behave, respond or perform

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criterion-related validity

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determines whether the measure is related to the phenomenon in question.

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construct validity

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involves a series of tasks with one common theme: all are designed to test whether a measure is related to certain phenomena that are empirically or theoretically related to that measure

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content validity

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the degree to which the measure is representative of the phenomenon being measured

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observations (controlled/analogue)

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-stimulate real world experience because you cannot obtain, the real experience, it is impossible to obtain a real world experience -usually done in a lab, under controlled conditions

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naturalistic observations

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observations in the real world

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potential for self-correction (characteristic of clinical research)

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-experiments are reproducible -data free from biases, values, attitudes etc

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hypothesizing relationships (characteristic of clinical research)

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identify and explain the relationship between variables

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Johnson et al. (2002): Correlations

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-assessed the relationship between the number of hours of television viewing and the number of aggressive behaviors over a 17 year period -watched less than an hour a day 5.7% committed a violent act -more than 3 hours/day 25.3% committed a violent act -causality cannot be made w/o conducting an experiment

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field study

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an investigative technique in which behaviors and events are observed and recorded in their natural environment

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single-participant experiment

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an experiment performed on a single individual in which some aspect of the persons behavior is used as a control or baseline for comparison with future behaviors

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multiple baseline study

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a single participant experimental design in which baselines on two or more behaviors or the same behavior in two or more settings are obtained prior to investigation

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Flooding (Treatment of Obsessive Compulsive disorder)

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-prolonged exposure -immerse person with the disorder in the situation they fear

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Body-dismorphic disorder

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involves a preoccupation with a perceived physical defect in a normal appearing person or excessive concern over a slight physical defect that is accompanied by repetitive behaviors such as checking appearance in mirrors, applying make up to mask flaws and comparing appearance to others individuals unwilling to bring attention to their problem compulsive behavior

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Hair-pulling disorder trichotillomania)

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-involves recurrent and compulsive hair pulling that causes significant distress and results in their hair loss

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skin picking disorder

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-repetitive and recurrent picking of the skin and resulant skin lesions -causes significant distress -3/4 of people w/ disorder are females -often comorbid with body dysmorphic disorder or hair pulling disorder

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etiology of Acute and Post-traumatic stress disorders

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-higher magnitude stressors and more severe physical injuries are associated with a greater likelihood of PTSD -Traumatic events -individual characteristics, perceptions of the event sand specific vulnerabilities

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Etiology and Treatment of ASD and PTSD

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• Classical conditioning: lack of extinction due to avoidance, model cannot explain why most people have been traumatized do not develop PTSD, perception of event is very important • Trauma model includes individual characteristics (I.e. cognitive processing abilities, anxiety and depression), nature of the traumatic experience (i.e. life threat, survivor), cognitive processing and interpretation (coping response) and the recovery environment (i.e. social support, immediate stressors, cultural, societal attitudes) that determine if PTSD will occur. o i.e. Cambodians more likely to get PTSD → were more angry about the traumatic event, and had a history of psychological disorders in their family o more than 50% of Cambodians who moved to C that had PTSD had lost an immediate family member in the genocide • individuals with a sensitized autonomic system and specific genetic factors are more likely to develop PTSD • Extinction through flooding (prolonged exposure) procedures-often difficult for patients to comply because need to generate a clear and vivid experience of the traumatic event • Cognitive factors: o Etiology: guilt, self-blame, cognitive set → people are critical of themselves o Treatment: psychoeducation (normalize the experience, show the patient others have had this experience and others have recovered from it), exposure, identify faulty thinking, stress management/muscle relaxation • Usually cognitive therapies and exposure are combined together Biological treatment: some evidence that PTSD is associated with an alteration in the neural and biological systems resulting in a hypersensitivity to stimuli similar to or related to the traumatic event. Tricyclic antidepressants and SSRIs have been effective in treating ASD and PTSD with SSRIs as the current treatment of choice.

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Psychphysiological disorders

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physical illnesses that have a strong psychological component which are distinguished from illnesses that are strictly organic problems o distinct from conversion disorder. Actual tissue damage in psychphysiological disorders o DSM 5 Criteria: a) temporal relationship between psychological factors and onset of or recovery from medical condition , (b) psychological factor interferes with treatment, (c) psychological factors are added health-risk factor for the person, or (d) psychological factors influence physiology and thus precipitate or aggravate the condition.

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characteristics of Psychphysiological disorders

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-actual tissue damage -a disease process (immune system impaired) -physiological dysfunction (i.e. migranes)

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Psychphysiological disorders: Coronary Heart Disease

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the narrowing of the arteries, resulting in the restriction or partial blockage of the flow of blood and oxygen to the heart

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Psychphysiological disorders: hypertension

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a chronic condition characterized by blood pressure of 140 systolic over 90 diastolic or higher

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Psychphysiological disorders: migraine, tension and cluster headaches

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i. migraine: moderate to severe pain resulting from constriction of the cranial arteries followed by dilation of the cerebral blood vessels ii. tension: produced by prolonged contraction of the scalp and neck muscles resulting in vascular constriction and pain iii.cluster: excrutiating, stabbing or burning sensations located in the eye or the cheek

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Psychphysiological disorders: asthma

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chronic inflammatory disease of the airways in the lungs

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Treatment of Psychphysiological disorders

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i. relaxation ii.biofeedback iii. cognitive-behavioral interventions

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Treatment of Psychphysiological disorders : relaxation

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progressive muscle relaxation-tense and relax each muscle group

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Treatment of Psychphysiological disorders biofeedback:

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information (feedback) on internal changes gives a patient a means of altering physiological response o an operant technique-feedback serves as reinforcer o relaxation always involves a keyword o useful fir high blood pressure, tension and migraine headaches, muscle tensions, blood flow control

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Treatment of Psychphysiological disorders: • cognitive behavioral interventions-used in anger and stress management

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o relaxation skills o self-instruction: alter self statements, focus on task rather than on demands and expectations. • used more than stress management • focus on task eliminate distracting thoughts o cognitive restructuring: identify, challenge and modify irrational distorted thinking and replace such cognitions with rational, task-oriented thoughts, use of "shoulds", ego-centric orientation o assertion training

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Etiology of Psychphysiological disorders:

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•biological: chronic activation of sympathetic nervous system, genetic influences •psychological: personality- positive vs. negative affect, hostility, depression •social: environmental stressors vs. strong support networks •socio-cultural: discrimination (actual and perceived), cultural roles

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stress and the immune system: Decreased immunological functioning as a function of stress

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o stress triggers expression of existing pathogen- Cohen and associates (1998) found that 84% became infected with the cold virus but only 40% developed cold symptoms. Those with chronic stress lasting more than 1 month were more likely to develop colds o direct effects: spouses if dementia victims, divorced or bereaving individuals, members of conflicted marriages all show weaker immune systems o indirect effects: stressed person eats poorly, get less sleep. Unhealthy life style may contribute to a weaker immune system o psychological factors that mediate the effects of stress

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mediating the effects of stressors

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-helplessness or control -hardiness -optimism -personality, mood states and cancer

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mediating the effects of stressors :helplessness or control

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belief that no relaionship exists between your behavior and consequences • helplessness increases ephinephrine levels and feelings of tensions and depression • helplessness no control • Laudenslager and associates : control over shock rats rejected cancer cells (65%), more than either yoked control (27%) or no shock control group one group of rats had no control over the shocks 65% of the group who had control over the stressor, the cancer cells rejected the cancer cells and did not develop tumors 27% of these rats with no control rejected the cancer cells

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mediating the effects of stressors : -hardiness

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personality style that tends to be resistant to stress • Maddi (2002): a longitudinal study of employees after massive layoffs, 2/3 developed health problems, the other third thrived and felt happier and were resilant to stress and thrived on the stress • The individuals who dud well had three characteristics: 1. commitment: they were involved in ongoing changes rather than giving up and feeling isolated 2. control: they made attempts to influence decisions and refused to feel powerless 3. challenge: changes were viewed as opportunities **Challenge is really important, the critical feature in hardy personalities, perceive the stressor as a challenge

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mediating the effects of stressors :optimism

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very positive beliefs about the future has been linked to longer survival among AIDS patients (Taylor et al. , 2000) • men had an unrealistic optimistic view of how long they would live • those AIDS patients who accepted the view of their doctors lived 9 months less • sometimes positive illusions can mediate the affects of stress

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factitious disorder imposed on another person

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a pattern of falsification of physical or psychological symptoms in another individual

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