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Lecture 5

BISC 102 Lecture Notes - Lecture 5: Thomas Szasz, Shayne Corson, Deep Brain Stimulation

64 Pages
87 Views
Fall 2012

Department
Biological Sciences
Course Code
BISC 102
Professor
Agnieszka Kopinska
Lecture
5

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1
Chapter 1: Abnormal Behaviour in Historical Context
----------------------------------------------------------------------------------------------------------------------------
What is a Psychological Disorder?
psychological disorder: a psychological dysfunction within an individual that is associated
with distress/impairment + a response that is not typical or culturally expected.
Criteria:
1. Psychological dysfunction
2. Distress/impairment
3. Atypical response/not culturally expected
- No one description has yet been identified that defines the sense of abnormality.
Phobia: a psychological disorder characterized by marked + persistent fear of an object /
situation
Psychological dysfunction: breakdown in cognitive, emotional, or behavioural functioning
- exist on a continuum/dimension rather than categories
- Most psychological disorders are EXTREME EXPRESSIONS of normal emotions,
behaviors, and cognitive processes.
Personal distress: individual is extremely upset
Atypical/not culturally expected: occurs infrequently/ // violating social norms
example: Saplonsky's study on Masai tribe in East Africa
- Deviating from the average = doesn’t work well as a definition of abnormal behavior
- Women acting aggressively, hearing voices "not at the right time"
- Wakefield = HARMFUL DYSFUNCTION = a psychological disorders caused by a failure of
one of more mechanisms to perform their evolved function and the dysfunction produces
harm or distress
official definition: behavioural, psychological, or biological dysfunctions that are unexpected
in their cultural context and associated with present distress and impairment in functioning, or
increased risk of suffering, death, pain, or impairment.
- Abnormal behavior (psychological dysfunction): it is a psychological dysfunction within a
individual associated with distress or impairment in functioning and a response that is not
typical or culturally expected
- Some scholars have argued that the health professions will never be able to satisfactorily
define disease or disorder
2
Prototype: typical profile
- Patient may have only some features/symptoms of the disorder (a min. number) and still
meet criteria for the disorder because the symptoms are close to the prototype
- the best thing to do: consider how the apparent disease or disorder matches a "typical"
profile of a disorder (depression/skitzo) when st or all symptoms that experts age are part of
the disorder are present
Thomas Szasz + George Albee (1960s)
- Highly critical of medical diagnoses being used in the case of psychological disorders
- "mental illness = myth" the practice of labelling mental illnesses should be abolished
- argued that a fundamental difference exists between the use of diagnoses for physical
diseases (objective criteria: blood tests) and their use in mental illnesses (subjective
judgements)
The Science of Psychopathology
psychopathology: the scientific study of psychological disorders.
- includes specially trained professionals: clinical + counselling psychologists, psychiatrists,
psychiatric social workers, psychiatric nurses, marriage + fam. therapists, mental health
counsellors
Clinical Psychologists: Ph.D after a course of graduate level study (5 yrs) // Psy.D (more
emphasis on clinical practice - less on research training) (not in Canada - in development in
Quebec)
- conduct research into causes + treatment of psychological disorders
- diagnose, assess, treat the disorders
Canada:
- regulation of the psychology profession is under the jurisdiction of the provinces/territories
- depending on jurisdiction: psychologist can have doctoral or masters
Ontario:
only those who are licensed or registered with their provincial board or college are permitted
to call themselves "psychologists" (psychotherapist + therapist are not regulated)
Psychologists with experimental or social training:
concentrated on investigating the basic determinants of behaviour but do not assess or treat
psychological disorders
counselling psychologists (Ph.D, Psy.D, Ed.D): tend to study+ treat adjustment + vocational
issues encountered by healthy individuals
3
Psychiatrists (M.D. + specialize in psychiatry during 3-4 year residency training program)
- investigate nature + causes of psychological disorder, often from biological point of view,
make diagnoses, offer treatments
- many emphasize drugs/other biological treatments + use psychosocial treatments
Psychiatric Social Workers (Masters in Social Work)
- develop expertise in collecting information relevant to the social and fam situation of the
individual with a psychological disorder
- treat disorders: concentrating on fam. problems associated with them
Psychiatric Nurses (Masters/Ph.D)
- specialize in care + treatment of patients with psychological disorders
- usually in hospitals as part of treatment team
Marriage + Family Therapists / Mental Health Counsellors
- Masters (1-2 year)
- provide clinical services in hospitals/clinic (under supervision of a doctoral-level clinician)
1. The Scientist-Practitioner
most important recent development in psych: adoption of scientific methods to learn more
about the nature of psychological disorders, their causes, and their treatment
scientist-practitioners: mental health professionals that take a scientific approach to their
clinical work
1. may keep up with the latest scientific developments in their field + use most current
diagnostic + treatment procedures
2. evaluate their own assessments/treatment procedures to see whether they work
(accountable to patients, government agencies, insurance companies that pay for treatments)
3. conduct research (in clinics/hospitals) that produces new info about disorders/treatment
2. Clinical Description
presenting problem: (presents) indication of why the person came to the clinic
clinical description: represents the unique combination of behaviours, thoughts, feelings that
make up a specific disorder
- what makes the disorder different from normal behaviour or from other disorders?
clinical: 1. the types of problems or disorders you would find in a clinic/hospital 2. the activities
connected with assessment + treatment

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Description
1 Chapter 1: Abnormal Behaviour in Historical Context ---------------------------------------------------------------------------------------------------------------------------- What is a Psychological Disorder? psychological disorder: a psychological dysfunction within an individual that is associated with distress/impairment + a response that is not typical or culturally expected. Criteria: 1. Psychological dysfunction 2. Distress/impairment 3. Atypical response/not culturally expected - No one description has yet been identified that defines the sense of abnormality. Phobia: a psychological disorder characterized by marked + persistent fear of an object / situation Psychological dysfunction: breakdown in cognitive, emotional, or behavioural functioning - exist on a continuum/dimension rather than categories - Most psychological disorders are EXTREME EXPRESSIONS of normal emotions, behaviors, and cognitive processes. Personal distress: individual is extremely upset Atypical/not culturally expected: occurs infrequently/ // violating social norms example: Saplonsky's study on Masai tribe in East Africa - Deviating from the average = doesn’t work well as a definition of abnormal behavior - Women acting aggressively, hearing voices "not at the right time" - Wakefield = HARMFUL DYSFUNCTION = a psychological disorders caused by a failure of one of more mechanisms to perform their evolved function and the dysfunction produces harm or distress official definition: behavioural, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment. - Abnormal behavior (psychological dysfunction): it is a psychological dysfunction within a individual associated with distress or impairment in functioning and a response that is not typical or culturally expected - Some scholars have argued that the health professions will never be able to satisfactorily define disease or disorder 2 Prototype: typical profile - Patient may have only some features/symptoms of the disorder (a min. number) and still meet criteria for the disorder because the symptoms are close to the prototype - the best thing to do: consider how the apparent disease or disorder matches a "typical" profile of a disorder (depression/skitzo) when st or all symptoms that experts age are part of the disorder are present Thomas Szasz + George Albee (1960s) - Highly critical of medical diagnoses being used in the case of psychological disorders - "mental illness = myth" the practice of labelling mental illnesses should be abolished - argued that a fundamental difference exists between the use of diagnoses for physical diseases (objective criteria: blood tests) and their use in mental illnesses (subjective judgements) The Science of Psychopathology psychopathology: the scientific study of psychological disorders. - includes specially trained professionals: clinical + counselling psychologists, psychiatrists, psychiatric social workers, psychiatric nurses, marriage + fam. therapists, mental health counsellors Clinical Psychologists: Ph.D after a course of graduate level study (5 yrs) // Psy.D (more emphasis on clinical practice - less on research training) (not in Canada - in development in Quebec) - conduct research into causes + treatment of psychological disorders - diagnose, assess, treat the disorders Canada: - regulation of the psychology profession is under the jurisdiction of the provinces/territories - depending on jurisdiction: psychologist can have doctoral or masters Ontario: only those who are licensed or registered with their provincial board or college are permitted to call themselves "psychologists" (psychotherapist + therapist are not regulated) Psychologists with experimental or social training: concentrated on investigating the basic determinants of behaviour but do not assess or treat psychological disorders counselling psychologists (Ph.D, Psy.D, Ed.D): tend to study+ treat adjustment + vocational issues encountered by healthy individuals 3 Psychiatrists (M.D. + specialize in psychiatry during 3-4 year residency training program) - investigate nature + causes of psychological disorder, often from biological point of view, make diagnoses, offer treatments - many emphasize drugs/other biological treatments + use psychosocial treatments Psychiatric Social Workers (Masters in Social Work) - develop expertise in collecting information relevant to the social and fam situation of the individual with a psychological disorder - treat disorders: concentrating on fam. problems associated with them Psychiatric Nurses (Masters/Ph.D) - specialize in care + treatment of patients with psychological disorders - usually in hospitals as part of treatment team Marriage + Family Therapists / Mental Health Counsellors - Masters (1-2 year) - provide clinical services in hospitals/clinic (under supervision of a doctoral-level clinician) 1. The Scientist-Practitioner most important recent development in psych: adoption of scientific methods to learn more about the nature of psychological disorders, their causes, and their treatment scientist-practitioners: mental health professionals that take a scientific approach to their clinical work 1. may keep up with the latest scientific developments in their field + use most current diagnostic + treatment procedures 2. evaluate their own assessments/treatment procedures to see whether they work (accountable to patients, government agencies, insurance companies that pay for treatments) 3. conduct research (in clinics/hospitals) that produces new info about disorders/treatment 2. Clinical Description presenting problem: (presents) indication of why the person came to the clinic clinical description: represents the unique combination of behaviours, thoughts, feelings that make up a specific disorder - what makes the disorder different from normal behaviour or from other disorders? clinical: 1. the types of problems or disorders you would find in a clinic/hospital 2. the activities connected with assessment + treatment 4 2. a) What' s Included in the Clinical Description? prevalence: the number of people in the population (as a whole) that have the disorder incidence: how many new cases occur during a given period (ie: year) sex ratio: percentage of males and females that have the disorder age of onset course: individual pattern the disorder follow chronic course (skitzo): tend to last a long time, sometimes a lifetime episodic course (mood disorders): reoccurring throughout lifespan time-limited course: will improve without treatment in a relatively short period acute onset: begin suddenly insidious onset: develop gradually over an extended time prognosis: the anticipated course of a disorder "the prognosis is good" "the prognosis is guarded" persons age 3. Causation, Treatment, Outcomes Etiology: the study of origins - why a disorder begins (what causes it) - includes biological, psychological, social dimensions - effect doesn't necessarily imply cause ex: aspirin may relieve headaches, but that doesn't mean headache was caused by lack of asprin - treatment may provide hints to nature of disorder - multidimensional perspective: current treatment does not focus on one theoretical approach: integrates most current + effective drugs or psychosocial treatments The Past: Historical Conceptions of Abnormal Behaviour 1. The Supernatural Tradition a) Demons + Witches (last quarter of the 14th century - through 15th - 1692 Salem Witch Trials) 5 - religious + lay authorities - catholic church split - Roman Church fought French Church - individuals possessed by evil spirits were responsible for any misfortunate experienced by the townspeople, which inspired action again the possessed treatments: - exorcism: various religious rituals were performed to rid the victim of evil spirits - shaving pattern of cross in victims hair + securing them on a wall near the front of a church b) Stress + Melancholy (roughly same time period as above) view: insanity = natural phenomenon cause by mental / emotional stress, + its curable mental depression + anxiety = illnesses - although church identified symptoms like despair + lethargy with the sin of acedia/sloth common treatments: rest, sleep, healthy + happy envr. other treatments: baths, ointments, potions - people with mental illnesses were moved from house to house in medieval villages Nicholas Oresme: depression = source of bizarre behaviour rather than demons * during 14th + 15th centuries some assumed that demonic influences were the reasons behind abnormal behaviour, while other the opposite * (p.10 - The Mad King) c) Treatments for Possession - in Middle Ages: if exorcism failed = individuals were subjected to confinement, beatings, tortured - some therapist decided that hanging people over a pit full of poisonous snakes might scare the evil spirits out of their bodies (this sometimes worked) - snake pits were therefore, built in many institutions - many other treatments based on the shock-method were developed (ie: dunkings in ice cold water) d) The Moon + the Stars (Paracelsus) - rejected notions of possession by the devil, suggested movements of stars and moons had profound effects on people's psychological functioning luna - lunatic - no serious evidence found to confirm this, however lots of horoscopes follow this belief e) Comments 6 - supernatural tradition still exists (some cultures outside North America + small religious sects in N.A) now: Roman Catholic Church requires that all health care resources be used before spiritual solutions such as exorcism can be considered 2. The Biological Tradition a) Hippocrates + Galen Hippocrates: father of modern medicine (Hippocratic Corpus) 450 BCE-350 BCE - suggested psychological disorders could be treated like any other disease - believed they might also be caused by brain pathology or head trauma and could be influenced by genetics - considered the brain to be sear of wisdom, consciousness, intelligence, emotion (therefore, disorders involving these functions would be located in the brain) - coined "hysteria": concept he learned from the Egyptians who had identified what we now call Somatoform disorders Somatoform Disorders: physical symptoms appear to be the result of an organic pathology for which no organic cause can be found (ie: paralysis, some kinds of blindness) - occurred primarily in women (egyptians assumed they were restricted to women) assumed cause: wandering uterus in body in search of conception prescribed cure: marriage / fumigation of vagina to lure the uterus back to its regular location - recognized the importance of psychological + interpersonal contributions to psychopathology (ie: sometimes negative effects of family stress) -- on some occasions removed patients from families Galen: adopted ideas of Hippocrates + developed them further = powerful + influential school of thought within the biological tradition that extended into the 19th century humoral theory (of disorders) - first example of associating psychological disorders with chemical imbalance - assumed that normal brain functioning was related to 4 bodily fluids (humors) - blood (heart) - black bile (spleen) (too much = depression/melancholia) - yellow bile (liver) -phlegm (brain) - disease = too much or too little of humors - 4 humors: Greeks 4 basic qualities (heat, dryness, moisture, cold) - applied to personality: sanguine (red/blood) - ruddy, cheerful/optimistic, insomnia, delirium melancholic: depressive 7 phlegmatic: apathy/sluggishness/calm under stress choleric: hot tempered - excess of humors: treated by regulating environment (increase/decrease in heat, dryness, etc) development of 2 new additional treatments: 1. bleeding/bloodletting: carefully measure amount of blood was removed from the body, often with leeches 2. induced vomiting: eating tobacco + half boiled cabbage b) The 19th Century - discovery of nature + cause of syphilis - support from American psychiatrist John P. Grey Syphilis - believing that everyone is plotting against you (delusion of persecution) - believing that you are God (delusion of grandeur) - bizarre behaviours - different from psychosis - (1825) general paresis: b/c had consistent symptoms (presentation) and a consistent course that resulted in death) - link between syphilis + general paresis only discovered later on - Pasteur: germ theory of disease: identified specific bacterial micro-organism that cause syphilis - Pasteur: stated that all symptoms of a disease were caused by a germ (bacterium) that invaded the body - cure for general paresis: malaria, because high fever burned out the syphilis bacteria // penicilin - malaria cure lead many to believe that "madness" could be traced directly to a curable infection + that comparable causes + cures might be discovered for all psychological disorders John P. Grey - superintendent at a hospital in NY - editor of American Journal of Insanity -- Psychiatry - American Psychiatric Association - believed that insanity always has physical causes; mentally ill patients should be treated as physically ill - emphasis on rest, diet, proper room temperature and ventilation - invented rotary fan in order to ventilate his large hospital 8 - under his leadership conditions in hospitals improved + became more humane + livable - became too large and impersonal, individuals didn’t receive required attention deinstitutionalization: patients released into communities (100 yrs later) - large increase in # of patients with chronic disabilities left homeless on the streets c) The Development of Biological Treatments 1930s electric shock + brain surgery - insulin (originally given to stimulate appetite, also seemed to calm patients down) (1927) Manfred Sakel: began using higher and higher dosages until patients convulsed + became temporarily comatose = recovery n mental health = attributed to convulsion (INSULIN SHOCK THERAPY) - abandoned b/c too dangerous - other methods of shock had to be found (1920s) Joseph von Meduna :observed skitzo rarely found in epileptics (not actually true) - concluded that inducing brain seizures would help skitzo d) Consequences of the Biological Tradition (19th century) John P. Grey + co. - eliminated interest in treating patients with mental illnesses because they thought mental disorders were due to some as yet undiscovered brain pathology and therefore incurable - in place of treatment, focus was on diagnosis, legal questions concerning the responsibility of patients + their actions during periods of insanity + study of brain pathology Emil Kraeplin (1856-1926) - dominant figure during this period - father of modern psychiatry - advocated major ideas of biological traditions - believed that disorders were due to brain pathology - contributed to diagnosis + classification of disorders - among the first to distinguish among various psych. disorders; seeing that each may have a diff. age of onset + course, with somewhat diff. clusters of presenting symptoms + prob. diff. cause - many of skitzo descriptions are still useful today overview of 19th century: - scientific bio approach to psych - search for biological causes - treatment based on humane principles - many drawbacks: active intervention + treatment were mostly eliminated 9 The Psychological Tradition Plato: (and later Aristotle) causes for maladaptive behaviour = social + cultural influences in a person's life and the learning that took place in that envr. (precursor to modern psychosocial approached) - wrote about the importance of dreams, fantasies and cognitions - advanced humane and responsible care for people with psychological disturbances psychosocial approaches: focus on psychological, as well as social and cultural factors. 1. Moral Therapy (1st half of 18th century) moral: emotional/psychological, rather than a code of conduct basics: treating institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction - emphasis on positive consequences for appropriate interactions + behaviour (staff modelled this behaviour) - lectures on various interesting subjects were provided - restraint + seclusion = eliminated (official origin: Philippe Pinel) Pinel and former patient Pussin who worked at hospital: socially faciliative atmosphere William Turke: founder of North American Psychiatry - introduced Moral Therapy to the New World early asylums (16th century): more like prisons than hospitals - mainly housed beggars + variety of people w. mental illnesses - horrible conditions - few treatment regimens - changed with rise of moral therapy 2. Asylum Reform + the Decline of Moral Therapy after mid-19th century - humane treatment declined because: - moral therapy worked best when # of patients was max 200 ppl - patient load increased to 1000-2000 + reasons: immigration + Dorothea Dix Dorothea Dix - mental hygiene movement - campaigned for reform in the treatment of insane in Canada) - involved in the constriction of the St. John Newfoundland asylum - appealed to Nova Scotia legislature (Where she described the conditions in asylums) 10 - worked to make sure everyone who needed care received it (including the homeless) - consequence = increase in number of hospital patients Clarence Hicks - followed Dix's example - important reformer - toured mental institutions throughout Manitoba - documented continued appalling conditions in institutions - found that often those that worked in mental institutions has no special psychiatric training - women in closer, people locked in coffins, mentally defective children rolled in long strips of cotton at night - placed on shelves to sleep - advocated that mental illness is treatable // at the time: belief that mental illness was incurable psychological analysis: Freud's theory of the structure of the mind + the role of the unconscious processes in determining behaviour behaviourism: (Watson, Pavlov, Skinner): focuses on how learning + adaptation affect the development of psychopathology 3. Psychoanalytic Theory Anton Mesmer - suggested to his patients that their problem was due to an undetectable fluid found in all living organisms called "animal magnetism" that could become blocked - had his patients sit in a dark room around a large vat of chemicals with rods extending from it and touching the patients, dressed in flowing robes he might then identify and tap various areas of their bodies where their animal magnetism was blocked while suggesting strongly that they were being cured|- was strongly opposed by the medical establishment -father of hypnosis: a state in which suggestible subjects sometimes appear to be in a trance Benjamin Franklin - put animal magnetism to the test by conducting an experiment in which patients received either magnetized or non magnetized water with strong suggestions that they would get better (double blind experiment) - both groups got better - concluded: animal magnetism/mesmerism was nothing more than strong suggestion Charcot: - demonstrated that some of the technique of mesmerism were effective with several psychological disorders - did a lot to legitimize the practice of hypnosis - Freud came to study with him 11 Freud + Breuer - asked patients to describe their problems, conflicts, fears in precise detail - 2 phenomena observed: patients became extremely emotional as they talked + felt relieved after emerging from hypnotic state + patients gained an understanding of the relationship b.w. their emotional problems and their psychological disorder - difficult/impossible for patients to recall the details they described under hypnosis - discovered the unconscious mind (one of the most important developments in psychology - 2nd discovery: recalling + re-living emotional trauma that has been made conscious + releasing accompanying tension = therapeutic AKA catharsis insight: fuller understanding of the relationship b.w current emotions and earlier events = insight - stories based on systematic case observations - Anna O: hysteria (blurred vision and difficulty moving arm + legs after father's death) - treated one behaviour at a time to remove complete disorder - Freud took these basic observations and expanded them into the psychoanalytic model psychoanalytic model: most comprehensive theory yet - constructed on the development + structure of personality, also outlined where this development could go wrong and produce psychological disorders 3 major facets: structure of the mind (distinct functions of personality that sometimes clash with one another defence mechanisms (with which the mind defends itself from these clashes and conflicts) stages of early psychosexual dev. (provide grist for the mill of our inner conflicts) 3. a) The Structure of the Mind The Id - source of our strong sexual + aggressive energies or our instinctual drives / the "animal" within us - libido: positive energy/drive ( life, dominance, fulfillment) - thanatos: death instinct (death, destruction) - operates on the pleasure principle // maximizing pleasure - eliminating associated tension + conflicts - primarily prominent in childhood; conflicts with social rules + regulations - primary process; emotional, irrational, illogical, led with fantasies, preoccupied with sex, aggression, selfishness, envy The Ego - ensures we act realistically - operates in occurrence with reality principle - secondary process: logic + reason 12 The Superego - the conscious - moral principle - instilled by parents/culture - mediates conflict between the ego + superego - successful mediation = ability to go on to higher intellectual + creative pursuits of life - unsuccessful mediation = id or superego become too strong = conflict overtakes, psychological problems develop intrapsychic conflicts: conflicts within the mind that occur as a result of unsuccessful mediation of id and superego * Id + Superego = entirely unconscious * Humans are only fully aware of the secondary processes of the ego 3. b) Defence Mechanisms * Conceptualized by Freud, developed further by his daughter Anna* - anxiety as a result of id and superego conflicts alerts ego to marshal defence mechanisms defence mechanisms: unconscious protective processes that keep primitive emotions associated with conflicts in check so the ego can continue its coordinating function. - can be both adaptive + maladaptive - have been subjected to scientific study: may be of potential importance in the study of psychopathology + health - different psychological disorders are associated with different DefMechs - healthy defence mechanisms: humour, sublimation - related to psychological health - coping styles Examples: (p.20) Denial: Refuses to acknowledge some aspect of objective reality or subjective experience that is apparent to others Displacement: Transfers a feeling about, or a response to, an object that causes discomfort onto another object or person Projection: Falsely attributes own unacceptable feelings, impulses, or thoughts to another object or individual Rationalization: Conceals the true motivations for actions, thoughts, or feelings through elaborate reassuring or self serving explanations Reaction Formation: Substitutes behaviour, thoughts, or feelings that are the direct opposite of unacceptable ones Repression: Blocks disturbing wishes, thoughts, or experiences from conscious awareness 13 Sublimation: Directs potentially maladaptive feelings or impulses into socially acceptable behaviour 3. c) Psychosexual Stages of Development - infancy + early childhood - have a profound + lasting impact - provide the first developmental perspective on abnormal behaviour - stages represent distinctive patterns of gratifying basic needs + satisfying drive for physical pleasure - fixation on a stage: individuals personality would reflect the stage in their adult life oral (0-2 yrs): need for food - act of sucking (source of pleasure: lips, tongue, mouth) fixation: excessive thumb sucking, emphasis on oral stimulation through eating, chewing pencils, biting fingernails personality: dependence + passivity or rebelliousness + cynicism anal phallic (controversial/frequently mentioned): Oedipus complex, genital-stimulation accompanied by images of sexual interactions with mother, fear that father may punish lust by removing penis, if resolves this issue: will channel sexual energy into heterosexual relationships + have harmless affection for other (girls = electra complex) - girl wanted to replace mother and posses father, penis envy, having baby = replacement of penis - this resolution is only partial, therefore less developed super ego - males are more developed psychologically than females latency genital fixation: a specific psychosexual stage left a strong impression // if person did not receive appropriate gratification during a specific stage - nonpsychotic disorders resulted from underlying unconscious conflicts, the resulting anxiety + implementation of ego defence mechanisms = NEUROSES/NEUROTIC DISORDERS (disorders of the nervous system) 3. d) Later Developments in Psychoanalytic Thought Anna Freud ego psychology/self psychology: the way in which defensive reactions of the ego determine our behaviour - the individual slowly accumulates adaptational capacities, skill in reality testing, defences 14 - abnormal behaviour = develops when the ego is deficient in regulating such functions as delaying + controlling impulses, or in marshalling appropriate normal defences to strong internal conflicts Klein + Kernberg - work on borderline personality disorders: some behaviour borders on being out of touch with reality (psychotic) object relations: study of how children incorporate images, memories, values of an important person to whom they are emotionally attached object relations theory: you tend to see the world through the eyes of the person incorporated into your self. (focuses on how these images come together to make up persons identity + the conflicts that may emerge) object: said important people introjection: the process of incorporation - introjected objects can become an integrated part of the ego/may assume conflicting roles in determining identity/self. Carl Jung + Alfred Adler -believed that the basic quality of human nature = positive - people have a strong drive toward self-actualization - by removing barriers to internal + external growth ; individual would naturally improve + flourish Karen Horney. Erich Fromm, Erik Erikson - development over the lifespan - influence of culture + society on personality Horney: feminine psychology off of Freud's ideas, recognized social factors Erikson: theory of development across lifespan: description of crises/conflicts that accompany 8 psychosocial stages 3. e) Psychoanalytic Psychotherapy - designed to reveal the nature of unconscious mental processes + conflicts through catharsis + insight free association (Freud): patients are instructed to say whatever comes to mind without the usual socially mandated censoring. intended to reveal emotionally charged material that may be repressed because it is too painful/threatening to bring into consciousness. - patients lay on couch, Freud sat behind (so they wouldn't be distracted) dream analysis: the content of dreams ( reflecting the primary process thinking of the id) is related to symbolic aspects of unconscious conflicts 15 - therapist interprets patients thoughts + feelings from free association + content of dreams + relates them to unconscious contents - patient may resist efforts of therapist/may deny interpretations goal of stage: to help patient gain insight into nature of their conflicts psychoanalyst: therapist - the patient- therapist relationship: therapist may discover the nature of patients intrapsychic conflict = transference transference: patients come to relate to the therapist as they did toward important figures in their childhood (esp parents) // often patient falls in love w. therapist - reflection of strong positive feelings that existed earlier towards parent (COUNTERTRANSFERENCE) - therapist may projects own emotions/feelings onto patient - often positive -therapist trained to deal with personal feelings + patients feelings - against ethical code for patient-therapist relations outside of practice 4~5 times a week (2-5 years) - analyze unconscious conflicts, resolve them, restructure the personality to put the ego back in charge mean length of treatment of patients going through psychoanalysis 4.8 yrs - Canada 5.7 yrs - USA 6.6 yrs - Australia reduction of symptoms = of little use unless underlying conflict is death because another set of symptoms can emerge in place (SYMPTOM SUBSTITUTION) - psychoanalysis: uncommon today (expensive, effectiveness is in question) - today: psychodynamic psychotherapy: conflicts + unconscious process still emphasized, efforts are made to identify trauma + active defence mechanisms, use of mixture of tactics within a social + interpersonal focus 7 tactics of psychodynamic psychotherapy 1. focus on affect + patients emotions 2. exploration of patients attempts to avoid topics/engage in activities that hinder the progress of therapy 3. identification of patterns in actions, thoughts, feelings, experiences, relationships 4. emphasis on past experiences 5. focus on patients' interpersonal experiences 6. emphasis on therapeutic relationship 7. exploration of wishes, dreams, fantasies 16 additional features of psychodynamic therapy 1. significantly briefer than classical psychoanalysis (still used in large cities) 2. psychodynamic therapists de-emphasize the goal of personality reconstruction most effective forms: depression treatment + IPT (interpersonal therapy) 3. f) Comments - pure psychoanalysis : historical rather than current interest - classical psychoanalysis : diminishing - neurosis : dropped from DSM - psychoanalysis major criticism: unscientific, events filtered through observer, can differ from one analyst to the next, no careful measurement of psychological phenomena, no way to prove/disprove hypothesis - have been valuable to study of psychopathology + history of ideas in Western civilization - studies support notion of unconscious mental processes - therapeutic alliance: patient-therapist relationship (important area of study) - before Freud source of good + evil + urges = external + spiritual (demons) 4. Humanistic Theory - mid 20th century (adopted by personality theorists) - positive/optimist side of human nature - every individual = good + whole - setting goals, looking towards the future, realizing our fullest potential (Jung) - contribution to others + society = realizing our fullest potential (Alder) self-actualizing: all of us can reach our highest potential, in all areas of functioning, if only we have the freedom to frow. conditions that block actualization: most originate outside of the individual - difficult living conditions, stressful life, interpersonal experiences Abraham Maslow - most systematic in describing structure of personality - hierarchy of needs basic needs (food + sex) ---(social needs; friendship)-- self-actualization (love, self-esteem) - we cannot progress up the hierarchy until we have satisfied needs at the lower levels Carl Rogers - most influential (point of view of therapy) client/person-centered therapy: therapist takes a passive role, making as few interpretations as possible. the point is to give the individual a chance to develop during the course of therapy, unfretted by threats to the self. 17 unconditional regard: the complete + unqualified acceptance of most of the client's feelings + actions empathy: sympathetic understanding of the individual's particular view of the world - result: clients will be more straightforward + honest with self + will access their innate tendencies toward growth - human movements in 60's + 70s - result of humanistic theorizing - relationships esp. therapeutic = most positive influence on human growth - people are more different than alike; individual experiences are unique Carl Rogers - psychotherapy process research Fredrick Fritz Perls - Gestalt Therapy: focus on peoples positive + creative potential - helps clients develop an awareness of desires + needs, and to understand how they might be blocking themselves from reaching their potential - no reference to past experiences // focus on the present - trained to use specific techniques: I-language + use of metaphor I-language: therapist encourages the client to refer to "I" rather than to "it" to take more responsibility for emotional and behaviour use of metaphor: therapist uses stories /scenarios to make problem more clearer to client today: greatest application with psychological disorders + psychopathology (mood/anxiety disorders) 5. Behavioural Model (beginning of 20th century) - systematic development of a more scientific approach to psychological aspects of psychopathology "cognitive-behavioural" / "social-learning" - today 5. a) Pavlov + Classical Conditioning - at the time: common in the biology but not psychology - dog salvation classical conditioning: type of learning in which neutral stimulus is paid with a response until it elicits that response - one way we acquire new information, particularly emotional in nature generalization: the strength of the response to similar objects or people is usually a function of how similar these objects or people are 18 - process begins with a stimulus that elicits a response in almost anyone + requires no learning: no conditions must be present for the response to occur. UCS: unconditioned stimulus UCR: natural or unlearned response to the UCR - UCR CS: a previously neutral stimulus that becomes a trigger for a CR after becoming associated with the UCS CR: an acquired response that is is elicited by the conditional stimulus extinction introspection (Edward Titchner) - subjects reported on their inner thoughts + feelings after experiencing certain stimuli (inconsistent results) 5. b) Watson + Rise of Behaviourism - John B Watson: founder of behaviourism (influenced by Pavlov) - psychology could be made as scientific as physiology "psychology is a purely objective experimental branch of natural science. its theoretical goal is the prediction and control of behaviour. introspection forms no essential part of its methods, - thinking = subvocal talking, one need only measure movements around the larynx to study this process - little Albert + ran + noise experiment Mary Jones Cover (Student) - if fear could be learned + conditioned, then it can also be unlearned + extinguished - Peter who was afraid of rabbits, saw other kids playing etc 5. c) The Beginnings of Behavioural Therapy Joseph Wolpe - developed variety of behavioural procedures for treating his patients, many of whom had phobias systematic desensitization: individuals were gradually introduced to the objects/situations they feared so their fear could extinguish. had patients do something that was incompatible with fear while they were in the presence of the dreaded object or situation. had patients imagine the phobic scene, the response he chose was relaxation - successful in systematic desensitization application = behaviour therapy 5. c) BF Skinner + Operant Conditioning - behaviour changes as a function of what follows the behaviour. - wrote fiction novels "Walden Two" - influenced by Watson " science of human behaviour must be based on observable events and relationships among these events" 19 - influenced by Thorndike (law of effect: behaviour is either strengthened or weakened depending on the consequences of that behaviour) - operant conditioning: behaviour OPERATES on the environment and changes it in some way - reinforcement, instead of reward - using punishment as a consequence = not effective in the long run - primary way to develop new behaviour is to positively reinforce desired behaviour - did not deny influence of biology or the existence of subjective states of emotion/cognition; explained these phenomena as relatively insequential side effects of a particular history of reinforcement - subjects of research: animals - rats/pigeons - taught pigeon to play ping pong shaping: a process of reinforcing successive approximations to a final behaviour or set of behaviours. 5. d) Comments - fails to account for development of psychopathology across the lifespan - doesn't consider biological effects - learning can occur indirectly or through observation The Present: The Scientific Method + an Integrative Approach 1990s: 1. increasing sophistication of scientific tools + methodology 2. realization that no on influence/theory ever occurs in isolation behaviour: product of the continual interaction of psychological, biological, social influences Adolf Meyer - emphasized the equal contributions of bio, psych, socio cultural determinism 2000s: - cognitive science + neuroscience - behavioural findings: importance of early experience in determining later development Chapter 2: An Integrative Approach to Psychopathology Multidimensional Integrative Approach Approach to the study of psychopathology that holds that psychological disorders are always the products of multiple interacting causal factors. (1) Biological dimension: causal factors from genetics + neuroscience (2) Psychological dimension: causal factors from behal + cognitive processes (ie: learned helplessness, social learning, prepared learning, unconscious processes) 20 (3) Emotional dimension (4)Social/ interpersonal dimension (5)Developmental dimension: changes over the lifespan (react diffly @ diff ages) * No influence operates in isolation. Each dimension is strongly influenced by the others + by development = WEAVE TOGETHER in various complex ways to CREATE a psychological disorder. * In Jody’s Case: Jody has a blood-injury injection phobia - he saw graphic scenes of blood-injury + had a bad reaction 1. behal Influences: watching the movie + fainting – classical conditioning + stimulus generalization 2. Biological Influences - Vasovagal syncope – low heart rate + low blood pressure in head (reduced by applied muscle tension) - Inherited tendency to overcompensate on increase in blood pressure 3. Emotional Influences: Rapid increase in heartbeat caused by emotions – triggered baroreflex = increases or decreases blood pressure in an effort to maintain a stable blood pressure in - emotions changed the way he thought about situations involving blood + injury, influencing his beh 4. Social Influences: Rejection by authority figures can make disorders worse. - Support only when symptoms are being experienced – increases frequency + intensity of reaction 5. Developmental influences: - Developmental critical period = when we are more or less reactive to a given situation or influence than at other times - Jody’s case may be it was his physiological changes as a teen + the film that provided just the right combination to this phobic experience Overall Jody best responded very well to brief but intensive treatment- fainting prevented by using muscle tension Genetic Contributions to Psychopathology Gene = Long DNA (deoxyribonucleic acid) molecules, the basic physical units of heredity that appear as various locations on chromosomes, w.in the cell nucleus. o DO NOT determine physical development in an absolute way, but provide boundaries to our development The Nature of Genes - 46 chromosomes arranged in 23 pairs (the first 22 pairs provide programs for the development of the body + brain + the last called the sex chromosome determines the sex) 21 - In each pair, one chromosome comes from ur father the other from ur mother - XX = female, XY = male (X chromosome are approximately 155 million base pairs) - a double helix is two spirals intertwined, turning in opposite directions - simple pairs of molecules are bound together - the ordering of these base pairs determines how the body develops + works - wrong ordering of these molecules can lead to a defective gene, leading to problems Genome = individuals complete set of genes 20,000 – 25,000 Dominant Gene – one of a pair of genes that determines a particular trait Recessive Gene – must be paired w. another recessive gene Mendelian laws of genetics - is used to predict how many offspring will develop a certain trait, characteristic, or disorder, depending on if one or both parents carry the gene. Polygenic = traits that are influenced by many genes that each contribute only a tiny effect all of which in turn may be influenced by the environment such as beh, personality + IQ Quantitative genetics = how genes affect individual differences (heritability) but does not tell us which gene causes the difference Molecular genetics = focus on the actual structure + the functioning of the genes through technologies such as DNA microarrays → these studies have shown that hundreds of genes can contribute to the heritability of a single trait DNA microarrays: analyze thous+s of genes @ once + identify broad networks of genes that may be contributing to a particular trait - researcher are trying to identify specific genes that contribute to individual diffs in temperament/traits (ie: shyness/impulsivity) - current findings: Serotonin transporter gene → involved in attention deficit + hyperactivity in children - genes influences body/beh through series of steps that produce proteins - all cells contain our entire genetic structure EXCEPT FOR RED BLOOD CELLS - only a small portion of genes in any one cell are “turned on”/expressed → cells become specialized - social + cultural influences / environmental factors can determine whether genes are turned on New Developments in the Study of Genes + beh - About half of individual differences in personality traits + cognitive abilities are attributed to genetic influence - During adulthood genetic factors determine stability in cognitive abilities, whereas environmental factors determine change 22 - psych disorders: genetic factors account for less than half of the variability ie: if one identical twin has schitzo, there is less than 50% likelihood the other twin will also - Adverse life event such as a “chaotic” childhood can overwhelm the influence of genes - behal geneticists have reached general conclusions on the role of genes + psychological disorders: 1. Specific genes or small groups of genes may be associated w. certain psychological disorders- BUT each gene has a small effect + all contribute together to cause a disorder 2. Genetic contributions cannot be studied w.out looking at the environmental interactions that trigger genetic vulnerability or ”turn on” specific genes The Interaction of Genetic + Environmental Effects - Eric Kandel- a distinguished neuroscientist + Nobel Prize winner suggested that the genetic structure of cells may actually change as a result of learning ( the environment can cause genes to become active/ turn on). - there is an idea that the brain + its functions are plastic, subject to continual change in response to the environment. - Two models of gene-environment interaction as they relate to psychopathology are: the diathesis-stress model + reciprocal gene-environment model (or gene-environment correlations). 1. The Diathesis-Stress Model- individuals inherit, from multiple genes, tendencies to express certain traits or behs, which can then be activated in stressful conditions. - diathesis- is an inherited tendency, which is a condition that makes a person susceptible to developing a disorder. - The tendency is the diathesis, or vulnerability- the greater the vulnerability the less life stress is required. - the diathesis is genetically based + the stress is environmental but they must combine to produce a disorder. - Jody inherited a tendency to faint at the sight of blood. * New Zealand Depression Study: ppl w. min 2 copies of LL [long] allele coped better w. stress vs. ppl w. SS [short] allele - ppl w. SS = risk for MDD doubled if they had min 4 stressful life events compared to LL ppl 23 - depression in LL ppl = related to stress in recent past - depression in SS ppl = related to stress in childhood experiences - SS ppl = more likely to develop PTSD after trauma - BUT if SS ppl had strong social support they were protected from developed PTSD 2. The Gene-Environment Correlation Model- genetic endowment may increase the probability that an individual will experience stressful life events. - people w. a genetic vulnerability to develop a certain disorder, may also have a personality trait that makes them more likely to be involved in minor accidents/ events that would result in them activating their stressors **example on page 39- influence of genes on divorce rate** Epigenetics + the Nongenomic “Inheritance” of beh - Francis et. al studied stress reactivity + how it is passed through generations - Cross-fostering is an experimental procedure, in which a rat pup born to one mother is assigned to another mother for rearing, demonstrating that maternal beh affected how the young rats tolerated stress - if the rearing mothers were calm + supportive, their rat pups were less fearful + better able to tolerate stress -it demonstrates that calm + supportive beh by the mothers could be passed down through generations of rats independent of genetic influences - the environmental effects of early parenting seems to override any genetic contribution to be anxious, emotional, or reactive to stress - “Epi” as in the work Epigenetics, means “on” or “around”- genes are turned on or off by cellular material that is located just outside of the genome (other external factors can affect it - stress, nutrition, etc) which is then immediately passed down to the next generation - the genome itself isnt changed - if the stressful env disappears eventually the epigenome will fade Neuroscience + its Contributions to Psychopathology - neuroscience focuses on how the NS + the brain work is central to any underst+ing of our beh, emotions, + cognitive processes. The Central NS 24 - The central NS (CNS) processes all info received from our sense organs an reacts as necessary. - The spinal cord is part of the CNS, its main function is to facilitate the sending of messages to + from the brain. - neurons- transmit info throughout the NS (approx. 100 billion in the brain) + has two cell body branches: 1. Dendrite have numerous receptors that receive messages in the form of chemical impulses, which are converted to electrical impulses. 2. Axon transmits these impulses to other neurons. a. the synaptic cleft- the space b.w the axon of one neuron + the dendrite of another. b. neurotrans- the chemicals released from the axon of one nerve cell + transmit the impulse to the receptor of another. major neurotrans relevant to psychopathology: i. norepinephrine (or noradrenaline) ii. serotonin iii. dopamine iv. gamma aminobutyric acid (GABA) - Excesses or insufficiencies of some neurotrans are associated w. diff groups of psychological disorders. The Structure of the Brain - The brain can be divided into two pairs: the brain stem + the forebrain forebrain: more advanced + evolved more recently - brain stem: lower + more ancient part of the brain that h+les most of the essential automatic functions such as breathing, sleeping, + coordinated movement. Parts of the brain stem are: 1. The Hindbrain- the lowest part which contains the medulla, the pons, + the cerebellum a. regulates many automatic activities, such as breathing, heartbeat, + digestion b. the cerebellum controls motor coordination 2. The Midbrain- coordinates movement w. sensory input + contains parts of the reticular activating system (RAS) a. contributes to processes of arousal + tension such as whether we are awake or asleep 3. The Thalamus + Hypothalamus- located @ top of the brain stem, which are involved w. regulating beh + emotion - Parts of the forebrain: 1. The Limbic System- limbic meanings “border”, is located at the base of the forebrain, above the thalamus + hypothalamus a. includes: the hippocampus, cingulate gurus, septum, + amygdala 25 b. the system helps regulate our emotional experiences + expressions, to some extent the ability to + control our impulses. c. involved w. basic drives of se, aggression, hunger, + thirst. 2. The Basal Ganglia- located at the base of the forebrain, include caudate (tailed) nucleus + control motor activity 3. The Cerebral cx- largest part of the forebrain, contains approx. 80% of all the neurons in the CNS. a. provides distinctly human qualities- looking to the future, planning, reasoning + creativity b. the cerebral cx is divided into two hemispheres: i. The Left Hemisphere- responsible for verbal + other cognitive processes. ii. The Right Hemisphere- better at perceiving the world around us + creating images iii. each hemisphere has four separate lobes: temporal, parietal, occipital, + frontal 1. temporal-recognizes sights, sounds + long-term memory storage 2. parietal- recognizes body sensations (touch) 3. occipital- makes sense of visual input 4. frontal- thinking, reasoning capabilities, memory, enables us to behave as social animals The Peripheral NS - Coordinates w. the brain stem to ensure the body is working properly + has two major components including the somatic NS + the autonomic NS (ANS): 1. The Somatic NS- controls the muscles (damage to area = inability to engage in voluntary movements ex: talking) 2. The Autonomic NS- regulates the cardiovascular system (e.g. heart, blood vessels), the endocrine system (e.g. adrenal, thyroid + gonadal gl), digestion + regulating body temperature. It includes the sympathetic NS (SNS) + parasympathetic NS (PNS). -endocrine system gl+ produces it own “hormone” = chemical messenger // released directly in bloodstream a. SNS- mobilizes the body during times of stress or danger + 3 things happen to mobilize us for action: i. heart beats faster- increasing blood flow to the muscles. ii. respiration increases- allowing more oxygen to get into the blood + brain. 26 iii. the adrenal gl’s stimulated, which produces the stress hormone cortisol. b. PNS- helps balance the SNS, taking over SNS (after SNS has been working for a while) after stress to normalize our arousal + facilitating the storage of energy by helping the digestive process. - The Endocrine System- each endocrine gl+ produces a hormone + releases it into the bloodstream. The hypothalamus connects to the adjacent pituitary gl+, which is the coordinator of the endocrine system. 1. Adrenal Gl → epinephrine (or adrenaline) [response to stress] 2. Thyroid Gl → thyroxine [energy, metabolism, + growth] 3. Pituitary Gl → master gl … variety of regulatory hormones. 4. Gonadal Gl → sex hormones (estrogen + testosterone). - endocrine → related to immune sys + stress-related physical disdrs -psychological disrds often involve = hypothalamus + endocrine sys. -adjacent pit gl = master/coordinator of endrocrine sys Hypothalamic-pituitary-adrenalcortical axis (HPA axis) threat/challenge → arousal→ hypothalamus releases adrenaline → cortical part of adrenal is stimulated = epinephrine *implicated in many psych disorders Neurotransmitters - biochemical neurotrans in brain + NS that carry messages from one neuron to another. - 100 + diff onesve - neurons that are sensitive to 1 type of neurotrans cluster 2gther + form paths from 1 part of brain to another - Brain circuits- the paths or currents of neurotrans that flow w.in the brain. (just beginning to discover + map them) - Changes in neurotrans activity may make people more/less likely to exhibit certain kinds of beh in certain situations w.out causing the beh directly. - changes in one neurotrans can cause changes in another - research focus: what happens when activity lvls change - Agonists- substances that effectively increase the activity of a neurotrans by mimicking it’s effect. - Antagonists- substances that decrease, or block, a neurotransmitter. - Inverse Agonists- substances that produce effects opposite to those produced by the neurotransmitter. - Reuptake- drawing back of neurotransfrom synaptic cleft into same neuron after being released. 27 “classic” neurotrans relevant to psychopathology: 1. monoamines (norepinephrine [noradrenaline], serotonin, dopamine) 2. amino acids (GABA + glutamate) * classic = synthesized in nerve - Glutamate + GABA (“chemical brothers”) - the balance of each in a cell determines whether the neuron is activated or not -fast acting // overactivity in the glutamate system = burn out sections of NS ● glutamate: excitatory = “turns on” diff neurons, leading to action. ○ MSG or Monosodium glutamate- increases amount of glutamate in body = headaches, ear ringing etc. ● gamma aminobutyric acid [GABA]: inhibitory = regulates transmission of info + action potentials. ○ reduces anxiety or overall arousal, levels of anger, hostility, aggression, could effect positive emotions, eager anticipation + pleasure ○ benzodiazepines (minor tranquilizers) make it easier for GABA molecules to bond w. receptors * more benzo’s = more GABA = feel calmer ○ wrong to conclude sys’s only responsibility = anxiety (ex: also relaxes muscle groups // possibly good for insomnia treatments // reduces lvls of anger, hostility, aggression, +ve emotional states [anticipation/pleasure] // composed of subsystems Serotonin (5-hydroxytryptamine → 5HT) - monoamine - midbrain - regulates: beh, moods, + thought processes - low serotonin = less inhibition, instability, impulsivity, overreacting = aggression, suicide, compulsive overeating, excessive sexual beh (can’t say “cause”) - approx. 15 diff receptors in the serotonin system - drugs that affect level: antidepressants (imipramine), selective-serotonin reuptake inhibitors (SSRIs) e.g prozac ● SSRIs = to treat anxiety, mood + eating disorders (used to treat # of psycho disrdrs) -wrong to conclude sys is resp for depression // low lvls can make us vulnerable to prob beh w/o directly causing it Norepinephrine (Noradrenaline) - monoamine // part of endocrine sys 28 - regulates certain beh tendencies [but bc of all circuits in brain it is not directly involved in psycho disrdrs/patterns of beh] - stimulates AT LEAST 2 groups of receptors: (1) alpha-adrenergic (2) beta-adrenergic - beta-blockers: block the beta-receptors to reduce norepinephrine → keeps blood pressure + heart rate down -# of them found in hindbrain [where bodily functions like breathing r controlled] - controls respiratory system/basic bodily func’s, emergency reactions - relationship to panic states - NOTE: its more likely this sys = general regulation/modulation of certain beh’s + ISNT directly involved in specific patterns of beh/psych disorders *NOTE: epinephrine aka = catecholamine // name also used for dopamine + norepinephrine bc of similarity in structure Dopamine - monoamine - sig. role in: schizophrenia [but going through revision as drug = clozapine = weak effects], addiction, depression + ADHD - switches on various brain circuits associated w. certain types of beh or emotions - once turned on → other neurotrans may inhibit/facilitate emotions/beh ex: serotonin [inhibitory] balances dopamine [excitatory] ● switches on the locomotor system: regulates ability to move coordinately [once turned on → influenced by serotonin] - min. 5 diff receptor sites relatively sensitive to dopamine - L-dopa (drug) = dopamine agonist (increases lvls of dopamine) -deficiencies associated w/ Parkinson’s disease [L-dopa helps w/ motor disabilities] Implications for Psychology -lesions in localized structures of brain do not typically cause disrdrs -focus of psychopathologists = role of brain func in dev of personality + which personalities = vulnerable to certain disrdrs - individuals w. severe anxiety-based disorders suffer intrusive, frightening thoughts- therefore they engage in compulsive rituals - OCD px = increased activity in the frontal lobe of the cerebral cx = orbital surface, cingulate gyrus + caudate nucleus [activities r correlated + have concentrated serotonin pathways] - lesions that interrupt serotonin circuits impair ability to ignore irrelevant external cues = organism becomes overactive 29 - so OCD px act on every thought that enters their head *example of lesion impairment p. 50 [dev OCD] but even though orbital frontal cortex implicated in anxiety can’t make causal connection // need more research, better tech, also consider social + psych influences Psychosocial Influences on Brain Structure [email protected] times effects of treatments tell us s/t about nature of psychopathology [although not pure relationship - bc effect ≠ cause] - psychosurgery- neurosurgery to correct severe psychopathology [≠ studied systematically] → last resort! [to treat OCD = drugs that increase serotonin activity] - research shows that psycho treatment alone = powerful enough to affect circuits directly (re- wiring of brain): - Lewis R. Baxter + colleagues used CBT to treat px using exposure + response prevention - treatments for depression + specific phobias - placebo effect: inactive medication (sugar pill) treatments that may result in beh + emotional changes ● may induce +ve expectation for change = change brain function ● medication + placebo re-wire MAY brain in different ways [ex: treatment for depression] ● placebo alone are not usually as effective as active medication [ie:study by Leuchter, Cook, Witte, Morgan + Abrams] vs. i.e: study by Petrovic, Kalso, Pteresson and Ingvar → px’s left hand was subjected to intense heat ● 3 conditions: (1) opioid drug (2) placebo pill (px assumed was opioid-based drug) (3) no drug ● results: placebo drug + opiate drug = reduced pain to less than lvl w/ no drug // but unlike above study on depression ….both treatments activated overlapping regions in brain [not different] // primarily activated = anterior cingulate cx + brain stem [≠ activated in “no drug” condition] - CBT vs. Antidepressants ● “top down” → CBT facilitates changes in thinking patterns starting from the cx then down to the lower brain ● “bottom up” → drugs reach the higher areas of the cx last -sum ppl respond better to psych treatments while others to drug treatments -future dream: to be able to choose best treatment/combined treatment based on analysis of person’s brain function Interactions of Psychosocial Factors w. Brain Structure + Function - psychosocial factors can directly affect lvls of neurotrans [+ functioning/structure of CNS] - interaction b.w neurotrans + psychosocial factors can affect px differently 30 EX STUDY: rhesus monkeys yoked toy study → ”yoked” - when outcome of 2nd group depends on first group premise: G1: free access to toys/treats G2: only access to toys/treats when group1 got them results 1: G1: grew up w. sense of control over things in life, but not those in G2 results 2: when injected w/ benzodiazepine: G1: did not beh anxiously, but behaved aggressively [attacking other monkeys] vs. G2: displayed signs of severe anxiety + panic conclusion: same lvl of neurochemical substance had diff effects depending on psych histories of monkeys - stress in during early development can lead to changes in the HPA functioning, making primates more or less susceptible to stress later in life - biological interventions (i.e drugs) + psychological interventions or experience are capable of altering brain circuits Behavioural+ Cognitive Science - Cognitive science is concerned w. how we acquire + process info + how we store + retrieve it (memory) -much a part of Freud’s theory of psychoanalysis - Conditioning + Cognitive Processes - diff judgments + cognitive processes combine to determine the final outcome of this learning - basic classical (operant) conditioning paradigms facilitate the learning of the relationship among events in the environment - cognitive + emotional processing of info is involved when conditioning occurs - Learned Helplessness Learned Helplessness (Martin Seligman) - occurs when rats or other animals encounter conditions over which they have no control whatsoever. → give up coping + develop depression ● learned helplessness may happen w. people who have uncontrollable stress in their lives. ● ppl become depressed if they decide or think they can do little about the stress in their lives// ppl process info about events in enviro in diff ways [important component in psychopathology] Learned Optimism: when ppl function better by displaying optimistic attitudes when faced w. difficulties + stress [positive side of learned helplessness] ● a study showed that individuals b/w the ages 50 + 94 who had positive view about themselves + aging, lived 7.5 years longer than those w.out positive attitudes. ● created interest in field of positive psych 31 Social Learning Albert Bandura: Canadian psych → observed that organisms do not have to directly experience certain events in their environment to learn effectively. ● Social Learning Theory: much of what we learn depends on our interaction w. other people around us. ● Modelling or Observational Learning: learning through observing what happens to someone else in a given situation. -Bandura’s study w/ nursery school children → Bobo Doll Experiment *results: children who witnessed the aggressive model that was reward = more aggression vs those who witnessed the aggression model that was punished = did not reproduce aggression ● The steps involved in vicarious learning (confirmed by Bobo Doll results) a. Attention- noticing the model’s beh. b. Retention- remembering the model’s beh c. Reproduction- exhibiting the model’s beh d. Motivation- children are more likely to reproduce beh of models that have been rewarded for the beh. -Bandura’s idea: that analysis of cognitive processes may produce most accurate scientific predictions of beh Prepared Learning Prepared learning: becoming highly prepared for learning about certain types of objects or situations through evolution, because this knowledge contributed to the survival of our ancestors *exposure to environment strengthens/weakens this ● Ex: even w.out contact, we are more likely to fear snakes than flowers because of the potential danger. -certain UCS (unconditioned stimuli) + CS (conditioned stimuli) “belong” together - shocks are less effective than poisoning at creating food aversion bc shocks do not occur in nature = are not as closely associated w. survival Cognitive Science + the Unconscious Blind Sight/Unconscious Vision- being able to reach accurately for objects + distinguish among objects + perform most of the functions usually associated w. sight. *ex: man w/ damage to visual cortex = blind but able to do tasks that require vision // also seen in hypnotized px Implicit Memory- when someone clearly acts on the basis of things that have happened in the past but can’t remember the events // can be selective // ex: Anna O Explicit Memory- a good memory of events. *both differ in dev patterns, brain structures + degree to which theyre affected by certain drugs. 32 The Black Box: unobservable feelings + cognitions inferred by an individual's self-report. Implicit Cognition- attempting to reveal unobservable cognitive processes Ex: Stroop colour-naming paradigm: ● subjects are shown various words, each printed in a diff colour. They are shown the the words quickly + are asked to name the colour in which the word was printed in. ● colour naming is delayed when the meaning of the word attracts the subjects attention - ppl with certain psychological disrdrs r slower @ naming words that r associated to their problem ● often the meaning of the word interferes w. the subject’s ability to process colour info. ● in some cases such as jody he would be much slower at naming the colours of the words like blood, injury, dissect ● psychs can now uncover particular patterns of emotional significance using stroop even if sjx cant verbalize/isnt aware of them (ex: ppl w. eating disorders are slower at naming food/body/weight words) Cognitive- Behavioural Therapy - CB-therapists: examine ongoing thinking processes of ppl who are anxious, depressed + stressed - where px monitor their own thoughts during periods of distress -CBT aims to clarify and modify attributions and attitudes (cognitive) and avoid situations that provoke unrealistic anxiety or depression, increasing activity, or improving social skills (behavioural). -therapy is usually short term:10- 20 sessions. - Aaron T. Beck developed methods for dealing with faulty attributions and attitudes associated with learned helplessness and depression and helped develop some methods of cognitive-behavioural therapy (CBT). -Albert Ellis developed another approach emphasizing cognitive procedures and techniques called rational- emotive therapy: ● focuses on the irrational beliefs Ellis thought were at the root of maladaptive feelings and behaviour. - Donald Meichenbaum, a clinical psychologist, developed an approach that combines psychodynamics and behaviour therapies called self-instructional training: ● works on modifying what clients say to themselves about the consequenc
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