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Lecture 18

PSYC 3F20 Lecture Notes - Lecture 18: Mania, Major Depressive Episode, Bipolar Disorder


Department
Psychology
Course Code
PSYC 3F20
Professor
Andrew Dane
Lecture
18

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PSYC 3F20 Abnormal Psychology Section 1 Tuesday, January 31st, 2017.
Lecture 19
w/ = with ppl = people ex., or eg., = example
b/w = between q = question ie., = in other words
w/o = without ps = participant
Acceptance and Commitment Therapy (ACT)
Hayes, 2006
psychological inflexibility (i.e., developing fixed ideas that paralyze you from taking action)
leads to psychopathology
Goal of ACT: create psychological flexibility to produce positive changes
Acceptance and Commitment Therapy: Psychological Inflexibility (Hayes, 2006)
- cognitive fusion: accepting thoughts as reality and assume being defined by these
thoughts causing inability to respond to opportunities in current reality for change;
bogged down by thought processes
- fusing thoughts w/ reality
- experiential avoidance: avoiding things you predict will make you upset or lead to
negative thoughts, experience miss out on opportunities for change, opportunities for
enjoyment
- dominance of past and future over present: spent a lot of time in your head regretting
mistakes and worrying about the future
- attachment to conceptualized self: too attached to narrative or story about themselves up
until that point, leading to belief they cannot change (e.g., get stuck believing you are a
failure b/c you have failed in the past)
- inactive, impulsive or avoidant b/c loss of sight of what is important in life
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Acceptance and Commitment Therapy: Psychological Flexibility (Hayes, 2006)
1) Acceptance:
flip side of experiential avoidance
ot giig up
illigess to eperiee hat ou’re eperieig
accept feelings rather than trying to change them experience to observe, not avoid
2) Cognitive Defusion:
Thoughts are observable experience, not reality
Let feelings pass
3) Being present:
Non-judgmental contact with thoughts and environment
Not ruminating
4) Self as Context
Use of mindfulness exercises (e.g., meditation)
Be flexible about self stories
5) Values
What are your values? What do you want to accomplish?
6) Committed Action
What do ou at out of life? Do soethig to ake that happe…
Problem-solving skills, exposure, social skills, goal setting etc. to facilitate achievement of
goals
YouTue ideo** Aeptae ad Coitet Therap ACT: Cotrol & Aeptae Video
- egatie thought is ot realit, ehaiour should’t e goered  that, should’t aoid situatios to aoid
thoughts
Cogitie Defusio Video
Differences from CBT
ACT:
accept feelings rather than trying to change them; reduce influence of cognitive biases
e.g, egatie attriutios, ruiatio  …
Reducing believability or attachment to negative thoughts through cognitive defusion, viewing
self as context (e.g., just thoughts, not reality)
Being present, mindfulness increases direct experience of life in the present without filter of
biased thinking, or having attention drawn to past (rumination) or future (worry).
Cognitive-behavioural skills directed toward accomplishing valued goals rather than
addressing problem
Effectiveness of ACT (Powers et al., 2009)
In two randomized control studies, ACT compared to cognitive therapy (e.g., Beck;
cognitive restructuring)
Equal to CT at post-test in reducing depressive symptoms
Greater than CT in reducing depressive symptoms at 3-month follow-up
Bipolar Disorders
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Manic and Hypomanic Episodes
Bipolar I; Bipolar II; Cyclothymic Disorder
Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive or irritable mood,
and abnormally and persistently increased goal-directed activity or energy, lasting at least
one week
How is this different from normal happiness?
DSM-5: mood in mani episode is euphori, eessiel heerful, high or feelig o top of the
orld feeling really good
May be characterized by unlimited or haphazard enthusiasm for interpersonal, occupational,
sexual interaction (e.g., talking to stranger in public place)
Increased activity level at unusual hours of the day
I hildre, happiess, silliess, ad goofiess are oral i the otet of speial oasios;
however, if these symptoms are recurrent, inappropriate to the context, and beyond what is
expected for the developmental level of the child, they may meet criterion A.
B. During the period of mood disturbance and increased energy, 3 or more of the following
symptoms (on next slide) are present
C. Mood disturbance is sufficiently severe to cause social/occupational impairment; or
hospitalization required; or psychotic features
Psychotic symptoms occur in 50% to 80% of individuals experiencing manic symptoms as
part of Bipolar Disorder
Hospitalization would likely occur if person were likely to harm themselves or others
1) inflated self-esteem or grandiosity
Example of inflated self-esteem and grandiosity in DSM-5: uncritical self-confidence. giving
advice on matters (running the United Nations) when person has no special knowledge or
expertise in the area; writing a novel; composing a symphony despite having no talent; seeking
publicity for some impractical invention. Grandiose delusions are common.
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
Manic speech is typically loud, rapid, difficult to interrupt. Non-stop talking without regard for
another individuals wish to communicate. May become theatrical: dramatic mannerisms,
excessive gesturing, etc. Loudness or forcefulness more important than what is conveyed.
4) flight of ideas or subjective experience that thoughts are racing
DSM-5 says Flight of ideas nearly continuous flow of accelerated speech with abrupt shifts
from one topic to another. Thoughts race faster than capacity to speak and thoughts are
experienced as so crowded that it is difficult to speak
5) distractibility
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
Goal-directed activity: Commonly increased sexual drive, fantasies. Increased sociability
(renewing old acquaintances), interactions may be intrusive, domineering and demanding;
Accompanied by psychomotor agitation or restlessness; May write excessive letters, emails, text
messages etc
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