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Abnormal Psychology 235.docx

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PSYC 235
Meredith Chivers

PSYC 235: Abnormal Psychology Week One 11/28/2013 5:18:00 PM What is abnormal?  There is no universal standard for abnormal, however these questions can be asked: o Does the behavior cause personal distress/significantly affect life? o Does the behavior violate cultural norms? o Results in dysfunction *MUST cause personal distress  Psychological Disorder o Associated with distress or impairment in functioning and a response that is not typical or culturally expected  Psychological dysfunction o Breakdown in cognitive, social or behavioural functioning Clinical Description  Presenting problem: why a person came to seek aid  Clinical description: specification of what makes the case abnormal  Statistical terms: o Prevalence: # of people in a population w/disorder o Incidence: # of new cases in given period of time o Sex ration o Age of onset  Chronic vs. Episodic vs. Time-limited  Acute vs. insidious onset Theories of Psychopathy Week Two 11/28/2013 5:18:00 PM Paradigm  Theoretical framework  Defines how to conceptualize a disorder  Guides research and treatment Factors of Psychopathy  Biological factors, genetics, physiology, neurobiology  Learning factors: conditioning, modeling  Emotional factors  Cognitive factors  Social factors  Cultural factors Behaviour Genetics  Is a behaviour heritable? o Family studies o Quantitative genetics: total risk is additive over many genes  Estimate for Heritability o Twin studies o Very few behavioural traits are 100% heritable o Environment has an influence  Genes vs. Environment o Adoption studies  Search for actual genes o Linkage studies o Molecular geneticists o Separating the effects of genes and the effects of prenatal environment  Diathesis Stress Model o The greater the underlying genetic vulnerability, the less stress in s needed to trigger a disorder  Eric Kandel o Learning changes genetic structure of cells o Brian is constantly changing in response to environment  Reciprocal Gene Environment Model o Genetic influences on personality can increase the likelihood of experiencing stressful life events o In part, we create environment Epigenetics  The non-genomic inheritance of behaviour  Outside of the genes  Behaviour transmitted to subsequent generations via environmental effects  For example: parenting style Psychodynamic Paradigm  Basic Assumptions: o Psychic determinism o Libido and aggression o Motivation is fully or partially unconscious o Insight from others for example is needed to change o Incomplete developmental stages lead to abnormal behaviour  Psychosexual developmental stages o Fixation  Little or too much gratification at any developmental stage o Means of coping  Oral fixation: smoking, overreacting, nail biting, overly dependent, interpersonally  Anal Fixation: retentive (excessive needs for self- control, perfectionism); expulsive (careless of messy) o Object Relations (newer theories)  How children incorporate valued others into self  Stages:  Undifferentiated (newborns)  Symbiosis (infancy)  Separation/individuation (childhood)  Integration (later childhood) Advantages Disadvantages Childhood importance Not scientifically testable Explains normal and abnormal Not objective behaviour Psychological variables Extremely long term therapy Behavioural (Learning) Paradigm  Basic Assumptions: o Abnormal behaviours are learned  Classical conditioning  Operant conditioning  social and prepared learning o Observable behaviour is the topic of investigation  Operant Conditioning o Behaviours have consequences o Some consequences increase likelihood:  Positive reinforcement: application of positive stimulus  Negative reinforcement: removal of negative stimulus o Some consequences decrease likelihood  Extinction: removal of positive reinforcement  Punishment: application of negative stimulus o Shaping or successive approximations  Other forms of learning o Learned helplessness  Seligman and depression  Consequences of dealing with uncontrollable stressors o Social/observational learning  Bandura  Bob experiment monkey see monkey do”  Prepared learning (ohman, mineka)  Content of phobias not random Advantages Disadvantages Scientifically based Over-simplifies Listable hypotheses Can’t explain all disorders Predictive of behaviour Neglects thoughts and feelings Generates research Views humans as victims of their environment Effective treatments Cognitive Paradigm  Basic assumptions o Reaction to behaviourism- subjective material (thoughts) can be studied (Wundt influence) o Meaning of association between events  Mediational model: cognitive appraisals of events can affect an individual’s response to these events o Psychopathology cause by dysfunctional thinking o Schemas: function beliefs and assumptions about self and world develop from early personal experience o Causal attributions  Global vs. Situational  Stable vs. variable o *negative global and stable causal attributions are associated with psychopathology Advantages Disadvantages Lots of research/testable hypotheses Problems in thinking may not cause Effective treatments disorders, may be an effect of the Makes sense to patients disorder Humanistic Paradigm  Basic Assumptions o Reaction to pessimistic views of behavioursim o Humans are basically good, self-directed and strive to self- actualize. o Industrialism and alienation disrupt natural process of self- actualization o Insight facilitates self-actualization Advantages Disadvantages Popular appeal Not scientifically based Could be used as a general approach Insufficient to treat severely to patients disordered Led to studies of therapy processes Does not explain specific causes Social Structural Theories  Society influences psychopathology by creating toxic environments and poor coping methods  Considers environment and does not blame person  Raises consciousness about societal responsibility Interpersonal Factors  These theories emphasize long-standing negative relationship patterns in psychopathology  Supportive social relationships protect against psychopathology  Social stigma influences metacognitions, symptom expression and treatment seeking behaviour Gender Role Factors  Varies with culture  Prevalence of disorders and expression of symptoms Cultural Factors  Although psychopathology is universal, content is somewhat determines by culture  Most societies are not developed to the social context to prevent and treat psychopathology Correlation Research  The basics of correlation: o Statistical research between two or more variables o Variable must be continuous o No independent variable is manipulated  Nature of correlation and strength of association: o Range from -1 to +1 o Negative vs. positive correlation o Zero is no relationship between variables  Types of Correlation Studies: o Continuous Variable  Two or more variables are measured and the correlation examined  o Group Comparison: Study two or more groups are compared on variable of interest o Cross-Sectional:  Participants assessed at one point in time  May suffer from cohort effects where experience and age confound results o Longitudinal:  Participants assessed on two or more occasions over time  May suffer from cross-generational effects where you cannot generalize data across other groups Advantages Disadvantages High external validity Correlation does not imply causation Relatively simple to conduct Longitudinal studies costly/time- consuming Longitudinal studies can find Third-variable problems variables that predict certain outcomes Epidemiological Studies  Frequency and distribution of a disorder in a population  Risk factors  Cannot identify causation  Prevalence rate: % of cases in a given time period  Incidence rate: # of new cases in a given period of time Experimental Research  Basics o Manipulation of variables o Attempt to establish causal relations o Premium on internal validity and control  Human lab studies: o Analogue studies (eg. Stress-induction) o Demand characteristics o Ethical issues  Minimizing confounds: o Use of control groups  Placebo  Double blind controls  Cross-over designs o Use of random assignment procedures  Treatment Studies o Determine whether therapy/medication show efficacy or effectiveness  Efficacy: works in a clinical trial/highly controlled setting  Effectiveness: works in typical treatment setting Assessment and Diagnosis Week Three 11/28/2013 5:18:00 PM Assessment  The systemative evaluation and measurement of: o Symptoms  Behaviour  Mood  Thinking  Time course o Possible causal factors:  Biological  Social/cultural  Psychological  Clinical assessment strives to: o Understand the individual’s symptoms o Predict behavioursim o Plan treatment o Evaluate treatment outcome o Like a funnel starts broad with a multidimensional approach that narrows to specific problem areas  Scientist-Practitioner Model o Assessment is a process of hypothesis testing o Delivering psychological assessment in accordance with scientifically based protocols o Practive-based research o Psychometric characteristics  Reliability and Consistency  Validity: the degree to which a technique measure what it is designed to measure  Standardization: application of certain standards to ensure consistency across different measurments  Ensures consistency in the use of a technique  Ex. Administration procedures o Clinical interview  Structured vs. unstructured vs. semi-structured  Could find resistance from the client or selective information  Can be subjective o Mental states exam  Appearance and behaviour  Thought processes  Rate of speech  Continuity of speech  Content of speech  Mood and effect  Intellectual functioning  Sensorium  Awareness of person, time and place o Behavioural Assessment  Antecents, behaviour, consequence  Self-monitoring asking patient to log daily o Psychological Tests  Projective Tests  Use of ambiguous stimuli and patient’s response to stimuli  Inkblots  Thematic appreciation  Sentence completion tests  Objective Tests  Personality inventories  MMPI-2 o Theory driven development o Excellent reliability/validity o Yes or no statements o Validity scales  F: Infrequency Scale “Faking bad”  L: Lie Scale “Faking good”  K: Defensiveness Scale “impression management” o Produces personality profile  Intelligence Tests  WAIS-IV  Average university prof. 135+  IQ does not equal intelligence  Used to estimate relative intelligence  Cultural bias?  Questionnaires  Brian Imaging Physical Disorders and Health Psychology Week Four 11/28/2013 5:18:00 PM Stress  Behavioural Medicine o Application of psychology to prevention, diagnosis and treatment of medical disorders (interdisciplinary)  Health Psychology o Role of stress and psychological factors on physical illness  Basics o Uncontrollable o Unpredicatable o Change/challenge capabilities or self-concepts  Challenge out sense of mastery  Physiology o Fight or flight o Sympathetic nervous system o Adaptive response to an immediate threat o Causes damage when chronic and uncontrolled  Physiological diseases linked to stress o Stress can cause brain damage  Social factors and psychological factors o High cortisol is associated with low social status o Vulnerabilities operative in mental illness contribute to physical illness o Interpretation of physiological response and situation is critical  Cardiovascular diseases o CHD  Heart attack, higher risk with chronic, uncontrollable stress o Hypertension  Elevated blood pressure depends on stress and genetic influence o Type A Pattern: time urgency, competitiveness, low self- esteem, anxious/depressed, higher risk of cardiovascular disease o Type B Pattern: not constantly in a hurry, can relax without feeling guilty, not overly competitive, lower risk for heart disease Psychoneuroimmunology  Effects of psychological factors on immune system functioning  Stress dramatically and quickly alters immune function  Perception of control influences health of people with diseases  Chronic Fatigue Syndrome o Vicious cycle of extreme stress and illness o Treatment  Seek social support Intervention Description Guided Mastery Model positive behaviours Cognitive Techniques Reduction of catastrophizing cognitions Biofeedback Help the person identify signs of bodily processes Time Management Teach the person to reduce obligations, prioritize and schedule  Suppression of negative thoughts Eating Disorders Week Five 11/28/2013 5:18:00 PM General  More prevalent in women (90% are female)  Strongly related to socio-cultural factors  Cognitive Signs: o Personal worth is based on appearance and attractiveness o Perfectionism o I must be thin/fit; cannot be overweight o Thinking others focus on their weight o Overgeneralization: thin=control o Dichotomous thinking: fat/thin; ugly/pretty; out of control/ in control o Misconceptions: being thin brings love and attention  Body Image Disturbance o Cognitive distortion  Overestimate actual size o Unrealistically low ideal size o Social comparison o Sensitivity to fullness o Degree of discrepancy between ideal/current shape Anorexia Nervosa (AN)  Fear of obesity/drive for thinness  Extreme dietary restriction  Strict control  OCD Bulimia Nervosa (BN)  Fear of obesity/drive for thinness  Binge eating followed by purging  Impulsivity  Substance abuse  Anxiety Binge Eating Disorder (BED)  New to DSM V  Similar body image concerns as AN/BN  Use food to self-soothe  Binge eating without compensatory behaviour  Highest mortality rate of all psychopathologies (20% die, ½ suicides)  More common in men Pica  Consumption of nonnutritive food that is inappropriate to the development level of the individual and not a cultural or social norm Rumination Disorder  Repeated regurgitation of food that is not attributed to physical health conditions or other eating disorders Avoidant/Restrictive Food Intake Disorder  Persistent failure to meet appropriate nutritional needs that cannot be explained by lack of food or body image disturbances Treatment  CBT o Techniques:  Nutrition interventions  Psycho-education  Food pyramid  Truth about purging  Cognitive restructuring  Body image interventions  No weighing  In vivo food exposure o Efficacy  BN: Purging: 79% reduction; 57% remission  BED: 86% reduction; 55% remission  Broad effects:  Dietary restraint, improves associated psychopathology, regulates and increases eating  CBT most effective since it addresses cognitive distortions and schemas Prevention  Psycho-education o Group treatment o Consequences and dangers o Info about eating disorders o Healthy weight control practices Sleep Disorders Week Five Cont. 11/28/2013 5:18:00 PM Stages of Sleep  Stages: 1. Wakefulness to drowsiness 2. Light Sleep ( easily awoken) 3. Deeper Sleep 4. Slow-wave deep sleep (difficult to wake) 5. REM dreaming  approx. 90 min cycles  normal sleep: 20% deep (3,4); 30% dreaming; 50% light  most people get less sleep than they need Sleep Deprivation  Increased proneness to accidents  Impairs cognitive processes  Impairs emotional regulation  Impairs immune system o <6hrs/night; 70% higher mortality Assessment  Sleep lab o Polysomnographic evaluation a) EEG electroencephalograph brain waves b) EOG electrooculography eye movements c) EMG electromyography muscle activity  Assess daytime behaviour and drug use  Sleep efficiency o % of time asleep (not just in bed) = time asleep/time in bed  distress o 90 min to fall asleep may be okay for one individual but not another Sleep Disorders 1) Dyssomnias  Insomnia Disorder  Difficulty initiating or maintaining sleep  Significant distress or impaired function  At least 3x/week for three months  Allows comorbity  Increases w/ age  65% stress related  Hypersomnolence Disorder o Excessive sleepiness o >9 hours that is not refreshing o 3x/week for three months  Narcolepsy o Hypocretin deficiency o Extreme tendency to fall asleep in relaxed surrounding o Small REM periods 2) Breathing-Related Sleep Disorders  Obstructive Sleep Apnea Hypopnea o 15+ episodes/hour  Central Sleep Apnea o 5+/hour  Sleep-Related Hypoventilation o Elevated CO2 levels 3) Parasomnias  Nightmare Disorder o Repeated occurrences of extended, extremely dysphoric and well-remembered dreams o Causes significant distress or impairment of functioning  Non-REM Sleep Arousal Disorder o Sleepwalking or sleep terrors  REM Sleep Behaviour o Arousal due to movements or motor behaviours 4) Circadian Rhythm Sleep-Wake Disorder o Persistent or recurrent pattern of sleep disruption that is primarily due to the misalignment between circadian rhythm and sleep cycle o Causes distress Treatment  Medications o Benzodiazephines  CBT o Behavioural  modify stimulus control  sleep hygiene  establish sleep routines  cool temperatures  low emotional arousal before bed  use your bed only to sleep  step away from the screens o Address maladaptive cognitions  “I need 8 hours or I can’t….” o psychotherapeutic interventions  AMT: Anxiety Management Training  PMR: Progressive Muscle Relaxation o CPAP  For sleep apnea Neuroscience 11/28/2013 5:18:00 PM Central Nervous System (CNS)  Communicates with all sensory organs and muscles  Composed of the brain and spinal cord  Two classes of cells: o Gilia or Glial Cells  Supportive and protective functions (helping neurons)  Supply oxygen and nutrients, remove dead germ cells, insulate axons of neurons o Neurons  Specialized cells for transmitting information  Compromised of a cell body and an axon (long fibre) Peripheral Nervous System (PNS)  Cranial nerves and spinal nerves  Transmits sensory information from the body to the CNS  Transmits motor information and other commands in the other direction (from the CNS to muscles, glands and internal organs)  Comprised of : o Skeletal Nervous System  Sensory or afferent  Motor of efferent o Autonomic Nervous System (involuntary)  Sympathetic (fight or flight)  Parasympathetic (rest and digest) Terminology  Tracts- nerves that are entirely within CNS  Nerves- bundle of fibres (axons) that communicate in PNS and between PNS and CNS  Afferent Neurons (Sensory)- body to the brain  Efferent Neurons (Motor)- brain to the body  Interneurons- link sensory/motor neurons  Spinal reflexes- movements that do not involve input from the brain  Neurotransmitter- medium through which signals flow at chemical synapses  Presynaptic Neuron- neuron sending the message  Postsynaptic Neuron- neuron receiving the message  Cleft- space between two neurons  Excitory Synapses- transmitter substance excites the postsynaptic neuron and increases likelihood of firing  Inhibitory Synapses- lower the likelihood that the postsynaptic axons will fire  Graded Potentials- small voltages generated by the action of neurotransmitters. If these potentials, when summed in the cell body, is excitory enough, an action potential is generates. Information Pathway  Dendrites → cell body (analyzes) → axon (transmits) → spinal cord  If neuron is sufficiently depolarized it will generate an action potential  Many drugs and chemicals affect the body’s nervous system by affecting the release, up take or reuptake of neurotransmitters Types of Neurotransmitters  Acetylcholine o Involved in memory, too little → Alzheimer’s disease o Activation of motor neurons o amine  Norepinephrine and Epinephrine o Mood, attention, arousal o Excitory o Mood elevation drugs increase norepinephrine release o amine  Dopamine o Cognitive and motor control o Voluntary movements o Too much → schizophrenia o Too little → Parkinson’s disease o amine  Serotonin o Mood, sleep and appetite o SSRI’s reduce uptake of serotonin o Treat depression o amine  GABA (gamma-aminobutyric acid) o Inhibits neural activity o Too little → anxiety o Treats anxiety when increased (valium) o Amino acid  Opioids o Allow body to cope with pain  Peptide  *Hormones are a lot like neurotransmitters however they travel long distances as opposed to short. The Brain  Left and Right Hemispheres  Connected by a nerve bundle called the corpus callosum  Left more specialized for speech and language  Right more appreciation  Seven Major Components o Brainstem  Lower part of the brain (connects it with the spinal cord)  Important for consciousness, sleep, breathing and heartbeat  Oldest part of the brain o Cerebellum  Pair of hemispheres  Involved in motor control  Coordination, timing, level of precision o *Hypothalamus  controls the hormonal system, body temperature, blood pressure, homeostasis  hunger and thirst (drives)  pituitary gland control  behaviours and responses to these drives o *Thalamus  regulates wakefulness and sleep  relays sensory information to cortex from basal ganglia o *Basal Ganglia  exchanges information with the cerebral cortex  procedural memory  voluntary movement, learning, remembering how to do something o *Limbic System  interlinked structures form border around the brainstem  motivation, emotion and some types of memory  contains:  Amygdala- emotional learning  Hippocampus- spatial memory, declarative memory o Cerebral Cortex  Outer layer (rind)  Most recently evolved  Communication with other cells  Humans have most cortical neurons  Four lobes: frontal, parietal, occipital, temporal  * means one in each hemisphere Cerebral Cortex  Frontal Lobe o Generates motor commands resulting in voluntary movement o Rational, goal-directed activity for directing and maintaining attention, for keeping ideas in the mind and for developing plans  Temporal Lobe o Storage of memories o The experiencing of strong emotions o Smell, taste, hearing o Smell- primary olfactory cortex o Taste- primary gustatory cortex o Dest
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