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PSY240H1 (233)


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University of Toronto St. George
Martha Mc Kay

PSY240 Review Notes LECTURE 1 1. Identify and describe the dimensions of abnormality Standards for what is normal or abnormal: 1) Cultural relativism- no universal standard, gender plays a role 2) Unusualness of behavior- depends on culture 3) Discomfort of the person exhibiting the behavior 4) Mental illness- is the behavior cause by a mental disease? 5) Maladaptiveness- Distress, Dysfunction, Deviance Abnormality as a harmful dysfunction •When there is a harmful dysfunction of the internal mechanisms to perform naturally selected functions e.g., A depressive disorder exists when there is dysfunction in the normal, adaptive functioning of the emotional regulation system •A dysfunctional system, in isolation, is an insufficient criterion; to be labeled abnormal, it must cause harm e.g., subjective distress or impairment Categorical v. Dimensional Categorical - Does it fit into one or the other category? Ex. depressed or not? Dimensional – along a continuum with opposite extremes at either end Ex. How depressed are you? Diathesis-Stress Model Diathesis: a vulnerability or predisposition to developing a disorder Stress: A life event that acts as a trigger for the emergence of a disorder -The amount of stress that triggers a disorder depends upon the diathesis, or predisposition 2.Review the historical perspectives on abnormality and its treatments  Biological theories -Similar to physical disease, breakdown of some systems of the body Classification systems: using objective criteria and definitions gave credence to biological factors as a cause of abnormality- the connection of syphilis to general paresis (Emil Kraplein)  Supernatural theories -Divine intervention, curses, demonic possession, and personal sin  Psychological theories -Mental disorders as the result of trauma(s) Behaviorism -emphasizes the role of the environment -Pavlov, Watson, and Classical Conditioning -Thorndike, Skinner and Operant Conditioning -examines role of reinforcement and punishment in determining behaviour Cognitive Revolution -A focus on thought as determinate of behaviours and emotion -Albert Bandura and Self-Efficacy Beliefs -Albert Ellis and irrationality (Rational Emotive Therapy) -Aaron Beck and theory of depression 3.Discuss the emergence of modern perspectives on understanding abnormal psychology. Biological Approach -Underlying Biological Factor (e.g., genetic vulnerability to depression inherited from parents, acquired head trauma) Structural Theories -Disorder as a result of damage to the structural integrity of the brain (e.g., brain trauma as a result of a car accident) Biochemical Theories -Problems or imbalances with neurotransmitters (the brain’s chemical messengers) or of the endocrine (hormonal) system 4 Common Neurotransmitters: 1) Serotonin (5-HT) -Regulating emotions; implicated in depression, anxiety, and stress-related disorders 2) Norepinephrine (aka Noradrenalin)- too much can be overly stimulating & too little - depression; implicated in mood disorders 3) Dopamine- Important for functioning of muscle symptoms and for affecting reward systems in the brain; implicated in psychosis (especially schizophrenia) and Parkinson’s Disease 4) Gamma-aminobutyric acid (GABA)- Typically has an inhibitory, tranquilizing effect; implicated in anxiety disorders Endocrine system: glandular system producing hormones -Hormones carry messages through the blood to affect mood, one’s energy level, and how we react to stress -Pituitary (Master) Gland lies just below the hypothalamus at the point of connection between the nervous and endocrine systems -The Central Nervous and Endocrine Systems work together for interactive effects (e.g., hypothalamic-pituitary-adrenal (HPA) axis so important for managing stress) Genetic Theories- Sometimes the malformation or transmission of a specific gene or genes but most often via polygenic transmission -Structural abnormalities, biochemical imbalances, & genetic abnormalities can all influence one another Psychological Approach Psychodynamic theories: Unconscious conflicts between primitive desires and constraints on those desires give rise to mental illness Freud Psychodynamic theories: Id (pleasure principal), Ego (rational deliberation), Superego (internalize personal standards) Freud Psychoanalytic theory: Oral (0-18months) Anal (18months-3yrs) Phallic (3 to 6yrs) Latent (Six years to puberty) Genital (Puberty to adulthood) Object Relations Theory: Early in life we create representations of ourselves and others and carry these with us throughout adulthood -problems with freuds theories: didn’t consider women, un-falsifiable Behavioral Theories Behavioral theories: Symptoms of mental disorders due to reinforcements and punishments for specific behaviors Classical Conditioning- Maladaptive learning by associating previously neutral stimuli with unconditioned stimulus and response pairings, particularly useful in explaining acquired fears ex. Pavlov Operant Conditioning- Shaping behaviours by rewarding those that are desired & punishing those undesired (Thorndike, Skinner)  Cognitive theories: People’s ways of interpreting situations, their assumptions about the world and self-concepts can cause negative feelings / behaviors -Thoughts and beliefs shape our experience -Dysfunctional or irrational thoughts and beliefs underscore abnormality -Replace these thoughts with functional, realistic thoughts Humanist and existential theories: Disorders arise when conforming to demands of others instead of pursuing own values & potentials -The inability to fulfill one’s potential arises from the pressures of society to conform to others’ expectations and values, and from existential anxiety. -Rogers- Humans strive to fulfill their potential and to self-actualize; develops client- centered therapy -Maslow- Hierarchy of Needs -Humanistic and existential theories are vague and hard to test Interpersonal theories: Mental disorders are a result of long-standing patterns of negative relationships that have roots in early caregivers Family System theories: Families create and maintain mental disorders in individual family members to maintain homeostasis. Social Structural theories: Societies create mental disorders in individuals by putting them under unbearable stress and by sanctioning abnormal behavior Social Approach -Relationships with classmates, poverty, family dynamics -Focus more on the larger social structures within which an individual lives. -Society increases stress on individuals, leading to disorders especially during times of major reorganization. -Some people live in more chronically stressful circumstances than others, and these people appear to be at greater risk (consider, for example, the effects of unemployment, poverty and racism. -Society influences the types of psychopathology by having rules about what types of abnormal behaviour are acceptable and in what circumstances. Vulnerability Stress Model -Incorporates multiple contributing factors from the biological, psychological, and social levels that have additive and interaction effects -Constant feedback effects or loops from biological, psychological, and social factors -A given stressor (e.g., job loss) or trigger (e.g., shift in hormonal levels) acts upon predisposed vulnerability (e.g., genetic predisposition & previously acquired coping strategies) to develop disorder 4.Discuss mental health care -Canadian psychiatrist Heinz Lehman’s discovery of antipsychotic medications made it possible for some people to be released from asylums. This discovery transformed psychiatric care in two ways: -Severely affected patients could be treated in the community -Psychobiological factors were recognized as contributing to mental illness. 5.Identify some professions related to abnormal psychology. -Psychiatrists, Clinical psychologists, psychiatric nurses, occupational therapists, marriage therapists LECTURE 2 Abnormal Psych & The Scientific Method 1) The Scientific Method Continuous Variable= Two or more variables are measured and the correlation between them is examined Group Comparison Study= Two or more groups are compared on the variables of interest Cross-sectional Study= Participants assessed at one point in time Longitudinal= Participants assessed on two or more occasions over times Epidemological Studies= Prevalence rates, Incidence rates, Risk factors Internal validity= the degree to which we can hold constant all variables between the experimental and control group except for the (independent) variable of interest Demand Characteristics= The unwanted effect of a participant trying to guess what the hypothesis might be or to try to meet some perceived expectation Meta-analysis= a statistical technique for analysing results across multiple studies Limitations: (1) incorporates the findings of studies that were poorly done or had methodological flaws in the first place (2) File drawer effect- Cannot capture those studies that were not published in the first place because they did not provide the hypothesized results Informed Consent: Requires participants know the following: -Purpose of the study -Who is doing the study and contact information -Study Procedures -Role of the participant -Risks of participation and how likely they are to occur -Voluntary – decline to participate will not result in future repercussions 2) Psychological Assessment: What is it that you are going to assess? -General vs. specific symptoms -For what purpose are you conducting the assessment? -Identify a diagnosis -Suitability for specific intervention Gathering Information: Current symptoms -How much do they interfere with the client’s ability to function? -How does he/she cope with stressful situations? Recent events -Have any negative or positive events happened lately? Are the events tied to the onset of symptoms? History of psychological disorders -Has the client experienced symptoms similar to the current ones at some time in the past? Different symptoms? Family history of psychological disorders -Does the client’s family have a history of psychological disorders or symptoms? Physical Condition -Any medical conditions? Drug and Alcohol Use -Is the client taking any drugs that could cause symptoms? Exacerbate symptoms? -Is the client taking any prescriptions that could interact negatively? Intellectual and Cognitive Functioning -Any cognitive deficits that could cause symptoms? -Important for differential diagnosis- process of ruling out other potential disorders (or determining which of a number of possible diagnoses is correct) Social Resources -Friends and family, amount of contact, and the quality of these relationships Sociocultural Background -culture has diff effects on symptoms of disorder Acculturation -To what extent does the individual identify with his/her group of origin vs. the mainstream dominant culture? Assessment Tools: Intake interview -Structured versus unstructured -Purpose of the interview Symptom Questionnaires -These questionnaires may cover a wide variety of symptoms, representing several different disorders such as the 21-item Beck Depression Inventory (BDI). Limitations of Interviews -Resistance from the client -Selective information provided by the client Are the measures that you are using valid and reliable? Validity: accuracy of a test in assessing what it is aiming to measure Reliability: consistency of a test in measuring what it is suppose to measure Types of validity of Assessment tools: Face= Test appears to measure what it is supposed to measure. Content= Test assesses all important aspects of phenomenon. Concurrent= Test yields the same results as other measures of the same behavior, thoughts or feelings. Predictive= Test predicts the behavior, thoughts, or feelings it is supposed to measure. Construct= Test measures what it is supposed to measure and not something else. Types of reliability: Test-Retest: Test produces similar results when given at two points in time. Alternate Form: Two versions of the same test produce similar results. Internal: Different parts of the same test produce similar results Interrater or interjudgement: Two or more raters or judges who administer a test to an individual and score it come to similar conclusions. Neuropsychological Test: -Used when neurological impairment or dysfunction is suspected (e.g., brain injury, dementia associated with Alzheimer’s disease) -Inferences may be drawn about brain-behaviour relationships (and dysfunctions) even in the absence of physically-observable damage or problems as may be observed with brain imaging techniques (e.g., CT-Scan). -May also be used with normally functioning brains to help link functions and skills with specific brain areas -As an example, the Bender-Gestalt test is used to capture a range of sensorimotor skills Verbal Fluency Test: "I'm going to say a letter of the alphabet and I want you to say as quickly as you can all the words that you can think of which begin with that letter. You may say any words at all, except proper names such as the names of people or places. So you would not say Rochester or Robert. Also do not use the same word again with a different ending, such as eat and eating. For example, if I say S, you could say Son, Sit, Shoe, or Slow. Can you think of other words beginning with the letter S?" "That's fine. Now I'm going to give you another letter and again you say all the words beginning with that letter that you can think of. Remember, no names of people or places, just ordinary words. Also, if you should draw a blank, I want you to keep on trying until the time limit is up. You will have one minute for each one. The first letter is F” If there is silence after 15 seconds, repeat the basic instructions and the letter Brain-imaging techniques: Computerized tomography (CT)- X-Ray beams are passed through the brain and images formed by the amount of radiation absorbed and reflected. Addresses structure not function. Positron-emission tomography (PET)- Assesses brain activity by measuring movement of photons through the injection of a radioactive isotope. Magnetic resonance imaging (MRI)- Provides finely detailed pictures and does not expose the person to radiation. Relies on magnetically affecting hydrogen atoms in a way that provides 3D images of the brain. Intelligence Test: -In a clinical context, intelligence tests determine intellectual strengths and weaknesses (e.g. when mental retardation or brain damage is suspected) -Often used in school settings to help place and/or determine appropriate resources for children with exceptionalities (e.g., giftedness) -Results can be useful on a test-by-test basis (e.g., vocabulary) , from composite scores from ability domains (e.g., verbal fluency, abstract reasoning, visual-spatial functioning), from IQ scores calculated on broader ability domains (e.g., Verbal and Performance IQs), and for capturing Full Scale IQ (a measure of the construct of overall intellectual functioning). -The Stanford-Binet and the Wechsler family of scales are the best known of the individually administered intelligence tests Criticism of Intelligence Test: -Little agreement as to what is meant by intelligence -Most intelligence tests only assess verbal and analytical abilities -Lack ecological validity -Biased toward middle and upper-class educated European Americans (but note, this depends upon what you mean by “biased”) Personality Inventories -Questionnaires meant to assess people’s typical ways of thinking, feeling, and behaving. -Minnesota Multiphasic Personality Inventory (MMPI) is the most widely used personality inventory (in addition to the 10 clinical scales are 4 validity scales to help determine the legitimacy of, and how to shape, what is learned across the clinical scales). -NEO – Five Factor Model – 240 Item Five Factor Scales: Neuroticism, Extraversion, Openess, Agreeableness & Conscientiousness Projective Tests: -Rorschach Inkblot Test -Thematic Apperception Test (TAT) -The Sentence Completion Test -Draw-A-Person Test -These tests are all designed to tap into unconscious processes -The most common criticisms directed at projective tests relate to concerns about reliability and validity Behavioural Observation -Example: Watching a child interact with another child to see what provokes him or her -Can be problems with inter-rater reliability; very important to “operationalize” the behaviour to be observed Self-Monitoring -Example: Asking a client to keep track of the number of times per day he or she engages in a specific behaviour such as smoking a cigarette -Open to various forms of self-report bias Problems in Assessment: Evaluating Children: -Difficulties in communication and reporting Cultural Bias: -Language barriers -Different cultures experience different psychological disorders differently (e.g., differences in manifestation of distress, most notably psychologically as opposed to physically) -Which culture gets to set the boundaries for what is normal or abnormal? Axis I Clinical Disorders Mood disorders, Anxiety disorders, Psychotic disorders, ADHD, eating disorders Axis II Personality Borderline personality disorder Disorders & Mental retardation Axis III General Medical Hypertension, Hypo thyroidism condition Axis IV Psychosocial and Occupational, educational, social or interpersonal environmental conditions Axis V Global Assessment 100 – Superior functioning in wide range of areas of functioning 60 – Moderate symptoms and difficulty functioning 30- Considerable delusions and hallucinations or serious impairment in communication 10 – Persistent danger of severely hurting self or others Concerns with DSM-IV: -Defining where normality ends and psychopathology begins. -Differentiating mental disorders from each other: Challenges of differential diagnosis & comorbidity. -Cultures define disorders differently. -Diagnostic criteria are influenced by politics, culture, and ideology. Put differently, they are socially constructed (the degree to which social and political forces shape the DSM remains a matter of debate). -Negative social implications of receiving a psychiatric diagnosis. LECTURE 3 Anxiety DIsorders 1. Fear and Anxiety Adaptive Fear Maladaptive Fear •Concerns are realistic, all things •Concerns are unrealistic; source of considered. anxiety either cannot hurt them or very •Amount of fear experienced in unlike to occur proportion to the threat •Amount of fear experienced is out of •Fear response subsides when the threat proportion to the harm the threat could ends cause •Fear response continues or is persistent even after the threat is no longer present; additionally, the person may experience a great deal of anticipatory anxiety Symptoms of Anxiety Somatic Goosebumps emerge, Muscles tense, Heart rate increases, Respiration accelerates, Respiration deepens, Spleen contracts, Peripheral blood vessels dilate, Liver releases carbohydrates, Bronchioles widen, Pupils dilate, Perspiration increases , Adrenaline is secreted, Stomach acid is inhibited, Salivation decreases , Bladder relaxes Emotional Sense of dread, Terror , Restlessness, Irritability Cognitive Anticipation of harm, Exaggerating of danger, Problems in concentrating , Hypervigilance , Worried, ruminative thinking, Fear of losing control, Fear of dying, Sense of unreality Behavior Escape , Avoidance, Aggression, Freezing, Decreased appetitive responding, Increased aversive responding Panic Attacks- not disorder but occurs within many anxiety disorders -characterized by dizziness symptoms, cardio-respiratory distress & cognitive factors Palpitations or pounding heart, Sweating, Trembling or shaking, Sensations of shortness of breath or being smothered, Feeling of choking, Chest pain or discomfort, Nausea or abdominal distress, Feeling dizzy, lightheaded or faint, Derealization (feelings of unreality or depersonalization (being detached from oneself), Fear of losing control or going crazy, Paresthesias (numbness or tingling sensations), Chills or hot flushes Agorophobia= Anxiety about being in places from which escape might be difficult/embarrassing, or in which help may not be available in the event of a panic attack 2. Panic Disorder Diagnostic Without Agoraphobia Criteria a)Both (1) and (2): 1)Recurrent, unexpected panic attacks 2)At least one of the attacks followed by 1 month or more of a.Concern about having another one b.Worry about the consequences of an attack b)Absence of Agoraphobia c)Panic attack not due to physiological effects of a substance or medical condition d)Panic attacks not better explained by another mental disorder such as social or specific phobia With Agoraphobia a)Anxiety about being in places from which escape might be difficult/embarrassing, or in which help may not be available in the event of a panic attack b)Situations are avoided or endured with marked distress or anxiety about having a panic attack c)Anxiety or avoidance not better accounted for by another anxiety disorder Panic Disorder with Agoraphobia = Criteria for PD + Criteria for Agoraphobia Cause Genetic Theories: Genetic transmission puts some people at risk for panic disorder; 10% of people with panic disorder have first degree relatives also diagnosed Neurotransmitter theories: Poor regulation of norepinephrine, serotonin, and perhaps GABA and CCK in the locus ceruleus and limbic system, causes panic disorder Poorly regulated fight-or-flight response: Some people are particularly sensitive to having their fight-or-flight responses triggered (as seen by sensitivity after increasing carbon dioxide levels by hyperventilating) Kindling Model: Poor regulation in the locus ceruleus causes panic attacks, stimulates and kindles the limbic system, lowering the threshold for stimulation of diffuse and chronic anxiety Poor regulation in locus ceruleuspanick attackslower threshhold for chronic anxiety in limbic system  chronic anxiety increases likelihood of dysregulation in locus cereleus panick attacks Cognitive theories: People prone to panic attacks (1) pay very close attention to their bodily sensations (i.e., increased interoceptive awareness), (2) misinterpret these sensations, and (3) engage in catastrophizing thinking. -Such people may be labeled as being high in anxiety sensitivity Gender Theories: -Women display anxiety sensitivity more frequently than do men - Some evidence that ovarian hormones, particularly progesterone, play a role in increasing susceptibility to panic disorder Prevalence -40% of young adults have occasional panic attacks; lifetime prevalence in Canada estimated at 1.2% in one study (other studies put this figure at 3-4%) -Characterized by: -Intense fear or discomfort -Physiological symptoms of anxiety -Perception of losing control, going crazy, or dying -Often precipitated by some sort of triggering event or stimulus but not always -Age of onset: late adolescence to mid 30’s Highly co-morbid with other anxiety disorders and depression Treatments Biological Treatments: Tricyclic antidepressants -Increase levels of norepinephrine and a number of other neurotransmitters Serotonin reuptake (SSRIs) -Increase levels of serotonin Benzodiazepines -Suppress the central nervous system and influence functioning in the GABA, norepinephrine, and serotonin neurotransmitter systems -Caution: Benzodiazepines are physically and psychologically addictive Cognitive Behavioral Therapy 1.Clients are taught relaxation and breathing exercises. 2.The clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations. 3.Clients practice using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session. -A number of methods used to induce feelings of panic (e.g. breathing through a thin straw, spinning in chair, running on the spot) – Interoceptive exposure 4.The therapist will challenge clients’ catastrophizing thoughts about their bodily sensations and teach them to challenge their thoughts for themselves 5.The therapist will use systematic desensitization techniques to gradually expose clients to those situations they most fear while helping them to maintain control 3. Phobic Disorders Agoraphobia Fear of places where help might not be available in case of an emergency Speciifc Disorders Fear of specific objects, places or situations Social Phobia Fear of being judged by others or of embarrassing oneself in front of others Diagnostic Specific Phobias Criteria -Marked or persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation -Exposure to phobic stimulus almost invariably provokes an immediate anxiety response or panic attack -Person recognizes that the fear is excessive or unreasonable -Phobic situation avoided or endured with intense anxiety or distress -Symptoms interfere significantly with normal functioning, or there is marked distress about the phobia -Duration of at least 6 months Blood Injection-injury type -Physiological reaction distinct from other types -DROP in heart rate and blood pressure when confronted with feared stimuli -Likely to faint -Runs more strongly in families than other types Social Phobias a) Marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny of others b) Exposure to feared social situation almost invariably provokes anxiety or panic c) Person recognizes that the fear is excessive or unreasonable d) Feared social or performance situation avoided or endured with great distress or anxiety e) Symptoms interfere significantly with person’s normal routine, or occupational or social functioning Cause Psychodynamic Theories -Unconscious anxiety is displaced onto a neutral object. Behavioural Theories -Classical conditioning leads to fear of the object when it is paired with a naturally frightening event the case of Little Albert. -Avoidance of the object reduces anxiety which is reinforcing through operant conditioning. -Can also develop phobia from watching phobic response of another Observational learning -We seem to more readily acquire a classically conditioned phobic response to some stimuli more than others (e.g., snakes). -This may be explained by prepared classical conditioning where our common past has predisposed us to become especially phobic to objects that were, from an evolutionary point of view, likely to harm us Cognitive Theories -Social phobia develops in people with excessively high standards for their social performance, who assume others judge them harshly, and who are attentive to signs of social rejection. Biological Theories -Genetics contribute to risk for phobias, either directly or by creating certain temperaments that are more prone to phobias. Prevalence Specific Phobias: 1/10 have phobia within lifetime ~ 6% met criteria in study of anxiety clinic referrals Most develop during childhood, peak between ages 7&10 90% will not seek treatment Social phobias: -Life time prevalence ~ 7% -Women > Men -Develops either in early preschool years or in adolescence -Often comorbid with other anxiety disorders and mood disorders Most common: public speaking, speaking in front of small group, speaking in front of others, using toilet away from home, writing whilst someone watches, eating or drinking in public, social fear Treatment Behavioural 1)Systematic desensitization -Client creates list of situations/objects feared ranked from most to least feared -Learn relaxation techniques (except blood-injection-injury type) -Exposure to feared situation/object starting with least feared – paired with relaxation technique -Once anxiety towards feared item ceases, client moves up the hierarchy towards the most feared 2)Modelling -Used in conjunction with systematic desensitization -Therapist models feared behaviour before client makes an attempt 3)Flooding (aka Implosive Therapy) -Intense exposure of feared object until anxiety extinguishes -E.g. Client with claustrophobia locking themselves in closet for several hours -Can work fast than other behavioural techniques Cognitive-Behavioural Helps clients identify and challenge negative, catastrophizing thoughts about feared situations Biological -Benzodiazepines - SSRIs and MAOIs particularly for social phobia Effectiveness of Treatment: -CBT techniques are effective and prevent relapse -Group CBT is particularly helpful for Social Phobia -SSRIs are more effective than placebo -Benzodiazepines effective in the moment but relapse once discontinued 4. Generalized Anxiety Disorder (GAD) Diagnostic a.Excessive anxiety and worry occurring more days than not Criteria for at least 6 months about a number of events or activities b.Person finds it difficult to control the worry c.Anxiety and worry associated with 3 or more of the following 6 symptoms for more days than not: 1)Restlessness or feeling keyed up 2)Being easily fatigued 3)Difficulty concentrating 4)Irritability 5)Muscle tension 6)Sleep disturbances d.Anxiety and worry not confined to features of another Axis I disorder e.Symptoms cause clinically significant distress or impairment in functioning Cause Psychodynamic Theories - Freud -Realistic anxiety -Neurotic anxiety -Moral anxiety Humanistic and Existential Theories -Conditions of worth and existential anxiety Cognitive Theory -Automatic thoughts overlaid on maladaptive assu
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