Study Guides (238,202)
Canada (115,009)
Psychology (633)
PS280 (28)


109 Pages
Unlock Document

Wilfrid Laurier University
John Stephens

1. Introduction 02/05/2014 Definitional and Historical Considerations, and Canada’s Mental Health System Psychopathology (aka abnormal psychology) Field concerned with the nature of development of abnormal... Behavior Thoughts or cognition Feelings or emotion What is abnormal behavior? Abnormality usually determined by the presence of several characteristics at one time such as: Statistical infrequency A behavior that occurs rarely or infrequently A 14-year-old wetting the bed and Mental retardation (IQ < 70) occur infrequently, as do most mental disorders Is statistical infrequency a good enough marker to determine if a behavior is abnormal? Consider elite athletic ability Consider the flip side of mental retardation -- intellectual giftedness (IQ > 130) Ex. Blue/red/purple/etc. hair Violation of norms A behavior that defies or goes against social norms; it either threatens or makes anxious those observing it Anti-social behavior of the psychopath violates social norms and is threatening to others But "violation of norms" needs to be considered in reference to prevailing cultural norms What is the norm in one culture may be abnormal in another A prostitute violates social norms but does this mean that she/he would necessarily meet diagnostic criteria for a mental disorder? Personal distress A behavior that creates personal suffering, distress or torment in the person This criterion fits many of the forms of abnormality such as depression but some disorders do not necessarily involve distress Psychopaths are often not distressed by their behavior, although these behaviors impact others in a negative way  Hunger and childbirth cause distress, but is this abnormal? Disability or dysfunction A behavior that causes impairment in some important area of life (e.g. work, personal relationships, recreational activities) Example of exceptions Being short if you want to be a professional basketball player Transvestism is not seen as a disability but it is currently diagnosed as a mental disorder if it distresses the person Why would transvestism without distress not be considered a disability? Most transvestites are married, lead conventional lives and usually cross-dresses in private Unexpectedness A surprising or out-of-proportion response to environmental stressors can be considered abnormal Ex. We would expect someone to be sad if they lost a loved one to cancer; we would not expect someone to laugh after they've been sexually assaulted Ex. Anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation The study and treatment of mental disorders in Canada There are approximately 3,600 practicing psychiatrists 13,000 psychologists and psychological associates 11,000 nurses specialize in the mental health area 8-9000 MSW's Non-medical practitioners usually work within hospital or agency settings on a salary or in private practice Public health plan reimbursement of fees-for-service is limited to medical doctors Most of the primary mental health care is delivered by general practitioners Psychiatrist/psychologist - what's the difference? Clinical psychologists typically have a Ph.D. or Psy.D. degree, which entails four to seven years of graduate studies Psychiatrists hold an MD degree and have had postgraduate training, in which they receive supervision in the practice of diagnosing and psychotherapy Because psychiatrists have an MD degree, they can prescribe psychoactive drugs, whereas psychologists can not History of Psychopathology "Those who cannot remember the past are condemned to repeat it." Pre-scientific inquiry Mental disorders were believed to be caused by: Events beyond the control of humankind, such as eclipses, earthquakes, storms, fire, diseases were regarded as supernatural Behavior that seemed outside individual control was subject to similar interpretation Thus, many early philosophers, theologians, and physicians believed that deviant behavior reflected the displeasure of the gods or possession by demons Demonology Demonology: The doctrine that an evil being, such as the devil, may dwell within a person and control his/her mind and body Found in record of early Chinese, Egyptians, Babylonians and Greeks Given that abnormal behavior was caused by possession, treatment often involved exorcism  Ranged from elaborate rites of prayer to flogging and starvation as a way of rendering the body uninhabitable to devils Trepanning Involved the making of a surgical opening in a living skull by some instrument Treatment used by Stone Age or Neolithic cave dwellers Used to treat epilepsy, headaches, and psychological disorders attributed to demons Thought to be introduced into the Americas from Siberia Practice was most common in Peru and Bolivia, 3 British-Columbia Aboriginal specimens found Hippocrates (ca. 460–377 B.C) Separated medicine from religion, magic, and superstition Rejected belief that the gods sent physical diseases and mental disturbances as punishment Insisted that illnesses had natural causes thus should be treated like other illnesses Somatogenesis vs. Psychogenesis Hippocrates is one of the earliest proponents of somatogenesis Somatogenesis (genesis = origin) Mental disorders are caused by aberrant functioning in the soma (i.e., physical body) and this disturb thought and action Psychogenesis Mental disorders have their origin in psychological malfunctions Hippocrates’ Humoral Physiology Hippocrates’ treatments were different from exorcistic tortures Tranquility, proper nutrition, abstinence from sexual activity were prescribed for melancholia Mental health dependent on a delicate balance among four humors, or fluids, of the body Imbalances and results Increase in blood = changeable temperament Increase in black bile = melancholia Increase in yellow bile = irritability and anxiousness Increase in phlegm = sluggish and dullness The Dark Ages and Demonology Churches gained in influence, papacy was declared independent of the state Christian monasteries replaced physicians as healers and as authorities on mental disorder The monks cared for and nursed the sick By praying and touching them with relics or Concocting fantastic potions for them Persecution of Witches During the 13th and the following few centuries, major social unrest and recurrent famines and plagues People turned to demonology to explain disasters Led to an obsession with the devil – ‘witches’ blamed and persecuted 1484 Pope Innocent VIII exhorted European clergy to leave no stone unturned in the search for witches Sent 2 Dominican monks to northern Germany as inquisitors who later issued the manual entitled the Malleus Maleficarum Used to guide witch hunters Came to be seen by Catholics and Protestants as a textbook on witchcraft Over the next several centuries, hundreds of thousands of people accused, tortured, and murdered Witchcraft and Mental Illness Were so-called witches psychotic? Detailed examination of historical period indicates most were not mentally ill Delusion-like confessions were obtained during torture Other info. that "witches" not mentally ill From 13th century on in England, hospitals took over churches’ responsibility to tend to the ill Laws allowed dangerously insane and incompetent to be confined to hospital And people confined were not described as being possessed Early 13th century “lunacy” trials held in England Trials conducted to protect the mentally ill Judgment of insanity allowed Crown to become guardian of estate Defendant’s orientation, memory, intellect, daily life, and habits were at issue in the trial Strange behavior were explained as physical illness / injury Development of asylums Until the end of the 15th century, very few mental hospitals in Europe but England and Scotland had 220 leprosy hospitals Leprosy gradually disappeared from Europe and attention turned to the mentally ill Confinement began in earnest in the 15th-16th centuries Leprosariums were converted to asylums Asylums took disturbed people and beggars Had no specific regimen for their inmates but work Despite the desire to help ‘the mad,’ hospitals tailored for the confinement of the mentally ill also emerged St. Mary of Bethlehem Founded in 1243 in London, devoted solely to the confinement of the mentally ill Conditions were deplorable (bedlam) Eventually became one of London’s great (paid) tourist attractions Viewing the violent patients considered entertainment Discussion Point: What might be the effects of such inhuman treatment on the sequela of mental illness? Moral treatment Philippe Pinel (1745–1826) considered primary figure in movement for humanitarian treatment of the mentally ill in asylums Believed patients should be treated with dignity Put in charge of a large asylum in Paris known as La Bicêtre Removed the chains of the people imprisoned Began to treat patients as sick rather than as beasts Light and airy rooms replaced dungeons Walks around the grounds were allowed Results? Some patients incarcerated for years were discharged Dorothea Dix Moral treatment was abandoned in the latter part of the 19th century but Dorothea Dix’s (1802–77) efforts resurrected it Boston schoolteacher who taught a Sunday-school class at the local prison  Shocked by deplorable conditions and interest spread to the conditions of patients in mental hospitals Campaigned vigorously and successfully to improve the lives of people with mental illness Created 999 Queen in Toronto Asylums in Canada Network of asylums eventually established in Canada Alberta Insane Asylum, Ponoka 1911 British Columbia Public Hospital for the 1878 Insane, New Westminster British Columbia Mental 1913 Hospital, Coquitlam Manitoba Selkirk Asylum, Selkirk 1886 Home for Incurables, 1890 Portage-la-Prairie Brandon Asylum, Brandon 1891 New Brunswick Provincial Hospital, Saint1835 John Provincial Lunatic Asylum 1848 Nova Scotia Nova Scotia Hospital for 1857 Insane, Halifax Ontario Provincial Lunatic Asylum, Toronto 1850 Kingston Asylum (Rockwood), Kingston 1856 London Asylum, London 1859 Orillia Asylum for Idiots, Orillia 1861 Hamilton Asylum, Hamilton 1876 Mimico Branch Asylum, Mimico 1890 Hospital for Insane, Brockville 1894 Cobourg Asylum 1902 Penetanguishene Asylum, Penetanguishene1904 Whitby Hospital, Whitby 1914 Prince Edward Island The Prince Edward Island Hospital for the1877 Insane Quebec Quebec Lunatic Asylum, Beauport 1845 Provincial Lunatic Asylum, St. John’s 1861 L’Hospice St. Jean de Dieu, Longue Point 1856 L’Hospice St. Julien, St. Ferdinand d’Halifax 1873 L’Hospice Ste. Anne, Baie-St. Paul 1890 Protestant Hospital for the Insane, Verdun 1890 St. Benedict Joseph Asylum, near city of Montreal 1885 Saskatchewan The Saskatchewan Provincial Hospital, Battleford 1914 Newfoundland Asylum for the Insane, St. John’s 1855 Northwest Territory Taken to asylums of Alberta and Saskatchewan 1914 Yukon Taken to New Westminster by Royal Northwest Mounted 1877 Police Beginning of Contemporary Thought In 19th century, return to the somatogenic views first espoused by Hippocrates Early system of classification established Emil Kraepelin (1856-1926) Created a classification system to establish the biological nature of mental illnesses (DSM) Noticed clustering of symptoms (syndrome) which were presumed to have an underlying physical cause, In fact, mental illness is seen as distinct, with own genesis, symptoms, course, and outcome Proposed two major groups of severe mental diseases: Dementia praecox (early term for schizophrenia) Thought chemical imbalance as the cause of schizophrenia Manic-depressive psychosis (now called bipolar disorder) Thought an irregularity in metabolism as the cause of manic-depressive psychosis Importantly, Kraepelin’s early classification scheme became the basis for the present diagnostic categories General Paresis and Syphilis Mid-1800s progress was being made in terms of understanding senile and presenile psychoses and mental retardation from a more biological perspective Far more was then discovered about the nature and origin of syphilis General paresis characterized by steady physical and mental deterioration, delusions of grandeur and progressive paralysis from which there was no recovery Discovery provides a good example of the increasing use of empirical approaches used to understand mental illness Louis Pasteur Germ theory of disease, established by Pasteur Laid the groundwork for demonstrating the relation between syphilis and general paresis Also helped establish a causal link between infection, destruction of brain areas, and a form of psychopathology Light bulb moment: If one type of psychopathology had a biological cause, so could others Result: Somatogenesis gained credibility and became a dominant theory Psychogenesis re-visited Somatogenic causes dominated field of abnormal psychology until 20th Century due in large part to discoveries about general paresis But, psychogenesis was still “in fashion” in countries like France and Austria Current Attitudes Much progress has been made in terms of understanding the nature, origin, developmental course and treatment of psychological disorders Still, many Canadians are still suspicious of people with mental health issues These concerns are reinforced with negative stereotyping and stigmatization Unfortunate consequence is that many people with mental illness do not seek help Mental Health Care in Canada Canada has a universal health care system since 1970 Each province/territory is responsible for administrating health care Health-care re-organization and funding cuts have led to the closing of long-term psychiatric mental hospitals and beds on psychiatric hospital wards Community services are expected to take over some of these services See Canadian Perspectives 1.2 for more details Historical Perspective of Mental Health Care in Canada The health care system in Canada has not always been stellar in its ethical treatment of patients under its care Examples are: Dr. Cameron’s brainwashing treatment in Montreal in the 1950s and 60s Psychosurgery (e.g., lobotomy) performed out of scientific curiosity, i.e., to see how it would change patients In either case, consent was not obtained from patients or families Lobotomies were banned in all psychiatric hospitals in early 1980s See Canadian Perspectives 1.3 for more details The Romanow Report Building on Values: The Future of Health Care in Canada (2002) The Romanow Report made 47 recommendations Romanow called mental health care “the orphan child of medicare” and recommended to make it a priority Some of the recommendations were: Include some homecare services for case management and intervention services Develop a national drug agency Provide a emergency drug program to help those with severe mental illnesses (e.g., schizophrenia and bipolar disorder) Establish a program to support informal caregivers (e.g., friends, families) who assist the mentally ill in critical times The Kirby Report Out of the Shadows at Last: Transforming Mental Health, Mental Illness, and Addiction Services in Canada (The Senate Committee on Social Affairs, Science and Technology, 2006) 2 Key recommendations were made: The creation of the Canadian mental health commission Facilitate a national approach to mental health issues Promote reform of mental health policies and improvement of services Educate Canadians by increasing mental health literacy Reduce stigma and discrimination of mentally ill individuals and families The creation of the 10-year Mental Health Transition Fund Provide affordable housing to the mentally ill Offer support to provinces / territories in order to increase services in the community The Future of Psychology The Canadian Psychological Association (CPA) was critical of the Romanow Report as it (1) did not include psychology’s vision and (2) embraced a ‘physical medicine vision’ or somatogenic perspective CPA argued that: A plethora of research on the improved effectiveness of pharmacotherapy when combined with psychological treatment Savings could range as high as 80% of currently dominant treatments, including medication The World Health Organization (WHO) and other organizations advocate for (1) the integration of mental health services into primary health care and (2) the collaboration of care teams as the way of the future 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 What is a paradigm? A model of reality: the way reality is or is supposed to be  It is a set of beliefs that shape our perception of events and help us explain these events  It is a set of concepts and methods used to collect and interpret data (Kuhn, 1992)  A paradigm guides the definition, examination, and treatment of mental disorders Paradigms in Abnormal Psychology • Biological Paradigm o Medical model o Continuation of the somatogenic hypothesis o Mental disorders caused by aberrant or defective biological processes o Often referred to as the medical model or disease model o The dominant paradigm in Canada and elsewhere from the late 1800s until middle of the twentieth century • Behavior genetics o Study of individual differences in behavior attributable to differences in genetic makeup o Genotype – unobservable genetic constitution  Fixed at birth, but it should not be viewed as a static entity o Phenotype – totality of observable, behavioral characteristics  Changes over time; product of an interaction between genotype and environment o Methods  Family method  Index cases, or probands  Twin method  Concordance rates  Adoptees method Molecular genetics o Tries to specify particular gene(s) involved and precise functions of target genes Overview 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 46 chromosomes (23 pairs); thousands of genes per chromosome Allele – any one of several DNA codings that occupy the same position or location on a chromosome Person’s genotype is his or her set of alleles Genetic polymorphism Involves differences in the DNA sequence that can manifest in different forms Entails mutations in a chromosome that can be induced or naturally occurring Linkage analysis Method in molecular genetics that is used to study people Typically study families in which a disorder is heavily concentrated; genetic markers Gene-environment interactions The Nervous System The nervous system is composed of billions of neurons Each neuron has four major parts: (1) the cell body (2) several dendrites (3) one or more axons of varying lengths (4) terminal buttons Nerve impulse Synapse Neurotransmitters Reuptake Structure of Brain Meninges – 3 layers of nonneural tissue that envelop the brain Cerebral hemispheres – constituting most of the cerebrum “Thinking” centre of the brain Includes the cortex and subcortical structures such as the basal ganglia and limbic system Corpus collasum – major connection between the two hemispheres 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Cerebral cortex – upper, side, and some of the lower surfaces of hemispheres Consists of six layers of neuron cell bodies with many short, unsheathed interconnecting processes Grey matter – thin outer covering Gyri – ridges Sulci – depression or fissures Deep fissures divide the cerebral hemispheres into several distinct areas called lobes Frontal lobe – lies in front of the central sulcus Parietal lobe – behind frontal lobe and above the lateral sulcus Temporal lobe – located below the lateral sulcus Occipital lobe – behind the parietal and temporal lobes Functions of the Brain Examples of Functions Vision in occipital lobe Discrimination of sounds in temporal lobe Reasoning and other higher mental processes, as well as regulation of fine voluntary movement, in frontal lobe Left hemisphere – responsible for speech and perhaps for analytical thinking in right- handed people Right hemisphere – discerns spatial relations and patterns, and is involved in emotion and intuition But keep in mind that the 2 hemispheres communicate with each other constantly via the corpus collasum Evaluation of Biological Paradigm Rapid progress is being made in understand brain-behavior relationships and the role of specific genetic factors Neuroscience helps improve psychological treatments Caution against reductionism – the simplification of a phenomenon to its basics elements Nervous system dysfunction are not always due to a neurological defect At times, a psychological intervention has a similar effect on the biology as a psychotropic medication would (see p. 46) Cognitive-Behavioral Paradigm Leading paradigm in therapeutic intervention Change thought = change behavior 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Behavioral perspective The behavioral (learning) perspective Views abnormal behavior as responses learned in the same ways other human behavior is learned Classical Conditioning Ivan Pavlov Operant Conditioning J. F. Skinner (1904-1990) Law of effect Behavior that is followed by + consequences will be repeated Behavior that is followed by – consequences will be discouraged Positive reinforcement Strengthening of a tendency to respond by virtue of the presentation of a pleasant event - Positive reinforcer Negative reinforcement Strengthens a response by the removal of aversive events Modelling Sometimes called Behaviour Modification Systematic desensitization #1 conditioning treatment Slowly desensitize Ex. Teach people how to relax around one of their fears Counterconditioning and Exposure Aversive conditioning Shock therapy Ex. Pedophiles shocked when shown various pictures depicting children Create connection between pain and inappropriate pictures/videos/thoughts of children Operant Conditioning Ex. Time-out 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Modelling Assertion training Cognitive perspective Focuses on people: Structure experiences, interpret experiences, relate current experiences to past ones Schemas Cognitive Behavior Therapy (CBT) Main focus: Cognitive restructuring Number one choice for therapy Approx. 85% of practicing psychologists/psychiatrists use CBT Piaget Language guides behaviour Ex. Thinking out loud when completing a task Beck’s Cognitive Therapy Ellis’s Rational-Emotive Behavior Therapy Meichenbaum’s Cognitive-Behavior Modification Kids in sandbox; found connection between thinking out loud and impulsive behaviour Taught children to be reflective to counteract impulsiveness Behavior Therapy and CBT in Groups Evaluation of the Cognitive-Behavioral Paradigm Criticism Particular learning experiences have yet to be discovered; e.g., showing how some reinforcement history leads to depression (life-time observation) Practicing new behaviors (satisfying activities) does not prove that the absence of rewards caused for the abnormal behavior How does observing someone lead to a new behavior? Cognitive processes must be engaged Some people's thoughts are not readily available/unable to articulate Schemas are not well defined; regarded as causing depression, BUT no explanation of what causes the ‘gloomy’ schemas Unclear differences between behavior and cognitive influences: importance of behaving in new ways for change to occur 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Contributions Integration of 2 perspectives, i.e., CBT, has shown benefits in psychotherapy Strong evidence of its benefits in improving depression, anxiety disorders, eating disorders, autism, and schizophrenia Ex. CBT can be more effective long-term than antidepressants in treating depression Psychoanalytic Paradigm Psychopathology results from unconscious conflicts in the individual Structure of Mind (according to Freud) ID Present at birth Part of the mind that accounts for all the energy needed to run the psyche Comprises the basic urges for food, water, elimination, warmth, affection, and sex Basic, raw thoughts Isn't expressed because we have been socialized Mainly present in psychopaths (lack ego/superego) Unless there are authorities around EGO Primarily conscious Begins to develop from the id during the second six months of life Task is to deal with reality Thoughts derived form id are stopped by the ego SUPEREGO Operates roughly as the conscience Develops throughout childhood The "mom" Judging side Ex. "I would not be a good person if I said the stuff that's on my mind right now" Objective anxiety vs. 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Neurotic anxiety vs. Moral anxiety Defense Mechanisms Unconscious strategies used to protect the ego from anxiety Pathology occurs when defense mechanisms are overused Examples Repression Denial Projection Displacement Reaction formation Regression Rationalization Sublimation Ex. Alcohol is the result of not enough breastfeeding - Freud Psychoanalytic Therapy The goal is to remove earlier repression, face childhood conflict, and resolve it from adult reality Recall: Much of Freud's theories are about looking back on childhood and the effects it has on the adult Free association Psychologist sits out of sight of patient to lessen distractions Dream analysis Latent content Analysis of repeated dreams Some key components of psychoanalytic therapy Transference Transferring behaviour/thoughts to therapist as if they are the patient's mom/dad/etc. Shows how patients look for mother/father/figure/role model in others 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Countertransference Same as above, but speaking to therapist as child instead of adult Interpretation Modifications in Psychoanalytic Theory Group Psychodynamic Therapy Ego Analysis Takes weeks (opposed to years as seen in previous years of ego anaylsis) Brief Psychodynamic Therapy Contemporary Analytic Thought Interpersonal Therapy Influence on eating disorders Evaluation of Psychoanalytic Paradigm Criticism Theories based on anecdotes during therapy sessions are not grounded in objectivity, thus, not scientific Freud’s observations, recollections could be unreliable Observable behaviour is not always reliable Contributions Childhood experiences held shape adult personality There are unconscious influences on behavior People use defense mechanisms to control anxiety and stress Valid research shows the effectiveness of psychodynamic therapies Humanistic-Existential Paradigms Similar to psychoanalytic therapies, in that they are insight-focused But psychoanalytic paradigm assumes that human nature is something in need of restraint Free choice/thought How people make choices that are problematic Humanistic and existential paradigms 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Place greater emphasis on the person’s freedom of choice Free will as the person’s most important characteristic Exercising one’s freedom of choice take courage and can generate pain and suffering Seldom focus on cause of problems Carl Roger's Client-Centered Therapy Also known as person-centered therapy (aka client-centered therapy) Our lives are guided by an innate tendency toward self-actualization, thus focusing on positive factors Based on following assumptions: People can be understood only from the vantage point of their own perceptions and feelings (phenomenological world) Healthy people are aware of their behavior, are innately good and effective, and are purposive and goal-directed Therapists should not attempt to manipulate events for the individual Create conditions that will facilitate independent decision-making by the client Features – unconditional positive regard & empathy Humanistic Paradigm All people are striving to reach self-actualization; Anxiety occurs when there is a discrepancy between one’s self-perceptions and one’s ideal self; Carl Rogers – Client-Centred Therapy Gestalt Therapy – Fritz Pearl Existential Paradigm Anxiety arises when what individuals does not bring meaning in their lives (Viktor Frankl) Learning to relate authentically, spontaneously to others Evaluation Criticism Therapists inferences of the client’s phenomenology (world) may not be valid Assumption not demonstrated: People are innately good and would behave in satisfactory and fulfilling ways if faulty experiences did not interfere Self-awareness does not necessarily lead to change Contributions 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Rogers insisted that therapy outcomes be empirically evaluated Good for working with "healthy people" to make them more self-aware/gain more insight into themselves Consequences of Adopting a Paradigm Eclecticism / integration in psychotherapy Cherry pickers Take from all perspectives and integrate into their own views Guides the data that will be collected and how they will be interpreted Leads to ignoring possibilities and overlook other information Most therapist use a Prescriptive Eclectic Theory, a combination of ideas and therapeutic techniques CBT therapists show empathy; Learning therapists inquire about clients’ thoughts; Freud was directive and encourage behavior change Integrative Paradigm Diathesis-Stress Paradigm (will be on midterm) Focuses on interaction between predisposition toward disease (diathesis) and environmental, or life, disturbances (stress) Diathesis Underlying (constitutional) predisposition toward illness Any characteristic or set of characteristics that increases a person’s chance of developing a disorder That is: genetic, psychological, environmental factors can be predisposing to the development of a mental disorder Ex. Inherit respiratory sensitivity to pollens = diathesis for seasonal allergy Having a predisposition does not always ensure development There must also be a stressor (environmental, life, stress, etc.) Unpleasant environmental stimulus Ex. Traumatic event, day to day hassles May not remember traumatic event, but it has been embedded and will act as a stressor Diathesis increases risk for developing the disorder, but stress may actually trigger the disorder's onset Biopsychosocial Paradigm Core; biology - can be influenced by psychological and social factors Risk Factors 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Balance risk factors with coping mechanisms Protective Factors Developing good positive psychology can protect against many issues Risks are buffered by protective factors Cultural Considerations Canada, A Multicultural Country Acculturation and ‘Cultural Mosaic’ vs. Assimilation and ‘Melting Pot’ in U.S. Canada and U.S. differ on the following aspects: Language Foreign birth Visible racial differences Mental Health Implications of Diversity in Canada Extremely low rates of mental disorder in Hutterites, MA ‘Healthy Immigrant Effect’ Similar levels of behavioral problems among French/English-Canadians and Caribbean/Filipino-Canadian adolescents Under-usage of mainstream mental health services by members of minority groups: Asians in Canada (Chinese, Indian, Filipino, Vietnamese) and West Indian Aboriginals and Mental Health Problems Depression, drug abuse, suicide, low self-esteem, PTSD symptoms, violence, obesity, and diabetes are widespread Institutional discrimination over 300 Inuit people moved to the Far North Indian Residential Schools for 100 years Moving Aboriginals in reserves Aboriginal children are raised by relatives, thus moving between households, which is not a sign of trouble Treatment, due to importance of family, may be conducted in the home with all members involved Diagnosing and Assessment 2. Current Paradigms and the Role of Cultural Factors 02/05/2014 Most assume that clients to best when matched w/ clinician of similar cultural background, however, Similarity in values or cognitive match may be more relevant for clients’ improvement The use of professional interpreters needs to become universal across Canada Mental health professionals need to be trained in cultural and ethnic particularities Clinicians must be aware that members of many minority groups are angry at a sometimes insensitive majority culture Both paradigms emphasize the interplay among the biological, psychological, and social/environmental perspectives 3. Classification and Diagnosis 02/05/2014 Diagnostic System of APA  Five Dimensions of Classification (DSM­V has no axis)  Axis I. All diagnostic categories except  personality disorders and mental retardation  Axis II. Personality disorders and mental retardation  Static, rare conditions  Axis III. General medical conditions  Axis IV. Psychosocial and environmental problems  How well school, friends, occupation is going  Axis V. Current level of functioning  Severity of disorder/illness  Measured by GAF   Global assessment of functioning  Symptoms begin to show between 70­61 GAF  Mild symptoms OR some difficulty in social, occupational, etc.  50­41 = serious symptoms  Typically hospitalized   10­1 = persistent danger of severely hurting self or others  Classification of Disorders  Substance­Related Disorders  Schizophrenia  Mood Disorders  Major depressive disorder  Mania   Bipolar disorder   Anxiety Disorders  Phobia   Panic disorder  3. Classification and Diagnosis 02/05/2014 Generalized anxiety disorder  Obsessive­compulsive disorder  Post­traumatic stress disorder  Acute stress disorder   Somatoform Disorders  Somatization disorder   Conversion disorder   Pain disorder   Hypochondriasis   Body dysmorphic disorder  Dissociative Disorders  Dissociative amnesia   Dissociative fugue   Dissociative identity disorder   Depersonalization disorder   Sexual and Gender Identity Disorders  Paraphilias  Sexual dysfunctions   Gender identity disorder   Sleep Disorders  Dyssomnias  Parasomnias   Eating Disorders  Anorexia nervosa  Bulimia nervosa  Binge eating disorder  Factitious Disorder  3. Classification and Diagnosis 02/05/2014 Adjustment Disorders  Impulse­Control Disorder  Intermittent explosive disorder  Kleptomania  Pyromania  Pathological gambling  Trichotillomania  Personality Disorders  Schizoid personality disorder  Narcissistic personality disorder   Anti­social personality disorder, etc.   Delirium, Dementia, Amnestic, and Other Cognitive Disorders  Gambling in Canada  Increases in gambling problems due to legalized gambling in several provinces  Prevalence rate of 2%; 2­4% for those ‘at risk’  Opening a casino increases gambling activities and negative consequences of gambling  Low­risk gambler: gambling 2­3 times / month; no more than 500­1000$ / year, or less than 1% of annual  family income   On­line problem gamblers have more problems than social gamblers   Who is likely to gamble?   Problem gamblers are more likely to be male, single, under the age of 30, and to have begun gambling  before age 18  Those with ‘gambler fallacy,’ the belief that one is more likely to win after a series of losses   Youth are at greater risk than adults;   Characteristics of youth gamblers in Toronto: male, out of school, working for pay, alcohol / marijuana use,  severe dating violence, carrying a weapon   Prevalence rates in students in Atlantic provinces are 8.2% for ‘at risk’ and 6.4% for problem gamblers  Consequences of gambling  For families: dysfunctional relationships, violence and abuse, financial pressure, disruption of growth and  development in children  Male & female adolescent severe problem gamblers hare similar rates of depression, substance use, and  weekly gambling   3. Classification and Diagnosis 02/05/2014 Linked to attempted suicide   Treatments for pathological gamblers  CBT;  Impulsivity  interferes with staying in treatment  Controlled gambling has shown efficacy in 35% of problem gamblers in 2­yr follow­up  Only 20% of adolescents problem gamblers admit having a gambling problem  Prevention, International Centre for Youth Gambling Problems and High­Risk Behaviors, Responsible Gaming Council and Canadian / U.S. universities   Classification of Disorders  Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence  Separation anxiety disorder   Conduct disorder   Attention­deficit/hyperactivity disorder   Mental retardation (listed on Axis II)   Pervasive developmental disorders   Learning disorders  Important Concepts  Epidemiology ­ the study of the course of a diathesis (geography, gender, etc.)  Prevalence  1/10 people w/ symptoms of depression, or anxiety, or alcohol/drug dependence  1/20 people met criteria for depression or bipolar disorder  1/20 with panic disorder, agoraphobia, or social phobia   1/30 met criteria for substance dependence (alcohol/drug)  1/50 met criteria for ‘at risk’ problem gambling   Eating disorders and agoraphobia 5x higher for women than for men  2/3 of young people ages 15­24 w/ depression and anxiety stated that their symptoms started before age  15  ½ people ages 45­64 and 1/3 of seniors reported that their symptoms began before age 25   3. Classification and Diagnosis 02/05/2014 Lifetime prevalence   Comorbidity   Overlap is dramatic  Go hand­in­hand  Ex. Alcoholism is comorbid with depression  Criticisms of Classification   General Criticisms  Loss of information about person  Stigmatizing  Specific Criticisms  Discrete Entity vs. Continuum  Dimensional Classification vs. Categorical Classification  DSM represents a categorical classification  Yes–No approach to classification  Continuity between normal and abnormal behavior not taken into consideration   Reliability  Reliability is the cornerstone of any diagnostic system  Inter­rater reliability   Validity   Validity of diagnostic categories?  Construct validity  Diagnosing at a Crossroads   The  DSM  revision process evaluated 2 alternatives:   Reorganizing the diagnostic classes   Implementation of fully dimensional schemes  A hybrid system : The DSM­V  will be a mixed categorical­dimensional system  Axes I, II, and III will be collapsed   3. Classification and Diagnosis 02/05/2014 Changes to Axes IV and V are being considered  Some diagnostic criteria are being revised to include gender, race, culture   ‘Meta­structure’ including shared risks (e.g., genetic, environmental) and clinical factors (e.g., comorbidity,  treatment response) are evaluated   Internet Addiction Disorder  Criticism: We are pathologizing normal behaviour  IAD is considered for inclusion in tDSM­V   Includes excessive gaming and email/text messaging   Shared components: excessive use, withdrawal symptoms, tolerance, negative repercussions   In Block’s (2008) study 86% of IAD cases also had another DSM  diagnosis   In Asia, therapists are trained to screen for IAD  In South Korea, 2.1% of children ages 6­12   80% of those requiring treatment need psychotropic medication, 20% require hospitalization    1.2 billion are considered at risk as they spend 23 hrs/w     *Bonus midterm question: What happened to Axis V*    4. Clinical Assessment Procedures 02/05/2014 A. Reliability and Validity in Assessment  Reliability  Inter­rater reliability  Test–retest reliability   Alternate­form reliability  Internal consistency reliability  Validity  B. Psychological Assessment  Interviews  Clinical interview  Initial assessment   History of client and problems  Allows for direct observation of client  Structured interviews  SCID  Diagnosis of psychopathology  Allow for direct observation of client  Psychological tests  Standardized procedures designed to measure person’s performance on a particular task or to assess  personality, or thoughts, feelings, and behavior  Personality Inventories  MMPI­2  Projective Personality Tests  Rorschach Inkblot Test   Thematic Apperception Test (TAT)  Intelligence Tests   Behavioral and Cognitive Assessment   Often a system that involves the assessment of four sets of variables is used (SORC)   4. Clinical Assessment Procedures 02/05/2014 S refers to stimuli  The environmental situations that precede the problem  O refers to organismic  Physiological and psychological factors assumed to be operating “under the skin  R refers to overt responses  These probably receive the most attention from behavioural clinicians who must determine  what behaviour is problematic, as well as the behaviour's frequency, form  C refers to consequent variables  Events that appear to be reinforcing or punishing the behavior in question  When a client avoids a feared situation, does his or her spouse offer sympathy and excuses, thereby  unwittingly keeping the person from facing up to his or her fears?  Getting some attention (though negative) is better than no attention at all ­ may reinforce  negative behaviour   Self­Monitoring  Ecological momentary assessment (EMA)  Conducted in real­world situations   Self­Report Inventories  Personality tests   Some Depression and Anxiety tests   Use of vignettes describing a situation to resolve  Assessment of wide­range of cognitions: “When  you witness some being unjustly punished, what  comes  through your mind?”   Specialized Approaches to Cognitive Assessment    Articulated Thoughts in Simulated Situations (ATSS)  Thought Listing  These measures are useful when investigators know little about the participants and the cognitive terrain  Videotape Recording    Participant watches the videotape and attempts to reconstruct thoughts and feelings  Family Assessment   Based on Family Systems Perspective (Minuchin et al., 1975)  Self­report measures   4. Clinical Assessment Procedures 02/05/2014 Family Environment Scale   Family Adaptation and Cohesion Evaluation Scale  McMaster Family Assessment Device   Family Assessment Measure­III  Parental Bonding Inventory   Behavioral assessment   C. Biological Assessment  Brain Imaging  Computerized axial tomography (CT scan)  Moving beam of X­rays passes into a horizontal cross­section of brain, scanning it through 360 degrees  Moving X­ray detector on the other side measures amount of radioactivity that penetrate  thus detecting  subtle differences in tissue density  Computer uses information to construct a two­dimensional, detailed image of the cross­section  Magnetic resonance imaging (MRI)  Superior to the CT scan because produces pictures of higher quality and does not rely on radiation required  by CT scan  Circular magnet causes the hydrogen atoms in the body to move  When magnetic force is turned off, the atoms return to their original positions and thereby produce an  electromagnetic signal  Signals are then read by the computer and translated into pictures of brain tissue  fMRI – records metabolic changes in the brain   Positron emission tomography (PET scan)  More expensive and invasive procedure  Allows measurement of brain function  Brain is labelled with a short­lived radioactive isotope and injected in bloodstream  Radioactive molecules of the substance emit a positron which collides with an electron  Pair of high­energy light particles shoot out from the skull in opposite directions and are detected by the  scanner  Computer analyzes millions of such recordings and converts them into a picture of the functioning brain  Neurochemical Assessment  Counting number of neurotransmitters on dead brain   4. Clinical Assessment Procedures 02/05/2014 Example— Analyzing the metabolites of neurotransmitters that have been broken down by enzymes in a  urine, blood, and cerebrospinal fluid samples  NOTE.  Biological assessments cannot be used to diagnose psychopathology but can play a role in its  accuracy    Neuropsychological Assessment  Neuropsychological tests — based on the idea that different psychological functions are localized in  different areas of the brain.   Halstead­Reitan Battery  1. Tactile Performance Test—Time  2. Tactile Performance Test—Memory  3. Category Test   4. Speech Sounds Perception Test  Luria­Nebraska Battery   Helps distinguish memory from meta­memory problem  Distinguish encoding problem from memory problem  Using 20 cards with photos, presented in stages   Psychophysiological Assessment   Activities of the autonomic nervous system are frequently assessed by electrical and chemical  measurements in attempt to understand the nature of emotion.   Heart rate measured with  electrocardiogram   Skin conductance measured with  electrodermal responding   Brain activity measured by electroencephalogram (EEG)    D. Cultural Diversity and Clinical Assessment  Cultural Bias in Assessment  Strategies to Avoid Cultural Biases in  Assessment  Example: language, Canadian norms, spiritual  and religious beliefs, illness beliefs, family  involvement,  individualistic vs. collectivistic  perspectives    5. Research Methods 02/05/2014 Science and Scientific Methods  Science: The pursuit of systematized knowledge through observation  Testability and Replicability  A hypothesis must be amenable to systematic testing that could show it to be false   Hypothesis: Expectations about what should occur if a theory is true  The Role of Theory  Primary goal of science is to advance theories  Theory: A set of propositions meant to explain a class of phenomena Research Methods  Case Study: The detailed study of one individual, based on a paradigm   Providing detailed descriptions   Collecting historical and biographical information   Often includes details of therapy sessions   Several case studies can be compared and analyzed for common elements through a specific method  The case study as evidence   Particularly useful to negate a universal theory or law   Not useful to rule out alternative hypotheses   Generating hypothesis  Exposure to a large number of cases may allow the clinician to notice  similarities of circumstances and  outcomes  Epidemiological Research  Epidemiology: Study of frequency and distribution of a disorder in a population  Data are gathered about the rates of a disorder and its possible correlates in a large sample or population   Provides a general picture of a disorder   Good for planning health care needs for specific communities   Focuses on determining 3 features of a disorder:  1.Prevalence : Proportion of a population that has the disorder at a given point or period of time  2. Incidence : # of new cases of the disorder that occur in some period, usually a year  5. Research Methods 02/05/2014 3. Risk factors : Conditions or variables that, if present, increases the likelihood of developing the  disorder  Why only some were affected and the others weren't   Correlational Method  Is there a relationship between or among 2 or more variables?  Measuring Correlation  Correlation coefficient r )  May take any value between +1.00 and ­1.00  Measures magnitude and direction of relationship  Statistical Significance  Likelihood results of an investigation are due to chance   Applications to Psychopathology  Problems of Causality   Critical drawback of correlational research  Does not allow determination of cause­effect relationships  Correlation between two variables tells us only that they are related or tend to co­vary with each  Directionality problem   How can we tell which is the cause and which is the effect?  Correlation does not imply causation   Prospective, longitudinal design helps resolve the directionality issue   High­risk method: individuals with a predisposition are studied   Third­variable problem  Experimental Design  Generally considered most powerful tool for determining causal relationships between events  Involves (1) random assignment of participants to different conditions (2) manipulation of IV and  measurement of DV  Basic Features of Experimental Design  1. Researcher typically begins with an experimental hypothesis   2. Investigator chooses an independent variable (IV)  that can be manipulated  5. Research Methods 02/05/2014 3. Participants are assigned to the two conditions byrandom assignment    4. Researcher arranges for the measurement of a  dependent variable  (DV)  5.  Produces an  experimental effect   Internal validity  Extent to which effect can be confidently attributed to manipulation of IV; Inclusion of at least one control  group  Confounders  Placebo Effect  Placebo control group; Double­blind procedures  Double blind  Neither the experimenter nor the participant knows which dv and iv is being used  External validity  Can the results be generalized beyond immediate study?  Analogue experiments   The use of a related phenomenon (an analogue) in the lab    Randomized Controlled Trials (RTC)  Single­Subject Experimental Designs  Participants are studied one at a time and experience a manipulated variable  Reversal design or ABAB design   Measurement of a specific behavior at different times:  (1) During an initial time period, the baseline (A)  (2) During a period when treatment is introduced (B)  (3) During a reinstatement of the condition that prevailed in the baseline period (A)   (4) During the re­introduction of the experimental manipulation (B)   Mixed Designs  The combination of experimental and correlational designs   Classificatory or correlational variables (e.g., having PTSD or not) are not manipulated nor created by the  researcher   Experiments demand the manipulation of a variable (e.g., 3 types of treatment for major depression)   5. Research Methods 02/05/2014 Meta­Analysis   The review of several studies in order to determine the effects of treatment, using a statistic called effect  size  Meta­analysis can hardly provide definite answers b/c:  1. It is a complicated process that requires decisions at each of numerous phases or steps   2. Results of a meta­analysis are difficult to interpret   Despite difficulties and shortcomings, meta­analyses have been useful   6. Anxiety Disorders 02/05/2014 Types of Anxiety Disorders  Phobias  Panic Disorder (PD)  Generalized Anxiety Disorder (GAD)  Obsessive­Compulsive Disorder (OCD)  Post­Traumatic Stress Disorder (PTSD)  Acute Stress Disorder  Anxiety Disorders  Anxiety: the unpleasant feeling of fear and apprehension   Anxiety disorders tend to be comorbid   The most common psychological disorders in Canada (2006)   Prevalence  In Ontario (one year)  16% of women and 9% of men suffered from anxiety disorders highest one­year prevalence rates found in  women 15 to 24 years of age   In U.S.   12% in university students for 12­month prevalence   80% of them do not seek treatment   In Canada (lifetime prevalence)  PTSD at 9.2%  Social anxiety disorder at 8.1%   Anxiety disorders are more common in women than in men across all age groups and decrease with age  Disorder  Description  Phobia  Fear and avoidance of objects or situations that do not present any real danger.  Panic Disorder  Recurrent panic attacks involving a sudden onset of physiological symptoms, such  as dizziness, rapid heart rate, and trembling, accompanied by terror and feelings of  impending doom; sometimes accompanied with agoraphobia, a fear of being in  public places.  Generalized Anxiety  Persistent, uncontrollable worry, often about minor things.  Disorder  6. Anxiety Disorders 02/05/2014 Obsessive­ The experience of uncontrollable thoughts, impulses, or images (obsessions) and  Compulsive  repetitive behaviours or mental acts (compulsions).  Disorder  Post­traumatic  Aftermath of a traumatic experience in which the person experiences increased  Stress Disorder  arousal, avoidance of stimuli associated with the event, and anxiety in recalling the  event.  Acute Stress  Symptoms are the same as those of post­traumatic stress disorder, but last for four  Disorder  weeks or less.  6. Anxiety Disorders 02/05/2014 Phobias Phobia—disrupting, fear­mediated avoidance that is out of proportion to the danger actually posed and is  recognized by the sufferer as groundless   Examples of common phobias  Claustrophobia: fear of closed spaces  Agoraphobia: fear of public places  Acrophobia: fear of heights.   Ergosiaphobia: fear of working   Mysophobia: fear of contamination and dirt  Example of uncommon phobias  Gephyrophobia: fear of crossing bridges   Specific phobias  Specific phobias— unwarranted fears caused by the presence or anticipation of a specific object or  situation  Phobias sub­divided according to source of fear:  Blood, injuries, and injections   Situations (e.g., planes, elevators, enclosed spaces)   Animals  Natural environment (e.g., heights, water)  Evidence to support the grouping of fears into 5 factors:  1.  Agoraphobia   2.  Fears of heights or water   3.  Threat fears (e.g., blood/needles, storms/thunder)   4.  Fears of being observed   5.  Speaking fears   Social phobia  Social phobias— persistent, irrational fears linked generally to the presence of other people.   Can be extremely debilitating  People with a SP try to avoid situations in which they might be evaluated because they fear that they will  reveal signs of anxiousness or behave in an embarrassing way   Examples:   Speaking or performing in public  Eating in public   Using public lavatories  Social phobias can be either  generalized  specific   6. Anxiety Disorders 02/05/2014 Generalized SP involve many different interpersonal situations  Specific SP involve intense fear of one particular situation (e.g., public speaking)  Generalized SP has an earlier age of onset and is more often comorbid with other disorders than specific  SP  Lifetime prevalence in Canada   7.5% in men   8.7% in women  Etiology of Phobia  Behavioural Theories   Focus on learning as the way in which  phobias are acquired  Several types of learning may be involved  Avoidance Conditioning — reactions are learned  avoidance responses  Avoidance­conditioning formulation  Phobias develop from two related sets of learning:  1.  Via classical conditioning  2.  Person learns to reduce conditioned fear by escaping from or avoiding the CS (operant conditioning)   Modelling—person can also learn fears through imitating the reactions of others.   Learning of fear by observing others is referred to as vicarious learning.  Prepared Learning—people tend to fear only certain objects and events  Fear spiders, snakes, and heights but not lambs  Some fears may reflect classical conditioning, but only to stimuli to which an organism is physiologically  prepared to be sensitive  Is a diathesis needed?   Cognitive diathesis such as the tendency to believe that similar traumatic experiences will occur in the  future or not being able to control the environment may be important in developing a phobia.   Social Skills Deficits in Social Phobias  Inappropriate behavior or a lack of social skills the cause of social anxiety  Cognitive Theories  Focus on how people’s thought processes can serve as a diathesis and on how thoughts can maintain a  phobia  Anxiety is related to being more likely to:  Attend to negative stimuli  Interpret ambiguous information as threatening  Believe that negative events are more likely than positive ones to re­occur  Cognitive­behavioral models of social phobia   Link social phobia to certain cognitive characteristics:   6. Anxiety Disorders 02/05/2014 Attentional bias to focus on negative social information   Perfectionistic standards for accepted social performances  High degree of public self­consciousness  Predisposing Biological Factors  1. Autonomic Nervous System   Autonomic liability  2. Genetic factors  Blood­and­injection phobia has a strong familial association  64% have at least one first­degree relative with the same disorder  3­4% prevalence in general population  Prevalence of social and specific phobias higher than average in first­degree relatives of patients  Twin studies also provide support  Psychoanalytic Theory  Phobias are a defense against the anxiety  produced by repressed id impulses  Therapies for Phobias  Behavioral Approaches  Systematic desensitization   In vivo exposure  Virtual reality exposure  Flooding   Cognitive approaches  Viewed with skepticism because of a central defining characteristic of phobias  Phobic fear is recognized by the individual as excessive or unreasonable.   Cognitive­Behavioral Case Formulation Framework  Contains causal and maintaining factors   Permits the development of case formulation and treatment planning   Biological Approaches  Anxiolytics—Drugs that reduce anxiety (sedatives and tranquilizers)  Barbiturates—first major category of drugs used to treat anxiety disorders and we supplanted in the 1950s  by two other classes of drugs:  Propanediols (e.g., Miltown)   Benzodiazepines (e.g., Valium and Xanax).   Today newer benzodiazepines such as Ativan and  Clonapam are prescribed   Monoamine oxidase (MAO) inhibitors and SSRIs also used to treat SP  Psychoanalytic Approach    6. Anxiety Disorders 02/05/2014 Attempt to uncover the repressed conflicts believed to underlie the extreme fear and avoidance  characteristic of disorder   Panic Disorder  Panic Attack—person suffers a sudden and often inexplicable attack of alarming symptoms:  Labored breathing, heart palpitations,   Nausea and chest pain;   Feelings of  Choking and smothering;   Dizziness, sweating, and trembling;  Intense apprehension, terror, and feelings of impending doom.  May also experience depersonalization and derealization  Other features:  Panic attacks may occur frequently  May be linked specific situations if so referred to as cued panic attacks  Panic disorder is diagnosed as with or without agoraphobia  Lifetime prevalence   2­3% for men   5­6% for women   Typically begins in adolescence   Onset associated with stressful life experience  > 80% of patients diagnosed as having an anxiety disorder also experience panic attacks  Panic Disorder in Canadian University Students  34% of first­year and 22.1% of university students reported having experienced at least one panic attack  during the previous year   Those meeting criteria for panic attack had 4 attacks on average over the previous year   Etiology of Panic Disorder  Biological Theories  Mitral valve prolapse syndrome  Inner ear disease causes dizziness  May be linked to “Val158Met COMT polymorphism” or other loci within or  near the COMT gene (on  chromosome 22)   Noradrenergic activity theory   Panic is caused by overactivity in the noradrenergic system  Specifically locus ceruleus has been implicated   Stimulation of the locus ceruleus causes monkeys to have “panic attack”   In humans yohimbine (drug that stimulates activity in the locus ceruleus) can elicit panic attacks  6. Anxiety Disorders 02/05/2014 Problem in gamma­aminobutyric acid (GABA)  GABA generally inhibit noradrenergic activity  Positron emission tomography study found fewer GABA receptor binding sites in people with PD  Cholecystokinin (CCK)  Peptide that occurs in the cerebral cortex, amygdala, hippocampus, and brain stem, induces anxiety­like  symptoms in rats and effect can be blocked with benzodiazepines  Psychological Theories  The fear­of­fear hypothesis   Suggests that agoraphobia is not a fear of public  places per se, but a fear of having a panic attack in   public  Misinterpretation of physiological arousal symptoms  Therapies for Panic Disorder  Biological Treatments  Antidepressants   Both selective SSRIs and tricyclic antidepressants  have been used successfully to treat PD  Psychological Treatments  Exposure­based treatments are often useful in  reducing PD with agoraphobia  Cognitive­Behavioural Therapy   Generalized Anxiety Disorder  People with GAD are persistently anxious and often about minor items.    Chronic, uncontrollable worry about everything  Most frequent worries concern their health and the hassles of daily life  Compared to the normal population, most individuals with GAD show less responsiveness on most  psychophysiological measures (heart rate, GSR, respiratory rate, BP) but are consistently elevated in  muscle tension (EMG).  Other features include:   Difficulty concentrating,   Tiring easily, restlessness,   Irritability,  A high level of muscle tension  Lifetime prevalence is 5% for the general population   GAD typically begins in mid­teens   Stressful life events play role in onset   6. Anxiety Disorders 02/05/2014 Cognitive features: (Michel Dugas & Robert Ladouceur, 1998)  Intolerance for uncertainty  Erroneous beliefs about worry ( think it’s a buffer for future negative outcomes)  Poor problem solving orientation ( problems are threats to be avoided rather than challenges)  Cognitive avoidance  Cognitive­Behavioral Perspectives  See learning views of phobias  Anxiety regarded as having been classically  conditioned to external stimuli, but with a broader  range of  conditioned stimuli  Biological Perspectives  GAD may have a genetic component  Neurobiological model for GAD based on fact  that benzodiazepines are often effective in  treating anxiety   Receptor in the brain for benzodiazepines has  been linked to the inhibitory neurotransmitter  GABA  Benzodiazepines may lower anxiety by increasing release of GABA  Drugs that block or inhibit the GABA system increases  anxiety  Psychoanalytic Perspective  Unconscious conflict between the ego and id  impulses   Therapies for GAD  Treatment for GAD is very similar to that  for  phobias  Obsessive­compulsive disorder  Obsessive­compulsive disorder (OCD)— an anxiety disorder in which the mind is  flooded with  persistent and uncontrollable  thoughts (obsessions)  and the individual is  compelled to repeat certain acts  again and  again (compulsions)  Obsession — intrusive and recurring thoughts, impulses, and images   Most frequent obsessions: fears of contamination, fears of expressing some sexual or aggressive impulse,  and hypochondriacal fears of bodily dysfunction  Compulsion — a repetitive behavior or mental act that the person feels driven to perform to reduce the  distress caused by obsessive thoughts or to prevent some calamity from occurring   Examples: checking, cleanliness and orderliness, avoiding particular objects, performing protective  practices or a particular act    Other features of OCD  Lifetime prevalence of 1 to 2%  Affects women > than men   6. Anxiety Disorders 02/05/2014 Early onset (before age 10) is more common  among men and is associated with checking  compulsions  Later onset is more frequent among women  and is linked with cleaning compulsions   Depression is often comorbid with OCD  Etiology of OCD  Behavioral and Cognitive Theories  Learned behaviors reinforced by fear reduction   Rachman’s theory of obsessions in OCD   Unwanted intrusive thoughts are the roots of obsessions   Obsessions often involve catastrophic misinterpretations of negative intrusive thoughts   See Table 6.4 for list of faulty cognitive appraisals  Biological Factors  Genetic evidence  High rates of anxiety disorders occur among the first­degree relatives (10.3%) than control relatives (1.9%)  Brain structure   Encephalitis, head injuries, and brain tumours associated with the development of OCD   PET scan studies shown increased activation in the frontal lobes  Basal ganglia dysfunction further linked to OCD due to link with   Tourette’s syndrome, which is marked by motor and vocal tics   Hypothesized to be related to decreased serotonin   40­60% of OCD clients treated with SSRIs do not show improvement   Psychoanalytic Theory  Classical psychoanalysis:   Obsessions and compulsions are viewed as similar  Result  from instinctual forces, sexual or aggressive, that are not under control because of overly harsh  toilet training  Alfred Adler viewed OCD as a result of feelings of incompetence due to an inferiority complex   Therapies for OCD  Exposure and Response Prevention (ERP)   6. Anxiety Disorders 02/05/2014 Most widely used and accepted behavioral approach  Combines exposure with response prevention  Cognitive­Behavior Therapy  Biological Treatment  Drugs increasing serotonin, e.g., SSRIs and tricyclics  ERP and fluoxetine treatments show same changes in brain function   Cingulotomy   Psychoanalytic Therapy  Resembles that for phobias and generalized anxiety  Post­traumatic Stress Disorder  Extreme response to a severe stressor, including increased anxiety, avoidance of stimuli associated with  the trauma, and a numbing of emotional responses.  Note . Unlike the definitions of other psychological disorders, the definition of PTSD includes part of its  presumed etiology   The stressor can be experienced directly, vicariously, or via indirect, information exposure   The symptoms for PTSD are grouped into three major clusters  Re­experiencing the traumatic event   Avoidance of stimuli associated with the event or  numbing of responsiveness   Symptoms of increased arousal   Prevalence rate = 1 to 3%  PTSD vs. Acute Stress Disorder  If stressor causes significant impairment in social or occupational functioning 
More Less

Related notes for PS280

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.