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Chapter 2

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Konstantine Zakzanis

Twin Method: both monozygotic twins (identical; develop from a single fertilized egg; same sex) and dizygotic twins (fraternal; develop from separate eggs and are on average only 50% alike genetically; can be same sex or opposite) are compared - Diagnosed cases compared to other twin to see presence of disorder - When twins are similar diagnostically they are said to be concordant; concordance for disorder should be greater in MZ pairs than DZ pairs if this happens than disorder said to be heritable - For child to get the disorder that the parents have, there doesn’t have to be a genetic predisposition it may run in families only because of the environment the child was raised - Equal environment assumption: environmental factors that are partial causes of concordance are equally influential for MZ pairs and DZ pairs; assumption only applies to factors that are plausible environmental causes of psychopathology; this assumption asserts that MZ pairs and DZ pairs have equivalent number of stressful life experiences - 3 factors as biasing heritability estimates: violation of the equal environments assumption, sex of the participants and his or her age when the assessment took place o Only environmental factors contributed to exposure to events involving non-assaultive traumas o Both genetic and environmental factors contributed to exposure to assaultive traumas o Therefore, genetic factors may determine the extent to which a person is likely to experience post-traumatic stress after an assaultive trauma Adoptees Method: study children who were adopted and reared apart of their parents with abnormal disorders - If there is a high frequency of panic disorders found in children reared apart from parents who also had panic disorders, then there would be support for the theory that genetic predisposition figures in the disorder [Molecular Genetics] - Tries to specify the particular gene or genes involves and the precise functions of these genes - Each cell consists of 46 chromosomes with thousands of genes per chromosome (our genetic material) - Allele: refers to any one of the several DNA coding that occupy the same position or location on a chromosome: genotype is his or her set of alleles - Genetic polymorphism: refers to variability among members of the species; involves differences in the DNA sequence that can manifest in very different forms among members in the same habitat; entails mutations in a chromosome that can be induced or naturally occurring - Linkage analysis: method in molecular genetics that is used to study people; researches use it to study families in which a disorder is heavily concentrated; they collect diagnostic info and blood samples from affected individuals and their relatives and use the blood samples to study the inheritance pattern of characteristics whose genetics are fully understood (genetic markers) - If occurrence of a form of psychopathology among relatives goes along wit the occurrence of another characteristic whose genetics are known, it is concluded that the gene predisposing individuals to the psychopathology is on the same chromosome in a similar location on that chromosome (i.e. it is linked) as the gene controlling the other characteristic - Linkage analysis: mood disorders, OCD and schizophrenia - Gene-environment interactions: notion that a disorder or related symptoms are joint product of a genetic vulnerability and specific environmental experiences or conditions [Neuroscience and Biochemistry in the nervous system] - Neurons have 4 major parts: cell body, several dendrites (short and think extensions), one or more axons of varying lengths (usually only one long and thin axon extending considerable distance from the cell body) and a terminal buttons on the many end braches of the axon - Nerve impulse: change in electric potential of the cell o When neuron is stimulated at its cell body or dendrites a nerve impulse travels down the axon to the terminal ending. Between the terminal ending and cell membrane of receiving neuron is a small gap called the synapse o Terminal buton of each axon contains synaptic vesicles (small structures that allow a nerve NT); NT are chemical substances that allow a nerve impulse to cross the synapse o Nerve impulses cause the synaptic vesicles to release molecules of their transmitter substances and these molecules flood the synapse and diffuse toward the receiving or postsynaptic neuron cell membrane of the postsynaptic cell contains proteins (receptor sites) that are configured so that specific NT can fit into them when NT fit into receptor site a msg can be sent to postsynaptic cell o What happens to postsynaptic neuron depends on its integrating thousands of similar msgs  Sometimes msgs are excitatory: leading to the creation of nerve impulse in the postsynaptic cell  Msgs is inhibitory: making postsynaptic less likely to fire nerve impulse - Returning back to normal state: o Not all released NT has found its way to postsynaptic receptors- some broken down by enzymes and some pumped back into the presynaptic cell through a process of reuptake - Norepinephrine: NT of the peripheral sympathetic nervous system is involved in producing states of high arousal and therefore may be involved in anxiety disorders - Serotonin and dopamine are NT in the brain; serotonin involved in depression and dopamine in schizophrenia - GABA: inhibits some nerve impulses and may be involved in anxiety disorders - Maturational changes influence NT levels o Onset of puberty results in decrease in serotonin and a decrease in dopamine activity in certain cortical areas - Disorder is caused y either too much or too little of a particular transmitter (i.e. mania- too much norepinephrine; anxiety disorder- too little GABA) - Synthesis of NT (series of metabolic steps): amino acids enzymes catalyzes each reaction o Too much or little of NT results form error in one of the metabolic pathways or from alterations in usual processes by which transmitters deactivated after being released into the synapse (i.e. reuptake)  Failure to pump leftover NT back into presynaptic cell and then new nerve impulse causes further NT to be released into synapse therefore postsynaptic cell has double the dose of NT therefore more likely to fire a nerve impulse - Receptors are also a cause of psychopathologies o If receptor on postsynaptic neuron were too numerous or too easily excited the result would be akin to having too much transmitter released therefore more sites available with which the NT could interact, increasing the changes of the postsynaptic neuron would be stimulated  Delusions and hallucinations of schizophrenia may result from an over abundance of dopamine receptors [Biological Approaches to Treatment] - Prevention or treatment of mental disorders should be possible by altering bodily functioning; biological defect  biological intervention - Use of Psychoactive drugs increasing; o tranquilizers (valium) effective in reducing tension associated with some anxiety disorders by stimulating GABA neurons to inhibit other neural systems that create the physical symptoms of anxiety o antidepressants (Prozac) increase neural transmission in neurons that use serotonin as a NT by inhibiting reuptake of serotonin o antipsychotic drug (Clozaril) used for treatment of schizophrenia; reduces the activity of neurons that use dopamine as NT by blocking their receptors o stimulants (Ritalin) used to treat children with attention deficit and hyperactivity disorder; these increase levels of several NT that help children pay attention - drugs can act efficiently and often provide symptomatic improvement relatively quickly o serotonin reuptake inhibitors described as having delayed onset; helps to treat depression - contemporary approaches to biological assessment: involves attempts to make inferences about the functioning of the nervous system (neuropsychological assessment) or to ―see’ the actual structure and functioning of the brain and other parts of the nervous system (MRI) - clinical scientist can believe in biological basis of mental problem but can recommend psychological intervention - effects of cognitive-behavioural theory (CBT) on OCD showed decreased metabolism in the right caudate nucleus whereas, CBT in phobia resulted in decreased activity in limbic and paralimbic areas - different effects for different types of interventions [Evaluating the Biological Paradigm] - reductionism: view that whatever is being studied can and should be reduced to its more basic elements or constituents - problems such as delusional beliefs and dysfunctional attitude may well be impossible to explain biologically, even with detailed understanding of the behaviour of individual neurons PSYCHOANALYTIC/PSYCHODYNAMIC PARADGM - developed by Sigmund Freud psychopathology results from unconscious conflicts in the individual [Classical psychoanalytic theory] refers to original views of Freud; his theories encompassed both the structure of the mind itself and the development and dynamics of personality -Structure of the mind- - he divided the mind into 3 parts : id, ego and superego- metaphors for specific functions or energies - id: present at birth and is part of the mind that accounts for al the energy needed to run the psyche o comprises basic urges for food, water, elimination, warmth, affection and sex o source of all id’s energy is biological o as infant develops: energy called libido, converted into psychic energy, al of it unconscious, below the level of awareness o id seeks immediate gratification and operates according to the pleasure principle o when id not satisfied, tension produced and it strives to eliminate the tension o to obtain gratification: primary process thinking: generating images-fantasies- of what is desired - Ego: conscious and begins to develop from the id during the second six months of life; its task is to deal with reality o Thru its planning and decision-making functions, called secondary process thinking, ego realizes that operating on the pleasure principle at all times is not the most effective way of maintaining life o Ego operates on the reality principle as it mediates between the demands of reality and immediate gratification desired by the id o Primarily conscious and involved in thinking and planning, it has important unconscious aspects (defence mechanisms) that protect it from anxiety - Superego: operates roughly as the conscience and develops throughout childhood o Develops from ego much as the ego developed from the id o As children discover that many of their impulses are not acceptable by their parents they begin to incorporate or introject, parental values as their own to enjoy parental approval and avoid disapproval’ - Interplay of forces referred to as psychodynamics of the personality - Freud postulated that much of human behaviour is determined by forces inaccessible to awareness - Id’s instinct and many of superego’s activities are not known to the conscious mind - Freud considered most of the important determinants of behaviour to be unconscious -Neurotic Anxiety- - When one’s life is in jeopardy, one feels objective (realistic) anxiety- ego’s reaction to danger in the external world - Neurotic anxiety: feeling of fear that is not connected to reality or to any real threat: a person who has fixated at one or another stage during development in personality may experience this - Moral anxiety arises when impulses of the superego punish an individual for not meeting expectations and thereby satisfying ht principle that drives the superego- perfection principle -Defence Mechanisms: coping with anxiety- - Objective anxiety can be reduced by: removing or avoiding the danger in the external world or by dealing with it in a rational way - Neurotic anxiety can be reduced by means of defence mechanisms: strategy unconsciously used to protect ego from anxiety o Repression: pushes unacceptable impulses and thought into the unconscious; by remaining repressed infantile memories and desires cannot be corrected by adult experience and therefore retain their original intensity and immaturity o Denial: disavowing a traumatic experience and pushing it into unconscious o Projection: attributes to external agents characteristics or desires that an individual possesses but cannot accept in her or her conscious awareness (a women who unconsciously is averse to regarding herself as angry at others may instead see others as anger with her) o Displacement: redirecting emotional responses from a perhaps dangerous object to a substitute (yelling at one’s spouse but not one’s boss) o Reaction formation: converting one feeling into its opposite o Regression: retreating to the behavioural patterns in early age o Rationalization: inventing a reason for an unreasonable action or attitude o Sublimation: converting sexual or aggressive impulses into social valued behaviour, especially creative activity - DM make people aware of their troubled natures and provide the impetus for consulting a therapist - Contemporary psychoanalytic theorists consider some use of DMs to be adaptive and healthy - For most part DM are maladaptive -Relationship of Psychoanalytic concepts to psychopathology- - Freud believed that various forms of psychopathology resulted from presence of strong drives or if instincts that contributed to the development of unconscious conflicts linked to a particular developmental stage - Phobias were caused by unresolved Oedipal conflicts- belief that when they are four or five years old boys covet their mothers, albeit at an unconscious level - OCD travel to anal stage, with urge to soil or to be aggressive transformed by reaction formation into compulsive cleanliness - Hysterical problems was caused by sexual abuse in childhood [Psychoanalytic Therapy (PT)]- Insight therapy - Classical psychoanalysis is based on Freud’s second theory of neurotic anxiety, that neurotic anxiety is the reaction of the ego when a previously punished and repressed id impulse presses for expression - When unconscious part of ego encounters a situation that reminds it of a repressed conflict from childhood it is overcome by debilitating tension - PT attempts to remove the earlier repression and help the patient face the childhood conflict, gain insight into it, and resolve it in the light of adult reality o Repression occurring so long ago has prevented the ego from growing in an adult fashion; lifting of repression is supposed to enable relearning to take place - Technique to lift repression: o Free association: patient reclines on a couch, facing away from the analyst and is encouraged to five free rein to his or her thoughts, verbalizing whatever comes to mind w/o the censoring done in everyday life  Resistances- patient changes topic or becomes silent; these signal sensitive or ego threatening area; areas the analyst will want to probe further o Dream analysis:  In sleep, ego defences are relaxed, allowing normally repressed material to enter the sleeper’s consciousness  Dreams take on heavily symbolic content referred to as latent content of the dream o Transference:  Patient’s responses to the analyst are not in keeping with the analyst-patent relationship but seem instead to reflect the relationship with important people in the patient’s past  When analyst notice transference developing that they begin to hope that an important repressed conflict is getting closer to the surface o Counter transference:  Analyst’s feeling towards the patient; the analyst must be aware of their own feelings so that they can see the patient clearly - When previously repressed material begins to appear then interpretation comes into play—analyst points out to patient the meaning of certain behaviours - DM are principal focus of interpretation -Modification in Psychoanalytic Therapy- - Ego analysis: greater emphasis on person’s ability to control the environment and to select the time and the means for satisfying instinctual drives, contending that the individual is as much ego as id; focus more on person’s living conditions; employ most of psychoanalytic techniques already described o Believe in set of ego functions that are primarily conscious, capable of controlling both id instinct and external environment and that significantly do not depend on the id of their energy o Individual’s social interactions can provide their own special kind of gratification - Brief Psychodynamic therapy aka brief therapy: time limited and does not go on for many years; target is specific problems in everyday lives o Assessment tends to be rapid and early o Made clear that therapy will be limited and improvement is expected within a small number of sessions (6-25) o Goals are concrete and focused on improving the of the patient’s worst symptoms, helping the patient understand what is going in his or her life, and enabling the patient to cope better in the future o Interpretations are directed more toward present life circumstances and patient behaviour than on the historical significance of feelings o Development of transference is not encouraged but some positive transference to the therapist is fostered to encourage the patient to follow the therapist’s suggestions and advice o There is a general understating that psychotherapy does not cure, but that it can help troubled individuals learn to deal better with life’s inevitable stressors - Interpersonal psychodynamic therapy: emphasizes the interactions between a patient and his or her social environment o According to Sullivan, our needs are interpersonal in that whether they are met depends on the complementary needs of other people o Analyst is a participant "observer‖ in the therapy process not as a blank screen for transference, the therapist is part of the process that he or she is studying-an analyst does not see patients without at the same time effecting them o Interpersonal therapy (IPT): concentrate on the patient’s current interpersonal difficult and discuss with the patient better ways of relating to others  Techniques combine empathic listening with suggestions for behavioural changes, as well as how to implement them  Therapist might explore with the patient the complexities of present-day problems with an emphasis on the patient’s relationship with others  Therapist then encourage patient to make specific behavioural changes sometimes facilitating these shifts by having patient practise new behaviours in the consulting room (role-playing) [Evaluating Psychoanalytic Paradigm]-assumes that human nature, the id, is something in need of restraint; that effective socialization request is the ego to mediate between the environment and basically anti-social, at best asocial, impulses stemming from biological urges CONS: - Theories based on anecdotal evidence gathered during therapy sessions are not grounded in objectivity and therefore are not scientific but Freud believed that info obtained from therapy sessions was enough to validate his theory and demonstrate the effectiveness of therapy - Case reports used by Freud not reliable because they were more on his perceptions and recollections since he didn’t make careful notes - Freud’s own interest in certain topics such as earlier sexual experiences might have affected his patients’ accounts, causing them to focus on certain experiences and overlooking others - Id, ego and the unconscious were sometimes described as though they had an existence of their own with power to act and think PROS: - Childhood experiences help share adult personality: psychosexual stages ; problematic parent-child relationship and how they can influence later adult relationships in a negative way - There are unconscious influences on behaviour: people can be unaware of the causes of their behaviour; unconscious is not a repository of id instinct - People use defence mechanisms to control anxiety or stress: HUMANISTIC AND EXISTENTIAL PARADIGMS aka experimental or phenomenological - Insight-focused, based on the assumption that disordered behaviour results from a lack of insight and can best be treated by increasing the individual’s awareness of motivations and needs - Focus on how psychological problems develop - Main influence is on intervention/therapy - Useful contracts b/w psychoanalysis and its offshoot on the one hand and humanistic and existential approaches on the other - Greater emphasis put on person’s freedom of choice regarding free will as the person’s most important characteristic o Freewill can bring out not only fulfillment and pleasure but also acute pain and suffering  Those who cannot meet this challenge regarded as candidates for client-centered, existential and Gestalt therapies [Carl Roger’s Client-Centered Therapy] aka person-centered therapy - Based on assumptions about human nature and way we can try to understand it o people can be understood only from the vantage point of their own perceptions and feelings phenomenological world must look at way they experience events rather than the events themselves each person’s phenomenological world is the major determinant of behaviour and makes the person unique o Healthy people are aware of their behaviour people similar to psychoanalysis and ego analysis: desirability of being aware of motive. People with high level of self awareness and sense of personal agency are said to be thoughtful and primary goal of counselling o Healthy people are innately good and effective. They become ineffective and disturbed only when faulty learning intervenes o Healthy people are purposive and goal directed. Self directed and don’t respond passively to influence of their environment or to inner drives. Rogers closer to ego analysis than to orthodox Freudian Psychoanalysis o Therapists should not attempt to manipulate events for the individual rather create conditions that facilitate independent decision making by the client. When people are not concerned with evaluations, demand and preferences of others, their lives are guided by an innate tendency toward self-actualization -Roger’s Therapeutic Intervention- - Avoid imposing goals on client during therapy - Client takes lead and direct the course of the conversation and session - Therapist’s job is to create the conditions that help client return to his or her basic nature and judge which course of life is intrinsically gratifying - Rogerians hold steadfastly to the rule that a person’s innate capacity for growth and self direction will assert itself if the therapeutic atmosphere is warm, attentive, and receptive and especially if the therapist accepts the person for who they are unconditional positive regard - People have value merely for being people and therapist must care deeply for and respect a client for the simple reason that he or she is human being engaged in the struggle of growing and being alive - Empathy is the technique used o Primary empathy: therapist understands, accepting and communicating to the client what the client is thinking or feeling. Therapist convey it by restating client’s thoughts and feelings in client’s own words  Therapist accepts the client’s view, understands it and communicates to the client that it is appreciated o Advanced empathy: inference by the therapist of the thoughts and feelings that lie behind what the client is saying, and of which the client may only be dimly, if at all, aware. Involves interpretation by the therapist of the meaning of what the client is thinking and feeling  Therapist offers something new, a perspective that they hope is better, more producti
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