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Chapter 2

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University of Toronto St. George

Chapter 2 • Albert Ellis: developed rational-emotive theory (cognitive theory of emotional problems) and related therapy; emotional problems result of irrational beliefs that therapists must confront patients with • Theory: set of ideas that provides a framework for asking questions about a phenomenon, as well as gathering and interpreting information about that phenomenon • Biological approach: abnormal behavioural symptoms caused by biological factor, such as a genetic vulnerability to anxiety; inherited • Psychological approach: symptoms rooted in psychological factors such as belief systems or early childhood experiences • Social approach: interpersonal relationships and social environment • Nature-nurture question: is the cause of a disorder something in the biology of a person or the history of events to which they were exposed? • Often many pathways that lead to the development of a specific disorder; accumulation of several factors (most common) or one factor • Vulnerability stress models: integrated models of biological, psychological and social approaches; person must carry a vulnerability to the disorder in order to develop it; can be biological (genetic predisposition) or psychological (personality trait); stress or trigger causes development of disorder (illness, traumatic event) Vulnerability Stress Biological factor (genes, disordered biochemistry, brain Biological trigger (onset of disease, anomalies) exposure to toxins) Social trigger (traumatic event, major Social factor (maladaptive + loss) upbringing, chronic stress) Psychological factor Psychological trigger (perceived loss of (unconscious conflicts, poor control, violation of trust) skills, maladaptive cognitions) = Disorder • Feedback effects: changes in one factor result in changes in a second factor but then those changes in the second factor feed back to change the first factor again; ex: change in brain chemical  irritability  rejection  more irritability  change in brain chemistry; psychopathological processes Biological approaches • Phineas Gage: construction foreman who in 1948 had a tamping iron hurled though his face, skull and brain; survived; previously had been responsible, well-liked and socially well-adapted; transformed into socially inappropriate, impulsive, profane, unemployable man; damage to his brain (cerebral cortex) impaired emotional control and judgment in personal and social matters • Structural damage: abnormalities in the structure of the brain cause mental disorders; lesions or other abnormalities can cause psychological dysfunction • Major structures of the brain o Cerebral cortex: involved in many of our most advanced thinking processes; contains four lobes (parietal, temporal, frontal and occipital); believed that this does not functional effectively/normally in schizophrenia o Corpus callosum: bridge of fibres passing information between the two cerebral hemispheres o Thalamus: relay center for cortex; handles incoming and outgoing signals o Cerebellum: involved in balance and the control of movement o Medulla: responsible for regulating largely unconscious functions such as breathing and circulation o Hypothalamus: responsible for regulating basic biological needs; hunger, thirst, temperature control; influences basic emotions; pleasure and pain o Pituitary gland: “master” gland that regulates other endocrine glands o Pons: involved in sleep and arousal o Reticular formation: a network of neurons related to sleep, arousal and attention o Spinal cord: responsible for communication between brain and rest of body; involved with simple reflexes o Amygdala: important in the regulation of emotion and memory o Hippocampus: important in memory o Limbic system: collection of structures that are closely interconnected with the hypothalamus; exert additional control over some of the instinctive behaviours regulated by the hypothalamus such as eating, sexual behaviour and reaction to stressful situations; includes hypothalamus, hippocampus, spinal cord, amygdala, septum, cerebral cortex, cingulate cortex, fornix; damage to system can make one excessively passive or chronically aggressive • Biochemical theories: imbalances in neurotransmitters or hormones or poor functioning of receptors for neurotransmitters causes mental disorders o Neurotransmitters: biochemicals that act as messengers, carrying impulses from one neuron to another in the brain and other parts of the nervous system o Neuron: nerve cell; each has a cell body and a number of dendrites or short branches o Impulses: dendrites and cell body receive impulses from adjacent neurons; impulse travels down the length of a slender, tube-like extension, called an axon, to small swellings at the end of the axon, called synaptic terminals, where the impulse stimulates release of neurotransmitters o Synapse: also called synaptic gap; slight gap between synaptic terminals and adjacent neurons; neurotransmitter released here o Receptors: molecules on membranes of adjacent neurons that neurotransmitters bind to; binding stimulates adjacent neurons to initiate impulse which runs through the neuron to cause the release of more neurotransmitter between that neuron and others • Neurotransmitter theories: too little/too much of a neurotransmitter can cause specific types of psychopathology; also linked to number and functioning of receptors (overexposure or inability to make adequate use) o Reuptake: initial neuron releasing the neurotransmitter into the synapse reabsorbs the neurotransmitter, decreasing the amount left in the synapse o Degradation: receiving neuron releases an enzyme into the synapse that breaks down the neurotransmitter into other bio-chemicals • Common neurotransmitters: over 100 identified o Serotonin: regulates emotions and impulses (like aggression); travels through many key areas of brain o Dopamine: prominent in areas of the brain that regulate our experience of reinforcements or rewards; affected by substances like alcohol; important to functioning of muscle systems and disorders dealing with muscle control (Parkinson’s) o Norephinephrine: produced mainly by neurons in brain stem; action prolonged by cocaine and amphetamines by slowing the reuptake (which prolongs activation of receiving neurons); too little of it can cause depression o GABA: gammaaminobutyric acid; inhibits action of other neurotransmitters; important role in anxiety disorders • Endocrine system: produces most of the major hormones of the body; regulated by hypothalamus o Hypothalamus: interacts with pituitary gland o Pituitary: “master” gland that produces hormones that influence secretions of the thyroid, pancreas, adrenals, and gonads; also secretes growth hormones  Relationship between them: complex interactions between nervous and endocrine systems; ex: in response to stress, neurons on the hypothalamus secrete CRF (corticotrophin-release factor) which is carried to the pituitary and stimulates it to release the body’s major stress hormone, ACTH (adrenocorticotrophic hormone); this is carried by the bloodstream to adrenal glands and other organs to release about 30 other hormones; each plays a role in body’s adjustment to emergency situations  HPA axis: hypothalamic-pituitary-adrenal axis; relationship between structures; dysfunction in this relationship can cause anxiety and depression (less able to cope with stress) o Thyroid: produces hormones that regulate metabolic rate o Adrenal glands: control salt and carbohydrate metabolism; secrete hormones active in arousal and sleep o Pancreas: produces insulin and glucagon to control sugar metabolism o Gonads: ovaries and testes produce hormones involved in development of secondary sex characteristics and reproduction • Hormones: chemicals that carry messages throughout body, potentially affecting a person’s moods, levels of energy and reactions to stress • Genetic theories: accumulation of disordered genes leads to mental disorders • Behaviour genetics: study of genetics of personality and abnormality examining inherited behaviours and processes by which genes affect behaviour • Genetic transmission: fertilized embryo has 46 chromosomes at conception (23 pairs); one pair makes up sex chromosomes (determines gender); alterations in structure or number can cause defects o Down syndrome: caused by triplicate of chromosome 21; characterized by mental retardation, heart malformations, flat face, etc • Genes: segments of long molecules of DNA (deoxyribonucleic acid) found in chromosomes; give coded instructions to cells to perform certain functions (usually to manufacture proteins); come in pairs (one from each parent); abnormalities more common than chromosomal • Polygenic: multi-gene process; takes multiple genetic abnormalities coming together in one individual to create a disorder; similar situation for physiological disorders like diabetes or epilepsy; genetic factors increase vulnerability instead of determining whether it occurs • Family history studies: used to determine whether genetically transmitted disorders show up more often in families of those who have the disorder than in the families of those who do not o Probands: people who clearly have disorder in question o Control group: people who clearly do not have the disorder o Family pedigrees: family trees; determine how many relatives have the disorder o First degree relatives: parents, siblings and children; most genetically similar (50%); exception is identical twins o Remember! Most families also share a similar environment – difficult to tease apart contributions • Twin studies: identical or monozygotic twins share 100% of genes because they come from a single fertilized egg that splits into two; dizygotic twins share 50% like regular siblings; researchers use studies to investigate contribution of genetics to disorders; again consider environment o Concordance rate: probability that both MZ twins will have a disorder if one does; if it is more than DZ twins, we have evidence that the disorder is genetically transmitted but if it is under 100% we have evidence that it takes a combinations of factors to develop the disorder • Adoption studies: identify people who have disorder who were adopted shortly after birth and then determine rate of the disorder in the biological relatives of these adoptees and adoptive relatives to determine whether prevailing factor is genetics or environment o Evidence that even the most mundane details influenced by genetics (television preferences, liking for roller coasters) • Flaws of biological theories: human behaviour reduced to firing of neurons; ignore influence of social factors and biology; often can’t explain why not everyone who carries a biological risk for a disorder eventually develops it; some biological processes (neurotransmitter levels) can be measured only indirectly and imprecisely in live humans (need animals); biological theories based on accidental discoveries of drug influences on humans/animals Psychological approaches • Psychodynamic theories: all behaviour, thoughts and emotions are influenced to large extent by unconscious processes; unconscious conflicts between primitive desires and constraints on those desires cause symptoms of mental disorders; late 19 century with Freud (now emphasize different processes) • Psychoanalysis: developed by Freud; theory of personality and psychopathology; method of investigating the mind; form of treatment for psychopathology o Catharsis: release of emotions connected to painful memories recounted under hypnosis; labelled so by Josef Breuer; work with patient Anna O o Repression: motivated forgetting of a difficult experience; “damned up” and emerges as symptoms; memories/desires repressed • Freud’s theories on human psyche o Drives: two that motivate human behaviour; sexual drive (libido) and aggressive; energy seeks release but can be harnessed by psychological systems; libido regulated by three systems of human psyche o Id: system from which libido emerges; drives and impulses seek immediate release; babies  Pleasure principle: drive to maximize pleasure and minimize pain as quickly as possible; id operates by this; reflex actions are expressions of this (nursing)  Primary process thinking: wish fulfillment; humans may use fantasies or memories to conjure up desired object/action when direct action can’t be taken o Ego: split off part of id; force that seeks to gratify wishes and needs in ways that remain within the rules of society for their appropriate expression; older child  Reality principle: drive to satisfy our needs within the realities of society’s rules; id follows this  Secondary process thinking: rational deliberation; ego’s primary mode of operation; replace inappropriate desires with appropriate ones o Superego: develops from the ego later in childhood; storehouse of rules and regulations for the conduct of behaviour that are learned from one’s parents and from society; internalize or introject these standards to feel good and reduce anxiety; two components o Conscience: evaluates whether we are conforming our behaviour to our internalized moral standards o Ego ideal: image of the person we wish to become, formed from images of those people with whom we identified in our early years (usually parents) • Levels of consciousness o Unconscious: completely out of our awareness; most interactions between id, ego and superego occur here o Preconscious: way station or buffer between unconscious and conscious o Conscious: mental contents and processes of which we are actively aware; ego pushes back certain wishes, needs and memories into unconscious or changes them to protect conscious from full awareness as are often unacceptable or cause anxiety; repression can lead to symptoms of depression (rage turned on itself) • Defence mechanisms: strategies the ego uses to disguise or transform unconscious wishes o Regression: retreating to a behaviour of an earlier developmental period to prevent anxiety and satisfy current needs o Denial: refusing to perceive or accept reality o Displacement: discharging unacceptable feelings against someone or something other than the true target of these feelings o Rationalization: inventing an acceptable motive to explain unacceptably motivated behaviour o Intellectualization: adopting a cold, distanced perspective on a matter that actually creates strong, unpleasant feelings o Projection: attributing one’s own unacceptable motives or desires to someone else o Reaction formation: adopting a set of attitudes and behaviours that are the opposite of one’s true dispositions o Identification: adopting the ideas, values and tendencies of someone in a superior position in order to elevate self-worth o Sublimation: translating wishes and needs into socially acceptable behaviour o Neurotic paradox: person’s behaviour becomes ruled by defence mechanisms/mechanisms are maladaptive, resulting in abnormal behaviour; ex: men abused as children beating wives (displacement) • Psychosexual stages: Freud proposed that children pass through a series of universal stages wherein sexual dives are focused on stimulation of certain body areas; psychological issues can arouse anxiety; must negotiate successfully through stages for child to become psychologically healthy adult; parents must help child to satisfy and control drives/impulses else it will become fixated at the stage (trapped in its concerns and issues) o Oral stage: lasts for first 18 months following birth; stimulation of mouth area satisfied libidinal impulses (feeding, sucking); central issues are dependence and reliability of others; fixation results in personality characterized by excessive dependence on others but mistrust of their love; habits focused in mouth area (smoking, excessive eating) o Anal stage: 18 months – 3 years; interest in passing and retaining of feces; parents should not be too harsh/critical during toilet training; fixation results in stubbornness, orderliness, tidiness, stinginess, etc o Phallic stage: 3-6 years; genitals focus of pleasure; conflicts of sexual development (differ for genders)  Oedipus complex: boys become sexually attracted to their mothers and hate their fathers as rivals; successful resolution of this helps instill a strong superego in boys, who then identify with their fathers  Castration anxiety: boys fears fathers will retaliate against them by castrating them; motivation for putting aside their desire and aspiring to become like their fathers o Latency stage: libidinal drives are quelled somewhat; attentions turns to developing skills and interests and become fully socialized; avoid opposite gender o Genital stage: age of 12 onward; enter puberty; interests turn to heterosexual relationships • Problems with Freud: doesn’t address individual, just release of energies, ignore environment and interpersonal relationships • Object relations theory: significant aspects of Freud’s drive theory integrated with the role of early relationships in development of self-concept and personality; proponents are Margaret Mahler, Otto Kernberg, etc; early relationships create images of ourselves and others which affect subsequent relationships; four fundamental stages in development of the self-concept o Undifferentiated stage: newborn only has image of self and no sense that others are separate from it (everything it feels, caregiver feels) o Symbiosis: infant still does not distinguish between self and other but does distinguish between good self-plus-other image and bad self-plus-other image; either all good or all bad o Separation-individuation: child begins to differentiate between self and other; images of good/bad self (or other) not integrated and focuses on either exclusively o Integration: child is able to distinguish clearly between self and other and to integrate the good and bad images of the self and the other into complex representations o Splitting: some people never resolve second/third stages so are prone to seeing the self/others as all good or all bad  Borderline personality disorder: people view themselves and others as either all bad or all good and vacillate between these two images; trouble accepting boundaries between themselves and others • Flaws of psychodynamic theories: emphasis on sexual drives and anatomy and exclusion of environmental and cultural influences; male as prototypical human being; universally applicable psychology based on small sample; difficult to scientifically test fundamental assumptions; personality not fixed in childhood • Behavioural theories: symptoms of mental disorders are due to reinforcements and punishments for specific behaviours; how behaviours are learned through experienced in the environment • Classical conditioning: Ivan Pavlov; form of learning in which a neutral stimulus becomes associated with a stimulus that naturally elicits a response, thereby making the neutral stimulus itself sufficient to elicit the same response; frequent pairing of stimuli can elicit seemingly irrational responses o Unconditioned stimulus: stimulus that naturally produced desired response (dish of food) o Unconditioned response: response created by unconditioned stimulus (salivating) o Conditioned stimulus: previously neutral stimulus (Pavlov or bells) o Conditioned response: response CR elicited (salivation) • Operant conditioning: E.L. Thorndike; shaping of behaviours by providing rewards for desired behaviours and punishments for undesired ones; law of effect is that behaviours that are followed by a reward are strengthened and behaviours followed by a punishment are weakened; B.F. Skinner in 1930s o Continuous reinforcement schedule: behaviours will be learned most quickly if they are paired with the reward or punishment every time the behaviour is emitted o Partial reinforcement schedule: reward or punishment occurs only sometimes in response to the behaviour o Extinction: elimination of a learned behaviour o Continued avoidance response: certain stimuli provoke anxiety so by avoiding them, anxiety is reduced and the behaviour is reinforced • Social learning theory: Albert Bandura; can learn behaviour by watching others; pure behaviourists like Skinner argue that only direct experience of rewards/punishment contributes to learning o Modelling: learn new behaviours from imitating the behaviours modelled by important people in their lives, especially wh
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