Section 1 Class Notes

Symptoms: thoughts, feelings, and behaviors that indicate a mental disorder
Syndrome: a group of symptoms that appear together and are assumed to represent a specific type of disorder
Additional considerations: • Duration • Impairment
Defining abnormal behavior • Personal distress o Subjective discomfort o May/may not be abnormal ▪ Nerves for test is normal distress o May/may not feel distress ▪ Person in mania may not feel distress in the moment • Relative frequency—how rare is it? o May/may not be abnormal if rare ▪ How rare should it be? How extreme should it be? ▪ Rare and desirable—talents • Social norm violations o Just because something isn’t mainstream doesn’t mean it’s bad ▪ Protests, parking illegally • Predictable responses to stressors are normal o Death of a loved one • Harmful Dysfunction—Wakefield o Results from the failure of some internal mechanism to perform its natural function o Causes harm to the person as judged by the standards of that person’s culture • DSM-IV-TR Classification of Disorders o Disorders are identified by their symptoms o Causes (etiology) often unknown • Mental disorder vs. abnormal behavior o May have one, the other, both, or neither ▪ Schizophrenia—both ▪ Anxiety disorder—both or only mental • Why classify? o Provides common nomenclature o Socially and politically defines the field o Can be negative ▪ Stigma ▪ Stereotypes • Role of culture o Etic Perspective—overall perspective (outsider) ▪ Assumes universal principles cal be applied to all cultures ▪ Culture-general or universal orientation o Emic perspective—culture specific (insider) ▪ Involves understanding the culture from perspectives of those in the culture ▪ Uses culture-specific criteria o Zeitgeist ▪ Spirit of the times ← Drapetomia (slaves wanting to run away) (no longer a disorder) ← Homosexuality (no longer a disorder) ← Pathological gambling (now disorder) o Problem Suppression-Facilitation Model ▪ Culture suppresses (via punishment) some behaviors ← Jamaican boys internalize, American boys externalize (1999) ▪ Culture facilitates (via modeling and reinforcement) other behaviors o Adult-Distress-Threshold Model ▪ Culture determines adult thresholds for different type of child problems • Epidemiology—study of the frequency and distribution of disorders within a population o Comorbidity ▪ Manifestation of more than one disorder o Incidence ▪ How many new cases of a disorder that occur in a population within a specific time period ← How many people were diagnosed with depression this year? o Prevalence ▪ The total number of active cases (old and new) present in the population at a given time o Lifetime Prevalence ▪ Total proportion of people in a given population who ever had the disorder o 32-46% lifetime prevalence for at least one disorder ▪ Abnormal? o 1 year prevalence of any psychological diagnosis=20% o 1 year prevalence rate of any addictive diagnosis=6% o most sever disorders are in people with 3+ lifetime disorders=17% o Race and ethnic groups ▪ Similar o Sex ▪ Sex differences exist, particularly in depression and substance abuse ▪ Women more likely to use mental health services o Global burden of disease: mortality and disability, both measured in years ▪ YLL (years of live lost) YLD (years of live disabled) ▪ Depression ← Third leading burden of diseases worldwide ← Suicide o Only 20-33% who get treatment (psychologists, doctors, etc) • History of mental illness o Demonology (“supernatural”) OLD ▪ Abnormality=possession of mind my spirits ▪ Treatment= exorcism, prayer, flogging, death o Hippocrates (5th century bd) ▪ 4 fluids in body o Lunacy ▪ Controlled by moon o Asylums ▪ Prior? Family problem ▪ 1600s Europe, 1800s US ▪ provide confinement and care of mentally ill ▪ treatment sometimes, often cruel o Humanitarian reforms ▪ Philippe Pinel (1745-1826) ← Pioneered humanitarian treatment ← “Moral Treatment” approach ▪ Dorothea Dix (1802-1887) ← Crusader for prisoners who were mentally ill ← Physicians ▪ Ongoing issue: Deinstitutionalization ← Community Mental Health Act (1963) to provide funding for community mental health centers • Public awareness • New meds to treat psychotic symptoms ← State hospitals(shorter stays and community-based care ← Problem: hospitals closed, but the centers didn’t always open ▪ Current issue: reinstitutionalization ← 50,000 in hospitals ← 500,000 in jail ← 16% of prisoners in Ohio (representative of national average) are mentally ill ← 16-30% of inmates have had a depressive episode in the last year ← related issues: homelessness, histories of physical/sexual abuse
Note: don’t need to know terms on Figures 2.3 or 2.4
What is a Paradigm? • A set of assumptions about the substance of a theory • Also assumptions about how scientists should collect data and test theoretical propositions
Which Paradigm is correct? • Elephant example o Some of the observations are correct together: systems theory
Psychoanalytic/psychodynamic paradigm • Freud • Abnormal behavior caused by unconscious mental conflicts, emphasizing early childhood experiences in the family o Id—biological drives ▪ Hunger, aggression, sex ▪ Primarily unconscious o Ego ▪ Real world fulfillment of id ▪ Assumed to mediate id and superego o superego ▪ conscience o difficult to use scientific examples cognitive-behavioral paradigm • abnormal behavior as result of learning o classical conditioning ▪ pavlov’s dogs ← bell with food, dog would salivate with just bell o operant conditioning • Wilhelm Wundt o Found first psych laboratory
Biological paradigm: behavior genetics • Focuses on brain (structures and neurochemistry) genes • Do disorders run in families? o Researchers identify a “proband” or the index person in a family o Examine the proportion of family members that suffer from different disorders o Proband ▪ Depression—30% of proband’s family will be depressed, .5% schizo ▪ Schizo—10%, 10% ▪ No diagnosis—10%, .5% • Twin studies o MZ=100% same DNA o DZ=~50% of same DNA o Do twins have same disorders? o Assumes MZ and DZ twins aren’t treated differently o Twins raised apart ▪ More differences • Adoption studies o Environment vs. genetic factors o Not related o Proband: biological parents ▪ With disorder X: 20% of adopted away children with disorder X ▪ Without disorder X: 10% of adopted away children with disorder X ▪ Example: alcoholism o Proband: adopted-away child ▪ Adoptees with alcoholism: 20% bio parents have, 10% adoptive parents have ▪ Adoptees without alcoholism: 10%, 10% • Misinterpretations of behavior genetics—These are not true! o If there is a genetic influence, a disorder is inevitable o If a behavior or characteristic is genetically influenced, it cannot be changed o If there is a genetic influence, a gene must be directly responsible for the behavior ▪ Frontal lobe damage o There is a “depression” or “schizophrenia” gene • Biological perspective o Phineas Gage o Biology can be influenced by psychology o Biological causes do not necessarily require biological treatment o Most psychologists view disorders as being caused by multiple factors ▪ Considering how biological and environmental factors effect people ▪ Nature vs. nurture • Reciprocal gene—environment model o Genes might influence the environment that people seek out o Environmental factors may bring out a genetic predisposition • Multidimensional model o Biology does not necessarily form the basis of, underlie or cause psychological factors to exist or develop o Social/psychological factors can cause changes in brain structures, hormone and neurotransmitters • Epigenetics: modification of gene expression by factors other than static DNA sequence
Systems Theory • Integrating psych, bio, social paradigms (causality) • Different paradigms operating at different levels of analysis when explaining human behavior o Including neuron, individual, couple, family, community, culture, etc • Centerpiece o Holism: whole=more than sum of its parts o Reductionism: whole is a sum of its parts ▪ Saying depression is just genetic • Causality o Equifinality: different causes for same disorder ▪ Death of a parent, loss of job, change in brain chemistry all cause depression o Multifinality: same event causes many different outcomes ▪ Earthquake might cause phobia, ptsd, depression, or no disorder o Reciprocal causality: causality is bidirectional ▪ Many researches have suggested that causality occurs in only one direction ← Parents cause their children to have certain behavior ← Children also change parent’s behavior o Diathesis-Stress Model ▪ Diathesis: existing vulnerability that precedes stressor ▪ Stress: any even that triggers onset of disturbance ▪ Remember: diathesis may or may not be biological and stressor may not be environmental
Psychoanalytic/psychodynamic therapies • See human behavior as motivated by unconscious processes • How early development as having profound effects on adult functioning • Using universal principles to explain personality and abnormal behavior • See insight in unconscious key to improvement • FREUD—psychoanalysis o Underlying personality theory ▪ Structural (drive) theory: id, ego, superego ▪ Anxiety alerts ego of threat ▪ When ego is unable to avoid danger through rational means, it resorts to defense mechanisms ← Example: denial, distort reality, projection ▪ Developmental theory: personality formed during childhood as results of experience during psychosexual stages of development ← Oral, anal, phallic, latency, genital ← Highlight children’s internal struggles with sexuality ▪ Maladaptive behavior: psychopathology stems from an unconscious, unresolved conflict that occurred during childhood ← Thinks depression was due to loss, anger turned inward—internalization o Goal ▪ Insight ▪ Reduce or eliminate pathological symptoms by bringing the unconscious into conscious awareness and integrating repressed material into personality o Main components ▪ Analysis (interpretation) of free associations, dreams, resistances, and transferences o Updates: ▪ Declined greatly ← Time consuming ← Little research ▪ Modifications ← Psychodynamic ← Collaborative, egalitarian view of therapeutic relationship ← Brief psychodynamic therapies • Time limited • Target specific problem • Promote positive relationship between client and therapist
Humanistic therapies • Assumed one must understand another’s experience to understand him/her • Focus on current behaviors • Believe in inherent potential for self-actualization • See therapeutic relationship as authentic, collaborative, egalitarian • Reject assessment and diagnoses o Client knows more about experience o Therapist shouldn’t be considered expert • Carl Roger’s client-centered theory o Underlying personality theory ▪ Focus on notion of self and integrating ideas of self into unified whole o Maladaptive behavior ▪ Incongruence between self and experience, leading to anxiety o Goals ▪ To be self-actualized ← Reach full potential ▪ Client is the expert o Major components ▪ Genuineness ▪ Accurate empathy ← Understanding ← See world as client does ▪ Unconditioned positive regard ← Regardless of self client is presenting, therapist is positive ← Accepting client without evaluation
Cognitive Behavioral Therapies • Not based on personality theory • Rooted in behavioral and cognitive psych • View thoughts, emotions, and behaviors as affecting one another • Goal: help clients learn new ways of thinking, acting, feeling o Based on the idea that people can do things differently • Components often included o Collaborative environment between therapist and client o Goal setting o Positive environment o Psychoeducation o Teaching skills ▪ Example: have client write down every time he/she starts worrying • Cognitive therapy for depression o Aaron T. Beck ▪ Had traditional psychoanalytic training ▪ Wanted to provide evidence to support for psychoanalysis ▪ Clinical research affects psych, psych affects clinical research • Monitor maladaptive (irrational) self-statements o Their antecedents and consequences o Evaluate support o Substitute rational cognitions o Evaluate support • Rehearsal (e.g. keeping a daily log) • Similar to science experiment • Outcomes o Treatment is short-term, goal directed o Progress is monitored o Used with many disorders ▪ Success particularly well documented for depression ▪ Often as well as medication and longer lasting ▪ fMRI changes after CBT biological treatments • psychopharmacology o oral medications o chemicals that interact with the central nervous system, producing change in mood, consciousness, perception and/or behavior ▪ increase or decrease profuction or reuptake of neurotransmitters o antipsychotic o antidepressant o mood stabilizing(bipolar o sedative-hypnotic(anxiety, alcohol withdrawals o psychostimulant o problems ▪ compliance ← side effects ▪ some people don’t respond ▪ right dosage can vary across people ← ethnic and age difference ▪ relapse rates are sometimes high following discontinuation • electroconvulsive therapy o despite horrific reputation, it is a safe, effective, and important form of treatment o administration of electrical current through brain under general anesthesia to induce seizure o effects brain widely—exactly how it works is unknown o side effects: transient memory and confusion • psychosurgery: deep brain stimulation o insertion of pacemaker, which send electrical signals to specific brain regions o underlying principles unknown o clinical trials for treatment resistant depression o side effects: headache, irritability, wound infection o more research needed • outcome research o why do we need evidence? ▪ The field has a long history of embracing treatments without evidence ← Lobotomy in 1930 ← People died in “rebirthing” therapy—SVU o Efficacy verses effectiveness ▪ Efficacy: does it work under ideal circumstances ← People with one problem • Ex: people who are just depressed, no anxiety or schizophrenia or anything ▪ Effectiveness: does it work in the real world? ← People may have many things effecting them o Treatment research ▪ Include patients random assigned to treatment, placebo, and treatment as usual groups ▪ Helps account for placebo effect: inert treatments that work ← Common in both medical and psychological studies ▪ How do you standardize psychotherapy? ← Manualized • Treatments provide session by session guidelines ▪ Meta-analysis: combine results across studies to examine an overall effect ← Average client is better off than 80% of untreated peers • Much more effective than commonly used medical treatments o From over 400 studies • For many disorders, psychotherapy provides more long-lasting benefits than meds alone • Many similar treatments used across disorders Other predictors: diagnosis, genuineness of therapist, etc • Classification: categorizing or grouping related objects (disorders) • Benefit: o Facilitates description and communication o Aids treatment decisions, prognosis o Facilitates research on etiology, treatment outcome o Facilitates 3rd party reimbursements • Concerns: o May lead to stigmatization o Unrelated problems may be misattributed to the disorder o Expectations for behavior may change as a result • Ways to classify: o The way they look, outward appearance o The back end, like how diamonds and coal are both made from carbon ▪ Inner workings o The causes, like how a stroke and heart attack have same causes • Categorical approach: reflects a difference in kind or quality o People with abnormal behaviors are qualitatively different than normal people (discrete groups) ▪ Largely used by DSM-IV ▪ You either are depressed or you aren’t ▪ Example: major/minor weaver ants by size • Dimensional approach: focuses on the amount of a particular characteristic an object possesses o People with abnormal behaviors are quantitatively different (continuum) ▪ There’s a scale of depression • Diagnostic Systems: o International Classification of Mental and Behavioral Disorders o Diagnostic and Statistical Manual of Mental Disorders ▪ American Psychiatric Association o Number of disorders have increased—subdivisions, some new diagnoses o DSM-IV ▪ Depends on symptoms not causes ▪ Largely categorical ▪ Multi Axial ← Axis I: Clinical disorders • Mostly characterized by episodic periods of psychological turmoil ← Axis II: Personality disorders and mental retardation • Mostly concerned with stable, longstanding problems ← Axis III: general medical conditions • medical problems relevant to etiology of patients behavior or treatment program ← Axis IV: Psychosocial and environmental problems • Factors that may affect treatment and prognosis of mental disorder o Poverty, legal problems, lack of support, turmoil at home ← Axis V: Global Assessment of Functioning • Rating 1 to 100 of individual’s overall level of functioning o 100 most functioning • Usually assessed at several points o Highest in the past year o At intake o Current ▪ Limitations of the DSM-IV ← Arbitrary boundary between normal and abnormal behavior • Cutoff points not always empirically justified • Reliance on clinicians’ subjective judgment • Time periods in definitions of diagnoses o Grief vs. depression ← Problem of comorbidity • Simultaneous appearance of two or more disorders in the same person • 56% of those who meet criteria for one disorder meet criteria for at least one other disorder • comorbidity affects the validity of the system and the reliability of the diagnosis o DSM-V ▪ Began in 2007: 27+ experts contributing to its development ▪ A few big issues: categorization vs. dimensional ▪ PTSD • Reliability: degree to which an assessment measure produces the same result each time it is used to assess the same thing o Inter-rater reliability—refers to agreement of raters about observations • Validity: extent to which a measuring instrument actually measures what it’s intended to measure o Conceptualized as a continuum of more to less useful ▪ Ex: classification systems are more to less valid o Etiological validity: concerned with the specific factors that are regularly and perhaps uniquely associated with a particular disorder ▪ Cause A causes disorder A o Concurrent validity: concerned with the association between disorder and other symptoms, life circumstances/life events, and test performance o Predictive validity: concerned with the accuracy of predicting future outcomes
Psychological Assessment • Projective tests o Based on psychodynamic theory o Indirect method using ambiguous stimuli o Unstructured o Time-consuming o Subconscious causes o Examples ▪ Rorschach Inkblot Sample ← Shown ambiguous stimuli ▪ Thematic Apperception Test: Administration ← Cards with people in ambiguous scenarios ← Test-taker is asked: • What’s happening in the scene? • What has lef up to this scene? • What are the thoughts and feeling of people in the scene? • What will the outcome be? ← Responses are recorded verbatim ← Idea of projecting own experiences/feelings on these scenes o Interpretation is subjective ▪ Low inter-rater reliability ▪ Questionable validity ▪ Often overpathologizes • Interviews o To aid making diagnoses ▪ Structured clinical interview for DSM-IV o Collect history, social context o Strengths: ▪ Can probe and get information as need ▪ Can code non-verbal behaviors o Problems: ▪ Some people are poor historians ▪ Some people are scared of getting a diagnosis ▪ Some people just say yes to everything ▪ Bias to how people view themselves, information taken through their lens • Observational Procedures o Often in natural environments ▪ Multiple settings for children o Quantifying behavior ▪ Rating scales ▪ Behavior coding scales ← Frequency of specific behaviors or events o Consistency, extremity of symptoms o Weaknesses: ▪ Biases of coders ▪ Act of observing something changes it • Personality tests and self report inventories o Structured inventories with carefully worded items and responses o Examples: ▪ NEO-Personality Inventory ← Assesses Big 5 (OCEAN) ▪ Minnesota Multi-phasic Personality Index (MMPI) ← Most widely used personality test for clinical and forensic assessment in the US ← Validity, critical scales o Pros: ▪ Low cost ▪ Efficient o Cons: ▪ Depends on reading ability ▪ No follow-up questions • Physiological Assessment o Often used to assess autonomic nervous system ▪ Heart rate ▪ Skin conductance (like sweating) ▪ Respiration o Pros: ▪ Hard to fake ▪ accurate o Cons: ▪ Intimidating ▪ Must have norms for different groups, like obese or elderly o Neurological ▪ Brain wave patterns ← EEG ▪ Brain structure ← MRI • Cons: can’t have braces, so hard to study adolescents ▪ Brain function ← PET ← fMRI (functional MRI)