Medical Psychology Course

Psychological Processes

• Learning: a relatively permanent change in behavior potentials due to experience and interaction with the environment
• Types of Learning:
  • Association Learning: concerned with events occurring together during the learning process
    • Classical Conditioning (Pavlovian Conditioning): focuses on pairing two stimuli to lead to new behavior
      • Principles:
        • Acquisition
        • Extinction
        • Spontaneous Recovery
        • Generalization
        • Discrimination
    • Operant Conditioning: a response or behavior is influenced by consequences
      • Through operant conditioning, individuals learn to increase certain behaviors followed by reinforcing stimuli and suppress others followed by punishing stimuli
  • Observational Learning: learning through observation and imitation

Clinical Interview

• A conversation between a psychologist and client intended to help the psychologist diagnose and treat the patient
• Structure of Interview:
  • "A conversation with a purpose"
  • Degree of structure: some interviews allow for free drift, while others are highly directive and goal-oriented
  • Types of Clinical Interviews:
    • Structured Interview: uses simple questions to get detailed and specific information from the patient
      • Examples: Schedule for Affective Disorders and Schizophrenia (SADS), Structured Clinical Interview for the DSM-IV (SCID)
    • Unstructured Interview: asks open-ended questions to encourage the patient to expand on their answers
    • Semi-structured Interview: offers a balance between structured and unstructured interviews, allowing for discussion and exploration of specific areas
• Types of Clinical Interviews:
  • Intake Interview: the first interview with a patient, focusing on their mental and physical health history, and goals for therapy
  • Mental Status Exam: a clinical interview that assesses a patient's behavior, appearance, attitude, and movements, as well as their answers to questions

Neural Mechanisms of Attention

• Sensation: the process of receiving and representing stimulus energies from the environment
• Perception: the process of organizing and interpreting sensory information to recognize meaningful objects and events
• Principles of Perception:
  • Perceptual Selection: selection to see, feel, and process certain stimuli
  • Perceptual Integration: organizing and structuring sensory information into a meaningful whole
  • Perceptual Comprehension: the ability to understand and interpret sensory information
  • Perceptual Constancy: the tendency to perceive objects as having constant shape, size, and brightness despite changes in stimulation
• Attention: the cognitive process of selectively concentrating on one aspect of the environment while ignoring others
• ADHD: distractibility, inattention, hyperactivity, and impulsivity

Neural Mechanisms of Working Memory

• Working Memory (Short-term Memory): maintains current, but temporary, representations of goal-relevant knowledge
• Encoding: forming new memories, translating information into a form that can be stored in memory
• Storage: maintaining information in memory over a period of time
• Retrieval: the process of searching for and bringing to mind previously stored information
• Theory of Memory Storage:
  • Sensory Memory: temporary storage of information in sensory areas of the brain
  • Short-term Memory: working memory, holding a small amount of information in awareness for a brief period
  • Long-term Memory: storing information for a longer period of time, allowing for retrieval at any later time

Neural Mechanisms of Visual Information Processing

• Selective Attention: focusing of conscious awareness on a particular stimulus
• Inattentional Blindness: failing to see visible objects when attention is directed elsewhere
• Bottom-up Processing: analysis that begins with sensory receptors and works up to the brain's integration of sensory information
• Top-down Processing: information processing guided by higher-level mental processes, such as constructing perceptions drawing on experience and expectations
• Visual Areas and Functions:
  • V1: feature maps
  • V2: higher-order color/brightness, contours, and surfaces
  • V4: contours, surfaces, figure/ground, curvature, and shape
  • IT: perception/identification
  • MT: motion direction/perception
  • MST: higher-order motion, flow field
  • Parietal: multisensory integration, spatial transformation

Clinical Relevance

• Ventral Pathway Lesion: deficit in shape perception (what an object is) coupled with intact visuo-motor functions (how to act on an object)
• Dorsal Pathway Lesion: deficit in moving using visual guidance (how to act on an object) coupled with deficit of visual spatial relations, but intact visual perception (what an object is)
• Hemispatial Neglect: a damage to hemisphere of the brain, resulting in a deficit in attention to and awareness of one side of the field of vision### Motivation and Emotion
• Motivation: process of starting, directing, and maintaining physical and psychological activities
• Instinct theory: complex, innate, biological behavior pattern characteristic of a species
• Drive reduction theory: internal state created by a physiological need
• Optimum theory: maintaining a certain level of stimulation or activity, best under moderate arousal
• Incentive theory: motivation stems from the desire to obtain valued external stimuli
• Cognitive theory: thinking about, planning, and exercising control over individual behavior
• Motives conflict:
  • Approach-approach conflict: attracted to two equally desirable goals
  • Avoidance-avoidance conflict: choosing between two equally unpleasant alternatives
  • Approach-avoidance conflict: one goal has both good and bad aspects
  • Multiple approach-avoidance conflict: choosing among several goals with good and bad features

Emotion Theory

• James-Lange theory: emotion occurs as a result of physiological reactions to events
• Cannon-Bard theory: physiological arousal and emotional experience produced simultaneously by the same nerve impulse
• Schachter-Singer theory (Cognitive perspectives on emotion): joint effect of physiological arousal and cognitive appraisal
• Opponent-process theory: experience of one emotion suppresses the other (e.g., fear-relief, pleasure-pain)

Thinking and Consciousness

• Thinking: manipulation of mental representations of information
• Brain regions involved: medial temporal lobe, lateral parietal cortex, medial parietal cortex, and medial prefrontal cortex
• Mental images: representations of objects, events, or scenes in the mind
• Concepts: categorization of objects, events, or people that share common properties (prototypes)
• Problem-solving: higher-order mental process that requires moving a given state toward a desired goal state
  • Ill-defined and well-defined problems
• Reasoning and decision-making:
  • Deductive reasoning: follows logically from some statements or premises
  • Inductive reasoning: attempts to infer new conclusions from available evidence and past experience
• Consciousness: awareness of an individual's perceptions, thoughts, and feelings being experienced at a given moment
• Characteristics of consciousness:
  • Subjectivity: individual's perception, thoughts, and feelings
  • Uniformity: unified whole experience
  • Change: constantly changing
  • Initiative: active process
• Levels of consciousness:
  • Conscious level: currently attended cognitions and emotions
  • Preconscious level: easily retrievable cognitions and emotions
  • Unconscious level: difficult or impossible to access cognitions, impulses, desires, and emotions

Gestalt Psychology

• Founded by Max Wertheimer, Wolfgang Kohler, and Kurt Koffka
• Principles:
  • Simplicity: objects perceived in simplest forms
  • Continuity: following lines or curves
  • Filling in gaps: brain fills in missing details
• Main principles:
  • Continuity: smooth, flowing lines
  • Closure: single, recognizable pattern
  • Similarity: similar elements grouped together
  • Proximity: elements close together perceived as related
  • Common Region: elements sharing a defined boundary grouped together
  • Focal Point: attention-grabbing element
  • Figure & Ground: object (figure) vs. background (ground)

Freud's Psychoanalytic Theory and Therapy

• Developed by Sigmund Freud
• Emphasizes unconscious motivations and inner forces
• Topographic Model:
  • Unconscious: underlying emotions, beliefs, feelings, and impulses
  • Preconscious: accessible cognitions and emotions
• Structural Model (Iceberg Theory):
  • ID: impulsive, childlike, and operates on the pleasure principle
  • Super-ego: moral component
  • Ego: rational, balances ID and Super-ego
• Psychosexual stages of development:
  • Oral stage (0-18 months): mouth as focal point of pleasure
  • Anal stage (18 months-3 years): anus as focal point of pleasure
  • Phallic stage (3-6 years): genitals as focal point of pleasure
  • Latency stage (6 years-puberty): repression of sexual desires
  • Genital stage (puberty onwards): mature sexuality
• Ego-defense mechanisms: coping with reality and maintaining self-image
• Life and death instincts: life drive (Eros) and death drive (Thanatos)

Behaviorism and Behavior Therapy

• Classical conditioning: Ivan Pavlov and John B. Watson
• Operant conditioning: B.F. Skinner
• Social Learning Theory: Albert Bandura
• Behavior therapy: based on classical and operant conditioning
• Goal: reinforce desirable behaviors and eliminate unwanted ones
• Types of behavioral therapy:
  • Applied behavior analysis
  • Cognitive-behavior therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Exposure therapy### Classical Conditioning in Behavioural Therapy
• Ways to alter behaviour using classical conditioning:
  • Aversion therapy: pairing undesirable behaviour with an aversive stimulus to reduce the behaviour
  • Flooding: exposing people to fear-invoking objects/situations intensely and rapidly to treat phobias
  • Systematic Desensitization: gradual exposure to feared objects/situations while learning relaxation techniques to treat phobias and anxiety disorders

Behaviour Therapy Applications

• Helps with:
  • Bipolar disorder
  • Alcohol/substance abuse disorders
  • Anxiety
  • ADHD
  • Autism spectrum disorders
  • BPD
  • Depression
  • Eating disorders
  • Panic disorders
  • Phobias
  • OCD

Humanism and Humanistic Therapy

• Proposed by:
  • Abraham Maslow
  • Carl Rogers
• Maslow's focus:
  • Unconscious aspects of personality
  • Acknowledging unconscious motives
  • People are free-willed, seeking to satisfy innate motives in a way that fits their style and environment
• Maslow's Hierarchy of Needs:
  • Physiological needs
  • Personal safety
  • Love and belonging
  • Self-esteem
  • Self-actualization (rarely achieved) – full development of one’s potential
• Peak experiences:
  • Transcending time and place
  • Unity with the universe
  • Sense of power and wonder

Personality Analysis of Freud

• Definition of personality:
  • Pattern of thoughts, feelings, and behaviour unique to each person
  • Stable for one person, develops over time
  • Maturing, different life experiences, and changing circumstances affect personality
  • Flexibility to learn from past experiences and cope with life more effectively
• Approaches to personality:
  • Psychoanalytic approach (Freudian concepts)
  • Trait approach
  • Behavioural and social learning approach
  • Humanistic approach
  • Biological approach

Psychoanalytic Approach to Personality

• Concepts developed by Sigmund Freud
• Freudian concepts:
  • Id, Ego, and Superego
  • Personality development concepts/phases

Personality Disorders

• Common types according to DSM-5:
  • Cluster A:
    • Paranoid personality disorder
    • Schizoid personality disorder
    • Schizotypal personality disorder
  • Cluster B:
    • Antisocial personality disorder
    • Borderline personality disorder
    • Histrionic personality disorder
    • Narcissistic personality disorder
  • Cluster C:
    • Avoidant personality disorder
    • Dependent personality disorder
    • Obsessive-compulsive personality disorder

Borderline Personality Disorder (BPD)

• Clinical features:
  • Mood instability
  • Interpersonal relationship instability
  • Explosive short-lived relationships
  • May drink/abuse drugs heavily
  • At risk of developing depressive disorders, anxiety, and eating disorders
  • Borders between neurological disease and personality disorder
• Theories:
  • Greater activation of amygdala in response to pictures or emotional faces
  • Decreased metabolism in the prefrontal cortex
  • Impulsive and aggressive behaviours linked to low levels of serotonin
  • Poorly developed views of themselves and others, stemming from poor early relationships with caregivers
• Treatments:
  • Drug treatment – reducing symptoms of anxiety and depression (lithium, anticonvulsants, antidepressants)
  • Psychodynamic therapy – helping persons gain a more realistic and positive sense of self, learn adaptive skills, and correct dichotomous thinking
  • Group therapy – working with interpersonal problems of BPD patients

Antisocial Personality Disorder

• Clinical features:
  • Impairment in ability to form positive relationships with others
  • Tendency to engage in behaviours that violate basic social norms and values
  • Tendency to engage in impulsive and aggressive behaviours
  • Self-centred, selfish, sometimes cruel, cold, and lacking in affection
  • Unable to appreciate the needs or feelings of others
  • Often exploit others with whom they are involved
• Theories:
  • Family and twin studies support a genetic component to the etiology
  • Aggressiveness in people with antisocial personality disorders may be linked to the hormone testosterone
  • ADHD in children
  • Deficits in verbal skills and executive functions of the brain
• Treatments:
  • SSRIs have been used to control aggressive behaviours
  • Lithium for reducing impulsive aggression
  • Psychotherapy helps people gain control over their anger and impulsive behaviours, increasing empathy

Schizoid Personality Disorder

• Clinical features:
  • Little concern or interest in other people or society
  • Prefer to be isolated
  • Internal activity – sometimes great in art, research, other creative activities
  • Little expression of emotion
• Sometimes transfers to schizophrenia; considered as signs of pathogenesis of schizophrenia
• Treatments:
  • Talk therapy and some medications
  • Schizoid PD people not necessarily suffering from disorder
  • If associated with schizophrenia – requires psychiatric treatment

Theoretical Perspective on Stress

• Fight or flight response (Walter Cannon):
  • Sequence of internal activities triggered when an organism is faced with a threat
  • Prepares the body for combat and struggle or for running away to safety
• Tend-and-befriend response (Shelley Taylor):
  • Response to stressors that is hypothesized to be typical for females
  • Stressors prompt females to protect their offspring and join social groups to reduce vulnerability
• General adaptation syndrome (Hans Selye)
• Lazarus’s model (Richard Lazarus):
  • Neither the stressor nor response could define stress
  • The individual’s perception and appraisal of the stressor determines if it would create stress

Stress in Psychology

• Definition of stress:
  • Pattern of specific and nonspecific responses an organism makes to stimulus events that disturb its equilibrium and tax or exceed its ability to cope
• Elements of stress:
  • Stressors
  • Stress responses
  • Genetic and environmental factors
• Concept of stress in psychology:
  • How vulnerable you are personally to becoming stressed out depends on various factors
  • Includes 3 related elements: stressors, stress response, and genetic and environmental factors
• Stressor characteristics:
  • External characteristics (intensity, duration, number)
  • Internal characteristics (coping skills, self-efficacy, appraisal)

4 A's of Stress Management

• Avoid unnecessary stress:
  • Learn to say “no” – know your limits and stick to them
  • Avoid people who stress you out
  • Take control of your environment
• Alter the situation:
  • If you cannot avoid a stressful situation, try to alter it
  • Be more assertive and communicate your concerns in an open and respectful way
  • Be willing to compromise – willing to bend a little
  • Manage your time better
• Adapt to the stressor:
  • Try to view stressful situations from a more positive perspective
  • Adjust your standards – stop setting yourself up for failure by demanding perfection
  • Set a reasonable standard
• Accept the things you cannot change:
  • Some sources of stress are unavoidable
  • The best way to cope with stress is to accept things as they are