Personality & Mental Health mindmap all notes.docx

Research Methods Case Study Case-Control Qualitative Quantitative Cross-sectional Data recorded once Longitudinal Data recorded multiple times Track changes in personality over time Experimental Manipulation Establish cause and effect Meta-analysis Summarises multiple studies What do personality res...

Research Methods Case Study Case-Control Qualitative Quantitative Cross-sectional Data recorded once Longitudinal Data recorded multiple times Track changes in personality over time Experimental Manipulation Establish cause and effect Meta-analysis Summarises multiple studies What do personality researchers study? Broad personality constructs Specific personality constructs Personality Psychoanalytic Approach Freud (1856-1939) Adler (1870-1937) Jung (1875-1961) Horney (1885-1952) Controlled by unconscious forces Personality fixed based on early life experiences Adult psychological experience = repeating conflicts of the past Impulses denied = healthy personality functioning Anxiety caused by unacceptable biological impulses of the id General critiques Humanistic Approach People have an innate tendency towards self-actualisation Personality is a result of an individual trying to become their best self Concerned with more developed and healthier aspects of human behaviour (e.g., creativity) Emphasis on the present rather than the present or future Self-reflection and choice are key to development Focus upon goals/outcomes of behaviour rather than describing individual differences or behavioural mechanisms Abraham Maslow (1908-1970) Carl R. Rogers (1902-1987) Personality defined by growth-promoting experiences (actualising tendency) When we are young, internal experiences influence personality. As we age, external rules replace inner experiences and desires and change personality Environment may interact with our motivations, producing fear and defensiveness (e.g., parents, peers, schools) Self Control by own actions/choices Personality not fixed - development is lifelong Adult psychological experience = achieving self-actualisation Congruence = healthy personality functioning Anxiety caused by incongruence between self and one's actions General critiques Behavioural Approach Personality is the result of learning Law of Effect Strengths Limitations Social and Cognitive Approaches Social Approach Cognitive Approach Social-Cognitive Theory Trait Approach Hans Eysenck (1916-1977) Walter Mischel (1930-2018) Does not try to explain behaviour Identifies personality characteristics that can be represented along a continuum Trait Nomothetic approach Idiographic approach Jungian Personality Theory Factor Analysis HEXACO model Criticisms Biological Approach Inherited predispositions that determine personality Physiological processes explain differences in personality Genetic influence Genetics vs. Environment Jeffrey Alan Gray (1904-2004) Measuring personality Phineas Gage (1823-1860) Is personality hardwired? Strengths Limitations Definition: An individual's unique and relatively consistent pattern of thinking, feeling and behaving Personality = individual differences Personality Measurements Self-Report Inventory Applying Psychology Projective Tests Barnum Effect Faking Designing assessments Mental Health Clinical Disorders Overview Abnormal Behaviour "Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community" Clinical Disorders: "Characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities" Influencing factors for mental health Understanding behaviour on a continuum (normal → psychological disorder; very severe) Essential Terms Diagnosing Clinical Disorders DSM-5 Issues with assessing abnormal behaviour How do we assess? Korsakoff's Syndrome Psychiatric vs. physical diagnoses Challenges to effective diagnosis Schizophrenia History of Schizophrenia Psychological disorder involves severely distorted beliefs, perceptions, and thought processes Diagnosed when two or more of characteristic symptoms Multilevel Process for Diagnosing Schizophrenia Catatonia Prevalence Temporary or chronic? Spectrum and related disorders Genetic Factors Other Factors Biological Factors Antipsychotic medications Anxiety and Obsessive Compulsive Disorders What do we mean by anxiety? Anxiety and arousal Autonomic responses in fear/anxiety Anxiety Disorders and anxiety-related difficulties History of Anxiety Disorders DSM-5 Common anxiety disorders PTSD Common cognitive symptoms of anxiety Common behavioural and affective symptoms of anxiety Comorbidity is common - 40% to 80% of people with anxiety meet diagnostic criteria for 2 or more disorders Chronic Mowrer Two Factor theory of phobia Panic Disorders Social Phobia/Social Anxiety Disorder OCD Mood Disorders Depression Bipolar Disorder Personality Disorders What is a personality disorder? General personality disorder Clusters Treatment Treatment of Clinical Disorders Schizophrenia Glutamate (GLU) GABA Anxiety Serotonin (5HT) Depression Bipolar Disorder CBT DBT IPT Research Methods Case Study Case-Control Qualitative Quantitative Cross-sectional Data recorded once Longitudinal Data recorded multiple times Track changes in personality over time Experimental Manipulation Establish cause and effect Meta-analysis Summarises multiple studies What do personality researchers study? Broad personality constructs Extraversion Introversion Neuroticism Mood disorders Academic performance Health behaviours Specific personality constructs Alcohol use Smoking Family history of specific behaviours Genetics Environment Why do people do specific behaviours? Personality Psychoanalytic Approach Freud (1856-1939) Studied neurology at medical school Conducted research before entering clinical practice Influences 'Conservation of energy' - physics Hypnosis as treatment for hysteria Freud concluded that examining brain anatomy could not sufficiently explain mental disorders Conscious (Ego) Thoughts that we're aware of in any given moment Balances Id's urges with Superego's constraints Operates via reality principle: long-term gratification Logical, rational and resilient = "You" Preconscious (Superego) Thoughts that we can become easily aware of Controls moral/rule-bound behaviour, including ideals and ethics Rewards good behaviour and punishes bad behaviour (e.g., guilt) Conflicts with the Id Unconscious (Id) Thoughts that we're unaware of or can only become aware of in certain situations Seeks release of unconscious and primal needs and desires Works according to the pleasure principle: immediate gratification Not concerned with moral or social rules Psychosexual Development of Personality Psychosexual development occurs in stages, via which personality style and individual differences develop At each stage, sexual energy is focused on a different target (i.e., source of interest and pleasure) Oral stage (up to 2yrs) Focus on oral pleasure (e.g., thumb sucking, feeding) Anal stage (2-3yrs) Tension between pleasure (release) from toileting and social pressure to delay Phallic stage (4-5yrs) Focus on genitals; realisation of physical male/female differences leads to psychological gender differentiation Oedipus/Electric complexes Latency stage (6 years until puberty) With key conflicts resolved, child represses sexuality and channels energy into social and intellectual pursuits Genital stage (puberty until death) Sexual and aggressive drives return Seeks pleasure through sexual contact with others Ego and Superego now fully developed Personality from fixation If sexual or libidinal energy is stuck or fixated at various stages, conflicts can occur and these can leave a deep imprint on adult personality What did Freud get right? Unconscious cognitive processes Talking therapies Repressed memories Defense mechanisms Profound cultural legacy What did Freud get wrong? Psychosexual stages of development Penis envy/Castration anxiety Oedipus/Electra complexes Defense Mechanisms Techniques of the ego to deal with unwanted thoughts and desires and reduce/avoid anxiety Repression Push threatening material out of consciousness Forceful forgetting Requires constant expense of energy Sublimation Channelling impulses into socially acceptable actions Usually rewarding No evidence Displacement Channelling impulses to nonthreatening objects Displaced impulses do not lead to rewards Denial Refusal to accept that certain facts exist Some evidence Reaction formation Acting in a manner opposite to threatening unconscious desires Good evidence Projection Attributing negative thoughts/emotions to someone else Adler (1870-1937) Believed Freud overemphasised sexuality People consciously strive to improve their lives (towards 'superiority') Relationships (parents, peers, siblings etc.) shape individuals; so does desire to contribute to society Individuals focus on compensating for painful inferiorities (inferiority complex) Jung (1875-1961) Believed Freud overemphasised sexuality Embraced a 'mythological' approach and rejected scientific method Proposed a 'collective unconscious' Plato's 'Meno' Soul is immortal, reincarnated All knowledge is kept within the soul We forget everything at birth due to trauma Focused on dual aspects of the personality: private self vs. persona presented to others Therapy should help the expression of the unconscious: an ally not an enemy Horney (1885-1952) Culture a primary influence on individuals' personality Personality traits relate to strategies to reduce interpersonal anxiety Women more likely to envy men's status, power and freedom than their penises Women are socialised into gender roles, not 'destined' to fulfil them by biology or psychology Controlled by unconscious forces Personality fixed based on early life experiences Adult psychological experience = repeating conflicts of the past Impulses denied = healthy personality functioning Anxiety caused by unacceptable biological impulses of the id General critiques Focus on psychiatric patients, not generalisable to general population? No clear way of refuting aspects of psychodynamic theory: often not testable or falsifiable Theories often not based in scientific, empirical research Humanistic Approach People have an innate tendency towards self-actualisation Personality is a result of an individual trying to become their best self Concerned with more developed and healthier aspects of human behaviour (e.g., creativity) Emphasis on the present rather than the present or future Self-reflection and choice are key to development Focus upon goals/outcomes of behaviour rather than describing individual differences or behavioural mechanisms Abraham Maslow (1908-1970) Studied behavioural psychology Mentored by Alfred Adler Focused on a person-centred approach Criticised psychology's focus on psychopathology to understand personality (e.g., abnormal behaviours) Thought focus on health and thriving was more informative (e.g., positive psychology) Hierarchy of Needs Stolen from Blackfoot Nation Development begins with basic needs (motives) - similar to animals Once lower needs satisfied, more uniquely human motives drive behaviour Signs of self-actualisation can appear at early levels of hierarchy Humans don't reliably follow the sequence Humans do broadly evolve through the stages as they age Different needs must be fulfilled for optimal human functioning Peak Experiences Occur when people are engaged in self-actualising activities Enter a "flow" state Challenging and skilful activity Attention is completely absorbed by activity Activity has clear goals Presence of clear feedback Concentration can only be on activity Achievement of personal control Loss of self-consciousness Loss of sense of time Carl R. Rogers (1902-1987) Studied history and agriculture, before joining the ministry Trained in psychology, worked with underprivileged kids Focused on therapeutic method and use of person-centred therapy Worked in international conflict resolution and was nominated for Nobel Peace Prize Person-centered therapy Application of Rogerian therapy makes clients more fully functioning and happier Involves creating a proper relationship with clients Open and genuine Reflection - helping clients understand their personality Unconditional Positive Regard: Non-judgmental valuing of an individual. Term Roger's preferred over 'love', as he felt most of what is termed love isn't unconditional. Personality defined by growth-promoting experiences (actualising tendency) When we are young, internal experiences influence personality. As we age, external rules replace inner experiences and desires and change personality Environment may interact with our motivations, producing fear and defensiveness (e.g., parents, peers, schools) Self Organised pattern of perceptions, consciously available Integrated and organised Endures over time Characterises who you are Maintained and updated as the 'self' changes Aims at consistency and congruence between self and actions Control by own actions/choices Personality not fixed - development is lifelong Adult psychological experience = achieving self-actualisation Congruence = healthy personality functioning Anxiety caused by incongruence between self and one's actions General critiques Though the positive focus is very attractive, theory may be too optimistic about human behaviour Majority of theories are not supported by evidence, they are based on assumptions Certain constructs are hard to define, even by humanists Behavioural Approach Personality is the result of learning Operant conditioning Personality develops from conditioning Reward = Behaviours are likely to be repeated Social gains → solidify personality Punishment = Behaviours are unlikely to be repeated Embarrassment → change personality B.F. Skinner & Rats Generalisation: Generalising a response of a specific stimulus to another stimulus Discriminate: Differentiation between rewarding and non-rewarding stimuli Observational learning Personality develops as a result of mimicry of others Particularly effective amongst children Gender roles Biological differences between the genders (debated) Lifelong process of gender-role socialisation (likely) Acquired through observational learning Law of Effect Behaviours are... More likely to be repeated if they lead to satisfying consequences Less likely to be repeated if they lead to unsatisfying consequences Strengths Based within empirical research Explains external influence on personality Development of useful therapeutic procedures Treatments based on conditioning are effective Most useful approach for certain populations Limitations Tends to view human behaviour as simple Assumes individuals are "blank slate" Narrow in its description of human personality Does not consider the role of genetics and biology Humans are more complex than lab animals Reduction to observable behaviours disregards cognition Social and Cognitive Approaches Social Approach How social processes and interactions, along with the environment, shape personality Social Learning Theory Individuals generate their own reinforcers Create expectancies of what will happen if we behave in a certain way Behaviour potential Different behaviours have a different likelihood of occurring Depends on anticipated and learned rewards/punishments Social Norms Unwritten rules for how to behave Ethical/moral behaviour Peer or family expectations Provide "blueprint" for behaviour Stanford Prison Experiment Participants were randomly assigned to be prisoner or guard The guards became aggressive, the prisoners became submissive Personality changed based on their expectations of that societal role Gender Roles Social pressure to act "like a man" or "like a woman" prevalent Norms to act as either masculine or feminine roles likely still shapes personality Albert Bandura We can provide our own reinforcers without direct experience of rewards and punishments Observe rewards/punishments for others Mimic others' successful behaviours (observational learning) Mirror neurons Cells in the brain that activate to mimic others' behaviour Help us to learn new behaviours, understand behaviour Linked to empathy Social Learning Theory Social Cognitive Theory Reciprocal determinism Operant conditioning influences personality Interacts with observations, morals, beliefs etc. Cognitive Approach How mental representations and cognitive processing shape personality Differences in personality are differences in the way people process and store information Personality due to mental representations and how these are accessed and stored People react differently to the same situation based on how they process the situation Semantic Network Model Mental links form between concepts Common properties provide basis for mental link Shorter path between concepts = stronger association in memory Spreading Activation Concept is activated in semantic network, spread in any number of directions, activating other nearby associations in network Nearby activated concepts inform behaviour Self-Schema Cognitive representations of oneself that one uses to organise and process self-relevant information Consists of the important behaviours and attributes People behave differently due to individual differences in self-schemas Provide a framework for organising and storing information about our personality Self-Reference Effect Easy remembering of self-referent words as they are processed through self-schemas Strengths Ideas developed through empirical findings Extensive investigation in controlled laboratory experiments Fits well within modern psychology Therapists from other approaches incorporate aspects of cognitive psychology in their practice Limitations Some concepts are too abstract for empirical research Not always well implemented within personality research No single model or theory to explain personality Central Executive Coordinates and decides on behaviour Controls attention, memory, and decision making 'Conductor' of your personality Your consciousness Social-Cognitive Theory Reciprocal determinism External and internal interactions influence personality Personality is determined by: External factors (rewards, punishments) Internal factors (beliefs, thoughts, expectations) Trait Approach Hans Eysenck (1916-1977) Identified two primary personality traits (independent of each other) Extraversion-Introversion Extraverts are outgoing, impulsive and social Introverts are quiet, reserved and distant Neuroticism People high on neuroticism are unstable or highly emotional, easily upset and angered People low on neuroticism are less prone to mood swings Argued that biology influences personality Consistency of extraversion-introversion over time Cross-cultural research indicates similar personality dimensions Genetics play vital role in determining personality Major opponent of lexical approach Walter Mischel (1930-2018) Personality is not always a reliable predictor of behaviour Long-term consistency, personality captures "average" behaviour Our behaviour usually depends on the environment we're in Does not try to explain behaviour Identifies personality characteristics that can be represented along a continuum Trait Characterises people according to degree to which they display a particular characteristic Assumes that personality characteristics are stable over time Surface trait Characteristics or attributes that can be inferred from observable behaviour Source trait Most fundamental aspect of personality; broad, basic traits that are thought to be universal and few in number Central traits Can easily describe an individual's personality Secondary traits Preferences, not main predictor of behaviour Cardinal trait Single dominating trait in personality Nomothetic approach Describing personality along a finite number of traits Extraversion Neuroticism These traits can be applied to everyone Idiographic approach Identifies any combination of traits to describe individual Infinite possibilities Idiographic traits may not apply to everyone Jungian Personality Theory Carl Jung (psychoanalyst) Personality traits for perceiving the environment and obtaining/processing information Factor Analysis Data reduction technique Simplify relations amongst variables Identify common patterns in data Why is Factor Analysis important? Simplifies assessment Shorter surveys Easier analysis Finds naturally occurring and covarying traits No more assumptions "Boils down" personality to key components Average together related traits into single traits Easier than interpreting each individual subtrait Assume overarching "factor" is responsible for subtraits Raymond Cattell 16 personality traits The Big Five Tested in more than 50 cultures Biologically influenced Traits seem stable over lifespan Openness Involves active imagination, divergent thinking, and intellectual curiosity People on the high end are unconventional and independent thinkers Individuals on the low end prefer the familiar rather than the imaginative Conscientiousness People on the high end are organised, plan oriented, and determined Individuals on the low end are careless, easily distracted from tasks, and undependable Extraversion Places extreme extraverts at one end and extreme introverts at the other Extraverts are very sociable people Introverts are reserved and independent people Agreeableness People with high scores are helpful, trusting, and sympathetic Individuals with low scores tend to be antagonistic and skeptical Neuroticism Places people according to their emotional stability and personal adjustment People with high scores are more vulnerable to anxiety and depression Individuals with low scores tend to be calm and well adjusted Assumes lexical approach is correct Factor Analysis is not perfect Subjective interpretation of results We have to decide what items are included What if we forget or miss something? Lexical Hypothesis Examine traits used within language - already embedded within everyday speech Allport and Odbert (1936) Searched dictionary for words that describe people 18,000 out of 550,000 Filtered to remove physical attributes, cognitive abilities and talents, transient states and highly evaluative terms 4500 words remained Raymond Cattell simplified into 16 traits HEXACO model Honesty-Humility (H) Emotionality/Neuroticism (E) Extraversion (X) Agreeableness (A) Conscientiousness (C) Openness to Experience (O) Criticisms Factor analysis is not perfect Subjective interpretation of results Included items are decided by researchers Big Five Too broad? HEXACO model Missing factors? Derives from the lexical approach Culturally biased Assumes personality is captured in everyday language Eysenck's approach developed as criticism of lexical approach Trait theory problems Are personality traits consistent? Is the structure of traits universal? Traits or types? Are traits sufficient for describing personality? Are individual differences consistent? Walter Mischel observed that behaviour and personality traits correlated weakly Criticisms of Mischel Weak correlations are still important Situational influences are about as weak as personality traits Biological Approach Inherited predispositions that determine personality Physiological processes explain differences in personality Genetic influence Twins Fraternal twins 50% shared genetics Dissimilar personality Identical twins 100% shared genetics Similar personalities Share similar environments from birth Limitations 100% of genetic similarities share roughly 50% of personality Environment may account for remainder of this variability Certain personality traits might have more genetic influence (e.g., neuroticism) Environment likely also plays a big role in development of personality Genetics vs. Environment Genotype Genetic makeup of an individual Contained in 23 pairs of chromosomes Made up of pairs of alleles provided by parents Epigenetics Genotype ≠ you Influence of environment on gene expression Alters structure of DNA Phenotype Observable expression of genetics e.g., height, eye colour, blood type, personality Jeffrey Alan Gray (1904-2004) Critique of Eysenck Introverts & Extraverts differ in how they respond to emotional stimuli Introverts are quickly aroused when exposed to external stimulation Maybe there is something beyond extraversion/introversion? Sensitivity to stimulation Reinforcement Sensitivity Theory The human brain has two behavioural systems underlying individual differences in sensitivity to reward, punishment, and motivation Behavioural Approach System (BAS) Seek out impulsive, rewarding behaviour Engage in emotionally intense situations Approach motivation Greater activity in left hemisphere of frontal lobe Behavioural Inhibition System (BIS) Avoid emotionally intense situations Anxiety Withdrawal/Avoidance motivation Greater activity in right hemisphere of frontal lobe Individuals vary in strength between these systems Clinical applications Left frontal cortex Inactivation (depression) Sporadic activation (bipolar) Right frontal cortex Activation (anxiety) Measuring personality EEG Measures electrical activity of brain's surface Brain activity useful in identifying personality Non-invasive Activation of left vs. right frontal cortex (BIS & BAS) Alpha frequencies Wavelengths picked up Assess cortical activation Can be displayed as "heat maps" Red = less activation Blue = greater activation No social desirability - cannot hide brain activity to seem more socially acceptable MRI Measure activation of certain areas of the brain Measure volume/size of certain areas of the brain Phineas Gage (1823-1860) Suffered severe injury to frontal lobe Complete personality change First case to demonstrate localisation of function Importance of frontal lobe to personality Is personality hardwired? Orbitofrontal Cortex (OFC) Essential part of personality Processes emotional information Decision making Assigns value to decisions What if the OFC is damaged? Phineas Gage Rod damaged OFC Personality changed Became erratic and impulsive Could not assign value to decision-making Amygdala Processes emotional stimuli Negative emotions Fear Disgust Anger Strengths Provides genetic account as source of individual variability Empirically supported neutral indicators of personality Limitations Assumption that biology is primary driver of personality Assessing personality via biology is not the easiest approach Definition: An individual's unique and relatively consistent pattern of thinking, feeling and behaving Personality = individual differences Personality determines how different an individual is from others & how they behave in different situations Personality Measurements Self-Report Inventory Asks people to respond to a series of questions about themselves Widely used form of personality assessment Used by researchers, managers, and clinical psychologists MMPI (Minnesota Multiphasic Personality Inventory) Self-Report inventory used by clinical psychologists Widely used clinical assessment tool Very long (567 items) Takes 1-2 hours to complete Dozens of personality factors MBTI (Myers-Briggs Type Indicator) Measures Jungian types Most widely known personality test Commonly used in business Eysenck Personality Questionnaire 48 items (later reduced to 24 items) Assesses two personality traits (extraversion & neuroticism) Assessing the Big Five John and Srivastava (1999) Widely used assessment of the big five Derived from the lexical approach 44 items Often translated for cross-cultural validation Consistent across most Western and European cultures Ten-Item Personality Inventory (TIPI) 10 items 2 questions per item Short Easy to implement Strengths Standardised and use established personality traits Predict behaviour and employee fit in the case of I/O psychology (to some extent) Limitations Participants may "fake" responses to look better (or worse) High number of items leads to loss of interest Takers not always accurate in self-judgments No personality test, by itself, is likely to provide a definitive description of any given individual Problems with Self-Assessments Carelessness and sabotage Participants can get bored with long tests and select responses randomly Test takers sometimes report incorrect information to sabotage a research project Instruction explanation, surveillance, and stressing the importance of the test can reduce the problem People may mark random answers on tests without paying attention Especially on longer tests Some tests include 'attention check' items - e.g., mark "strongly agree" for this answer There are also statistical tests to examine effortful responding Social Desirability Extent to which people present themselves favourably Problematic for embarrassing or illegal behaviours - alcohol use, sexual activity, illegal substance use Applying Psychology Industrial/Organisational Psychology Psychology of the workforce Occupational Psychology (UK) Poor organisational behaviours lead to Poor employee satisfaction Greater employee attrition Low morale and motivation Predicting behaviour is of interest to managers Employees have the ability to influence coworkers Anticipate what employees may do in situations May provide index of "fit" in organisation Uses of personality assessment in organisations Conflict resolution and team building Hiring decisions Person-Job fit When job characteristics align with employees' personalities, motivations, and abilities Lack of fit increases burnout and physical symptoms Good fit results in higher job satisfaction, organisational commitment, and better performance on the job Employers use scores from personality assessments to make decisions about hiring and promotion Critics complain that employers misinterpret or rely too heavily on these test scores when making these decisions Research provides stronger evidence for the relationship between personality and job performance Beyond the Big Five Myers-Briggs Type Indicator (MBTI) Measures Jungian types Most widely used personality test in business Questionable evidence in predicting workplace performance Personality assessments designed for the workplace Too many to count Account for changes in personality Personality not always consistent Attempt to provide framework for why personality changes Whole Trait Theory Personality is multifaceted We have a distribution of personality states Personality states depend on context and environment Standard personality assessment capture "average" but not entire distribution or variability of our behaviour Each person has a different distribution shape Individuals can have more or less variation from baseline Variation can be explained by social and cognitive factors Within and Across Context Framework Expands on Whole Trait Theory Attempts to capture situational factors that predict personality Measures situational context during personality measurement ADEPT-15 Workplace scale which expands on the big five Proprietary scale developed for consulting firm Organisational Behaviour Focused on understanding, explaining and improving attitudes of individuals in organisations Projective Tests Freudian defensive mechanism (e.g., projection) Access unconscious by providing an ambiguous stimulus Participants 'project' personalities as they describe the object Rorschach Inkblot Tests View series of inkblots and describe what you see Manual used for scoring participant responses Thematic apperception test Create story about a highly evocative, ambiguous scene The person is thought to project their own motives, conflicts, and other personality characteristics into the story they create Strengths Provides qualitative information about individual's personality Information can facilitate therapy Limitations Scoring highly subjective Fails to produce consistent results Poor at predicting future behaviour Barnum Effect When someone believe personality descriptions specifically apply to them, while the description applies to mostly everyone Faking We CAN fake, but not clear how much we actually do Faking = less response time, only consider most extreme options Prevent faking Correct for social desirability Behavioural personality tests Use forced choice response options Ask for written elaboration Include warnings that fakers can be caught Designing assessments Keep it simple Avoid double-barrelled items Use neutral or unbiased language Minimise the use of negative wording Avoid repetitive responses Reverse coded item: item phrased in opposite direction Use rating scales consistently Likert scales Keep scales between 4 and 7 Clearly indicate what a rating scale means Minimise item and survey length Mental Health Clinical Disorders Overview Abnormal Behaviour Not culturally accepted Statistically uncommon Causes distress Causes dysfunction "Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community" More than just absence of mental illness Essential in collective and individual relationships and interaction, ability to think, earn a living and enjoy life Clinical Disorders: "Characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities" Significant emotional distress and/or impaired functioning Behaviours, thoughts, emotions, responses that are not typical or expected within cultural context Influencing factors for mental health Social Biological Psychological Understanding behaviour on a continuum (normal → psychological disorder; very severe) Essential Terms Psychopathology: Study of symptoms and development of psychological disorders Psychological Disorder: Pattern of behavioural or psychological symptoms Lifetime prevalence: Likelihood of someone experiencing a disorder at some point in their life Diagnosing Clinical Disorders DSM-5 Lists 20 categories of disorders Covers more than 300 disorders Takes an atheoretical approach Shows improved reliability over time Defines mental disorder as a clinically significant disturbance in cognition, emotional regulation and behaviour Helps to identify a dysfunction in mental functioning Expectable reactions to common stress ≠ mental disorders Reflects a medical model of psychopathology Each disorder categorically listed and defined symptoms History of the DSM DSM Earlier Editions (I and II) 1952 DSM-I 1968 DSM-II Similar to each other Different from subsequent editions Definitions not scientifically or empirically based DSM-III (1980) Relied on empirical data Used specific diagnostic criteria to define disorders DSM-III followed by DSM-III-R, DSM-IV, DSM-IV-TR Retained major changes made by DSM-III Introduced significant other changes Categorical approach (person either does or does not have disorder) Problems with the DSM Over-reliance on the medical model Categories not dimensions People often get more than one diagnosis Categories shift over time People can have 'sub-threshold' problems but experience more impairment than those who meet full criteria Psychiatrists often do not agree on diagnosis, especially for common disorders Includes some conditions that are too "normal" to be considered disorders Uses arbitrary cutoffs Gender bias Insufficient sensitivity to cultural diversity Changes considered in the DSM-V but not made Use of biological markers as diagnostic tools Rating of disorders/symptoms on a scale Dimensional approach toward a disorder Rejection of new disorders in the DSM-V Attenuated psychosis syndrome Mixed anxiety-depressive disorder Internet gaming disorder Revised disorders in the DSM-V Bereavement exclusion Autism ADHD Increased age of symptoms from before 7 to 12 Minimum number of symptoms in adults increased to 5 Bulimia Nervosa Frequency of binge eating reduced to once a week Anorexia Nervosa Reduction of less than 85% of body weight Learning disorders in maths, reading and writing combined as specific learning disorder OCD removed from anxiety disorders to new category Criticisms Many "work groups" members quit midway Leaders of mental health organisations boycotted DSM-5 Most vocal critic was Allen Frances Led development of previous DSM Changes unsafe and scientifically unsound Medical illnesses diagnosed as somatic symptom disorder DSM-V will mislabel normal people, promote diagnostic inflation, encourage inappropriate medication use Diagnostic over-expansion Lack of transparency of the revision process Diagnostic Categories What do diagnostic categories do? Describe patterns of experiences or behaviours that may be causing distress and/or be seen as difficult to understand Imply that distressing experiences are the symptoms of a medical illness This can lead to people thinking that the main cause of distress is that something has gone wrong with the brain/body Questions about diagnostic categories Does it diagnose normal functioning? Are there overlaps between behaviours/cognitions that exist in everyday life and the symptoms of the disorder? Are there overlaps between symptoms of multiple disorders? Arguments for categories Fundamental part of clinical psychology Helps identify useful interventions Validates patient's experiences Do diagnostic categories help people? Helps make experiences make sense Helps people to feel less alone Helps people to feel worthy of help and care Helps people feel less guilt or self-blame for their difficulties Helps people feel hope for recovery Helps people find language to describe their experiences Diagnostic categories and stigma For some diagnoses, stigma increases (e.g., schizophrenia) For others, there's no effect (e.g., depression) Degree to which people believe a condition is biological does not reduce stigma Some feel that diagnosis is a barrier to recovery Diagnosis might make people feel different and feel more alone or isolated Diagnosis may not capture experiences that have caused current difficulties (e.g., childhood trauma) Comorbidity Are there overlaps between symptoms of multiple disorders? When individuals with mental health problems meet diagnostic criteria for multiple conditions Regier et al. (1990) Of those with an alcohol use disorder, 37% also had a psychiatric disorder Of those with a drug use disorder, 53% also had a psychiatric disorder Of those with a psychiatric disorder, 29% also had a substance use disorder Which develops first? Addiction or psychiatric disorder? Why is comorbidity a problem? What should be treated? If addiction is responsible for depression/anxiety due to withdrawal, then treatment should focus on addiction Treating anxiety/depression would not alleviate root cause, just symptoms If depression/anxiety is responsible for addiction, via coping mechanism or self-medication, treatment should focus on depression/anxiety Treating addiction alone would not alleviate root cause, just symptoms Do psychologists agree? Field trials of DSM-5 (Friedman et al., 2013) Two clinicians interviewed the same patient Used same diagnostic criteria and interview methods Levels of agreement indicated using Kappa Only 2 conditions had a strong level of agreement according to Kappa There were no conditions with an almost perfect level of agreement Strengths Emphasis on empirical research Use of explicit diagnostic criteria Inter-clinician reliability (sort of) A-theoretical language Facilitated communication between researchers and clinicians Issues with assessing abnormal behaviour The dividing line between normal and abnormal behaviour is often determined by social or cultural context Strong stigma attached to psychological disorders How do we assess? Unstructured interview Initially gather information concerning status of individual Building rapport with client Identify areas of consideration for diagnosis Structured interview Similar questions across clients to provide consistency Questions based on criteria taken from DSM-5 Structured Clinical Interview for DSM Disorders (SCID) An interview that probes for the existence of the criteria for disorders within the current classification manual Projective tests Rorschach inkblot test Thematic apperception test Based on psychodynamic approaches Pros Informal format allows for greater flexibility in administration and less likely to prompt social desirability Potentially assess unconscious conflicts and desires Good for rapport building, non-threatening Helps to generate hypotheses about diagnoses Adds to "larger picture" of overall assessment Cons Reliability is questionable, even with scoring guides Not great at predicting behaviour in the long-term Does not always help in understanding of behaviour May be adding unreliable piece to the puzzle Clinicians may pursue wrong avenue for diagnosis Time could be spent elsewhere Questionnaires MMPI (Minnesota Multiphasic Personality Inventory) BDI (Beck Depression Inventory) HDRS (Hamilton Depression Rating Scale) GAD-7 (Generalised Anxiety Disorder Assessment) Neuropsychological Testing Weschler tests WAIS (Weschler Adult Intelligence Scale) WISC (Weschler Intelligence Scale for Children) WPSSI (Weschler Preschool and Primary Scale of Intelligence) Assess general levels of cognitive functioning IQ Verbal comprehension Perceptual reasoning Working memory Processing speed Korsakoff's Syndrome Disturbance in memory caused by alcohol Ability to learn new information is impaired Decline in cognitive functioning not explained by other causes e.g., Vitamin B1 (thiamine deficiency), Wernicke's encephalopathy) Psychiatric vs. physical diagnoses There are not always physical tests for psychiatric diagnoses No firm evidence mental distress is caused by biochemical imbalances, genes, or the brain in most cases Our brains are involved in everything we do but not always the cause of abnormal behaviour The theory that mental distress is best understood as a kind of physical illness, like diabetes or cancer, is not fully supported Challenges to effective diagnosis How should criteria capture mental health issues? Severe mental health problems have multiple interacting causes Are the relevant phenomena categorical or dimensional? Where should thresholds be placed which set the boundaries between disorder and non-disorder? How should we deal with comorbidity? Schizophrenia History of Schizophrenia Psychological disorder involves severely distorted beliefs, perceptions, and thought processes Diagnosed when two or more of characteristic symptoms At least one symptom must be delusions, hallucinations, or disorganised speech Diagnosed either with or without movement issues (catatonia) Multilevel Process for Diagnosing Schizophrenia Symptoms (positive/negative) Positive symptoms Delusions (false beliefs) Can lead to dangerous behaviours Persecutory delusions Beliefs about being followed or watched, usually by agents of authorities such as the FBI or the government Grandiose delusions Beliefs about being a famous or special person (e.g., being the president of USA) Delusions of reference Believing that others are talking about them Delusions of thought control Somatic delusions Believing you have a physical defect or physical abnormality Hallucinations (false perceptions) Can be indistinguishable from reality People might see, hear, taste, smell, or feel something that others do not perceive Auditory hallucinations is the most common altered perception Followed by visual hallucinations The hallucinations may tell the person to perform certain acts or may be frightening Disorganised thought processes, speech, and behaviour Disorganised speech Lack of associations between ideas and events "Loose associations" or "word salad" Disordered behaviour Unusual, odd, or repetitive behaviours or gestures Childlike silliness, inappropriate sexual behaviour (such as public masturbation), or difficulty maintaining hygiene Negative symptoms Deficits in behavioural or emotional functioning Symptoms can occur in combination Flat affect Lack of emotional expression Passive, with immobile facial expression Vocal tone does not change Do not respond to events with emotion Speech lacks the inflection that communicates mood Alogia (reduced speech) Avolition (lack of follow through) Reduction in functioning (e.g., work, relationships, self-care) Symptoms exist in 6 months, 1 month of positive symptoms Rule out symptoms found in other disorders Mania Depression Drug abuse Subtypes? DSM-5 removed classification of subtypes Paranoid subtype Disorganised subtype Catatonic subtype Undifferentiated subtype Residual subtype Catatonia Catatonic stupor Absence of motor behaviours, totally motionless and rigid Catatonic excitement Agitated, fidgety, shouting, swearing, or moving rapidly Either can last for hours Prevalence 200,000 new cases are diagnosed in US per year Approximately 1 million Americans are treated annually 1% of the US population will experience at least one episode Most cultures correspond very closely to the 1% rate England is supposedly around 0.5% Temporary or chronic? Onset typically occurs during young adulthood 25% of those who experience schizophrenia recover completely 25% experience recurrent episodes of schizophrenia 50% schizophrenia becomes a chronic mental illness, and the ability to function may be severely impaired Spectrum and related disorders Brief psychotic disorder Symptoms last less than a month Schizophreniform disorder Symptoms last for at least a month but less than 6 months Schizoaffective disorder Psychotic symptoms along with symptoms of a major mood disorder Substance/Medication-induced disorder Triggered by drugs or medication DSM-5 Diagnosis Genetic Factors Family, twin and adoption studies 50% risk for a person whose identical twin has schizophrenia Rate not close to 100% as might be expected If biological parent to an adopted individual has schizophrenia, there is a greater risk to develop schizophrenia Schizophrenia clusters in certain families The more closely related a person is to someone who has schizophrenia, the greater the risk of schizophrenia Chromosomes associated with genes that influence brain development, memory, and cognition seem related No specific pattern of genetics can be identified as "cause" of schizophrenia, but presence of variations increase susceptibility Bipolar disorder and schizophrenia might share genetic origins Other Factors Paternal age Schizophrenia caused by mutations in the sperm of fathers Age increases the rate of mutation Compared to fathers younger than 25 years 45 to 49 years: 2x as likely to develop schizophrenia 50+ years: 3x as likely to develop schizophrenia Mother's age made no difference Biological Factors Abnormal brain structures 50% of people with schizophrenia show some type of brain abnormality Most consistent finding: enlargement of the ventricles Loss of gray matter tissue and lower overall volume of the brain Gray matter = cell bodies White matter = myelinated axons Adolescents with early-onset schizophrenia Severe loss of gray matter - correlated with symptoms Pattern of loss mirrored progression of neurological and cognitive deficits Schizophrenia and the brain Suppression of default mode network absent Default mode network Parts of brain active under wakeful rest (e.g., daydreaming) Normally, we switch between this and executive functioning Schizophrenics tend to stay in the default mode network Weaker connections between brain areas Hallucinations due to dysfunction of areas Issues with neurotransmitters Activity of dopamine neurons Dopamine imbalance hypothesis Glutamate linked to psychotic-like symptoms Biological factors not conclusive Some people with schizophrenia do not show brain structure abnormalities Evidence is correlational Brain abnormalities seen in other mental disorders Dopamine Reward and reinforcement Responsible for feelings of euphoria Motor movements Implicated in movement disorders like Parkinson's disease Produced in brainstem, but has projections which affect activation in the cortex (surface of the brain) Overactivity of dopamine in midbrain regions Underactivity of dopamine in cortical regions Dopamine imbalance hypothesis Leads to both positive and negative symptoms Hallucinations/delusions result of overactivity in midbrain/brainstem Lack of motivation/flat affect results of underactivity in cortex Changes in dopamine activity results in more creative thinking Inability to stop influx of thoughts Increased information flow resulting in more creative thinking 1954 discovery of chlorprozamine (Thorazine) Reduces dopamine activity in the brain Reduces agitation, hostility, aggression, hallucinations, delusions Increases time between hospitalisations Does not change negative symptoms and cognitive deficits These are due to underactivity of dopamine Early drugs only target overactivity of dopamine Anti-dopamine drugs do not help upwards of 40% of those seeking treatment Nicotine Mimics acetylcholine in the brain (excitatory) Improves negative symptoms (e.g., flat affect) Stimulates underactive parts of the cortex 80% of people with schizophrenia smoke Self-medication Environmental Origins of Schizophrenia Direct brain damage or injury during early development Prenatal complications Stress, immune responses and starvation during pregnancy Winter birth effect Antipsychotic medications 1954 discovery of chlorpromazine (thorazine) Reduces agitation, hostility, aggression, hallucinations, delusions Increases time between hospitalisations Does not change negative symptoms and cognitive deficits Side effects Tardive dyskinesia (movement disorder) Involuntary movement of lower face, limbs Affect dopamine neurotransmitters Weight gain Atypical medications 1990 Advantages Less likely to cause movement-related dopamine side effects More effective in treating the negative symptoms of schizophrenia Target dopamine imbalance, rather than just overactivity Disadvantages Weight gain, diabetes, cardiac problems No greater improvements than with older antipsychotics Issues with antipsychotic medications Do not cure schizophrenia Unwanted side effects "Revolving door" pattern of hospitalisation, discharge, and rehospitalisation Atypical second-generation medications Target specific dopamine receptors, not all types of dopamine Produce less tardive dyskinesia Equal to, or sometimes more effective than typical, first-generation medication Psychosocial interventions Family interventions reduce relapse and hospitalisations Provide practical emotional support to family members Provide information about support services Help family develop model of schizophrenia Modify unhelpful, inaccurate beliefs about schizophrenia Enhance positive communications Involve everyone in relapse prevention plan Cognitive Behavioural Therapy Importance of individual's interpretation of psychotic events Understand client's interpretation of past and present events Normalise and reduce impact of symptoms Early intervention Seek out high-risk individuals Develop cognitive skills to increase memory, attention, executive control, and other cognitive processes Anxiety and Obsessive Compulsive Disorders What do we mean by anxiety? Fear: an emotional response to an immediate threat and is more associated with a fight or flight reaction Anxiety: associated with anticipation of a future concern Anxiety and arousal Functional and adaptive Important and helpful in shaping behaviour and avoiding aversive/dangerous stimuli High levels aversive Yerkes-Dodson law - arousal impacts performance Autonomic responses in fear/anxiety Perception of threat triggers sympathetic nervous system for "fight-or-flight" Stress hormones (e.g., epinephrine, norepinephrine, cortisol) trigger and maintain variety Resolution of threat associated with reduction of activation in sympathetic nervous system and increased activation of parasympathetic nervous system Anxiety Disorders and anxiety-related difficulties Anxiety disorders - differs from normal feelings of anxiousness and involve excessive fear or anxiety Typically lead to avoidance of stimuli/situations which impacts psychosocial functioning Typically characterised by fear or anxiety out of proportion to the situation and/or significant impact on functioning Most common group of mental disorders and affect nearly 30% of adults at some point in their lives Number of effective treatments available History of Anxiety Disorders DSM-5 Common anxiety disorders Specific Phobia Marked fear or anxiety about a specific object or situation Exposure to stimuli elicits an intense fear response Avoidance/Safety behaviours Anxiety sensitivity Panic Disorder Recurrent, unexpected panic attacks Persistent concern or worry about additional panic attacks or their consequences Significant maladaptive change in behaviour related to the attacks Catastrophic misinterpretation of physical symptoms Avoidance/Safety behaviours Self-focused attention Social Phobia/Social Anxiety Disorder Persistent fear and avoidance of social and performance situations Fears typically concern potential negative evaluation by others as a result of anxiety symptoms and/or social performance Negative mental imagery Avoidance/Safety behaviours Self-focused attention Generalised Anxiety Disorder (GAD) Chronic, persistent and excessive anxiety and worry about a number of events or activities that individuals find difficult to control Intolerance of uncertainty Metacognitive beliefs about worry Cognitive avoidance Agoraphobia Fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms Avoidance/Safety behaviours Anxiety sensitivity PTSD No longer classified as an anxiety disorder in DSM-5 Develops in some people after extremely traumatic events Symptoms typically begin within three months after trauma Symptoms Intrusion Avoidance Negative alterations in cognition and mood Hyperarousal Relative predominance of symptoms may vary over time Common cognitive symptoms of anxiety Fear of Losing control/not coping Impending death or injury Negative evaluation by others "Going crazy" Thinking about matters outside the focus of threat may be more challenging Hyper-vigilance Threat-related imagery/memories Impaired reasoning processes Common behavioural and affective symptoms of anxiety Behavioural Avoidance of threat Behaviours to mitigate against perceived threat Escape/flight Reassurance seeking Restlessness/agitation Freeze response Affective Nervousness Wound-up Frightened Fearful Jumpy Jittery Frustrated Impatient Comorbidity is common - 40% to 80% of people with anxiety meet diagnostic criteria for 2 or more disorders Chronic Mowrer Two Factor theory of phobia Explains the origins of phobias in terms of a combination of operant and classical conditioning Classical conditioning is responsible for the initial learning, associating a previously nervous stimulus with fear Operant conditioning reinforces the fear because every time someone avoids the feared stimulus, they feel calmer Panic Disorders Panic Attack: An abrupt surge of intense fear or intense discomfort that reaches a peak within 5 minutes Symptoms Pounding heart Tachycardia Palpitations Sweating, trembling or shaking Experience of choking, shortness of breath Fears of losing control, dying or going crazy Pain or discomfort in the chest Tingling sensations Nausea Dizziness, lightheadedness Feelings of being detached from self Hot flashes or chills Up to 28% of population will experience an occasional, unexpected panic attack sometime in their life Panic Disorder: individual experiences recurrent panic attacks and experiences persistent concerns and regarding occurrence and consequences of attack and/or maladaptive change in behaviour Cognitive Model of Panic Disorders Social Phobia/Social Anxiety Disorder Social phobia is characterised by persistent fear and avoidance of social and performance situations Lifetime prevalence estimates up to 12% in UK Onset typically during adolescence Anxiety symptoms experienced in anticipation of and during social events Fears typically concern potential negative evaluation by others as a result of anxiety symptoms and/or social performance Believe that negative evaluation will result in negative social consequences and engage in variety of behaviours to prevent/minimize this → non-occurrence of social catastrophe attributed to performance of behaviours Cognitive maintenance factors Information and interpretation bias Interpret performance significantly more critically Self-focused attention Excessive post-event processing of social events OCD Obsessions: recurrent, unwanted, intrusive thoughts, images or impulses that cause distress/interference Lifetime prevalence estimates 2-6% Usually begins gradually, in adolescence or early adulthood Obsessions are ego-dystonic Content of obsession is alien/inconsistent with values Not within an individual's control Obsessions which threaten self-view more likely to capture attention Majority of individuals in a population (80-90%) experience intrusive thoughts images and impulses with content similar to clinical obsessions Appraisal of meaning/importance of unwanted thoughts may be key Compulsions: Repetitive behaviours that an individual feels driven to perform to reduce distress or to prevent some dreaded event from happening Number of cognitive processes implicated Mood Disorders Depression Major Depressive Disorder Depressive symptoms, including emotional, motivation and cognitive features, negatively impact upon: Individual ability to work Interpersonal functioning and ability to sustain relationships Systems (family, community, workplace) Personal and family income Five or more of the symptoms during the same 2-week period Depressed mood most of the day, nearly every day Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day Significant weight loss or weight gain / decrease or increase in appetite nearly every day Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day (observed by others) Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death / recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide Prevalence 12-month prevalence suggest 5%-7% in adults in the UK Young adults 3x higher prevalence 1.5-3x higher prevalence for women Persistent Depressive Disorder (Dysthymia) Chronic symptoms of depression, lasting at least 2 years Risk Factors Biological Factors Genetics Structure, Process (e.g., neurotransmission), Regulatory dysfunction Psychological Factors Cognitive schema, beliefs, assumptions Information processing, attention & memory Rumination Optimism/Pessimism Problem-solving Social Factors Attachment Trauma/loss Life events Parental psychopathology Relationship difficulties Social support Cognitive theories of depression Distorted ways of thinking develop in childhood and place one at increased risk for depression later in life Beck "Cognitive Triad" Treatments Treatment Stages Antidepressants Widely utilised: 2017-2018 7.3 million people in UK had one or more prescriptions issued SSRIs (Selective Serotonin Reuptake Inhibitors) most commonly prescribed antidepressant type in UK TCAs (Tricyclic antidepressants) MAOIs (Monoamine oxidase inhibitors) Efficacy of antidepressants demonstrated across multiple international trials but mechanism of action subject to debate Bipolar Disorder Manic Episode DSM-5 Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalisation is necessary) Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features Symptoms During the period of mood disturbance and increased energy or activity, three or more of the following symptoms (four if mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractibility (reported or observed) Increase in goal-directed activity or psychomotor agitation Excessive involvement in activities that have a high potential for painful consequences Hypomanic Episode DSM-5 A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day Displays 3 of the symptoms assessed in manic episode The episode is associated with an unequivocal change in functioning The disturbance in mood and change in functioning are observable by others Episode is not severe enough to caused marked impairment in social or occupational functioning or to necessitate hospitalisation. Bipolar and related disorders Bipolar I At least one manic episode has occurred, major depressive episodes are typical but not required to meet diagnostic criteria Bipolar II Individual has experienced at least one hypomanic episode and one major depressive episode Cyclothymic disorder Hypomanic and depressive symptoms are experienced for at least 2 years but which don't meet the criteria for hypomanic episode or MDE Prevalence Lifetime prevalence of bipolar disorder in UK = 1.7% Often large delay in receiving appropriate diagnosis There are a number of factors that work together that may make a person more likely to experience symptoms of bipolar disorder There are thought to be a complex mix of physical, environmental and social factors Family history and genetics Brain anatomy Psychosocial stressor, e.g., traumatic/abusive experience Symptoms, maintenance and treatment Research suggests individuals who meet criteria for bipolar disorder on average spend significant (majority) time “asymptomatic”, next commonly experiencing periods of low mood and least time experiencing manic or mixed symptoms Variety of cognitive, behavioural and psychosocial factors may perpetuate symptoms Combination of medication(s) and psychological therapy dependent upon current symptom which may include CBT, mood stabilising medication (e.g., lithium carbonate), antipsychotic medication, antidepressant medication Personality Disorders What is a personality disorder? Pattern of deviating behaviour Inflexible: leads to distress Varying criteria of characteristics General personality disorder DSM-5 10 broad criteria Personality disorders as extremes of normal personality The Big 5 of personality disorders Detachment (introversion-extraversion) Unconventionality (openness) Antagonism (agreeableness) Disinhibition (conscientiousness) Psychoticism (neuroticism) Environmental and genetic influences Emotional/sexual abuse, neglect 73% report prior abuse and 82% report childhood neglect Childhood maltreatment Common among individuals with BPD Genetic heritability estimates ∼50% range Suggests both genetic and environmental factors are involved Comorbidity Anxiety disorders Mood disorders Substance use disorders Other personality disorders Often within the same cluster Clusters Cluster A: Odd or eccentric disorders Paranoid Personality Disorder Pervasive distrust and suspiciousness Prevalence rates: 4.4% to 2.3% Symptoms (at least 4 must be present) Believing that others are exploiting or deceiving the person. Having a preoccupation with unjustified doubts about the trustworthiness of a friend or colleague. Being reluctant to confide in others. Seeing simple statements as having hidden meanings. Bearing grudges. Seeing others as attacking the person’s reputation. Not trusting one's sexual partner as being faithful. Schizoid Personality Disorder Pervasive pattern of detachment One of the least studied disorders Prevalence: 3.1% to 4.9% Symptoms (at least 4 must be present) Not desiring or enjoying social relationships. Mainly engaging in solitary activities. Showing little interest in sexual activities with others. Finding little pleasure in any activity. Having no close friends. Showing indifference to both praise and criticism. Showing emotional coldness or detachment. Schizotypal Personality Disorder Odd behaviour and cognitive distortions Prevalence rates: 3.3% Initially confused with schizophrenia Symptoms (five must be present) Makes connections between ideas and events that are not related Holds odd beliefs or engages in magical thinking Experiences unusual perceptual experience Engages in odd thinking and speech Is suspicious Shows inappropriate affect Appears odd to others Does not have close friends Shows excessive social anxiety Cluster B: Dramatic, emotional or erratic disorders Problematic patterns of social interactions Inclusive of four conditions Dramatic and impulsive behaviours Borderline Personality Disorder Instability in mood, relationships, self-esteem Self-harm prevalent (75% of cases) Splitting Things are either "all good" or "all bad" Fearful preoccupation Intense need for attention and fear of abandonment Symptoms (at least 5 must be present) Frantic effort to avoid abandonment Pattern of unstable, intense interpersonal relationships Unstable self-image Impulsivity in areas such as sex, substance abuse, driving, binge eating Recurrent suicidal/self-mutilating behaviours Emotional instability lasting only few hours Chronic feelings of emptiness Inappropriate anger and inability to control anger Short-term, stress-related dissociative experiences or paranoid ideation Narcissistic Personality Disorder Constant need for admiration Sense of privilege and entitlement Ignoring needs of others (lack of empathy) Loss of close contact with others Symptoms (at least 5 must be present) Grandiose sense of self-importance Preoccupation with ideas of unlimited success/attractiveness Seeing one’s self as special Needing excessive admiration Entitlement Taking advantage of others for one’s own needs Lacking empathy Envious of others Arrogance Prevalence: 1.6%; more commonly diagnosed in men Antisocial Personality Disorder Detachment and moral insanity Psychopathy Emotional detachment Lack of empathy Impulsivity Cannot be diagnosed in under-18s Conduct Disorder Before age of 18 Cruelty to animals Attacking or harming adults or other children Theft Setting fires and destroying property Symptoms (at least 3 must be present) Failure to conform to social norms concerning lawful behaviours, such as performing acts that are grounds for arrest. Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit. Impulsivity or failure to plan. Irritability and aggressiveness, often with physical fights or assaults. Reckless disregard for the safety of self or others. Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations. Lack of remorse, being indifferent to or rationalising having hurt, mistreated, or stolen from another person. Prevalence: Around 3%; more males than females, high comorbidity (80%) with substance use disorders Histrionic Personality Disorder Extreme attention-seeking behaviour Constant want to be the center of attention Excessively dramatic and make up stories to draw attention to themselves, uncomfortable if not the center of attention Symptoms (at least 5 must be present) Discomfort when not center of attention Inappropriate sexually seductive or provocative behavior Rapidly shifting/shallow expression of emotions Consistent use of physical appearance to draw attention Excessively impressionistic style of speech Self-dramatisation, theatricality, exaggerated emotions Suggestability Considering relationships more intimate than they are Prevalence: 2-3% - diagnosis more common in women Cluster C: Anxious or fearful disorders Avoidant Personality Disorder Pervasive pattern of social inhibition Fear of criticism, feelings of inadequacy Prevalence rates: 2.3% to 5.1% Symptoms (at least 4 must be present) Avoidance of occupational activities involving interpersonal contact that could lead to criticism Unwillingness to be involved with others Restraint within intimate relationship Preoccupation with being criticised Inhibition in new interpersonal situations View of one’s self as socially inept, unappealing, or inferior Reluctance to take personal risks/engage in new activities for fear of being embarrassed Dependent Personality Disorder Pervasive pattern of being submissive Difficulties making everyday decisions Relies on reassurance from others Prevalence rates: 0.4-0.6% Symptoms (at least 5 must be present) Inability to make everyday decisions without excessive amount of advice, reassurance from others Need for others to assume responsibility for one’s life Difficulty disagreeing with another person Difficulty beginning projects Need to work hard to receive support from others Uncomfortable feeling when alone Beginning new relationship when old one is over as source of care Feeling fearful that one cannot take care of one’s self Obsessive Compulsive Personality Disorder Preoccupation with orderliness Perfectionism and wanting control over environment Prevalence rates: 2.4 to 7.8% Symptoms (at least 4 must be present) Preoccupation with details, rules, lists, order, or schedules Perfectionism that interferes with task completion Preoccupation with work to exclusion of fun and friendships Inflexibility concerning morals and values Inability to discard worthless objects with no emotional connection Reluctance to delegate tasks Hoarding of money Rigidity and stubbornness Often confused with certain behavioural addictions Treatment Psychotherapy more individually focused Individuals with certain personality disorders find it difficult to maintain a close, intimate relationship with their therapist Because of this, psychotherapy for personality disorders is more individually focused than that for other disorders Medications only used as an adjunct Treatment of Clinical Disorders Schizophrenia Medication Strong biological component Dopamine hypothesis Reduces positive symptoms (hallucinations, delusions) Typical, first-generation Atypical, second-generation Slightly better Revolving door pattern of hospitalisation Psychotherapy Strategies to deal with maladaptive thoughts Learn to tell difference between what is real and what is not Often combined with medication Glutamate (GLU) Excitatory neurotransmitter Receptors found on 90% of neurons in brain Primary facilitator of communication in the brain GABA Inhibitory neurotransmitter Receptors found on 30% of neurons in brain (2nd place) Primary facilitator of communication in the brain Anxiety Increased activity in the brain Amygdala Thalamus Hippocampus Over-excitation caused by excess neurotransmitters Glutamate Epinephrine/Norepinephrine (also excitatory) Medication Anxiolytics Drugs developed and prescribed to treat anxiety Sedative and calming effects Can be dangerous when overdosed Usually start working immediately Barbiturates Powerful sedative effect Side effects include reduced respiration Reduced prescription immediately in the 1950s Benzodiazepines Replaced barbiturates to treat anxiety Increase effectiveness of GABA Safer compared to barbiturates but still deadly in high doses Commonly prescribed today Short-term use due to potential development of physical dependence and withdrawal symptoms Safer alternatives? Buspirone (affects serotonin) Anticonvulsant drugs (affect GABA) Beta-Blockers Anxiety as sensitivity to engaging 'fight or flight' These drugs block receptors for norepinephrine and epinephrine which trigger 'fight or flight' Block physiological response to anxiety Cognition remains mostly unaffected More common for less severe types of anxiety Antidepressants Psychotherapy Specific phobias - exposure therapy CBT Learn how maladaptive thoughts contribute to anxiety May be used alongside medication Severe cases may require long-term use Serotonin (5HT) Mostly responsible for regulation in the brain Mood Appetite Sleep (melatonin) Sex Biological rhythms Learning/Memory Depression Potentially due to depletion of serotonin in the brain Serotonin levels are sometimes normal Other neurotransmitters implicated Epinephrine/Norepinephrine Dopamine Anhedonia Inability to feel pleasure Medication Antidepressants Developed and prescribed to treat depression Used to help regulate emotion Are not always immediately effective MAOIs (Monoamine Oxidase Inhibitors) Monoamines - category of neurotransmitters Bind to enzymes to prevent breakdown of monoamines Tricyclics Inhibit reuptake of norepinephrine and serotonin Severe side effects Dry mouth/eyes Constipation/urinary retention Memory/cognitive impairments Hypertension/weight gain SSRIs (Selective Serotonin Reuptake Inhibitors) Block reuptake of serotonin by transporters Leads to greater levels of serotonin in synapse Side effects Sexual dysfunction Emotional detachment, less extreme emotions Discontinuation leads to hallucinations, sleep disruption SNRIs (Selective Norepinephrine Reuptake Inhibitors) Block reuptake of serotonin and norepinephrine Same side effects as SSRIs Used when SSRIs not effective Not as effective as therapy Severe cases of depression likely require medication Psychotherapy Learn how maladaptive thoughts contribute to depression Focus on strategies to challenge these thoughts Effective for most forms of depression Bipolar Disorder Medication Strong biological component Main route of treatment Lithium Not clear how it works Can be lethal Relapse if medication stops CBT Evidence-based Used to treat variety of mental health conditions Time-limited, structured therapy Treatment driven by goals of patients and a joint understanding of difficulties Treatment is action-oriented and involves actively addressing processes of maintenance Cognitive and behavioural components crucial Thoughts, behaviours and emotions can be reciprocally deterministic Key Components Psychoeducation Identifying thoughts, feelings and behaviours Identifying triggers for specific behaviours, thoughts, feelings Evaluating function and consequences of behaviours/strategies central Through "cognitive restructuring" - clients monitor and learn to challenge/re-evaluate negative thoughts and beliefs Identifying and addressing processes of maintenance Strategies Cognitive restructuring: Identifying and challenging unhelpful/irrational thoughts (e.g., appraisal of symptoms/feared outcomes/personal meaning) → remedying cognitive distortions Thought records: Identifying and challenging negative automatic thoughts Behavioural activation: Supports individuals to increase participation in activities that will be intrinsically rewarding Behavioural experiments: Pragmatically testing beliefs/predictions/perceived function or consequences of behaviours Gold standard of psychotherapy Most researched form of psychotherapy No other form of psychotherapy has been shown to be systematically superior to CBT CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behaviour CBT (overall) effective for many people in treatment of variety of disorders Some meta-analyses suggest CBT somewhat more effective than medication Limited evidence to determine who is most likely to benefit from a given evidence-based intervention DBT Closely allied to CBT 3rd wave Developed to help individuals experiencing intense emotions and difficulties consistent with personality disorders (particularly BPD) but may be helpful for individuals who have difficulties regulating emotions Benefits individuals with mood intolerance, emotional dysregulation, self-harm, destructive interpersonal relationships Incorporates and promotes Mindfulness Distress tolerance Emotion recognition and awareness Understanding causes and consequences of feelings Interpersonal effectiveness IPT IPT conceptualises psychological problems understood as being maintained through interpersonal difficulties and aims to address symptoms by improving interpersonal functioning Attachment-focused intervention initially designed for tx. of depression Time-limited (12-16 sessions) Focus on attachments, grief, role transitions, interpersonal disputes and deficits IPT aims to improve interpersonal functioning, and well-being through helping individuals effectively communicate, resolve interpersonal crises, help patients effectively utilise social support