PSYC3140 Q L2 W2025 Post (PDF)

Redevelopment of Queen Street Site 1998: Queen Street site changed from a provincially run psychiatric hospital into a public hospital As a result of this tranformation... CAMH was created: merger between Addiction Research Foundation, the Clarke Institute, Queen Street Mental Health Centre, and Do...

Redevelopment of Queen Street Site 1998: Queen Street site changed from a provincially run psychiatric hospital into a public hospital As a result of this tranformation... CAMH was created: merger between Addiction Research Foundation, the Clarke Institute, Queen Street Mental Health Centre, and Donwood Institute CAMH = Centre for Addiction and Mental Health/affliated with U of T Redevelopment of 1001 Queen Street Site: “Urban Village” CAMH Redevelopment (2010) Consumer Survivor Ex-Patient Movement Dr. Reaume: Critical Disabilities York U Prof Published in 2000: “Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940” Dr. Reaume inspired… David Reville David Reville: Psychiatric survivor and part-time instructor at TMU of “History of Madness” Consumer Survivor Ex-Patient Movement: D. Reville Consumer Survivor Initiatives: CSIs - What are they? Organizations operated exclusively by and for people with a history of mental illness In Ontario: Ontario Peer Development Initiative (OPDI) – started in 1991 Potential programs offered: one-to-one peer support; self-help & peer support groups; community-economic development; education/training for public & mental health professionals; advocacy; opportunities for CSs to develop skills; resource development based on CS knowledge; artistic & cultural activities Consumer/Survivor Initiatives Study: Nelson, Ochocka, Janzen, & Trainor (2006) Longitudinal study: baseline, 9mths, 18mths Purpose: to evaluate effects of participation in C/S initiatives on “wellbeing” 7 factors examined: social support, community integration, personal empowerment, subjective quality of life, symptom distress, utilization of hospitals, and employment/education Consumer/Survivor Initiatives Study: Nelson, Ochocka, Janzen, & Trainor (2006) Time of # of participants # of active Interviews participants Baseline (BL) 161 9-month 129 64 18-month 118 61 9-month: “Active” = participating 2 hrs or more in CSIs in 8-month period 18-month: “Active” = participating 4 hrs or more in CSI in 16-month period Consumer/Survivor Initiatives Compared: Active versus non-active members Results: 9 months: 18 months: Consumer Survivor Ex-Patient Movement PSYC3140 Section Q Fundamental One-Dimensional Paradigms and Integrative Models of Psychopathology Role of Paradigms SCIENCE is limited by: a) current state of knowledge b) remaining objective when studying thoughts, emotions, & behaviours What is a Paradigm? …a set of basic assumptions, a general perspective, that defines how to: ❑ conceptualize and study a subject ❑ gather and interpret relevant data ❑ think about a particular subject A paradigm is a set of basic assumptions that outline the particular universe of scientific inquiry. Importance of Paradigms “Scientists whose research is based on shared paradigms are committed to the same rules and standards for scientific practice.” (Kuhn, 1962) Paradigms: ❑Are an intrinsic part of science ❑Play a vital role in defining what rules are to be followed Consequence of Adopting a Paradigm A paradigm injects inevitable biases into the definition and collection of data and may also affect the interpretation of facts. The meaning or importance given to data may depend to a considerable extent on a paradigm. Primary/Integrative Paradigms of Psychopathology 1. Biological; Diathesis-Stress Model 2. Psychoanalytic Paradigm; Schema Therapy 3. Humanistic Paradigm; Dialectical Behaviour Therapy (DBT) Primary/Integrative Paradigms of Psychopathology 4. Behavioural (Learning) Paradigm; Lazarus’ Multimodal Therapy 5. Cognitive Paradigm; Cognitive Behavioural Therapy (CBT) Biological Paradigm Continuation of the somatogenic hypothesis Mental disorders caused by aberrant or defective biological processes Often referred to as the medical model or disease model The dominant paradigm in Canada and elsewhere from the late 1800s until middle of the twentieth century Behavioural Genetics Study of individual differences in behaviour attributable to differences in genetic makeup Genotype: unobservable genetic constitution ❑ The total genetic makeup of an individual ❑ Fixed at birth, but it should not be viewed as a static entity Phenotype: totality of observable, behavioural characteristics ❑ Dynamic (i.e., it changes over time) ❑ Product of an interaction between genotype and environment (e.g., high intelligence) Behavioural Genetics Clinical syndromes = disorders of phenotype Predisposition or diathesis may be inherited, NOT the disorder itself! Video: Nature & Nurture: The Study of Twins Integrative Paradigm: The Diathesis-Stress Model Individuals inherit, from multiple genes, tendencies to express certain traits or behaviours, which may be triggered under certain circumstances Diathesis: a constitutional predisposition toward illness; any (set of) characteristics that increases a person’s chance of developing a disorder Stressors: any event, force, or condition that results in physical or emotional stress; may be internal or external forces that require adjustment or coping strategies on the part of the affected individual. Integrative Paradigm: The Diathesis-Stress Model This model links biological, psychological & environmental factors Example from biological realm: schizophrenia & genetically transmitted diathesis Examples from psychological realm: depression & cognitive set for hopelessness; dissociative identity disorder & easily hypnotized Diathesis-Stress Model in Research Action Based on a sample of 300 American boys, researchers found three biologically based personality types: 1. The resilient type 2. The overcontrolling type 3. The under-controlled type (Robins et al., 1996) Diathesis-Stress Model in Research Action Employing the diathesis-stress model, a more recent longitudinal study examined life experiences (stressors) and adjustment profiles of children (baseline 10 to 12 years old) until 18 years old: (Oshri, Rogosch & Cicchetti, 2013) 1. The resilient type 2. The overcontrolling type *3. The undercontrolling type = greater substance use and externalizing problems *differences were mediated by different levels/types of childhood maltreatment Biological Clinical Approaches to Treatment An important implication of the biological paradigm: prevention or treatment of mental disorders should be possible by altering bodily functioning. Most biological interventions in common use, however, have not been derived from precise knowledge of what causes a given disorder. Biological Approaches to Treatment Most common psychoactive drugs used today: 1. Valium – benzodiazepine – anxiety disorders 2. Prozac – SSRI – depression 3. Clozaril – antipsychotic – schizophrenia 4. Ritalin – stimulant - ADHD Other biological treatments: i. deep brain stimulation ii. electroconvulsive therapy Psychoanalytic Paradigm Sigmund Freud: 1856-1939 Central assumption: psychopathology results from unconscious conflicts within the individual Psychoanalysis: Structure of the Mind  Psychoanalytic Paradigm ID: pleasure principle: immediate gratification ❑primary process thinking = fantasies ❑source of energy: biological & unconscious EGO: reality principle: “the mediator” ❑secondary process thinking: planning & decision making ❑source of energy: psychic ❑primarily conscious, also unconscious SUPEREGO: perfection principle – conscience ❑punish individual for not meeting expectations ❑source of energy: psychic ❑conscious, primarily unconscious  Defense Mechanisms: Coping with Anxiety Neurotic anxiety: a feeling of fear that is not connected to reality or any real threat Defense mechanism: a strategy, unconsciously used, to protect the ego from being overwhelmed with anxiety Function of defense mechanisms: allows the ego to discharge some ID energy while not directly facing the true nature of the motivation Psychoanalysis: Defense Mechanisms Denial: not accepting some aspect of objective reality which is apparent to others Regression: reverting to a younger, less mature way of handling stresses and feelings Reaction Formation: substitutes behaviour, thoughts, or feelings that are the direct opposite of unacceptable ones Rationalization: inventing reasons for unreasonable action or attitude Displacement: channeling a feeling or thought from its actual source to something or someone else Psychosexual Stages & Fixation: Associated Unresolved Adult Issues Oral Stage Inability to trust oneself or others Result: fear of loving and forming close relationships; low self-esteem Anal Stage Inability to recognize and express anger Result: denial of one’s own power as a person; lack of a sense of autonomy Psychosexual Stages & Fixation: Associated Unresolved Adult Issues Phallic Stage Inability to fully accept one’s sexuality & sexual feelings Result: difficulty in accepting oneself as a man or woman; negative sexual feelings  Psychoanalytic Therapy An insight therapy that attempts to remove earlier repression & help the client face the childhood conflict, gain insight into it, and resolve it in the light of adult reality. Techniques: 1.Free Association, Resistance, & Interpretation 2.Dream Analysis: interpreting symbolic content 3.Using the Transference Relationship to increase insight Psychoanalytic Concepts Transference: patient response is not congruent with analyst-patient relationship; rather reflects relationships with important people in patient’s past Countertransference: feelings that the analyst unconsciously directs to the patient, stemming from his/her own emotional vulnerabilities & unresolved conflicts E.g., empty-nest analyst & letting go of patients Evaluating Psychoanalytic Paradigm Contributions: 1. Childhood experiences shape adult personality 2. There are unconscious influences on behaviour 3. People use defense mechanisms to control anxiety Criticisms: 1. Vague concepts based on anecdotal evidence 2. Theories based on small, select group (case study method) 3. Unscientific & not objective 4. Ignored situational factors Integrated Therapy Model: Schema Therapy (Young, 1996) Schema therapy combines theory & techniques from cognitive & behaviour therapies, Psychoanalytic Object-Relations, Attachment Theory, & Gestalt therapy Some examples of Young’s Early Maladaptive Schemes: mistrust, abandonment, incompetence /dependence Key Goal: to help clients get their core emotional needs met. Integrated Therapy Model: Schema Therapy (Young, 1996) Unmet core emotional needs in childhood can lead to: early maladaptive schemas (18 identified) e.g., “Everyone leaves me” (abandonment schema) “I am not worth loving” (defectiveness/shame schema) Coping mechanisms: three basic patterns 1. Surrender (e.g., “I am incompetent = highly reliant on others to function) 2. Avoidance (e.g., addictions, constant distraction) 3. Over-compensation – do the opposite of our schema (e.g., feel out of control, engage in extreme planning) Video: What is Schema Therapy Behaviour/Learning Paradigm Views psychopathology as responses learned in the same ways that other human behaviours are learned Originally focused solely on observable behaviour rather than subjective experience Central assumption: Environmental/prior learning experiences determine behaviour Three main types of learning: 1. Classical conditioning – Pavlov & Watson 2. Operant conditioning - Skinner 3. Modelling – Bandura  Learning Paradigm: Classical Conditioning Pavlov (1849-1936) – physiologist – experiment with dogs Unconditioned stimulus (UCS) Unconditioned response (UCR) Conditioned stimulus (CS) Conditioned response (CR) Classical Conditioning: Case of “Little Albert” (Watson & Rayner, 1924)  Learning Paradigm: Operant Conditioning Skinner (1904 – 1990) – research on rats “operant conditioning” Reinforcement vs. Punishment Increases Decreases Likelihood Likelihood of Behaviour of Behaviour Presented Positive Positive Punishment Reinforcement (give electrical shock) (paycheck, praise) Removed Negative Negative Punishment Reinforcement (time-out or take away (taking aspirin) privileges) Behaviour Therapy Definition: involves the systematic application of learning principles & techniques to assess & improve individuals’ behaviours to improve functioning Some behavioural interventions: 1. Positive reinforcement 2. Systematic desensitization 3. Token economy & shaping 4. Social skills training Actions speak louder than words (emotions or cognitions)! Behaviour Therapy Functional Assessment: ABC Model Antecedents: events that cue or elicit a certain behaviour Behaviours: problem behaviour Consequences: events that maintain a behaviour in some way either increasing or decreasing it Scenario (ABC model) Integrative Therapy: Lazarus’ Multimodal Model (Lazarus, 1973) Multimodal Therapy: uses technical integration to create comprehensive treatment plan for each client using a more comprehensive assessment: BASIC ID Behaviour: operant conditioning, counterconditioning Affect: acknowledging, clarifying feelings; abreaction Sensation: tension reduction; sensory distress tolerance Imagery: visualization/coping images, change self-image Cognition: cognitive restructuring, education Interpersonal relationships: modelling; develop social skills Drugs/biology: exercise, nutrition; identifying medical illness