PSYCH 127A Lecture Notes PDF

Lecture 1 What's in a name ? · abnormal psychology : studies unusual patterns of behavior, emotion ,...

Lecture 1 What's in a name ? · abnormal psychology : studies unusual patterns of behavior, emotion , and thoughts which may or may not be related to , a mental disorder ↳ stigmatizes mental disorders and has a negative connotation clinical psychological science directed at the assessment understanding · : , , and amelioration of human problems in behavior, affect , cognition or , health, and at the application of knowledge to such problems in ways consistent with scientific evidence - sounds more scientific Defining Psychologic Disorders When it causes distress impacts their day-to-day life (sometimes) · or · if it's causing harm to self or others affecting quality of life · Elements of Mental Health Problems suffering · statistical deviancy-rare undesireable · , · violation of the standards of society · social discomfort(others experience discomfort or uneasel · irrationality and unpredictability dangerousness · maladaptiveness : functional impairment · The Elements of Abnormality · no one element sufficient to define or determine abnormality is e g Suffering violations of standards of society ↳.. , · definition of what is problematic changes as society changes - eg.. anxiety in context of pandemic was more normal ↳ may need to recalibrate based on context (ex : cultural background religion , , SES) Is it a typical given context ? · is it typically within society ? is it typical for person's age ? · - developmentally appropriate ?. biological changes - Latin culture illness linked to a cultural concepts of distress (e g "Susto".. : terrifying event ; belief that the event caused their soul to leave their body) culture and context shape what is considered distressing · "life is suffering" ↳ - culture influences what is acceptable to talk about What is a Psychological Disorder ? Figure 1 1. - accepted definition behavioral Psychological : , , or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning , or increased risk of suffering death , pain , , or impairment Clinical Description Figure 1 3. · clinical description (phenomenology) begins with the presenting problem Symptoms (e g chronic worry , panic attacks) -.. ↳ guided by research ; Diagnostic and Statistical manual (DSM) description aims to distinguish clinically - significant impairment from common human experience may also describe other factors : · > - prevalence and incidence of disorders ↳ onset of disorders ; acute vs. insidious onset ; age of onset episodic or chronic course of disorders - : prognosis good vs guarded > - :. How common dre mental health disorders ? planning establishing , and funding mental health , Significant question 7 services for specific disorders for many reasons > providing of mental disorders clues to causes eX social media increasing anxiety & depression in : Youth ; context of pandemic ; social isolation Prevalence and Incidence epidemiology study of distribution of diseases disorders or health-related · : , , behaviors in a given population ↳ usually very large sample populations prevalence number of active cases in population during a given period of time · : ~ > - typically expressed as percentages different types of prevalence estimates /e g. 1 year , lifetime ↳. · incidence number of new cases in population over given period of time : ↳ figures are typically lower than prevalence figures doesn't include existing cases - causation , Treatment , and outcome etiology what contributes to the development of psychopathology ? : · · treatment development how can we help alleviate psychological suffering ? : ↳ includes pharmacological psychosocial , , and combined treatments who treats individuals with mental health problems ? Treatment settings · what are barriers to care ? & not all people receive treatment ; disparities exist about - 53 % of people receive treatment · vast majority of treatment is done on outpatient basis · in patient hospitalization typically for seriously mentallyIll (SMI) : ↳ suicidality eating disorders violent/dangerous people , , Stigma · psychological disorders remain the most stigmatized condition of the 21st Cent., despite advances in scientific of the origin of psychological disorders - understanding of neurobiological basis has not lessened stigma ↳ attributions about mental illness as a sign of personal weakness contributes to stigma  Lecture 2 One-dimensional models · explain behavior in terms of a single type of cause · could mean paradigm school or a , , conceptual approach tend to ignore information from other dreas · explaining a disorder ex : the result of family history as alone · Multidimensional Integrative approach Interdisciplinary · , eclectic , and integrative system · psychopathology results from multiple influences - biological ↳ behavioral ↳ social & cultural ↳ developmental ↳ environmental understanding Causes of Mental Health Problems 1. Biological factors : genetics neurotransmitters hormones and brain dysfunction , , ,. 2 Psychological factors behavioral and cognitive :. sociocultural and interpersonal factors 3 Biological viewpoint · genes carry our genetic info (DNA) heritability extent to which variability in behavior is due to genetic factors · : ↳ ranges from 0 00 to 1 00.. - almost all behavior is heritable to some degree genes account for 150 % of variations in psychopathology - · very health related problems are caused by a single gene few mental > - eX Huntington's disease /gene on chromosome 4) : - most psychological disorders are polygenic influenced by many genes : The Interaction of Genes and Environment · diathesis stress model disorders are the result of underlying risk factors : combining with life stressors that cause a disorder to emerge · reciprocal gene-environment model or gene environment correlation model outcomes are a result of interactions between genetic vulnerabilities : and experience ↳ genetics may make people more likely to seek out certain environments > ex : - someone's risk-taking genes may make them seek out drugs epigenetics (epi over or above) environmental influences affect the · = : expression of certain genes both for the individual and descendents - animal models /rat pups and rhesus monkeys) early maternal deprivation : may prevent the genetic expression of receptors that regulates stress hormones, thus making the "maternally deprived" person more susceptible to stress ↳ some human studies Neurotransmitters · neurotransmitters : chemicals that allow neurons to communicate with each other > send - signals across the synapse to another neuron · receptor sites on postsynaptic neuron absorb neurotransmitter - can be excitatory /influences another neuron) ↳ inhibitory (blocks reuptake) · influenced by reuptake reabsorption of leftover : neurotransmitter by presynaptic neuron Neurotransmitters may contribute to mental health problems · excessive or inadequate levels of neurotransmitters · insufficient reuptake of neurotransmitter · faulty neurotransmitter receptors ↳ over or under-responsive Types Neurotransmitters of · serotonin and dopamine implicated in depression mania and schizophrenia : , , · morepinephrine implicated in anxiety and other stress-related conditions : glutamate key role in learning memory and cognition : · , , gamma-aminobuty vic acid (GABA) implicated in anxiety when low levels : · Hormones : The HPA AXIS hypothalamic pituitary adrenal (HPA) axis : involves - · - the cental nervous system and the endocrine system adjusting hormones when there is stress > - hypothalamus releases CRF > - pituitary gland releases ACTH - adrenal cortex promotes release of cortisol Istress hormone) chronic stress can impact functioning of HPA AXIS · ↳ impact negative feedback system increase risk for depression and PTSD > - Brain Dysfunction contributes to mental health problems · brain lesions and defects in brain tissue can result in Psychiatric disorders ↳ traumatic brain injury associated with depression · structural differences seen in Schizophrenia OCD ASD etc. , , , Psychological Models Psychoanalytic viewpoint : " · "your problems stem from things you've not aware of · Freud : mind is divided into 3 principal parts (Id , Ego, superego) which are continually in conflict · intrapsych conflicts influence Psychopathology ; anxiety depression phobias , , , somatic disorders Psychodynamic viewpoint · "your problems from your early stem relationships" · parent-child attachment insecure and maladaptive relationships create anxiety , low self-esteem and guilt - · , Behavioral Viewpoint · "your problems stem from what you learn/observe" · classical conditioning operant conditioning · · observational/social learning/modeling classical conditioning · Pavlov (1849-1936) · learned associations occur when a neutral stimulus is repeatedly "paired with a conditioned stimulus ~ applies to phobias and PTSD the most · Operant (instrumental) conditioning · Thorndike and Skinner · mental health issues emerge through learning through consequences behavior which is reinforced tends to be · repeated · behavior which is not reinforced tends to die out or be extinguished ↳ e g.. child tantrums , substance use Observational learning/social learning / modeling · involves cognition as well "your problems stem from what you have observed " · · we learn from others and what is around us > -.g e aggressive behavior. · involves self-efficacy and motivation > - are they similar to us ? > - do they receive rewards for their behavior ? ↳ do we admire them ? Cognitive perspective · Beck and Ellis-late 1960s · "your problems stem from your thoughts/perceptions) now we perceive the occurrence of an event or situation impacts how we · act , think and feel , Schema : underlying representation of · knowledge that guides current processing o information ↳ how we think about the world · attributional style : characteristic way in which individuals may assign responsibility to bad or good events your fault my fault the world's fault etc. > - , , , sociocultural/interpersonal viewpoint "You are a product of your environment and current relationships" · · cultural factors influence the form and expression of behavior : gender effects men and women may differ in emotional experience and expression · : may be related to gender roles certain ways of coping with emotion are more ↳ : acceptable for men and women · effect of social support low social support related to mortality , disease and : , psychopathology - frequency and quality important ↳ social support especially important in the elderly  Equifinality Multifinality Factor outcome ↓ T Factor Factor outcome outcome ~ outcome M factor Different factors can The same factor can influence the same contribute to many outcome different outcomes · contributing factors · the same contributing (child adversity , factor (e g Child.. familial history , abuse) can lead to low social support, various outcomes significant stressful [depression , PTSD , events etc) are , anxiety , etc..] variable but may lead to the same outcome /e g. depression (. Lecture 3 Assessing Psychological Disorders · clinical assessment : systematic evaluation and measurement of psychological , biological , and social factors ↳ data collected helps lead to a... · diagnosis degree : of fit between Symptoms and diagnostic criteria Are you psychoanalyzing me ? psychologists ask a lot of questions · psychoanalysts tend to ask Less questions more open ended · - The Clinical Interview · the core of clinical work · addresses multiple domains > - presenting problems - current and past behavior > - detailed history > - family , education , friends, physical therapy and medication ux) , , · 1-2 hours ; 1- 3 visits · sometimes need to make differential diagnoses : gathering info to understand if it's one condition or another if they are similar The Mental Status Exam mental status exam involves systematic observation of an individual's behavior : · ↳ appearance and behavior thought processes ↳ mood and affect (facial expressions) > - ↳ intellectual functioning - sensorium : How aware are they Semi-structured Clinical Interview · carefully phrased and tested questions that elicit useful information in a consistent manner - reliable and valid components of the mental status - standardized questions · advantages : Clinician - confident that a semi-structured can feel interview will accomplish its purpose · disadvantages : - loss of spontaneity may inhibit the patient from volunteering useful info ↳ that is not directly relevant to the question being asked Physical Examination ex of semi-structured as · can be helpful in diagnosing mental problems · understand and rule out physical etiologies ↳ lack of nutrients ↳ medication issues ↳ physical disorders · ex : someone with panic disorder who uses stimulants that cause panic attacks probably has a stimulant use disorder  ex : person using weed is lethargic could be cannabis use disorder or depression · - Behavioral Assessment · behavioral assessment uses direct observation to assess formally an individual's : thoughts, behaviors feeling and behavior in a specific situation or context , , target behaviors are identified and observed with the goal of determining the · factors that seem to influence them cantecedents and consequences). school assessment tantrums at home social interactions ↳ g e. , , · self-monitoring involves an individual monitoring their own behavior : ↳ reactivity can distort any observational data ↳ knowing you are being observed can change behavior Psychological Testing Projective Tests : · emerged from psychoanalytic tradition (Freud · used to assess unconscious processes project aspects of personality on to ambiguous test stimuli · · require high degree of inference in scoring and interpretation · examples : ↳ Rorschach linkblot] > - Thematic Apperception Test (TAT] strengths : · - one way to gather qualitative data · criticisms : ↳ hard to standardize and score ↳ reliability and validity data may be mixed Personality Inventories · personality inventories self-report questionnaires : that assess personal traits · Minnesota Multiphasic Personality Inventory (MMP1) easy to administer and score ↳ ↳ includes validity scales to detect lies , defensiveness and infrequent responses , > - excellent reliability Intelligence Testing · originally developed to identify children who would benefit from additional help in school · not the same as IQ > -involves more than is typically measured in an IQ test - ability to adapt to environment ↳ ability to generate new ideas & ability to process into efficiently ↳ Street smart vs book smart. Neuropsychological Testing neuropsychological · abilities in areas such as receptive and tests : measure expressive language attention and concentration memory motor skills perceptual , , , , abilities and learning and abstraction , · allow the clinician to make inferences about brain functioning and organic damage ↳ problems that come with neurodevelopmental disorders Neuroimaging pictures of the : Brain · neuroimaging pictures of the : structure and function of the brain · structural imaging methods : ↳ computerized axial tomography (CAT) Scan or CT Scan - nuclear magnetic resonance imaging (MRI) · functional imaging methods : ↳ position emission tomography (PET) scan ↳ functional MRI (fMRI) and blood-oxygen-level dependent /BOLD) MRI - Psychophysiological Assessment psychophysiological assessment measures changes in indicators of nervous system · : functioning that reflect emotional or psychological events - electroencephalogram (EEC) measures electrical activity in the brain ↳ electrodermal responding measures sweat gland activity controlled by the peripheral nervous system not diagnostic by itself · Classification issues Categorical · : a set of defining criteria that everybody has to meet to have the disorder · dimensional approach notes the variety of cognitions moods and behaviors : , , which the patient presents and quantifies them on a scale · prototypical approach identifies certain essential characteristics of an entity : So it can be classified , but also allows certain nonessential variations that do not necessarily change the classification ↳ eX : DSM Psychological Diagnosis I · Diagnostic and Statistical Manual of Mental Disorders (DSM) > - DSM-5 (2022) ↳ not tied to any one theory ↳ backed by data and research · International Classification of Disease (ICD-11) ↳ comprehensive of all medical disorders · number of DSM disorders has increased # of DSM Disorders eX Of DSM diagnoses Lecture 4 Anxiety Disorders : Classification advantages : · > - provide nomenclature that allows us to organize information in useful way ↳ provides a common language for clinicians and researchers ↳ facilitates research ↳ defines the domain of what is considered problematic - facilitates insurance reimbursement · disadvantages : ↳ all or none approach ↳ what about subthreshold ? (ex : someone has 315 symptoms required) > - categories are overlapping ↳ focus on diagnosis not person , ↳ lose contextual info ↳ stigund labeling and self concept > - anxiety vs Fear. anxiety apprehension : over an anticipated problem · worry/apprehension > - 1 " about what if fear : a reaction to immediate danger · ↳ fight or flight response · both involve physiological arousal anxiety-moderate arousal (e g restless energy tension) ↳.. , fear-higher arousal le g overpowering urge to run) > -.. > - by autonomic Sympathetic nervous system caused can turn into a panic attack · ↳ expected triggered : ↳ unexpected no clear trigger (panic disorder) : Adaptive Responses to Anxiety and Fear Figure 5 1. · anxiety : increases preparedness anxiety interferes performance ↳ absence of with > - moderate levels of anxiety improve performance high levels of anxiety are detrimental to performance > - · fear : triggersfight or flight" response > - in the right circumstances fear , saves lives ↳ fear system seems to misfire in some anxiety disorders Anxiety Disorders · DSM-5-TR anxiety disorders : ↳ generalized anxiety disorder specific phobia - > - social anxiety disorder - panic disorder ↳ agoraphobia most common class of psychological disorders · > - 28 % of people report significant anxiety symptons in their lifetime (adults) criteria for anxiety disorders symptoms interfere with importantdreds of functioning or cause marked distress · symptoms are not caused by a drug or a medical condition · symptoms persist for at least 6 months or at least 1 month for panic disorder ·. 1 Generalized Anxiety Disorder (GAD) · chronic or excessive worry about multiple events and activities (family health finances , , , work , school , etc) · hard to control worries occurs more days than not for 6-month period · associated somatic symptoms (muscle tension , fatigue , irritability sleep problems etc · , , · impairment or distress. 2 specific phobias strong and persistent fear · · triggered by a specific object or situation great lengths to avoid or else endured with intense anxiety · can cause panic attacks · subtypes of. social 3 phobia ; social anxiety disorder phobias · disabling fears of one or more specific social situations · fear of exposure to scrutiny and potential negative evaluation of others and to numiliation or embarrassment · avoidance or endured with intense anxiety impairment or distress ·. Panic Disorder 4 · recurrent , unexpected attacks panic attacks. phobia) should triggered by specific Situations (e g not be ·. considered in diagnosing panic disorder · persistent worry about additional attacks change in behavior and associated impairment · 25 % of people will experience a single panic attack which is not the same as panic · , 5 disorder symptoms of. Agoraphobia panic attacks · two or more situations avoided : need 4 of 13 1. using public transportation. 2 being in open spaces. 3 being in enclosed spaces. 4 standing in line or being in a crowd being outside 5. of the home alone · fear situation because escape might be difficult or help not available if one should develop panic like symptoms or other embarrassing symptoms fear is out of to actual danger proportion · · situations are avoided , endured , require companion · usually seen as comorbid with Panic Disorder (but not always) Prevalence , Age of onset Gender , · phobias and social anxiety are most common · comorbidity is the rule , not the exception ↳ depression very common : 50-75 % - affects treatment outcomes · anxiety disorders more common in women Gender Factors · women are twice as likely anxiety disorder 12 as men to have an to 1 ratio > - and experience greater functional impairment possible explanations : · likely ↳ women may be more to report symptoms & men more likely to be encouraged to face fears and feel a sense of control over situations > - women more likely to experience sexual assault > - may interfere with sense of control to stress and have higher neuroticism ↳ women show more biological reactivity levels Lecture 5 anxiety disorders : Factors that Increase General Risk for Anxiety Disorders 1. Biological factors ↳ genetic vulnerability & disturbances in the activity of the Amygdala , the prefrontal cortex , and other brain regions involved in fear and emotion ↳ neurotransmitters - functioning decreased of gamma-aminobutyric acid (GABA) and serotonin ; increased horepinephrine activity ↳ nevitable traits ↳ behavioral inhibition neuroticism ↳>. 2 Psychological Behavioral - fear conditioning ↳ > - Cognitive factors including perceived , lack of control , over-attention to cues of threat , and intolerance of uncertainty Genetic Factors · twin studies suggest heritability of about 40-50 % · same genes may elevate risk for several anxiety disorders ↳ e. g. a family member with a phobia is associated with increased risk of developing a phobia and otheranxiety disorders genetic vulnerability for anxiety and depression may overlap · Neurotransmitters · GABA : neurotransmitter (calming effect-reducing firing of neurons) inhibitory ↳ depleted levels associated with anxiety · disruptions in serotonin mood regulating problems : corticotropic release factor system activates HPA axis which regulates cortisol · production and advenaline like neurotransmitters (norepinephrinel ↳ increases heart rates and blood flow , leading to physical boosts and heightened awareness glutamate helps to code for fear-related experiences increased : · oversensitive fear network amygdala drives autonomic and emotional responses · : ↳ overreactive/related to inc glutamate. and norepinephrine along With IOW GABA & sero · hippocampus distinguishes between real : and perceived threat context & oversensitive fear conditioning prefrontal Cortex : involved in attention , Cognition , and action · ↳ regulates limbic responses of amygdala and hippocampus ↳ serotonin helps to regulate emotions · the anxiety disorders appear to be related to heightened activity in the amygdala and diminished activity of prefrontal cortex in response to threatening stimu the Personality Factors - 5 personality factors · neuroticism Five factor model of personality dimensions : 1. neuroticism > - tendency to experience frequent or intense negative affect 2. extroversion - predicts onset of anxiety disorders and depression. openness 3 4. conscientiousness 5. agreeableness Behavioral Inhibition tendency to become agitated distressed and cry in unfamiliar or novel settings · , , observed in infants as young as 4 mo Old ·. may be inherited · · longitudinal studies learly childhood through adolescence - increased risk of social anxiety GAD and depression) , , Behavioral models fear conditioning : · Mowrer's two-factor model (1947) ↳ classical conditioning ↳ operant conditioning - avoidance maintained through negative reinforcement Behavioral conditioning · classical conditioning can occur in different ways : ↳ direct experience real danger results in true alarm response : ↳ ex getting Bitten by a dog : - false alarm in a situation (paric attackIn a specific situation but no real danger ↳ participating ex : in a group ↳ modeling I vicarious experiences - seeing someone else experience feared situation ↳ verbal instruction (being told about danger) ; information transmission - e g.. hearing a parent say dogs are dangerous Cognitive factors belief that one lacks control over environment ·. abuse) and severe life events may foster the Bellef ↳ negative childhood experiences (e g. that life is uncontrollable attention to threat · ↳ tendency to notice negative environmental cues ; negative angry faces in experimental studies anxiety sensitivity : tendency to become distressed by physiological arousal sensations , · and worries that sensations are harmful ex on anxiety sensitivity measures unusual body sensations scare me - : - Synthesis : etiology of social anxiety disorder biological · - behaviorally inhibited ↳ genetically vulnerable · behavioral factors > - classical and operant conditioning ↳ safety behaviors maintain and intensify social difficulties ↳ e.. avoiding eye contact g , disengaging from conversations, standing apart from others cognitive behaviors · focus on negative/dismiss positive aspects > - overly negative in evaluating their social performance ↳ Etiology of Panic Disorder : Neurobiological Factors overactivity in locus coeruleus · > - releases norepinephrine in presence of a perceived threat ↳ oreractive in patients with panic disorder - leads to exaggerated response including palpitations , shortness of breath , sweating ,  dizziness ↳ interacts with fear network not overactive in other anxiety disorders , only panic disorder · · introceptive conditioning : classical conditioning of panic in response to internal bodily sensations ↳ a person experiences somatic signs of anxiety - interpreted as impending doom ↳ followed by panic attack a - panic attacks become a conditioned response to somatic changes beliefs increase anxiety and arousal ; creates vicious cycle · · avoidance and safety cues Sustain Cycle Treatment for Anxiety Disorders · Biologica treatment options : - medications ↳ SSRIs to increase Serotonin (Prozac, Lurox , and 2010ft) ↳ typically takes 4-6 Weeks to have noticeable effects ↳ benzodiazepiness are fast-acting HOW SSRIs Work Medications benzodiazepines (Valium and Xanax) · ↳ iMC GABA which is inhibitory. , - calmingeffect , reduces anxiety , fast acting · response rate 55-60 %: > - comparable to CBT alone but CBT alone protects against relapse Treatment of Anxiety Disorders change feelings : relaxation skills · change behaviors exposure therapy : · ↳ face the situation or object that triggers anxiety & e. exposure hierarchy graded exposure to a list of triggers : g. - can also require person to face images that they are avoiding or to face sensations that are scary Cognitive restructuring technique change thoughts · : - overestimation of likelihood of a negative event happening Social ↳ Phobia : I am 90 % certain that I will make a fool out of myself at the party - overestimation of how bad it will be - DamiceX : "If my heart starts racing I will pass out " , Lecture 6 anxiety, : lotsd and OCD , Learning fear responses · modeling : ↳ watch parent being terrified of spiders ↳ sibling terrified of going to the doctor > - friend freezes during important presentation strangers/new - avoid people - things you see in the media le g shark attack.. on news , plane crash , etc information transmission · : & the ocean is dangerous stay away from it - - a low exam grade will ruin your future > - don't talk to people you don't know-they might kidnap you - don't go near the water , you might drown ↳ stay away from dogs , they bite Obsessive Compulsive and Related Disorders · obsessive compulsive disorder body dysmorphic disorder · · trichotillomania · hoarding disorder · skin-picking disorder Obsessive compulsive Disorder (OCD) recurrent persistent and intrusive thoughts urges or images that are unwanted · , , , usually accompanied by Compulsive (repetitive) behaviors aimed at preventing · d readed events · don't need to have both obsessions AND compulsions - can have one or the other · need to cause significant distress or be time , consuming , or interfere with functioning Obsessions Repetitive Thoughts - · cleaning and contamination ↳ concerns or disgust with dirt or germs fear of touching other people and getting them sick after you touch something - · forbidden/aggressive thoughts ↳ fear you might harm others - poisoning other people's food harming babies , , running over somebody with car in ↳ sexual thoughts event-trig tableton ↓ symmetry thoughts · ~ things must be in perfect order or done in a specific way ↓ · hoarding : fear of throwing anything away anxiety ↓ · culture can shape obsessions more anxiety ↳.g e. religious thoughts T compulsions repetitive behaviors - action / compulsive behavior ↓ · cleaning compulsions washing showering cleaning : + emporary relief/anxiety reduction , , ? · checking locks , store that you didn't harm others : , (compulsive behavior is reinforced) organizing and reorganizing cabinets repeating routine activities ; combing · : , hair , in and out of doorway doing things a specific # of times , · saving things of little or no value O CD Prevalence · lifetime prevalence : 1 6 %. · affects both geriders equally it might be more biological / higher heritability - indicates · typically begins in adolescence or early adulthood - often in pregnant/postpartum women Often comorbid with tics (Tourette's) · Biological : Brain structures · moderately heritable ↳ especially if early onset OCD · cortico-basal-ganglionic thalamic circuitry - ~ functions are to initiate and suppress voluntary movements , decision making , habit formation and impulse control ↳ hyperactivity in this circuitry leads to repetitive thoughts and compulsions and impaired inhibition of unwanted thoughts · started using psychosurgeries to reduce the overactivity Psychological Factors · classical conditioning direct experiences -.g not checking paired with something bad happening ↳ e. Thought Action Fusion thinking something is equivalent to actually having done it or increases chance · of actually doing so ↳ thought "If I think about my family getting into an accident it means I am : , causing it to happen" > - fusion : the individual feels responsible for their thoughts and fears they might somehow influence real events engages in checking rituals or other types of rituals to reduce their anxiety ↳ OCD Treatment Exposure plus response prevention (ERP) · · exposing them to their trigger (e g dirty surface) and not allowing them to.. engage in the compulsion or relieving behavior /e g not allowed to wash hands).. ↳ creates new associations with the triggers · medications : SSRIs/ = 40% effectiveness) OCD Spectrum Disorders · Body dysmorphic disorder persistent , intrusive and horrible thoughts about : their appearance , and they engage in such compulsive behaviors as repeatedly looking in mirrors to check their physical features - Often lifelong course · trichotillomania the urge to pull out one's own hair from anywhere on the : Body , including the scalp, eyebrows and arms , ↳ treatment habit reversal : break the hair-pulling habit or distract from it - · both have similar etiology to OCD Trauma related disorders · DSM disorders triggered by stress ↓ ↓ posttraumatic * cute stress Stress disorder disorder Posttraumatic Stress Disorder (PTSD) · first entered BSM in 1980 when research demonstrated that many Vietnam Veterans were having emotional problems and unable to return to civilian life Stress symptoms fail to abate even when the traumatic event has passed · , and the danger is over · main criterion : exposure to a traumatic event & e g natural disasters war, sexual assault , etc... , Traumatic Event · traumatic event defined as : ↳ it happened to you direct exposure ↳ It happened and you saw it (witnessing in person , ↳ indirectly by learning that a close relative or close friend was exposed , to trauma levent must be violent accidentall ↳ repeated or extreme indirect exposure to aversive details of the events) , usually in the course of professional duties /e g. first responders. , social workers) - DOES NOT INCLUDE indirect non-professional exposure through electronic media television , , movies , or pictures PTSD Criteria 1. Re-experiencing le g nightmares, memories , flashbacks) /1 needed... 2 Avoidance : efforts to avoid thoughts , feelings , reminders of trauma (1 needed). 3 Hyperarousal and reactivity : hypervigilance aggression , , reckless behavior ↳ two of these needed. Negative alterations in cognitions and mood (two of these 4 > - inability to recall key features of the traumatic event , negative beliefs about self and world , self-blame , anger , loss of interest in things lack of positive emotions , · markedly interferes with one's ability to function diagnosable only after one month post-trauma ↳ PTSD After Exposure toSpecific Stressors military combat · ↳> 12 16 1 PTSD Viethar %. ↳ 12 9. Iraq and Afghanistan % PTSD · prisoners of war concentration camp , · traumas caused by human intent · accidents or natural disasters · comorbidity with suicide , depression alcohol use , substance use disorders etc. , , AcuteStress Disorder Can be diagnosed when symptoms develop shortly after experiencing a traumatic · event and last for at least 2 days · shorter duration of symptoms /not lasting more than a month after traumal · some data suggest that Acute Stress disorder is predictive of PTSDdX but findings ↑ of consistent Contributory causal factors Psychological biological sociocultural ↑ actors factors factors ↓ - > - PTSD genetic vulnerabilities · serotonin transporter gene 1. study of female undergrads who witnessed shooting on campus - those with specific type of the serotonin transporter gene had increased ↑ robability of a stress disorder. Hurricane exposure /Florida in 2004) 2 - those with specific type of the serotonin transporter gene had increased ↑ robability of a stress disorder - 3 2 % in overall sample vs 14 8 % in those with specific gene.... ↳ Impact magnified in context of low social support HDA AXIS prepares body for Fight or flight response · · chronicstress creates excess cortisol ↳ inhibits innate immune response > - body in escape mode rather than healing · too much cortisol can damage brain cells & neurons in Hippocampus (memory) · high cortisol I found in all people with PTSD ↳ women with PTSD have higher levels than women without PTSD ↳ not true for men Structural Differences in Brain · smaller hippocampal volumes in individuals with war related PTSD and adult survivors of child sexual abuse ↳ brainarea known to be involved in memory/stress · data from twin studies suggests smaller hippocampus may be a vulnerability factor /exists prior to traumal · other studies suggest stress and trauma may have negative impact on brain creduce hippocampal volume) Psychological and socio-cultural factors · conditioning acquire through classical Mowrer's two-factor model of : conditioning and maintain through operant conditioning · social factors - strong social support reduced risk of onset and persistence of PTSD greater pre-trauma family instability increases risk ↳ ↳ greater pre-trauma cognitive abilities lower risk ~ may affect now individual makes meaning of event