Psychopathology Notes PDF

Exam 1 1/23/25 Part 2 - Reconceptualizing mental health (the HiTOP movement) Solutions to issues with the DSM5 -​ Heterogeneity: getting the same diagnosis for very different symptom groups -​ What if we removed diagnostic categories? -​ Reliability: Multiple professionals would...

Exam 1 1/23/25 Part 2 - Reconceptualizing mental health (the HiTOP movement) Solutions to issues with the DSM5 -​ Heterogeneity: getting the same diagnosis for very different symptom groups -​ What if we removed diagnostic categories? -​ Reliability: Multiple professionals would be able to reach the same diagnosis based on the same set of criteria/symptoms -​ What if clinicians saw symptoms as puting the patient somewhere on various spectrums of mental health (dimensional approach -​ Comorbidity: Possibility of two or more conditions/diagnosis being present at once -​ Unspecified Diagnosis HiTOP: Hierarchical Taxonomy of Psychopathology -​ The proposed alternative to the DSM5 which a lot of psychologists and researchers are working on developing and using in mental health treatment -​ Taxonomy: system of classification, a shared language to describe someone -​ Isn't created by clinical intuition, its derived from factor analysis -​ Much more reliable and objective, constant results -​ Less room for personal interpretation by the psychologist and larger research/professional community, instead using data to develop categories and diagnostic criteria -​ Factor analysis -​ Clumps together different feelings and symptoms based on ones that have statistically been shown to be correlated together strongly -​ Can do this for all the words in the dictionary that can describe people and their behavior -​ The lexical hypothesis by Francis Galton -​ If something in the universe exists, humans will create words to describe it -​ The dictionary and language is a powerful tool to understand how people differ and behave -​ The periodic table is a taxonomy: figuring out the core “elements” of a person can help us to describe them Big 5 → PID 5 -​ PID 5 = Personality Index for DSM5 -​ The core of personality, the core of psychopathology 1  -​ Big 5 is considered part of HiTOP but is tiptoeing into the DSM5 and is seen as an “alternative” method of diagnosing personality disorders -​ In the DSM, traits are clustered by common disorders/disorder correlations instead of common language -​ Even when using different data, the same basic categories emerge -​ The big 5 as the PID 5 -​ Neuroticism = Negative Affectivity -​ Extraversion → Detachment -​ Agreeableness → antagonism -​ Conscientiousness → Disinhibition -​ Openness = psychoticism -​ Myers Briggs vs. The Big 5 -​ Another example of binary made using different data and research but which came out with very similar basic categories of personality PID 5 → HiTOP -​ PID 5 → DSM5 model of personality dimensions -​ HiTOP → clustering disorders onto spectrums -​ The PID5 maps onto the HiTOP model, ie Negative affectivity maps onto the internalizing spectrum -​ As you go lower in the hierarchy you're increasing specificity -​ Somatoform: a dimension that does not map on clearly to big 5/PID5 -​ Has to do with physical sensations as symptoms, such as feeling like you have a tight band around your neck, being bothered by the amount of saliva in your mouth, etc, to the point where it becomes somewhat imaginative and becomes an impairment -​ Sexual dysfunction can be seen as internalizing, somatoform, or nestled between the two -​ Ringwald et al -​ Did a factor analysis of all factor analytic studies, found the most evidence for the five factor model/big 5/etc, and suggested that not enough research considered and included/measured somatic complaints 2 Research advantage and utility of HiTOP -​ Continuous measurement -​ Allows us to capture variance in symptoms over time -​ Can take into account when circumstances may be causing spikes or lulls in certain traits/behaviors -​ What is your zone of fluctuation or normal range of difference? -​ Reduces psychopathology to its core units -​ Allowing us to understand each spectras cognitive, neurobiological, behavioral, and relational manifestations -​ People with conditions like depression still have personalities: how does it manifest differently in people with different traits? -​ Generalizability -​ Comorbid disorders no longer a problem in participant recruitment -​ Allows you to account for co occurrence in a way that's easy to dissect statistically -​ Clinical Utility -​ Robust information -​ Clinician obtains a comprehensive profile of the patients personality proclivities -​ Empirical means of tracking progress -​ From meeting criteria to not vs. scores on dimensions reducing -​ Can show clients a real trend of progress, more rewarding then “the yo-yo” -​ Enhancing case conceptualization -​ Colleagues can better communicate case presentations by having a shared language to discuss individual differences in patients -​ Considering all the aspects of someone's life and events, as well as heritable traits/factors and environmental impacts -​ Having a shared language to discuss individual differences 3 The Spectra: the broad dimensions of psychopathology -​ There is one level above the spectra, the super-spectra, which shows all spectra correlate together and could mean there's an overall genetic risk to general abnormal traits DSM5 still has its merits -​ Common language for clinicians -​ Provides people with community to relate to one another based on their diagnosis -​ Helps people acquire services, insurance billing/coding -​ standardizes/guides treatment 1/28/25 Part 1 - Earliest Views of Abnormal Behavior Early views: Demonology, Gods, and Magic -​ References to abnormal behavior in early writings show that the chinese, egyptians, hebrews, and greeks often attributed such behavior to a demon/god that had possessed the person -​ Exorcism and rituals were performed to ‘expel’ these spirits Hippocrates’ medical concepts -​ Shifted our understanding of mental disorders from supernatural forces to natural causes such as brain pathology -​ “Father of modern medicine” -​ He emphasized clinical observation and proposed that mental disorders stem from imbalances in the body -​ Appeared to shift in 400 BCE -​ Hippocrates doctrine of the four humours -​ The state of the body mirror the four core elements 4  -​ Fire, earth, water, air -​ The choleric, melancholic, sanguine, and phlegmatic humours -​ Imbalanced humours = abnormal behavior and personality -​ Hippocrates believed that temperament as influenced by four body fluids: blood (sanguine), phlegm (phlegmatic), yellow bile (choleric), and black bile (melancholic) Hippocrates’ personality types -​ Sanguine = extraversion -​ Active, optimistic -​ Phlegmatic = low neuroticism -​ Calm, relaxed, chill -​ Choleric = high neuroticism, volatility -​ Agitated, irritable -​ Melancholic = openness -​ Pensive, thoughtful Hippocrates and the classification of mental disorders -​ Hippocrates classified mental disorders into mania, melancholia, and phrenitis (brain fever/delirium) -​ He advocated for treatments like lifestyle changes, diet, and removing patients from stressful environments -​ Mania, melancholia, and “phrenitis” (delirium) were observable in 400 BCE! The role of Plato -​ Acknowledged sociocultural influences on mental health -​ Believed some criminals were not responsible for their crimes -​ Hospitalization over punishment -​ Conversations (like psychotherapy) -​ Recognized individual differences in cognition -​ *Belief in divine causes The role of aristotle -​ Influenced by plato: aristotle emphasized rational thinking as a way to alleviate emotional distress -​ First step towards cognitive therapy? -​ *Belief in bile disturbances Progress through history -​ Trend: progress is not linear. Advanced thinking can be accompanied by antiquated ideas Galen’s contributions to abnormal psych -​ Galen expanded on hippocrates’ ideas and introduced the role of the nervous system in psychological disorders -​ mental/physical distinction 5  -​ Separating these two different camps of causes was considered novel for the time -​ Causes: head, excessive use of alcohol, shock, fear, adolescence, menstrual changes, economic reversals, and disappointment in love -​ Some of these causes had been completely unthought of up until this time -​ Observation allowed him to track these correlations between physical and mental states A.D. 200: Chinese Medicine -​ Natural rather than supernatural causes -​ Chung Ching -​ “Hippocrates of China” -​ Hypothesized physiological underpinnings -​ Cause: organs -​ Intervention: regaining emotions; balance through appropriate activities Historical Case Study: Avicenna’s approach -​ Avicenna, a Persian physician, who lived during the middle ages, treated mental disorders humanely and emphasized a blend of physical and psychological approaches -​ Main point of intervention was to make sure to feed the patient in order to allow him to think properly -​ Played into the princes delusions in order to persuade him to take the food -​ Empathized and believed the horror the prince was experiencing Mental Disorders in the Middle Ages -​ During the middle ages, treatment of mental illness reverted to supernatural explanations, such as demonic possession -​ The clergy played a central role, relying on prayer, holy water, and relics to ‘cure’ individuals -​ Exorcisms often involved rituals such as chanting, fasting, and physical punishments to expel evil spirits Views in the 1500s-1600s -​ The renaissance period saw a reemergence of scientific thinking and humanis, -​ Scholars like Paracelsus rejected demonology and conceptualized mental illness as a conflict between instinctive and spiritual forces -​ Astral forces → moon → luna → lunatic -​ Treatment: body magnetism → hypnosis -​ Got people to think in and enter an imaginary world to open up to talking about deeper/unconscious conflicts -​ Beginnings of freudianism 6  -​ John Weyer (1515-1588): founder of modern psychopathology -​ Observed horrors of people accused of witchcraft → published a book about mental illness -​ Progressive and mocked for it -​ “Weirus Hereticus” and “Weirus Insanus” The establishment of early asylums -​ In the 16th century, asylums were established to confine individuals with mental illness -​ However, these early asylums were often overcrowded, unsanitary, and cruel -​ Asylum by Henry VIII -​ Contracted to “bedlam” -​ Violent patients shown to the public for money -​ Harmless inmates forced to seek money on the street -​ Residents were treated more like beasts than humans -​ People intending to only go to asylums for short periods and rehabilitation often ended up dying there Later asylums continued horrific treatment -​ Fallacy of choice -​ Residents needed to choose rationality over their mental illness -​ Ice/hot water plunges, patients bled to drain them of “harmful” fluids 1500s-1600s marked a rise of humanism and scientific thinking -​ The humanist movement emphasis dignity and the intrinsic worth of individuals, paving the way fro more humane treatment of mental illness -​ Setting the stage for humanitarian reform in the 1700s -​ Humanitarian reforms: Philippe Pinel -​ Pinel introduced humane reforms in French asylums, removing chains and promoting kindness and care -​ His approach demonstrated the benefits of humane treatment in improving patient outcomes -​ High stakes -​ Could've been executed if this didn't go well, it was seen as equivalent to letting beasts out to terrorize society 7 1/30/25 Part 2 - Earliest views of abnormal behavior Tuke’s Work in England -​ Pinel’s work and experiment (unchaining people) alloped William Tuke’s (1732-1822) goals to actualize -​ He had no official medical training but had a “big heart” and wanted to spread quaker beliefs -​ All people deserve to be treated with kindness and acceptance -​ Founded the york retreat -​ Patients lived, worked, and rested in peace there -​ As close to an oasis for the mentally struggling as you could get at the time -​ Founded after a quaker widow, hannah mells, died in the york madhouse where she was being held for melancholy -​ Believed in the importance of nature for healing, important part of the retreat is the extensive grounds -​ Hope was on the horizon… policy has power to make widespread change Policy changes in mental health care -​ The lunacy inquiry act (1842) -​ Mandated all asylums and houses be inspected every 4 months -​ Elimination of restraints -​ Proper diet -​ Elephant in the room: this is a very low bar -​ Incremental change leads to progress -​ The country asylums act (1845) -​ Requirement: all countries provide asylum to “paupers and lunatics” -​ Britain's policy of more humane treatment expanded to australia, south africa, india, etc after widespread news of a horrific event… -​ Maltreatment of patients in Kingston, Jamaica -​ “tanking “ to control and punish patients -​ Nurses held patients underwater, sometimes until the point of death -​ Takeaway: disturbing acts of injustice can occur where there is a lack of oversight. Policya can serve as that oversight -​ Reforms in the US: Benjamin Rush -​ Founder of american psychiatry -​ Also signed the declaration of independence -​ Advocated for humane treatment but still used outdated methods (e.g. bloodletting, tranquilizing chair) -​ Helped transition from punitive to therapeutic approaches -​ Medical Inquiries and Observations Upon Diseases of the Mind (pre pre DSM) -​ The Moral Management Movement -​ Focused on rehabilitating character rather than just treating symptoms 8  -​ Treatment: manual labor and spiritual discussion, helping to contribute to society and be a “good person” -​ Achieved high recovery rates despite limited medical treatments -​ 45.7% of patients were “cured” -​ *Dorothea Dix and the Mental Hygiene Movement -​ Dix (1802-1887) campaigned for improved asylum conditions -​ Established over 30 hospitals for the mentally ill -​ Started working as a teacher in women’s prisons and asylums and saw how horrific the conditions were -​ Raised millions of dollars for the mentally ill -​ Led to legislative changes and increased funding mental health care -​ Mental hygiene: exercise, food, clothing, activities, rest, cultivating opinions and attention to emotions -​ 19th Century Psychiatric Shifts -​ Shift from moral management laypersons to medical treatment -​ Psychiatrists (‘alienists’) gained control over asylums -​ Victorian morality linked to mental health → disorders seen as exhaustion of nervous energy -​ “Shattered nerves” -​ Clifford Beers and 20th Century Reform -​ Had three different stays in mental health hospitals himself, wrote about how horrible conditions were and the pain of being restrained in a straightjacket -​ Beers (1876-1943) wrote ‘a mind that found itself’ exposing asylum abuses -​ Advocated for more humane treatment -​ Inspired public and professional support for mental health reforms The rise of mental hospitals -​ Early 20th century saw an expansion of psychiatric hospitals -​ Over 400,000 patients in state-funded hospitals by 1940 -​ Long-term institutionalization was common -​ Much more common now for people to have outpatient care, but inpatient care still helps some people -​ Deinstitutionalization movement - mid 20th century -​ Government didn't want to pay for state mental hospitals -​ Many people that left institutions ended up in shelters or jail -​ Aim: transition patients to community-based care” -​ Led to reduced hospital populations but increases homelessness among the mentally ill 9  -​ Perceptions of long-term patients… they're just lazy and taking up taxpayer dollars to be fed and sheltered -​ Imagine their world Emil Kraepelin (2856-1926) and the Classification of Mental Disorders -​ Developed an early system for categorizing mental illness (the pre DSM) -​ Distinguished between different syndromes with predictable courses -​ Shared language allows accurate diagnosis and more effective treatment -​ Foundation for DSM -​ Founder of modern psychology The role of psychological factors -​ Late 19th century shift toward psychological explanations -​ Hypnosis and hysteria: mesmer;s theories of ‘animal magnetism’ -​ Magnetic fluid → wand hovering over the body in a dark room -​ Benjamin Franklin's experiment: not about the wand or magnetism, its about the hypnosis -​ The power of suggestion -​ Placebo effect, if you believe in the treatment the treatment will work for you -​ Freud's studies on unconscious influences -​ If someone is left in a room in the dark to just talk for an hour, they will start to reveal things from the unconscious Freud and psychoanalysis -​ Developed concept of unconscious motives -​ Techniques: hypnosis (later rejected) → free association, dream analysis -​ Mechanism: catharsis, releasing pent up emotions, hardships, traumas -​ Once its all released it no longer burdens you -​ Established psychoanalysis as a treatment method, mainly free association and dream analysis 2/4/25 Part 1 - Causal Factors and Viewpoints This week’s goal: -​ Explore correlations, risk factors, causes, and perspectives in psychopathology Correlates vs risk factors -​ Correlate: when one variable (x) is associate with an outcome of interest (y) -​ Does not mean causation: i.e. ice cream sales and drownings correlate but arent causing each other -​ Risk factor: A variable that is associated with an increased risk of developing a given outcome -​ Key word: developing -​ Suggests the variable must precede the outcome of interest (x comes before y) 10  -​ Does not necessarily cause the outcomes–instead, it can contribute to the risk outcome Risk Factors -​ Types of risk factors -​ Variable risk factor: X can be changed - i.e. obesity -​ Fixed risk factors: X cant be changed - i.e. family history/genetic predisposition -​ Causal risk factors - risk factors that directly cause the problem/condition -​ Example: a heart attack -​ Atherosclerosis: the buildup of plaque in the arteries that supply blood to the heart, when plaque ruptures a clot can form -​ Coronary artery spasm: a sudden narrowing of the coronary arteries, which can block blood flow -​ Blood clots: blood clots can form in the arteries due to various factors, such as smoking and certain conditions, locking blood flow -​ Types of causes -​ Necessary causes: a factor that must exist for a disorder to occur (e.g. heart attacks require a blockage of blood flow) -​ Sufficient cause: a factor that guarantees the occurrence of a disorder (e.g. hopelessness causing depression) -​ Contributory cause: a factor that increases the likelihood of a disorder but is neither necessary nor sufficient (e.g. parental rejection → troubled relationships) -​ Distal and proximal factors -​ Distal risk factors: early life experiences that predispose individuals to later disorders -​ Proximal risk factors: immediate conditions that trigger the onset of a disorder -​ Example: childhood abuse (distal) may lead to depression after job loss (proximal) -​ DIathesis-stress model: variables combine, or interact, to produce risk for a condition -​ Diathesis -​ Distal -​ Stress -​ Proximal -​ Additive vs. interactive model -​ Third variable: interactive model. Different slopes for different folks Protective factors and resilience -​ Protective factors reduce the likelihood of a disorder in high-risk individuals 11  -​ Examples: supportive relationships, problem-solving skills -​ Resilience: the ability to adapt successfully despite adversity -​ Negative consequences: labeling people as “resilient” could result in people’s suffering being invalidated The biological perspective -​ Mental disorders are viewed as diseases of the brain and nervous system -​ Biological factors include: -​ Genetic vulnerabilities -​ Neurotransmitter and hormonal abnormalities -​ Brain dysfunction and neural plasticity -​ Temperament -​ Genetic contributions -​ Genes influence behavior indirectly by interacting with the environment -​ Polygenic inheritance: multiple genes contribute to vulnerability -​ Twin Studies -​ Monozygotic: share 100% of genetic information -​ ACE modeling -​ Can figure out what parts of environment were shared or unshared, since genetics are identical this can reveal how environmental factors influence the prominence of certain conditions -​ Isolate the amount of variance explaining a condition -​ When a given condition is typically observed in both twins, compared to the environment, the condition iss aid to be highly genetic -​ Dizygotic: share same amount of genetic information as regular siblings -​ Comparing results from both types of twins can help understand the extent to which environmental factors have an influence -​ Shared vs nonshared environmental influences -​ Shared:: factors making family members more aline (e.g. parenting, income level) -​ Nonshared: unique experiences (e.g. different peer groups, specific life events) -​ Studies suggest nonshared influences often play a larger role in personality differences -​ Personality can be thought of as ~ 40% genetic and 60% environmental -​ Other gene focused study designs -​ Linkage studies: studies of mental disorders capitalize on several currently known locations on chromosomes of genes for other inherited physical characteristics or biological processes (i.e. eye color or blood group) -​ Association studies: test hundreds of thousands of common genetic variants (SNPs - single nucleotide polymorphisms) across many genomes to find those statistically associated with a specific trait or disease 12  -​ Linkage studies: identify genetic markers inherited with disorders -​ Example: attempts to locate bipolar disorder genes on specific chromosomes -​ Association studies: compare genetic markers in affected vs unaffected individuals -​ Example: dopamine-related genes linked to ADHD -​ Gene-environment correlations -​ Genotype-environment correlations: when ones genotype shapes their environmental influences -​ Passive: parents provide both genes and environment -​ The association between the genotype of a child inherits from their parents and the environment in which the child is raised -​ Evocative: child's behavior elicits a specific responses -​ Active: child seeks environments that match genetic tendencies -​ Orchids vs dandelions -​ Orchids: incredible potential for beauty, but are very very sensitive and need tender care -​ Dandelions: survive almost anywhere, very resilient 2/6/25 Part 2 - Causal Factors and Viewpoints Review from last class -​ Interaction models vs. additive models a.​ Interaction effect: relationship between X and Y depends on Z -​ Relationship between hours spent studying a visual textbook (X) and eam grade (Y) depends on the type of learner you are (Z) -​ The type of learner you are determines your slope on the graph in this example b.​ Addictive effect: relationship between X and Y is the same across all levels of Z -​ Studying (X) consistently increases exam grades (Y) and if having a tutor (Z) gives you an additional boost -​ Studying (X) consistently increases exam grades (Y). Having a tutor (Z) does not change how much each extra hour of studying increases your grade (slope), but it raises your baseline performance (y-intercept) giving an overall boost to your score 13  -​ Twin and adoption studies -​ Sufficient/necessary/contributory causes and example – what causes a fire? a.​ Necessary cause → oxygen -​ A fire cannot occur without oxygen, no matter how much fuel or heat you have, if there's no oxygen, there's no fire -​ Oxygen is necessary for a fire, but by itself it does not cause a fire b.​ Sufficient cause → a lit match in gasoline -​ If you drop a lit match in gasoline, it will start a fire every time. Nothing else needs to happen -​ Fire can also start in other ways c.​ Contributory cause → wind -​ Wind isn't required to start a fire, nor is it enough to cause one on its on, but once a fire has started wind makes it spread faster -​ Wind contributes to fire but is neither necessary nor sufficient on its own Neurotransmitter “imbalances” and mental disorders -​ The presynaptic neuron releases neurotransmitters which go into the synaptic cleft. In order for the signal to be received, they need to bind to the receptors -​ Sometimes things go wrong in this process: -​ Storage malfunctions -​ Overly sensitive or insensitive receptors -​ Excessive production or release of a neurotransmitter -​ Imbalances linked to psychopathology (e.g. depression, schizophrenia) -​ Key neurotransmitters: -​ Dopamine: motivation/reward (a matter of wanting/craving–not liking) -​ Schizophrenia, ADHD -​ Serotonin: mood regulation -​ Depression, anxiety -​ Medications aim to correct neurotransmitter imbalances (e.g. SSRIs for depression Hormonal imbalances and psychopathology -​ Endocrine system impacts behavior via hormone release -​ If your body is accustomed to floods of cortisol from constant stress, it can lead to hormonal imbalances that get in the way of your feedback response loop -​ HPA Axis: stress response system involving cortisol -​ Malfunctions in HPA Axis linked to depression and PTSD -​ Your body and mind are connected and the HPA Axis and how its linked to depression shows this -​ Stress has a very biological and physiological component 14 Temperament and Personality Development -​ Your “biological” personality, unadulterated by the “environment” -​ Key dimensions: -​ Fearfulness → neuroticism -​ Positive affect → extraversion -​ Attentional Persistence → conscientiousness -​ Interest → openness -​ High behavioral inhibition in childhood predicts later anxiety disorders -​ Three basic temperaments -​ Easy – generally lowkey, happy, and consistent in their routines -​ Difficult – irregular habits, intense emotions, sensitive to stimulation, often especially independent and insightful -​ Slow to warm – can be kind of in between, initially withdrawn, can end up being less emotional than difficult children but more negative than easy ones Psychological perspectives -​ Psychodynamic Perspectives -​ Freud's psychoanalytic theory -​ mind divided into: -​ Id: instinctual drives, pleasure principles -​ Ego: reality-oriented mediator -​ Superego: internalized moral values -​ Ego deploys defense mechanisms to escape conflict between Id/superego + protect against anxiety -​ Denial, displacement, projection, rationalization, reaction formation, regression, repression, sublimation -​ Jungian individuation - called a “terrifying thinker” -​ Physical world/society: represents the external environment in which we interact and express ourselves; our social context that influences how we present ourselves -​ Persona: the “mask” or social facade we show the outside world; developed to meet societal expectations and roles; can differ depending on our environment or the people we are with -​ Ego: the center of our conscious awareness; responsible for our sense of identity and self-image; mediates between internal needs and external reality -​ Shadow: the part of ourselves we tend to repress or deny, often containing socially or personally “unacceptable” traits; integrating the shadow can lead to personal growth and self-awareness 15  -​ Personal unconscious: formed by individual experiences, memories, and emotions that have been forgotten or repressed; contains “complexes” emotionally charged ideas or memories with a common theme (e.g. power complex, mother complex) -​ Cultural unconscious: a layer of inherited cultural norms, values and images that shape our worldview; bridges personal experiences with wider collective patterns unique to a culture -​ Collective unconscious: a universal layer of the psyche shared by all humanity; inherited psychic structures that manifest as archetypes, forming the foundation of shared myths, symbols, and instincts -​ Archetypes (anima, animus, etc): primordial images or symbols that recur across cultures (e.g. the “wide old man”) -​ Anima: the unconscious feminine aspect in men -​ Animus: the unconscious masculine aspect in women -​ Self: the central archetype, representing the total integration of the conscious and unconscious; the guiding force in achieving wholeness and balance within the psyche -​ The unconscious and the psychic world: the broader world, largely hidden aspects of our mental life that profoundly shape our thoughts, feelings, and behaviors. Becoming conscious of these layers is a key part of jungian individualization and personal growth -​ Object-relations theory -​ Object: symbolic representation of another person in an infants environment -​ Introjection; the process by which the child symbolically incorporates the object into his/her personality -​ Internalized images of the punishing father, giving rise to an inner harsh self critic -​ Interpersonal theory -​ Asserts that humans are first and foremost, social beings–their core desire is to belong and be accepted by their group -​ Attachment theory (John Bowlby) -​ Core concept: infants are biologically wired to from an emotional bond with a primary caregiver -​ This ensures protection, security, survival 16  -​ Secure base: the caregiver serves as a secure base from which the child an safely explore the world -​ Emotional safety, reduced anxiety, confidence -​ Internal working model: early attachment experiences form a mental blueprint for how relationships work -​ Influences expectations and behaviors in future relationships -​ Separation and loss: Bowlby emphasized the potential negative impacts when the attachment bond is broken or absent -​ Prolonged separation can lead to distress, anxiety, and potential long-term emotional difficulties -​ Developmental significance: secure attachment fosters healthy social-emotional development. Insecure or disrupted attachments can contribute to later relationship challenges -​ Behavioral perspectives -​ Classical conditioning -​ A learning process where an organism learns to associate two stimuli, leading to an automatic response -​ Operant conditioning -​ A learning process where behavior is shaped by consequences, either reinforcing or discouraging future behavior -​ Generalization and discrimination -​ Generalization: when a learned response (e.g. fear salivation, or any conditioned response) is elicited by stimuli similar but not identical to the original conditioned stimulus -​ Discrimination: the ability to distinguish between different stimuli and respond only to the specific one that was conditioned -​ Why it matters: overgeneralization is seen a lot in anxiety, impaired discrimination prevents individuals from accurately differentiating safe versus threatening stimuli, can perpetuate fear, avoidance, maladaptive beliefs -​ Observational learning (Bandura) -​ When individuals learn by watching others and imitating their behaviors -​ Modeling: learning by observing and imitating others -​ Vicarious reinforcement/punishment: observing rewards or consequences for others affects our own behavior -​ C/B perspectives -​ Schemas: schemas are mental frameworks that help us organize and interpret information about ourselves, others, and the world. They shape how we think, behave, and make decisions -​ Types of schemas: -​ Self-schemas – beliefs about ourselves (e.g. “I am intelligent”) -​ Social schemas – expectations about others (e.g. “Doctors are caring”) 17  -​ Event schemas – understanding of how situations unfold (e.g. “Funerals should be somber”) -​ Cognitive distortions and maladaptive schemas -​ Schemas are useful but can also be inaccurate and resistant to change, leading to cognitive distortions. Here are the ways schemas may change/operate -​ Assimilation – fitting new information into existing schemas, even if distorted -​ Accommodation – changing schemas to incorporate new, conflicting information -​ Cognitive distortions – biased ways of thinking that reinforce negative emotions -​ Schemas and mental health -​ Depressed individuals may have negative self-schemas, reinforcing low self-worth -​ Anxiety-prone individuals may have threat-focused schemas, increasing worry -​ Therapy (e.g. CBT) aims to challenge and modify maladaptive schemas -​ Attributions: attributions are explanations we create fro why things happen, influencing emotions and behaviors -​ Internal vs external – due to personal traits (“im stupid”) vs outside factors (“the test was unfair”) -​ Stable vs unstable – consistent over time (“ill always fail”) vs temporary (“i had a bad day”) -​ Global vs specific – applies to everything (“I'm bad at life”) vs one area (“i struggled with this subject”) -​ Attributional styles and mental health -​ Depressive attributional style – tendency to attribute negative events to internal stable, and global causes -​ Self-serving bias – non-depressed individuals tend to attribute success to internal factors and failures to external ones -​ Impact on therapy – cognitive interventions help reframe maladaptive attributions to improve emotional well-being -​ Social perspectives -​ The ways in which we are socialized can contribute to psychopathology -​ Early deprivation or trauma -​ Neglect and abuse in home -​ Separation -​ Parental psychopathology -​ Parenting styles -​ Marital discord and divorce -​ Low SES and unemployment -​ Maladaptive peer relationships -​ Prejudice and discrimination in race, gender, ethnicity, religion, etc 18 2/13/25 Clinical Assessment and Diagnosis Ch 4 Reliability in clinical assessment -​ Consistency in assessment results over time -​ Example: if a personality test provides different results on two occasions for the same person, it lacks reliability -​ Types of reliability -​ Test-retest reliability: measures stability over time -​ Inter-rater reliability: agreement between different clinicians Validity in clinical assessment -​ The degree to which a test measures what it claims to measure -​ Example: an IQ test should predict academic performance -​ Types of validity -​ Predictive validity: a tests ability to predict future behavior -​ Concurrent validity: how well a test correlates with established measures of a similar construct -​ Construct validity: how well a test captures the theoretical concept it is designed to measure Standardization in psychological assessment -​ Ensures consistent administration, scoring, and interpretation of a test -​ Uniform procedures: tests must be conducted the same way for everyone -​ Normative samples: test scores are compared against large, representative populations The nature and goals of assessment -​ Common assessment goals -​ Identify the presenting problems -​ Predict course of symptoms -​ Establish baselines -​ Three influences on clinical assessment -​ Cultural factors: assessments must be cultural sensitive -​ Professional orientation: theoretical backgrounds influence assessment methods -​ CBT vs attachment -​ Trust and rapport: clients must feel comfortable with the clinician Methods of psychological assessment -​ Clinical interviews: structured, semi-structures, unstructured 19  -​ Structured: a set of questions that have to be asked in the same, way, in the same order, every time with no variance -​ Semi-structured: starting with a set of questions, clinician can base which questions are asked next on clients responses (choose your own adventure) -​ Unstructured: open interview, no set of questions/guide for clinician going in -​ Behavioral observation: appearance, emotional expressions, social interactions -​ Psychological tests: objective and projective measures assess cognition, personality, and pathology -​ Intelligence tests: WAIS, WISC -​ Projective personality tests: rorschach, TAT, wartegg -​ Objective personality tests: MMPI-3 Integrating assessment data for treatment -​ Dynamic formulation: understanding personality traits,, cognitive data, culture stressors, and coping mechanisms -​ Predicting treatment outcomes: -​ Will symptoms worsen without treatment? -​ What intervention will be most effective? -​ How responsive is the client to therapy? MMPI-3 Structure and Purpose -​ Uses empirical keying method to differentiate psychiatric diagnoses -​ Profiles are created by comparing an individual's responses to established norms -​ T-scores -​ Mean = 50 -​ SD = 10 -​ Validity and clinical scales of the MMPI-3 -​ Validity scales: detect response inconsistencies and test-taking biases -​ Lie Scale (L): detects exaggerated virtue -​ Infrequency scale (F): detects false or exaggerated psychological symptoms Advantages and limitations of objective personality tests -​ Advantages: cost effective, reliable, objective, and can be administered via computer -​ Limitations: require literacy and cooperations, potential for response distortion (malingering, impression management) Technological advances in psychological assessment -​ Smartphones and biosensors enable real-time data collection 20  -​ Study example: frequent phone-based depression assessments revealed higher symptom severity than retrospective paper surveys -​ Wearables track physiological data such as sleep patterns, movement, heart rate Physical and neurological assessment -​ Physical exams rule out medical causes for psych symptoms -​ Neuropsychological testing assesses cognitive, perceptual, and motor functions -​ Trail making test: measures attention, processing speed, and executive function (frontal lobe damage) -​ Finger tapping test -​ Wechsler memory scale (WMS-IV) -​ EEG, CT, MRI, fMRI, and PET scan imaging Dimensions; vs categorical approaches -​ Categorical approach (e.g. DSM-5): disorders are distinct entities -​ Dimensions approach: psychological traits exist on a spectrum (e.g. HiTOP, RDOC) Future Directions -​ Research Domain Criteria (RDoC) -​ RDoC focuses on neurobiological underpinnings of psychopathology -​ Examines constructs (e.g. reward learning, emotional regulation) across multiple levels (genes, circuits, behavior) -​ Criticized for de-emphasizing psychosocial factors Cultural considerations in diagnosis -​ Cultural factors influence symptom expression and diagnosis -​ DSM-5 includes a Cultural Formulation Interview (CFI) with 16 questions -​ Aims to reduce bias and improve culturally informed diagnoses Labeling and Stigma in mental health -​ Diagnosis can shape expectations and influence treatment -​ Accurate diagnosis can sometimes reduce stigma by providing explanations Formal diagnostic classification systems -​ DSM-5 (APA) and ICD-11 (WHO) are primary classification systems -​ Both have substantial overlap but differ in symptom grouping -​ DSM-5 aims for categorical distinctions, but disorders often overlap Challenges in psychiatric diagnosis -​ Increased number of disorders raises concerns of over-medicalization -​ Thresholds for disorders have been relaxed, leading to potential misdiagnosis -​ Criticism: are we diagnosing normal variations in behavior as disorders? 21