Clinical Psychology Summary PDF

Clinical Psychology Summary Ehlers & White 0 Several theories of PTSD: 1 Cognitive behavioral treatments for PTSD 2 CT-PTSD...

Clinical Psychology Summary Ehlers & White 0 Several theories of PTSD: 1 Cognitive behavioral treatments for PTSD 2 CT-PTSD 2 Hill & Harris 3 Theories of addiction 4 Cognitive Behavioural Approach Addiction 4 Change, motivation, and MI 4 Comorbid problems 5 CBTp and psychosis 8 Stages of treatment 9 Different types of CBTp 9 Efficacy of CBTp 10 White & Cheung 10 Generalized anxiety disorder 11 Panic disorder and agoraphobia 11 Social anxiety disorder 12 Specific phobia 13 Separation anxiety disorder 14 Selective mutism 14 Lecture slides 15 Week 1 15 Week 2 15 Week 3 17 Week 4 18 Week 5 18 Week 6 19 Week 8 21  Ehlers & White PTSD What prevents some people from recovering from PTSD symptoms after a traumatic event? Which factors can prevent change, and how can they be addressed in cognitive behavior therapy? Several theories of PTSD: Avoidance behavior prevents the extinction of conditioned responses → early exposure treatment People suffering from PTSD often have delayed extinction and overgeneralized conditioned responses Through learned associations, the stimuli become associated with strong affective responses, which can generalize to other stimuli. Perceptual priming and associative learning are thought to lead to easy detection in the environment. However, several theorists pointed out three factors that play a role in maintaining PTSD symptoms (Ehlers & Clark’s, 2000). Features of trauma memories Negative meanings of the trauma Avoidance The cognitive strategies that people have to maintain their perceived threat consist of; Rumination Avoidance/Reminders Substance use Safety behaviors Suppression of memories Emotional processing theories of anxiety: Forms the theoretical framework for prolonged exposure. A network of associations in memory that includes excessive stimulus and response elements. The fear structure could be changed by activating it and presenting it with incompatible information. 1 Changes to cognitive schema are central to the understanding and treatment of PTSD. People with PTSD over-accommodate trauma-relevant information by having an “all-or-nothing” belief system Ehlers & White believe in two basic dysfunctional cognitions in people with PTSD The world is completely dangerous I am incompetent External threats can result from appraisals about impending danger, leading to excessive fear, whereas internal threats come from negative appraisals about one's behavior, emotions or reactions during the trauma. Cognitive behavioral treatments for PTSD The APA strongly recommends for PTSD: Cognitive processing therapy Cognitive therapy Prolonged exposure therapy Cognitive behavioral therapy (combines imaginal exposure, in vivo exposure, and cognitive work) Eye movement desensitization and reprocessing Brief eclectic psychotherapy Narrative exposure therapy Effective trauma-focused therapy have these 6 ingredients in common. This is explained in more detail in week 8 of the lecture slides. Psychoeducation Exposure Changing personal meanings Dealing with a range of emotions Emotion regulation Changing memories In the first 12 to 18 months after a traumatic event, there is a substantial rate of natural remission to PTSD symptoms. This raises the question of when and whether treatment should be given. 2 CT-PTSD Cognitive therapy for PTSD (CT-PTSD) targets three factors (appraisals, memory characteristics, cognitive/behavioral strategies) Modifying excessively negative appraisals Reduce reexperience of trauma by elaborating on triggers Reduce cognitive strategies that maintain a sense of current threat Core treatments of this procedure (CT-PTSD) include: Individualized case formulation ○ Normalizing PTSD symptoms ○ Getting a brief account of a client’s trauma ○ What strategies has the client used so far? Reclaiming/Rebuilding life assignments ○ Discussed in every treatment session Changing problematic appraisals Updating trauma memories 1. Identifying threatening personal meanings Careful questioning, imaginal reliving, writing a narrative 2. Identifying information that updates these meanings 3. Linking the new meanings to the worst moments/personal interpretation Discrimination training of triggers ○ Memory work A site visit Dropping unhelpful behaviors and cognitive processings A blueprint/summary of the CT-PTSD process Hot spots are parts in a traumatic experience that have been misinterpreted, and that have to be u updated to change the beliefs that make a person feel bad about themselves. CT-PTSD is usually in up to 12 to 20 weekly individual trauma sessions, depending on the intensity of the trauma. CT-PTSD is supposed to have a collaborative therapy style focussed on guided self-discovery, using e.g Socratic questioning. This socratic questioning is meant to stimulate critical thinking and elicit idea as to let the patient change their mindset. There is good evidence that CBT is effective in reducing the severity of PTSD symptoms. Studies have shown that TF-CBT is the most effective, and also shows improvement in comorbidity. However, it has a higher-than-average drop-out rate (23%). Military populations, however, may benefit less from psychological and pharmacological treatment for PTSD than other civilians. 3  Hill & Harris Addiction Theories of addiction Psychoanalytic theory: Addiction as a form of defense against feeling helpless, along with a failure to regulate emotions stemming from childhood events Classical conditioning: A neutral stimulus causes a specific response. Factors that occur at the same time elicit the same responses as the stimulus itself. Cue exposure is therefore an intervention technique. Operant conditioning: The mood-altering consequences of a substance act as a positive reinforcement, causing continuous use. Social learning: We develop outcome expectancies from watching those around us engage with different substances. This highlights the importance of AA/NA. Cognitive approach: see below According to Freud, the ideal outcome of treatment is the strengthening of the ego. Heroin overdose mystery: People can overdose with the same amount of drugs they usually use, but in another environment. Environment therefore plays a big role. In a study about heroin use in US veterans, it was found that addiction is a social construct; even though half of the veterans in the study were addicted to heroin, only 12% got addicted again. Cognitive Behavioural Approach Addiction The cognitive theory of addiction proposes that individuals develop addictive beliefs alongside their beliefs about the self; these may reflect social learning processes and become activated in response to life stressors. These beliefs are activated in a particular sequence, starting with anticipatory beliefs about the outcome expectancies. CBT focuses on thinking biases in maintaining problematic behavior. There are 4 important assumptions underlying the CBT approach when attempting to treat addictive behavior; Addiction is a learnt behavior Addiction emerges in an environmental context Addiction is developed and maintained by particular thought patterns and processes CBT can be integrated well with different approaches, since these different ones tend towards similar outcomes. 4 Change, motivation, and MI CBT emphasizes collaboration and active participation when treating addiction. Therapy should be viewed as teamwork in which joint decisions are made. The therapist is therefore encouraged to take a guiding rather than directing style. Motivational interviewing (MI) is a counseling style that focuses on the interplay of ambivalence and motivation. It facilitates the client’s expression towards ambivalence and facing change. It has three underlying assumptions: Client motivation is critical for change Motivation is dynamic rather than static Motivation is influenced by external factors There are four core counseling skills at the heart of MI Asking open questions Affirming client’s position Listening reflectively Summarizing The transtheoretical model of change suggests that people move through five stages when overcoming addiction: Precontemplation → Contemplation → Preparation → Action → Maintenance → (Relapse) The PRIME theory of motivation suggests motivational systems operate at different levels of complexity. It highlights some key principles for addiction and relapse prevention strategies. Plans are formulated when we cannot act. Responses Inhibitory sources Motives allow us to consider the possible outcomes of a behavior Evaluations involve the world being represented in terms of beliefs. Comorbid problems It is estimated that about half the clients seeking treatment for alcohol dependence have cognitive impairments. However, these deficits are rarely incorporated into treatment modalities Many substance-dependent clients have comorbid problems, especially when it comes to depression and anxiety disorders. Zimberg identifies three types of dual diagnosis. Type 1: A primary mental health problem where substances are used as a pattern of self-medication for that disorder 5 Type 2: The misuse of a substance that leads to mental health problems Type 3: Coexisting mental health problem that involves substance misuse. This is caused by a third variable that could explain them both (e.g a genetic predisposition). Relapse prevention (RP) RP is a theory, a model, and an intervention. The original model of RP introduced relapse as the last step in a series of events. RP as an intervention, therefore, aims to prepare individuals for High-Risk Situations. The long-term global focus of the model is to identify and cope with determinants of relapse. There are four main components to be taken into consideration when giving RP: Current cognitive functioning (e.g literacy levels) Attentional ability Memory Executive functioning Impairments in one of these components can lead to problems to overcome addiction through RP. Furthermore, RP has been criticized for overemphasizing the deliberate and conscious actions of individuals and overlooking the automatic, habitual processes of addiction. This laid the foundation for mindfulness-based relapse prevention (MBRP). It is patterned on stress reduction. Because of its foundation, it appears to target some of the automatic processes of addiction by enhancing attention and countering avoidance by nurturing acceptance. MBRP has been shown to result in improved abstinence rates, reduced drug and alcohol use, and reduced relapse rates. Borland’s central concern, however, is on hard-to-maintain behavior. Borland notes that a particular individual and external context interacts with two internal processes, the operational and executive. Borland names his theory CEOS. This Is a combination of social context, and an adaptive operating system, OS, which controls responses on a moment-to-moment basis and controls the means by which we act on the world. There is also an executive system (ES), which is essentially linguistic and logical and is involved in self-regulation. While the OS operates automatically, ES has to monitor this. Addiction could therefore be seen as the ES having to monitor the OS. 6  Daskalasis et al Stress & CORT Focus of this article: CORT in human & non-human primates & corticosterone in rodents How can CORT action during stress change from a protective to a harmful signal? Cortisol & Corticosterone : CORT : End Product of glucocorticoid. Coordinate and synchronize daytime and sleep-related events, regulate the organism's response to stress, and facilitate adaptation. Traumatic stress, especially in early life, is a major risk factor for almost all psychiatric disorders. However, it is unknown which combination of life events is most etiologically relevant. Cumulative stress hypothesis: In a given context vulnerability is enhanced when failure to cope with adversity accumulates. Stress inoculation hypothesis & match/mismatch hypothesis: The experience of relatively mild early-life adversity prepares for the future and promotes resilience to similar challenges in later life; when a mismatch occurs between early and later-life experiences, coping is compromised and vulnerability is enhanced. Therefore, the three-hit concept is important in understanding how humans are prepared to cope with adversities. It is an interaction of the three hits you see in the triangle below. The autonomic nervous system and HPA axis mediate the stress effects in which emotional and cognitive functioning is impaired. Because there are enduring changes happening in these critical periods, it is often believed there is a concrete change in DNA methylation and chromatin modifications. Corticotropin-releasing hormones (CRH), vasopressin and their receptors, and also the receptors for circulating adrenal corticoids in the limbic-cortical circuitry are prime targets for epigenetic modification. 7  Stolar and Wolfe Psychosis CBTp and psychosis Psychosis consists of hallucinations and delusions and can be seen as an addition to reality. Everyone reacts differently when receiving a diagnosis involving psychosis. Some may finally understand their thought processes, whereas others feel limited. In this case, it is important to make the client understand the connection between stress and symptoms. This will help clients realize that symptoms are dependent on their state of mind. CBTp: Cognitive Behavioural Therapy for Psychosis The core of CBTp is a verbal, collaborative interchange between client and therapist in which beliefs of the former are evaluated by examination of the evidence supporting or opposing these beliefs while considering alternative explanations. Not all instances of psychosis need treatment, but CBTp represents an important part of the collection of treatments available when the person is distressed or functioning sub-optimally. CBTp has more recently been expanded to include other modalities of treatment including acceptance and change therapy, compassion-focused therapy, and mindfulness approaches. It is used to Help with the depression, anxiety, and anger of clients with psychosis Increase understanding of how symptoms could result from physiological alterations Treat both positive and negative symptoms Limitations of CBTp: Symptoms can be too severe for meaningful use of CBTp (e.g paranoia of therapist) Many retain symptoms, despite getting rid of hallucinations and delusions Medication is nearly always necessary It does not work if some parts of cognitions are severely impaired. 8 Psychosis and the cognitive model In the general cognitive model, an event triggers an Automatic Thought (AT) or Automatic Belief (AB). This belief leads to an emotional reaction that can have behavioral consequences. Symptoms of psychosis can also fit within this model. Hallucinations can be seen as both an event and a belief. Delusions can be in reaction to specific situations, or be ongoing beliefs Bizarre behaviors are behavioral responses that are approached by determining what led to this behavior. Formal Thought Disorder can be considered a physiological response Negative symptoms can be considered as a ‘lack of behavior’. Stages of treatment Treatment using CBTp is divided into multiple stages. Each session consists of symptom ratings, setting an agenda, using active problem-solving methods, assigning homework, and eliciting an evaluation. These are the different stages of treatment: 1. Establishing rapport 2. Assessment a. Use of standard evaluation b. Reports from surroundings 3. Goal setting (difficult due to patients not seeing problem) 4. Coping skills a. Needs to be individualized b. Clients list the effectiveness of coping skills c. Identifying factors that ameliorate symptoms d. Utilizing physiological strategies 5. Normalization 6. Cognitive/behavioral approaches 7. Case conceptualization a. Begins with precedents of the current situation (e.g genetic or prenatal factors) and lists the precipitating, perpetuating, and protective factors b. Compiling samples of thought belief records c. Presented to the client to increase understanding of conditions 8. Relapse management 9. Termination 9 Different types of CBTp CBT for hallucinations → Use audio recording equipment whenever client says they hear voices. You can also let the client discover the fact that they can lower their voices at will, and that the voices become stronger when stressed. Letting the clients explain the content of their voices, and later rationalizing it together, has also been proven to help the consequences of hallucinations. CBT for delusions → Examining the context and logical outcomes of the beliefs. This can be done through Guided discovery Socratic questioning Behavioral experiments Evidence for/against charts Externalization of voices Spectrum lines CBT for negative symptoms → Beck and associates conceptualized negative symptoms as years of not succeeding. Simplification and repetition of communication in therapy is very important in this aspect of psychosis. Efficacy of CBTp CBTp has been shown to be efficacious in treating the positive and negative symptoms of psychosis, mood, hopelessness, and overall functioning. Research has found that mechanisms driving change in CBTp have included reasoning processes, use of case formulation and homework, and alteration of negative asocial and defeatist self-beliefs. 10  White & Cheung Anxiety disorders Anxiety is a normal experience and a common part of an adaptive lifestyle. Anxiety involves the activation of the sympathetic nervous system, triggering fight or flight reactivity. Generalized anxiety disorder When worry becomes excessive (i.e., occurring on more days than not for at least 6 months) and is difficult to control, a diagnosis of generalized anxiety disorder (GAD) is assigned. Excessive anxiety and worry are the chief cognitive symptoms, and three of six associated symptoms (e.g., restlessness, irritability, sleep disturbance) characterize the physical symptoms of GAD. People prone to GAD may also have an underlying propensity toward neuroticism. GAD is twice as common in women compared to men. GAD is also commonly comorbid with Major Depression. Treatment response is less effective in the case of comorbidity. Cognitive behavioral theory explains why individuals with chronic worry and GAD show common characteristics that maintain the cognitive and behavioral cycle of worry. Among these attributes are the ones below, with the first two being the 2 core cognitive features of anxiety; Catastrophizing negative events Overesimating the likelihood of negative outcmoes A low tolerance for uncertainty Difficulties with problem-solving Interpreting ambiguous events as threatening According to the cognitive avoidance model, worry may function as avoidance by subduing upsetting imagery and associated autonomic activation, creating a negative reinforcement cycle. The most supported treatment for GAD is CBT. In CBT, patients are taught to identify anxiety-related thoughts and beliefs and then search for evidence to create alternative, less anxiety-arousing assumptions or interpretations. CBT for GAD is multimodal and can include psychoeducation, relaxation training, identification and monitoring of worry cues/triggers, exposure, etc. Treatment of GAD includes repeated exposure to situations that are avoided or endured. Decentering is important in attempting to treat anxiety in CBT; it entails the ability to observe thoughts and feelings as objective events rather than attributing these to oneself. Panic disorder and agoraphobia Panic attacks are characterized by sudden and acute surges of fear or discomfort that reach peak levels of intensity within several minutes of onset. Symptoms may be shallow breath, chest pain, 11 depersonalization, and derealization. PD is highly comorbid with agoraphobia. Due to their symptoms, many people believe panic attacks to be the result of a physiological problem. A central feature of PD is anxiety sensitivity, the belief that interoceptive sensations reflect signs of impending harm. In efforts to avoid the real or imagined consequences of panic, individuals are hypervigilant for changes in physiological arousal and maintain urges to avoid or escape situations and behaviors that would likely elicit panic. Aversion to somatic sensations associated with anxiety and panic is known as interoceptive avoidance. Patients engage in safety behaviors to prevent feared outcomes and to promote a sense of security. Whereas interoceptive avoidance minimizes the exposure to the conditioned stimulus, safety behaviors mitigate the intensity of the response. CBT, again, shows great efficacy as a treatment for Panic Disorder. There are two different, well-documented, forms of CBT for panic disorders. These are Clark’s CT and Barlow and Craske’s Panic Control Treatment (PCT). Both short-term treatments involve psychoeducation on the components of anxiety and panic, identifying and restructuring misinterpretations about physiological sensations, and exposure therapy. The results about the usefulness of breathing exercises are actually mixed. However, the efficacy of supportive therapy and applied relaxation in Clark’s CT has also been found. PCT emerged from the idea of the ‘triple vulnerabilities’ model of anxiety, which posits three different types of vulnerabilities. In PCT, exposure helps to extinguish the feared response and to gather evidence to disconfirm distorted thoughts. PCT integrates skills in exposure (i.e., situational and interoceptive) and cognitive restructuring over time. On the other hand, in CT, exposures serve to elicit cognitive change through the modification of erroneous assumptions Social anxiety disorder SAD is prevalent and characterized by an intense fear of negative evaluation from social or performance situations. Estimates show that 10% to 12% of the U.S. adult population is affected during their lives, and SAD can have a severe, chronic course leading to disability, functional impairment, and reduced quality of life. SAD onsets in childhood or adolescence, and treatment seeking is somewhat low. CBT is the most studied and most efficacious treatment for SAD, as evidenced by numerous randomized controlled trials. Its aims are to →Identify and modify maladaptive cognitions accompanying social situations → Reduce behavioral factors that maintain avoidance during SAD 12 According to one model by Rapee and Heimberg, when exposed to social situations, people with SAD will Fear they are in danger of acting inept Attentive for cues that signal the realization of their fears Observe and monitor their physiological responses Engage in safety behavior to ensure anxiety reduction Evidence-based CBT helps patients to detect and restructure automatic thoughts and expectations about social situations. It includes… Psychoeducation about normal social worries versus problematic social anxiety. Teaching the three-component model of anxiety (cognitive, behavioral, physiological) Discussing costs and benefits of treatment Empirical data show CBT for SAD produces large effect sizes. Specific phobia Specific phobias (SPs) are the most common anxiety disorders. According to the DSM-5, an SP is marked by a persistent fear of specific objects or situations. Phobias precipitate active avoidance of feared stimuli or are endured with extreme anxiety when faced. There are five subcategories of SP Animals (the most common) Natural environments Blood-injection-injury Situations/spaces Other Of the available treatments, exposure therapy has garnered the most support and is the benchmark treatment for SP. In exposure therapy, the patient is exposed to feared items on the fear hierarchy in vivo until the fear has subsided, thus reducing the strength of the conditioned response. Phobic items are presented in various contexts to generalize fear reduction. To prepare clients for in vivo exposure, therapists can begin with imaginal exposure. In addition to exposure treatments, cognitive interventions of SP target attributions regarding the safety of stimulus and one’s perception of control over external events. Two core cognitive features of anxiety include catastrophizing and overestimating the likelihood of negative outcomes. Treatment involves identifying distorted beliefs associated with SP, evaluating the evidence of such beliefs, and replacing irrational thoughts with more rational probabilities of outcome. 13 Separation anxiety disorder When children feel excessive distress when separated from their caregivers, they might have separation anxiety disorder. For a diagnosis, the DSM-5 requires that three of eight symptoms last for at least 4 weeks in children and adolescents, and the symptoms include experiencing distress when away from home or a major attachment figure. Some symptoms include nightmares, fear of being alone, unwillingness to leave home, etc. Adults with separation anxiety disorder are typically (over)concerned about their children and partners and experience marked discomfort when separated from them; separation anxiety disorder is assigned if the onset of the symptoms is before age 18. Consistent evidence shows CBT reduces separation anxiety, and treatments involving parent training are especially effective for children and adolescents. Selective mutism Selective mutism (SM) is marked by an inability to speak in specific situations (e.g., school), despite competence in expressive verbal communication in other contextual settings (e.g., home). SM occurs more often in younger children and adolescents than adults. Reticence or shyness are normative in the first few months of a new environment. Pathology arises when silence continues despite acclimation to new settings. SM symptoms usually remit within a duration of 8 years. However, the treatment of SM remains an understudied area. Two trials have shown CBT is effective for SM. Behavioral models conceptualize SM as an avoidance strategy used to regulate emotions in distressing situations. Avoidance is negatively reinforced when it reduces anxiety. Early intervention is critical to the successful treatment of SM. 14  Lecture slides Week 1 Clinical Psychology: an integration of science and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress/dysfunction, and to promote well-being and development. A syndrome is operationalized in terms of a diagnosis. A diagnosis is a predefined set of symptoms. It should cause impairment and noticeable distress. A case formulation A hypothesis on causes, precipitants, and maintaining influences on a person’s well-being A dynamic, active, ongoing process Detailed but less scientific/reliable The two-factor theory of Mowrer A fear is created by classical conditioning (a stimulus gets meaning) and operant condition (the avoidance of the stimulus causes relief) Incentive-sensitization theory: Liking becomes wanting and craving in an addiction. MSE: Mental State Exam: A tool/skill that allows structured assessment and observation of a person’s mental state. It measures: Orientation (self, place, time situation) Insight Appearance Thought process/content Behavior Speech Mood Affect Memory & concentration Week 2 Bidirectional relationship between mental disorder and chronic disease Treatment may worsen comorbid condition Mental conditions may impair self-management to manage symptoms. One might for instance forget to take their medication. 15 Consequences of comorbidity between chronic and mental disorders High symptom burden More functional impairment Lower quality of life Premature mortality Expensive costs Culture, social support, biological differences, etc, can all explain differences in disorders found among different populations. There is for instance a large and chronic burden in refugees due to poor mental health. This burden impedes functioning and the possibility to adapt (post-migration factors), creating a vicious cycle. However, the majority show resiliency. General stress theories Stress sensitization: Impact increases with successive stimuli Hormesis: Adaptive response mechanisms to moderate exposure and maladaptive responses on high-level/intense exposure. It is basically a functional response to new stress exposure. An example of this would be a newborn puppy opening his eyes earlier due to the absence of his mother. Allostatic load: The accumulating wear and tear on the body. Our homeostatic recovery gets worse Kindling: There is a weakening temporal relationship between major life stress and episode initiation. The same stressful experience experienced multiple times over creates a lower threshold. Incentive-sensitization theory: The “wanting” of a stimuli increases, whereas the liking does not. Stress-inoculation theory: You can train yourself to become more resilient to stressful stimuli. Specific stress theories (see figure on the right) Cognitive theory Neurotrophin theory 16 Week 3 Often, the diagnosis of a disorder seems quite arbitrary. An example of this is the criteria that need to be met in order to be diagnosed as having Major Depressive Disorder: 1 of first 2 symptoms 5 of 9 overall symptoms More than 14 days Most of these criteria date back to the times of Cassidy in 1957, who famously said ‘it sounded about right’ when choosing the criteria. Diagnoses can therefore be seen as practical summaries that facilitate treatment selection, communication, etc. Due to their constructs used in clinical settings, they cannot be seen as natural kinds, and cannot be seen as equal to mental disorders. Reductionism Simple mechanical system can be decomposed into elements and their relations Lower levels (e.g biology) offer inherently more explanation than higher levels (e.g psychology, chemistry) Common cause theory Network theory Symptoms are passive, interchangeable Symptoms are important, autonomous, causal indicators agents that should be studied A symptom is an indicator of an underlying Mental disorder as emergent property disease Intervention should focus on the latent Intervention should focus on symptoms variable 17 Network theory resonates well with practitioners. There are two different types of networks. Temporal network - One variable predicts the other one Contemporaneous network - Partial correlations of variables in the same window of measurement Week 4 In addiction, neutral stimuli get meaning and become cues that trigger craving: physiological changes opposite to the effect of the drug. Alcohol lowers your body temperature. Everytime you drink alcohol, you have a cue (e.g seeing the bottle of wine). When seeing this cue, your body becomes prepared for a lowering of your body temperature. The cue therefore soon become something that helps you cope and raises your body temperature, even without alcohol. According to Tinbergen, a behavior is understood when you understand the following four points. Behind is how you would explain addiction. Its development - A mix of classical and operant conditioning Underlying mechanisms - The activation of a disturbed reward system Its functions Its evolution - Served the survival of its species Heroin - Morphine impacts the pain and reward cells, causing euphoria Cocaine - Dopamine floods the brain with pleasure Alcohol- Boosts inhibitory pathways, causing pleasure The incentive-sensitization theory Liking and wanting are not interchangeable in addiction Wanting increases in addiction Liking decreases in addiction Contingency management: Substance use/behavior is contingent upon the presence of alternative reinforcers Arrested flight model: Suicide risk increases when feelings of defeat and entrapment are high, and the potential for rescue (social support, medication) is low. Week 5 CO2 enriched air can actually induce panic attacks in some people. 18 Anxiety can cause excessive avoidance behavior. However… Anxiety disorders are usually well treatable → Treatable in 1 session (needs consolidation) Mowrer’s theory of fear and avoidance (see week 1). Fear becomes the result of feeling stress and a feeling of safety. Early versions of behavior therapy for anxiety disorders Based on habituation model Teach physiological responses antagonistic to anxiety → relaxation techniques Work your way through an anxiety hierarchy Moderately effective People often fear death, fainting, and losing control during panic attacks, despite having survived multiple… Your task as a therapist is to transform fear from an irrational to rational fear. What is someone really afraid of? Trauma being a reason for an irrational fear is unusual, usually, traumas are more likely to become intrusive memories. Safety behaviors Social phobia → Gripping objects tightly to avoid shaking & Monitoring speech OCD → Compulsion PTSD → Discuss trauma in an unemotional way Pain → Avoid activities so as not to reinjure Panic disorder → Holding onto objects, lying down, escaping a situation EMDR: Eye Movement Desensitization and Reprocessing. It is the practice of moving your eyes a specific way while you process traumatic memories. According to research: 1. Eye movements reduce the vividness of imagination 2. Eye movements and imaginations both use working memory 3. EMDR works through a different mechanism than ‘exposure’ Week 6 In the field of clinical psychology, we often result to reductionism. It shows multiple levels of understanding. Psychosis: Losing some sense of reality, usually in the form of hallucinations. The causes of psychosis depends on the approach with which you study the phenomenon. 19 Some mental health conditions in which psychosis may occur are delusional disorder, schizoaffective disorder, or major depressive disorder. The city & psychosis Pollution, noise Little green Stress sensitization Socio-economic disparities Less social cohesion Drug use… hower ○ People might use cannabis to relieve psychotic symptoms ○ There is just a correlation Social causation hypothesis Social selection/drift hypothesis In general, there is a strong genetic factor in psychosis. The risk of psychosis is very high when one’s parents experience it. Heritability of 75%. The older the biologial father, the higher the risk of psychosis. De novo mutation hypotesis (as you age, genetic mutation in sperm increases) The selection into late fatherhood hypothesis (under correlates of late fatherhood) The lower the prevalence of a disease, the higher the heritability. Alice in Wonderland Syndrome disrupts your brain’s ability to process sensory input. It disrupts the way your perceive things around you. Area V1has a role in the detection of lines (we believe) Area V4 has a role in the perception of colour. Area V5 has a role in the perception of motion. Damage there can cause dysmorphopsia, corona phenomenon, plagiopsia, hyperchromatopsia, achromatospia. Dysmorphopsia: General distortion of visual perception Plagiopsia: Slanted lines Achromatopsia: Incapability to see colours Corona phenomenon: Seeing contours around an object Riddoch’s phenomenon: You only see movement, only V5 is spared Porropsia: John Todd brought all the symptoms together, and made the link to Alice in Wonderland. 20 Week 7 Your mood usually tries to keep a homeostatic ballance. However, in many disorders such as Bipolar Disorder, this balance is disrupted. It is hard to grasp the individual and subjective consequences of these mood disorders, which is why in psychology these consequences are put on a statistical level (e.g higher odds of mortality, suicidality, etc for people with MDD). These lower odds are often linked to a stigma: a mark of disgrace because of particular circumstances, a quality, or type of person. Humans were evolved to stigmatize → we needed to make decisions from a situation. It is an automatic process we all apply to some extent. It is omnipresent. Thin slicing: Giving very little information to people, and asking extensive information about them. What effect does a little bit of extra information (e.g a picture with a mental disorder) have on the opinions of participants? → Opinions change, showing stigmatizatioon. In the timeframe of late childhood to middle adulthood, mental disorder are what lead to most disruption. This is partly because your brain is still very plastic. Psycho-social theories on suicidal thoughts behavior Escape from self (discrepancy between current and ideal self) Diathesis-stress models: if people who have a predisposition to something are exposed to stimuli such as stress, people may develop certain behaviours (e.g personality trait of impulsivity + mental disorder) Clinical model of suicide behavior Arrested flight model : feelings of defeat & entrapment are high Interpersonal psychological model ○ Suicidal desire comes from high level of burdensomeness & thwarted belongingess ○ Capability needs to be absent in order for suicidal attempt to take place Newer definitions of mental health → The capacity of coping with your environment Week 8 There is an underlying arch in all the articles. Regardless of the problem or disorder, CBT, seems to bean effective treatment. 21 The contemporary approach to CBT is all about cognitive mediation. Its common treatment element is to make dysfunctional beliefs and thoughts explicit and to develop alternative, more useful, and realistic ones. Despite CBT being mainly use in western countries, many different types of treatment that are used elsewhere (psychodynamics, psychoeducation, IPT) have a large overlap with it.. Clark’s tripartite model of anxiety. There is a large overlap between anxiety and depression. The three factors down below all impact this overlap and the individual disorders between anxiety and depression differently. Physiological hyperarousal High negative affectivity Low positive affectivity Effective trauma-focused therapy have these 6 ingredients in common: Psychoeducation - This has actually been shown to reduce symptoms in forced migrants. ○ Understand the normal reactions to trauma ○ Identification of symptoms and skills Exposure - This has also been shown to lead to a decrease of symptoms in forced migrants. ○ Due to safety behaviours, the conditioned fear response of a stimuli is never extinguished. By exposing people and showing that there are not necessarily consequences, the anxiety response is extinguished. Changing memories ○ This is linked to the dual representation theory of PTSD. See below. Changing personal meanings Dealing with a range of emotions The dual representation theory of PTSD. Your memory can be divided into your VAM (hippocampus-driven), consisting of your Verbal Accessible Memory, and your SAM (amygdala-driven) , consisting of your Situational Accessible Memory. Your SAM is not accessible on free will, and is triggered by stimuli. This stimuli can cause the activation of many associations to a relatively long-term. This is why the SAM plays an important role in the core components of PTSD, as it the triggering of stimuli can cause intruse re-experiencing of events, hyper arousal, and more. This 22 is why people suffering from PTSD might avoid situations; they avoid the strong activation of memory-related networks that the SAM causes. Narrative exposure therapy uses the concept of the SAM and VAM. In this therapy, the SAM is seen as a ‘cold memory’ and the SAM as a ‘hot memory’. The therapy creates a lifeline, in which the traumatic experiences are aligned as experienced. These events are contextualized in relation to other positive events of the lifeline. When this is done, the SAM and VAM are tried to be brought closer together, in order to bring more control to diverse memories. 23