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What is a disorder: Wakefield 1. Myth of a myth of mental disorder a. For social control i. Yet some stigmatized disorders are still real ex. HIV b. Mental disorders correspond to physical lesions i. But some don’t 2. Value concept...

What is a disorder: Wakefield 1. Myth of a myth of mental disorder a. For social control i. Yet some stigmatized disorders are still real ex. HIV b. Mental disorders correspond to physical lesions i. But some don’t 2. Value concept a. Socially undesirable / a problem i. Many undesirable conditions are not disorders ex. poverty ii. Era dependent 3. Whatever professionals treat i. Professionals work on non disorders ex. birth ii. Professionals can be wrong 4. Stat deviance i. Positive and negative traits can be stat deviant 5. Unexpectable distress / disability i. There are normal intense responses ex. grief, stress ii. Abusive relationships are not a disorder iii. There are expected distresses ex. PTSD 6. Biological disadvantage a. Evo criterion = lowered survival / repro i. Implies disorder can be cured by increasing survival / repro which isn’t true ii. Some disorders do not affect survival / repro iii. Non disorders affect survival / repro ex. societal rejection, socioeconomic iv. Sociological fallacy: human behaviours aren’t entirely due to evo pressures, aka removes culture influences by saying everything is biological v. Traits don’t necessarily evolve cause it has great effect on overall fitness vi. Adaptations are always in context of EEA vii. Evo makes mechanisms for specific tasks, must look at specific function to not mix up scale (prox vs ult) b. Better argument is disorders are mental mechanisms that do not fulfill their function c. But this still misses value component Harmful dysfunction / Wakefield disorder: - Mechanism failing to perform naturally selected function and causes harm by cultural standards - Properly functioning adaptation cannot be a disorder - Ex. pref for sweets - Reinforced by pleasurable feeling when consumed - Access to sugar limited in EEA so little selection for limiting sugar consumption - But today w unlimited access it can be bad - Neurocircuitry is fine by it is dysfunctional and harmful in today’s world - Adaptions don’t alway produce adaptive outcomes How to identify an adaptation: - Identify features of trait (cog, behaviour, emo, neuro, physio)  - Determine if features are highly organized and promote unique function Emo: - Rewarding motivate pursuit of goals - Aversive motivate avoiding harm - Highly coordinated whole body response - High degree of order - Adaptations Depression: - Psych: loss of motivation - Bio: neuro dysfunction - Cog: learned helpless - Behavioural: lack of reinforcers - 12-17% lifetime rate - Involves persistent and hard to solve complex problems - Because aversive feelings motivate avoidance learning, dep is probably altered motivation, not loss Function of dep: - Energy reallocation hyp - Evolved in response to situations where body needs to make prolonged reallocations of limited energy - Sickness, starvation, melancholia each have diff patterns of reallocation - Learned helplessness assumptions and rebuttals: - Sense of control is default = it’s learned - Motivational deficit = motivational alteration - Learning deficit = selection learning - LH triggers depression = LH is a painful state motivating avoidance learning - LH maps on melancholia - LH pay attention to external cues and hypothesis test - Isn’t it maladaptive to spend energy trying to avoid INESC? Only researcher knows is INESC - Anhedonia is selective and prioritizes analytical thinking - Sadness triggers type 2 thinking - Exp. - 1: dep v not dep women provided info of breast cancer risk - 2: 1-2 wks later, given Gail model explanation and individual score (risk of dev breast cancer in next 5 yrs), asked to predict risk of dev breast cancer (must understand score), asked to recall risk - At 1 most said 25% chance - At 2 non dep said same, dep lowered it a lot and were more accurate based on actual Gail score of most participants - All had good recall of score, but dep closer to predicting on odds - So they aren’t pessimistic cause they lowered their estimate - Understood Gail score and integrated it, not due to better memory  - Exp. - 1: dep v not dep women provided info of breast cancer risk - 2: 1-2 wks later, given PSA about breast cancer, asked to predict own risk of dev, asked to recall avg risk of dev from PSA - At 1 dep v not dep had similar estimates - Est lowered a lot in dep after PSA - More likely to factor in info they learned to own life - Again not pessimistic - Depressive realism: - Dep women are not more pessimistic when faced w obj info - Dep women do not have better recall - Dep women are better at processing, understanding, and factoring in info Energy reallo in melancholia: - Down: repro, physical and social act, growth / maint - Up: cog act - Distraction resistant WM needed for analytical processing - Shortened latency in REM needed for retaining complex info - Physio and neuro components: prolonged cortisol release and chronic stress state - Exp: - Unmedicated MDD patients, subsets of w melancholia or wo, v non dep - Normal fasting blood glucose levels - Given glucose tolerance test - Glucose and insulin measured - Melancholic had hyperglycemia and hyperinsulinemia in peripheral tissues - High glucose and then high insulin - Glucose not entering cells - Excess glucose means insulin released to get rid of it but peripheral tissues won’t take it up - Functional IR - Non mel similar to non dep - Excess glucose goes to the brain - Increased glycolysis in brain - Glutamate: GABA relationship is very increased, suggesting overactive excitatory state in brain - Heightened state also associated w chronic APA activation, which leads to elevated cortisol (associated w rumination) - Feedback loop - Higher resting activity in DMN (needed for self referential thinking, social cog) - Higher activation of executive control network (needed for introspection, attentionally demanding tasks) - DMN and ECN usually work in opposition so dep is rare state where they are both activated Why do we think serotonin is low in dep: - 1950s: - Iproniazid (TB) and imipramine (schiz) reduced dep symptoms  - Both increase monamine levels in brain - Iproniazid is MAOI (inhibits breakdown of monoamines like serotonin and catecholamines) - Imipramine is a tricyclic antidepressant (inhibits serotonin transporters) - Reserpine increased dep symptoms and it depletes monoamines (blocks storage in vesicles) - Suggests reducing monamine caused dep - Problem 1: reserpine inducing dep is a myth, might actually have ADM properties, the only proper study of reserpine in dep showed ADM effects - Problem 2: ADMs increase serotonin in first few mins-hrs of taking and symptoms of dep worsen for first chunk of taking ADMs, increased serotonin = worsened symptoms - Problem 3: drugs blocking serotonin uptake do not work to treat dep - Problem 4: reducing serotonin via tryptophan did not trigger dep - Problem 5: neonatal exposure to SSRIs (serotonin uptake inhibitor, keeps serotonin active in synapse) causes dep in adult rodents - Problem 6: genetic downreg of SERT increases dep symptoms - Problem 7: ADMs are only a little more effective than placebo at reducing dep symptoms Serotonin and dep: - Can’t be measured in human brain, no direct test ever - Can measure serotonin conc in extracellular space in non humans via microdialysis - But not a direct measure of transmission thought cause conc depends on transmission and uptake - Serotonin can’t pass blood brain barrier, but 5-HIAA (product of broken down serotonin) can and reflects how much serotonin has been used - Jugular vein drains into brain and is not very contaminated by periphery 5-HIAA so we can mostly tell brain levels of 5-HT - 5-HIAA elevated in jugular veins of dep humans indicating serotonin use - High 5-HIAA:5-HT ratio in non humans = active serotonin use - Low ratio in non humans = less serotonin use - 5-HIAA levels in nucleus accumbens increase w DRN stim (more Hz = more usage) - Non humans - 5-HT goes from DRN to nucleus accumbens - 5-HT levels in nucleus accumbens are low cause it’s being broken down - Did not correlate w stim of other brain regions - Regions w elevated serotonin transmission in melancholic rodent: - Hippocampus (allocate WM, decrease BDNF signaling), lateral PFC (distraction resistance, analysis of problems), amygdala (direct attention), DRN (5-HT), nucleus accumbens (anhedonia), hyp (decrease physical act, growth/maint) - States where 5-HT transmission to hyp is elevated: - Infection, starvation, physical exhaustion, sexual exhaustion, proestrus - Ratio 5-HIAA:5-HT higher in awake vs REM and female vs male - More than just mood neurotransmitter - Stressor models of dep show evidence of elevated 5-HT transmission - INESC, chronic social defeat, chronic mild stress, material separation, social isolation, infection, starvation, neonatal SSRI exposure  - Genetic models of dep show evidence of elevated 5-HT transmission - Knocking out certain genes, using toxins to create dep symptoms - But lesioning DRN is not a model of dep - Should be if low serotonin = dep - Rats w lesioned DRN are less anhedonic - DRN transmits serotonin in a state dependent way (based on depressogenic trigger) the lesion doesn’t just have a simple effect cause no trigger = no effect from lesion - Development of dep symptoms was inhibited when exposed to dep trigger - Serotonin not released → Elevation of serotonin is crucial for coordinated response in brain during dep Reducing interruptions: - Anhedonia involves increased ability to hold info in WM during distractions - There’s reduced sensitivity to dopamine in nucleus accumbens - This affects reward system (pleasurable activities are less pleasurable) - VLPFC must continuously fire - Serotonin coordinates sustained neuron activity - Can make neurons switch from phasic to tonic firing - Tonic firing is associated w serotonin acting on 5-HT1A inhibitory receptor of postsynaptic neurons - Serotonin can also cause tonic activation of cortical networks by acting on 5-HT2A excitatory receptor - Requires a lot more energy than 1A - This is what psychedelics act on - Serotonin controls blood flow by changing dilation / constriction by acting on astrocytes in 5-HT1A receptors - Serotonin increases intracellular and mitochondrial Ca in many cells - Ca needed for regulating energy production in cell - Ca upregulates ATP prod, activates Krebs cycle enzymes, and imports essential substrates based on energy demand - Increased mitochondrial Ca helps meet energy needs of dep - Too much Ca = oxidative stress, can cause cell death - ROS = reactive oxygen species, increased w too much Ca - Serotonin is an antioxidant and helps address oxidative stress - Serotonin levels are proportional w decrease in oxidation - Shows how coordinated serotonin is (increases Ca AND manages it) - 2 fates of extracellular serotonin: - 1. Back to presynaptic via transport - This is what SSRIs block to allow for more serotonin activity in synapse - 2. Passive diffusion across membranes - If conc high enough - Enzymes distribute themselves to ensure enough serotonin gets to mitochondria and is broken down to become an antioxidant (MAO-A) - Enzymes also ensure serotonin goes back to DRN to be stored (MAO-B)  - These enzymes change affinity for serotonin - All of this suggests serotonin has a functional coordinated non random role - 2 enzymes w specific roles for serotonin, increases Ca and manages effects, coordinated pathway Neuro underpinnings of analytical thinking: - Amygdala: orients attention to problem - Hyp: energy reallocation; serotonin downregulates repro, immune, growth; increases energy available for cog - Nucleus accumbens: anhedonia - Hippo: allocation of WM - PFC: distraction resistance; sustained glutamatergic firing (tonic); glycogenolysis and vasoconstriction Hypothetical serotonin and glutamate patterns in projection neurons during dep and SSRI treatment: - Equilibrium: - Extracellular serotonin in synapse - Serotonin acts on 5-HT2A (excitatory) - Stims glutamate to produce more energy - Balance between intracellular in pre and extracellular in synapse - Depressed equilibrium: - More extracellular serotonin - Whole equilibrium elevated - Activates glutamatergic cortical networks to engage depressive parts of brain - Non human evidence only - SSRI just taken: - Increase in extracellular serotonin cause SSRI blocks reuptake - Glutamaterigc projection more activated - Leads to increase in dep symptoms - SSRI chronic use: - Brain homeostatic mechanism decreases excess gluta activity by inhibiting serotonin synthesis - Brings extracellular serotonin back to dep equilibrium - Leads to reduction in dep symptoms ADMs: - Interfere w adaptations relating to neurotransmitter regulation in brain - Time course of symptom reduction suggests SSRI blocking isn’t what’s fixing it but brain’s response is - Symptom reduction could also be due to impairment of adaptive learning normally triggered aversive stimuli cause serotonin is required for this as well - ADM use better than placebo Relapse and rebound: - Symptoms return after months / years cause brain adapts so more dosage is needed - Relapse / rebound after discontinuation is proportional to strength of ADM  - Attending therapy while taking ADM can mitigate relapse (addresses cause) → ADMs increasing extracellular serotonin is where low serotonin = dep came from Side effects: - Serotonin affects many peripheral organs and tissues - SSRI blocking transports can cause their own Wakefield dysfunction - Sexual, GI, cardio problems Ruminating on cause of problems: - Persistent distraction resistant thoughts - Dep people believe ruminations give insight into problems - Positive beliefs about rums maintains dep episode - Most dep people are more interested in psychotherapy vs ADMs cause therapy treats causes - More belief of self contributing to dep, more rumination and pref for therapy → Rum puzzles clinicians cause it involves upsetting symptoms that stick around Physician dep: - After making serious mistake - Can reach clinical levels - Study: - No error = 33% chance of dep, error = 64% chance of dep - Also less likely to feel accomplishment and more likely to experience depersonalization and emo exhaustion - Emo distress associated w changes to practice (more attention to detail, advice seeking, literature reading, trusting others judgement less) Analytical rum hyp: - Dep is an evolved response to complex problems that have unclear cause - Rum is to motivate cog and behavioural activity to prevent future similar events - Promotes causal analysis of problem → Rum is self deprecating to alter motivation - Without that, same events would happen again → Distress, guilt, and self esteem prevent future mistakes by motivating - Strong emotions are not forgotten → Learning opps are missed if reassurance is given cause that inhibits reflection Root cause analysis: - Cause in chain of events where you could have done something to prevent failure - Biased towards self blame but often not the individual’s fault - Conclusion can be that nothing different could have been done - Still need RCA to determine this  - Requires WM - Counterfactual thoughts are the output of RCA and are the beliefs of the root causes → Rum is repetitive cause repetitive recall promotes learning by consolidating info into LTM → Increase in REM sleep cause it’s needed to remember complex info → Rum is distraction resistant cause analysis requires WM Analytical rum questionnaire: - Isolated 3 questions related to causal (early) and 3 for problem solving (later) analysis - Study hypothesizes a model of what happens during dep rum - Dep symptoms predict causal analysis which predicts problem solving analysis which predicts decrease in dep symptoms - Occurs over and over until gradual decreases leads to episode end - Rum is how dep generates its own tools to solve itself Spon remission: - Most common reason for becoming not dep - Not actually disappearing, just no intervention - Due to rum (tool for its resolution) - Rum leads to regaining control over cause of episode - Once a lesson has been learned about event and is solidified in LTM then the ep can resolve - But not always cause dep isn’t always due to 1 event Problem w studies: - Most studies on dep use correlational and case control methods - Need experimental study triggering dep rum to make causal inferences Paradigm at Mac: - Induce dep symptoms in non clinical pop - Social rejection is an evo stressor and now a common trigger of dep - 4 participants told looking at intersection between mood, cog, and teamwork - Told they were in teamwork condition not solo (but there’s actually no solo) - Real conditions are exclusion and inclusion (exp and control) - Sat in circle and asked increasingly personal qs - 1 of 4 was an experimenter to monitor - Pre screening qs checked if they are okay to be in exclusion - Played cyberball - Exclusion were passed to a lot less - Afterwards had to rank top 2 - Inclusion told that someone left early and everyone has to move to solo - Exclusion told no one picked you so have to move to solo - Write about experience - Exclusion always ruminates about convo - Sad post exclusion, sad while writing, not sad after debrief - RCA triggered, trying to figure out where they went wrong / what they said  - Counterfactual thinking triggered (ex. should have censored self) - Some people do a memory task to test if WM is preoccupied w rum - Sequential model of rum: - Sadness post exclusion → RCA → counterfactual thoughts - Sadness alone doesn’t predict counterfactual thoughts - Some people said they were suspicious when debriefed which is indicative of dep rumination cause they’re thinking of all possibilities - Excluded were more confident in people liking them after debriefed (relief?) - Usually rated experimenter care as high cause being compassionate is criteria for study - Effects only lasted until debriefed (yes short but they were cut off) Conceptual paradox in therapy: - Depression as a brain disorder is a conceptual paradox for therapists - Clinical settings view self blaming as not helpful - But therapy can harness rum content to make it useful - Acceptance and commitment therapy and behavioural activation look for truth - Acknowledging analgesic behaviours are distraction attempts is good - Successful therapy involves exposure to aversive thoughts and feelings Avoidance learning in therapy: - Expressive writing initially increases sadness but reduces dep symptoms long term due to working through dep content - Electroconvulsive therapy used to treat resistant dep by impairing recall of info related to dep event and avoidance learning - Metacog therapy considered rum maladaptive - CBT sees dep as having biased thoughts so it requires high levels of cog functioning to work - Psychotherapy thinks dep people must learn something from therapy Evo tips for therapists: - Validate client - Dep can be a normal response - Validation promotes alliance and avoids secondary dep (gets more dep when diagnosed) - Promote avoidance learning - Help learn from past - Identify causes in and out of control - Target barriers to avoidance learning (analgesic behaviours, hidden barriers) → Evo argument is not that dep doesn’t exist - Rate is probably just less than we think - Dep usually satisfies only harm criteria, need dysfunction of mechanisms too Early life experiences: - Adults more likely to be dep if abused as children - Youth experiences alter stress response mechanisms  - Child trauma might make nervous system more susceptible to dep cause threshold for type 2 is lower - Study: - More early life trauma = thinner pMCC - pMCC involved in rum - Thinner = lower threshold for rum triggering - Thinner is brain trying to adapt w abuse Atypical dep: - Mood can temporarily be improved during positive events - More sensitive to interpersonal rejection - Common in younger women - Greater sex diff in atypical - Earlier and gradual onset - Less triggered by episodes, more triggered by chronic stress, interpersonal dynamics, and life experience - Makes sense more common in young women (they have more complex problems) Persistent depression / dysthymia: - Chronic sad mood for 2+ years - Predicted by adverse childhood experiences, chronic stress, chronic pain, personality, lifestyle → All 3 might have genetic basis Bereavement: - Reaction to death of loved one - More pronounced in children (true for many emotions) - Same cross culturally - Darwin very interested - Lost several children, gained new vigor for work after death of his eldest - Evo ideas of grief aren’t to reduce it but to appreciate it - But doesn’t show complexity of today’s relationships Symptoms: - Sadness, anhedonia, rum, insomnia, low appetite, weight loss, grief - Overlaps w MDD criteria - Grief could be classified as MDD if laster longer than 2 months (cause it’s normal) - This lowered overdiagnosis and focus treatment on grief - But new one removed this - Why? - Failed to show MD due to bereavement is diff from dep in another context - Study compared complicated ber, uncomplicated ber, and uncomplicated non death loss and found no diff between groups except thoughts of death higher in ber (but this incl. general thoughts of death so makes sense) - MD is serious and potentially lethal so all kinds should be a disorder Grief from evo lens: - Animals grieve (chimps, elephants) - Distress mechanism: distress when separate from loved one and trying to reunite, can’t so we get grief - Close relationship mechanism: after effects of close relationship create distress - Signalling theory: signal showing we can make non utilitarian bonds, shows commitment - First 2 argue grief is maladaptive byproduct of something else, 3rd has no comment on cognition Child mortality: - Really high until industrial revolution (50%) - Modal number of offspring was 6 - Bereavement might help us avoid this Selecting for cog reflection: - To understand cause of death - In terms of child mortality would prevent other kids from dying - Not necessarily evolved for child loss but that’s one of biggest fitness losses - In general related to avoiding fitness loss - Even if grief has no benefit it’s worth it if it sometimes does - Sense making: predictor of working through grief, less sense to be made the worse and longer the grief - Still go through RCA even to come to conclusion that nothing could have been done - Reinvestment analysis (RIA): focusing on how to reinvest time and energy after loss, to maximize inclusive fitness / for meaning and purpose - Meaning making: understanding life events, more subjective than sense making, important for working through grief - Grief related rum study: - 400 people w 1 loss - Most were traumatic child loss - RCA: tried to think of what they could’ve done diff, why it happened, details of events and leading up; more pronounced in unexpected deaths - RIA: thought of things to do that would give them purpose, nothing replaces loss but reinvesting is the best option available - Loss of child led to most rum (no diff in grief) - Makes sense from evo lens since child loss is biggest fitness loss - ADM rum more - Traumatic loss rum more - Women rum more - RCA: more motivation to understand cause women have more impact on child survivorship - RIA: women required more social support for success in EEA - Consistent w dep rates - RCA decreased w age of bereaving  - Mauve cause less likely to have another kid? Or already experienced loss so more equipped? - RIA did not change w age of bereaving (all parents have to find purpose again) - RCA increased w age of child until mid 30s then back down - Losing infant / child might be out of control and past 35 natural death is more likely - More problems w reinvesting w older child (maybe cause there’s grandkids?) Exposure to painful feelings: - Successful therapy exposes to painful thoughts and feelings - Sense and meaning making usually occur through exposure to painful feelings and are important for working through grief Analgesic behaviours: - Suppression of thoughts, feelings, memories, avoiding places, situations - Intrusive death imagery depends on how traumatic loss was - Seeking analgesia is normal but can disrupt overcoming in long term - They predict increase of intrusive thoughts about the loss and prolonged symptom severity and impairment - Need balance between avoidance and exposure Emo processing: - Info integrated into structure for emo change to occur - Integrating of challenging problems into self is needed for emo change USEs: - Discrepancy between what is perceived and what is real - Hallucinations, misperceptions - Ranges from dreams to audio visual hallucinations - 50% of bereaving individuals (so it’s normal for them) - Usually earlier in bereavement process, when alone at night - Consequences for healing → Random psychosis experiences in 30% of people Expression: - Related to personal history w deceased - Distress during is not due to hallucinating or person, but due to relationship w person Categorizing experiences: 1. Resolving unfinished business / saying bye 2. Interaction w deceased and current problem (advice) 3. Continuing challenging relationship (distress) Deriving meaning: - Mediated by bereaved’s response  - Make connections to personal history - Can change based on perspective / relationship w deceased - Can change over time as healing occurs - Having spiritual framework maximizes USE benefits Premises: involuntary, form of exposure to loss, relevant to details of loss, personally meaningful Hyp: - USEs are a mechanism to involuntarily expose bereaved to painful thoughts and feelings - Stimulates rum and contributes to emo processing of loss - Agnostic idea - Crucial for healing regardless of where you believe they come from - Emo processing role best understood through evo understanding of dep Study: - 64% said they have had a USE - These people scored higher for RCA and RIA (ruminating more on those topics) - Child loss, women, and ADM more likely to experience USE - Same 3 groups as more likely to rum during bereavement - Connection between USE and facilitation of rum Sleep: - Sleep disruptions during bereavement - Sleep involved in memory consolidation - Esp for emo charged memories - Which are recalled easier over time cause stronger emo means more important to remember for fitness / avoidance learning - REM important for emo processing and encoding complex info - Decreased latency into REM in dep - But also disruptions - Sleep dep affects eval of emo stim - Sleep dep viewed neutral as more negative and were less alert - Negative bias during sleep dep - Sleep dep affects eval of events - Sleep loss amplified negative emo consequences of disruptive events and blunted positive benefits of rewards / goals - Sleep def impairs nervous system’s discrimination of social threats - ACC involved in emo expression, attention, and mood reg - Anterior insula cortex mediates interoception - Sleep dep less able to discriminate between threat and non threat stim - Probably cause less sleep = more vulnerable = better to be more vigilant (negative bias) REM: - Closest to wake - Consolidation of emo stim - Areas involved in memory during wake are reactivated her for reprocessing very emo mems  - Study: - Amygdala and hippocampus encode memories while awake - Adrenergic activity (adrenal) higher when awake - Cholinergic activity moderate when awake - Memories reactivated during REM and consolidated into LTM - Elevated cholinergic activity - Stims thalamus which facilitates transmission of sensory experiences into cortex - This has to do w dreaming - Suppressed adrenergic activity - Amygdala sends emo tone of experience - Adrenergic suppression enables reactivation of memory but dampens response to dampen emo tone of memory - Allows for strong emo memories to be consolidated - Cortical strengthening consolidates memories when awake - Recollection of memory reinforces storage - Amygdala connects to mPFC when you wake (reevaluates memory in less emo tone) - With each sleep memories become more committed to LTM and lose emo tone - Emo memories are more easily recalled cause they are very committed to LTM - Emo reactivity can be retained in REM in short term cause there needs to be authenticate reactivation but then the tone dissipates - Salience for stuff that just happened, weakens over time Suppressing REM sleep: - Adrenergic levels remain elevated during sleep and connection to mPFC upon sleep is weaker during PTSD and REM suppressed sleep - Less able to diminish emo tone cause adrenaline stays high - Less able to integrate memory into LTM cause of imbalance - Memory left fragmented, emo charged, and unintegrated - Contributes to flashbacks and nightmares - Adrenergic levels stay high after trauma cause of heightened vigilance - Chronic stress state - Lack of mPFC control amplifies emo response and adrenergic activity - Like if vPFC doesn’t signal DRN there is control - Weaker connection means it struggles to signal - Stuck in heightened state - Increased threshold for perceiving control is due to event being severe enough to not be able to move past it right away - Preventing consolidation into LTM is cause memory is too painful - Dampening can’t take place - Fragmented memories can protect from the full emo intensity since it’s really bad but this makes it more intrusive - Helpful in short term but bad once the person becomes safe - PTSD therapy involves putting memory back together so it can be dampened and consolidated Sleep and ADMs: - ADMs increase REM latency - Users report worse sleep - Due to suppressed REM not amount of sleep - ADM use predicts USE Where are USEs in brain: - Decreased connection w PFC and dACC (higher order) - Increased connection w vACC - dACC: cognitive, connected to higher thinking areas - vACC: emo, connected to reward and emo centres, affective and distressing components of physical and emp pain, increased activation attenuated via social support - Area signaling pain is activated during USE Emo pain and support: - Support = decline in subjective distress - Rum promotes help seeking - In bereavement context - Even though they have anhedonia - Typically trusted loved ones - Counters loneliness - vACC signals social and emo pain and promote rum and strengthens connections to perception during USEs Study: - Hypnotizable men, hallucinators and non hallucinators - rCBF in vACC was same for hearing something and hallucinating, but not baseline or imagining - So vACC responds to hallucination in same way as hearing something - Increased vACC activation might lead to internal thoughts being experienced as external Role of dopamine study: - Schiz and controls played consistently short tone or variable tones - Test was a long tone - C: controls perceived long tone as shorter cause of expectation - V: controls were unbiased - Schiz were more likely to expect regardless of reliability - Stronger hallucinations = more bias of expectation - Subsample of controls got amphetamines and they had increased expectation bias and less reliability sensitivity - So dysregulated dopamine disturbs integration of expectation (top down) and sensory input (bottom up) - Rum activates neural reward pathways and contributes to dysregulated dopamine prod - So rum leads to same thing Thalamus: - Conscious perception normally constrained by sensory input coming to thalamus - Ensures we adapt to enviro - Increased thalamic activity can mask sensory input - Hallucinations are associated w loosening constraints of sensory input - Increased thalamus activity → downreg of sensory input → perception decoupled from reality → focused on top down - Increased thalamic and cholinergic activity during rum = decoupling perception and reality → Increased rum and dysregulated dopamine during bereavement contribute to disruption of organizing experience which causes USEs that reflect internal expectations Temporoparietal junction: - Temporal and parietal lobe conjunction - Incorporates info from thalamus, limbic, visual, auditory, somatosensory - Takes observations and makes connections w memories - Crucial for self-other distinction and ToM - Damage impacts moral decisions and can cause out of body experiences - Role in grief (interacts w ACC, insula, amygdala) - Study: - Electrically stimmed woman w healthy TPJ for epilepsy treatment - Hallucinated a shadow person - Started to say the person didn’t want her to do something etc - Concluded she was experiencing perception of her own body but weird she suggested it had intention Mentally healthy person = clear contact w reality and can pursue goals wo distorting reality to achieve them Illusion: - Enduring pattern of error / bias - Perception diff from reality - Part of normal human cog cause they involve central aspects of self and enviro Self serving bias: - Tendency to attribute successes to internal factors and failures to external factors - Still normal even though diff from reality Positive self evals: - Most people have very positive view of self - When asked to give traits about self, positive traits are described as more true of self than negative - Positive personality info is more efficiently processed and easily recalled - Negative aspects are dismissed as not important - People avoid participating in things where loss may occur - Poor abilities viewed as common, good abilities seen as rare  - Most people think they are better than average - People compliment others on their own positive abilities to ensure favourable self comparison - Less bias w people close to you Are there truly mentally healthy people: - Accept good and bad of themselves - Yes: people w low self esteem, mod dep, or both - More balanced self perceptions - Recall pos and neg info equally - More evenness in attributions of responsibility (not just all good) - More similar self evals and evals of others - Self appraisals similar w appraisals by others Exaggerated perceptions of control: - People act like they have control in chance events - Increased when you feel involved - Ex. if I roll dice I’ll get what I want vs someone else rolling it - When outcome is desired people overestimate involvement - Mildly and severe dep people have less of this - Dep people are still more accurate in estimates of personal control even when direct involvement of skill is present (ex. rolling dice) Unrealistic optimism: - Most people think future will be better than present which is better than past - College students have easier time coming up w future positives - People rate own likelihood of experiencing future good is higher than peers and bad is lower than peers - People overestimate how good they will do in task esp if personal to them - Mildly dep and low self esteem have more balanced assessment of future → These things aren’t public posturing, it maintains in private settings, it’s instinctive, type 1 - Therefore having this view of self is beneficial all the time Positive delusions are important for healthy functioning: - Most people have it so not dysfunctional - Increases happiness - Able to care for others - High self eval linked to perceived / actual popularity = more social - Being in good mood = more likely to help others and initiate convos - Contributes to capacity for creativity and productivity - Positive affect is retrieval cue for positive info and facilitates diverse associations (problem solving) - More motivated, persistent, and performance - High self esteem rate higher performance than others even when success is equal, but this further enhances motivation and can make them more successful in long run  - Positive conceptions of self = work harder and longer on tasks - Positive affect not as good for complex decision making though - Depressive realism good for complex stuff Delusional tradeoff: positive people try harder and longer where success chance is low, but illusions pay off more than no persistence → Reliable world > accurate, reliable = subjectively accurate Evo of psychodynamic mechanisms: - Freud wanted to look at this - Mental traits may have evolved by nat sel - Uniform in humans, development patterns appear related to tasks faced at each life phase, functions appear complex and regulated, mediate behaviours crucial for repro, fitness decreases when they function abnormally - Science dismisses psychodynamic ideas cause they’re subjective Repression: - Keeping unacceptable thoughts unconscious - Freud discovered when clients unknowingly lied about motives - Inhibits expression of impulses - Decreases anxiety by removing awareness of bad intentions - Doesn’t eliminate wishes altogether cause deceiving is good just makes us unaware - Can sometimes mean no expression of wishes though Selection for self deception: - Repro success → social success → reciprocal relationships → getting more than give → deceiving → enhanced by deceiving oneself - Perceiving self as altruist improves ability to deceive - Ex. children - Manipulate parents, do bad things, behaviours make no sense but they do it anyways - Adult neuroticism reflects over adherence to moral principles and lack of awareness of true personal wishes Values of self deception / repression: 1. Achieving complex goals a. Motives can be suppressed as they are pursued b. Repression can hide alternative strategies (ex. pleasing mate while planning to leave) 2. Conceals motives of others a. Important in hierarchy b. Ex. overlooking friend’s betrayal cause they’re a friend 3. Prevents unhelpful ambivalence a. Ex. positive feelings repressed when threat made, prevents mixed attitude while important thing is getting message across to threat i. Ex. when mad you’ll say whatever and that’s all you feel, forget good things → Schiz are less likely to self deceive so this means don’t deceive self about others’ motives and are able to spot secret motives of others Defenses: - Denial: disavowal of stim arousing unacceptable thoughts - Regression: reverting to previous behaviour pattern - Next ones are more mature as they involve ability to partially fulfill one’s unconscious motivations - Sublimation: wish is satisfied in displacement, partially satisfy forbidden wish - Rationalization: making up alternative explanation for true motive - Intellectualization: facts are acknowledged but emo content kept separate - Humour: problems made into play Mental conflict: - At every moment we have to decide whether to cooperate or not - Lots of processing dedicated to this - Self deception needed to conceal rejected alternative - Ex. bring gift or not, bring one, not mention the not - Helps us pick a lane cause ambivalence all the time paralyzes effective action - Seen in people w OCD and schiz - Giving benefit of the doubt is not as helpful as it once was - Smaller group in EEA - More exploitation now - Psychotherapy weakened evolved tendency towards this benevolent self deception by making us aware of our motives so we can make informed decisions Conscience: - Mental agency punishing behaviours deviating from internal and external norms - Anticipating guilt weakens impulse to violate morals - Following norms enables stable personality and enable transmission of cultural knowledge - Esp good when benefits are not obvious so its best to follow norms until you learn - Morals gets at kin selection and reciprocal relationships (cooperation) - Morals are about social behaviour requiring short term sacrifice - Giving up short term gain shows you have altruism - People feel pride when they forgo short term gain - People who help friends over self are valuable - We prefer emo bonds vs transactions Transference: - Displacing feelings about one relationship into another - Expectations from prior relationship inform how you think other people will behave - Early childhood relationships templates for later - Strong feelings in adult come from templates - People try to make others behave like their transference object - Transference is inflexible which makes stable personality (reliable) - EEA was reliable but this is not as useful now  - Foundation for self deception - Ex. loved child thinks people want to be their friend, abused child doesn’t Kraepelin: - Distinguished 2 groups of delusions - Manic depressive insanity: episodic, resembles modern bipolar - Dementia praecox: gradual, resembles modern schiz Jaspers: - Delusions are beliefs that are held strongly, unaffected by experiences / counters, have bizarre / impossible content - 3rd is what’s dysfunctional Do delusions explain strange experiences? Maybe delusions are a rational response to a perceptual disturbance. - Strange experience can be a feeling state too Prevalence: - Can be subclinical - Study: 10% of nonclinical sample had delusional beliefs - Study: followed children for 15 yrs, 20% had delusions at some point - Prevalence particularly high for those w paranoid thoughts (which are more common in nonclinical samples) - Delusions more common than hallucinations - Study: 22% w psychotic symptoms no disorder, 20% w delusions, 6% w hallucinations, 4% w both, 3% w psychotic diagnosis Delusion as a defense mechanism? - Paranoid delusions share conceptual similarities w self serving bias - Paranoid individuals have more SSB - But SSB leads to failures = external, paranoia leads to negative events = people - Paranoia may defend against dep and low self esteem - Dep blame others less Poor me: - Think their persecution is undeserved - They are the victim - More common in psychiatric patients w psychosis - Higher grandiose delusion score - Aligns w SSB Bad me: - Think their persecution is deserved - Punished for their thoughts / actions - More common in nonclinical samples - Higher shame and dep scores Self: - Continuously constructed - Life experiences lead people to behave as poor or bad me - Neglected people had to define self wo input and are more likely to manipulate negative stim and make it positive about self (poor me) - Malevolent world is reliable - Intrusive experiences leads to bad me - They are bad is reliable Self attribution model: - Contrary to poor and bad me - Self esteem is unstable among paranoid patients - Poor and bad me are different phases - People can be in one or the other, but persecutory delusions switch - Implicit self esteem: automatic knowledge about self, might not be conscious - Explicit: conscious reflections about self worth, informs presentation of self - Bully has high explicit and low implicit - Goal of delusions is to prevent low implicit from becoming explicit - Reducing discrepancy in self esteem = dep - More extreme external attributions must be made as self esteem becomes more unstable - Feedback loop of attributions and self representations → Other theories argue paranoia is a complex threat belief Evo paradox: - Psychosis comes during repro years, unlike other diseases - Psychosis is prevalent and cross culture, these diseases usually come later - Connections made between madness and genius (schiz relatives often intelligent) - Group selectionist hyp: schiz are hypervigilant cause it’s good to have one in a group - Frowned upon cause nat sel acts on genes of individual not group - Might have that effect in long run but not at nat sel level Advantages of psychosis?: - Psychosis might be a byproduct / dysfunction of an adaptation - Probably related to more highly evolved recent part of brain - Ex. maybe a byproduct of social brain - Ex. personality spectrum Speciation hyp: - Psychosis emerged from speciation event of language development - Genetic change allowed 2 hems to independently develop for more functional diversity - Led to prolonged brain plasticity and rapid growth - Cerebral asymmetry is greater in men, and psychosis is greater in men  - Women’s pref for older men would have favoured later plateau in brain growth which could be why men develop at slower pace and why psychosis comes during repro (more time for something to go wrong) - Longer brain development leads to more var in personality, intelligence, and language, and extreme vars = psychosis - Issues: - Other species can have psychosis - Emergence of language was likely gradual Maladaptive byproduct of social brain: - Genes leading to psychosis are same ones regulating social development - Some combo of alleles relating to social development leads to psychosis - Nesse’s cliff’s edge hyp: collection of alleles give increasing benefits to social function until they pass threshold and become social dysfunction Delusions reflect social challenges: - Delusions related to ancestrally relevant social challenges - Ex. persecutory = allying w enemy, jealousy = partner fidelity - Reading intensions of others is crucial, mistrust is adaptive - Maybe delusions are ToM to the extreme - Persecutory people have intact ToM about things unrelated to delusions - Some initial premise is paranoid so rational thoughts seem irrational to them Creativity: - Connection w delusion - Involves cog flexibility, divergent thinking, unique associations - Link between schizotypic and divergent thinking - Schizotypic associated w reading patterns - Latent inhibition reduce in psychotic people (suggests sensitive dope receptors) - Sexual selection of creative traits may account for psychosis persisting Psychological adaptivity: - Delusions help cope - Ex. chronic low anxiety makes you feel good but is biologically bad - Provide momentary relief - Delusions involve avoiding painful feelings / neg stim that threaten world perception Dopamine: - Involved in motivational salience and detecting aversive events - Stamps in new associations - Aberrant salience theory: psychosis is result of assigning novelty and significance to regular events - Dysregulated dopamine receptors release dopamine w no cue during psychosis - Prodromal phase (early onset of psychosis) involves increases in novelty - Doesn’t account for why they are maintained though Predictive learning: - Perception is based on bottom up but constrained by top down - Children perceive size and weight of coins diff based on socioeco - Sensory influenced by experience - Prediction error: top down violated by bottom up, mental model updated, crucial for reward / punishment learning - Bayesian models of prediction error: - Coding errors in firing of midbrain dopamine neurons to VTA and substantia nigra - Attention is directed to stim to try to explain why expectations violated - Want to learn cause predictive learning minimizes uncertainty - Bayesian model of cortical processing: - Delusions arise from abnormal processing of prediction errors - Strong prediction errors generate uncertainty - Delusions arise to bring order - Intensity of prediction error signals correlates w severity of delusions - Abnormal prediction error signals seen in schiz (mostly in mesocorticolimbic path) - Dysregulated dope due to dysfunctions in glutamatergic and GABAergic signalling leads to expectation impaired and more false positives - Downregulated NMDA (glutamate) receptors leads to impaired top down processing - Overstimulating AMPA (glutamate) receptors leads to false positive prediction errors - GABAergic dysfunction leads to excessive dope release How delusions persist: - Beliefs are a form of memory - Delusion removes uncertainty and is instantiated like a memory - Acts as top down - When new prediction error occurs delusion is reactivated and strengthened - Dorsal striatal habit system is engaged when delusion reinforced - Not PFC, goal oriented instead of analytical - This is why people can now delusions are false but still believe them - Unpleasant emos engage w fronto-striatal learning system (in conj w amygdala) to charge the delusion - Experiencing emos reminding of delusion further solidifies it Antipsychotics: - Reduce dopamine levels by blocking D2 receptors - Attenuates excessive significance perception - Affect normal motivational salience in rats - Inhibited pre conditioned avoidance response to tone signaling pain - Doesn’t reverse underlying mechanism cause when discontinued same symptoms return w same content and rats learning returned even when shock was unpaired w tone Trauma and psychosis:  - Childhood adversity, bullying, unwanted sexual advances, persecution of other sorts can predict paranoia - Social defeat mediates relationship between childhood trauma and psychosis - Relationship is associated w overactive dope in mesolimbic - Abnormal dope sensitivity also seen in animals experiencing chronic social defeat - There is a possible pathway to psychosis via dissociation in response to trauma event - Disrupts ability to process memories after trauma but can later manifest as delusions Enviro predictors: - Intrusive events predict psychotic symptoms - Patients had 20x more intrusive events than control - Study: - Caribbeans living in Britain have higher chance of being diagnosed w paranoid schiz - Rates in home country are same as Brits in Britain - Being in other culture increases paranoia Thought addiction: - Addicted to the delusion (simplified world view) - Theoretical → Overall informed by experiences and stressors, prefer certainty over healthier view Narrative identity: - Internalized story of self, how we became us - Changes w time - Provides sense of unity and moral purpose and makes a timeline Stories are social: - Communicating through stories coevolved w complex social dynamics - Storytelling explains some of brain size - Stories are meant to be told Pieces of stories: - Human / humanlike agent attempts to accomplish desired end, encounter some obstacle, sequence of events creates uncertainty, resolution at end Development of narrative identity: - 2: awareness of self - Kindergarten: ToM - Elementary: recognizes complex motivations, plans for future based on memories of past - Narrative identity allows us to reflect on our life and enhance autonomy How does development inform narrative identity: - Exp 1: asked elderly to recall memories from 7 decades, coded by psychosocial themes - Exp 2: asked elderly to recall memories based on psychosocial themes, coded by age - Memories from diff life stages reflected Eriksonian themes  - Ex. trust in early life, intimacy in young adult - Life events tied to developmental goals are more easily recalled Neurosci of narrative: - vmPFC, dmPFC, and PCC involved in retrospection and prospection - Make up DMN - Supports ability to project self into stim of another time / place - Narrative construction of scenes - Supports invention of life story Role of life story: provides purpose Purpose of narrative identity: - Builds cog skills developed in ToM and autobiographical memory - Autobiographical reasoning: deriving semantic meaning from episodic events in life, needed for avoidance learning - Can’t help but make narrative sense of things How does tension define meaning: - Study of college students - Meaning making was most linked to tension memories particularly involving mortality or relationships - Achievement / leisure memories less likely to lead to efforts to integrate meaning Wisdom: - Study of adolescents, early adults, older adults - Asked to define moments of wisdom - Most highlighted negative situations w lessons - Thinking you possess wisdom enhances sense of competence and self efficacy and gives assurance you can cope - Capacity for it emerges in early adult and remains constant - Younger people relied more on life lessons vs insights Narrative identity research: - Schemas: bodies of knowledge - Scripts: schemas that detail sequences of events, what we expect to precede events, makes us aware of deviations - Shaped by cultural norms - Ex. young lovers rely on rituals, myths, literature to guide intimacy - Prediction error when expectations violated - Disappointed when things aren’t what we expected Role of defensive avoidance and self restraint: - Study - Defensive individuals recall memories w less details to avoid re experiencing conflict - Same amount of negative memories recalled though, just less detail  - Self restraint: ability to govern aspects of socialization - Low = impulsive, problem behaviours - High = rigid, overcontrolled, overintellectualized (no emo) - Integrating memories correlates best w moderate self restraint King and Raspin: - Divorced women had to write narrative of best future self before and after divorce - Lost possible self = dreams unachieved - Found possible self = aspirations held on to - Salience = freq - Elaboration = detail - Salience of LPS neg related to well being - Salience of FPS pos related to well being - Elaboration of FPS pos related to ego development (personality) - Elaboration of LPS predicted ego development w time since divorce - More tolerant to complexity over time? As time goes on remembering what they’ve lost is useful for avoidance learning? - Likely reflects rum where upsetting thoughts are committed to LTM to help future behaviour but are not thought often cause bad for well being → We need meaning - Greatest burden of a child is unlived life of their parents → Jung looked for meaning in symbols - Not the same as a sign - Involves subjective encounter Dream interpretation: - Very old - Greeks and Romans believed dreams give us info about past, pres, future but need interpretation WWI: - Stressful time - Initial hallucinations in Jung predicted bad thing globally - Advancements in science said our brains worked for accuracy - Bad decisions were result of reasoning - Neglected emo - Humanity needed to reestablish what is meaningful not just true How to live meaningful life: (IFM ones) - Dedicate life to something greater than self - Help others achieve their potential - Keep connections - Do something that makes you feel like you made a diff and leave a trace if you can → Science is a tool to make a world view, no concept can describe everything What we learned: - Our beliefs underlie everything - Social brain tells stories to others and makes meaning - Brain’s goals is to tell reliable story, not accurate - Beware of brain looking for reliability - Narrative determines how we conduct ourself Painful feelings: - Adaptive and part of life - Keep us out of danger through avoidance learning - Cues regarding fitness - Reliable but aren’t objective - Ex. drug addiction (feel good but doing bad) - Dark thoughts inform us but might not be true about our whole life - Negative self talk Emo self harm: - Dom mice are physio diff from sub mice - Sub have more active adrenal, less active testes, higher turnover of brain catecholamines - Failure is repeatedly instantiated in sub mouse when dope produced when expectations of failure are met - Familiar pain > uncertainty - Desire for self harm comes from this pref (primitive, not analytical) - Embracing loss was likely protective in EEA cause more loss would kill you - So now we’re biased to attend to neg stim cause they feel more objective since dope is being stamped in due to expectation Beliefs underlie everything: - REBUS: relaxed beliefs under psychedelics - Psychedelics relax high level beliefs - Liberate bottom up info flow via intrinsic sources (ex. limbic) - Therapeutic benefit is that downregulating top can allow you to better receive bottom up from ex. trained therapist - Enables revisions in belief system - Only works if bottom up is different from belief system otherwise can cause psych harm Altering beliefs: - Hack yourself by romanticizing life - How you treat yourself is a cue for cog, so cog dissonance can go the other way - Thoughts dictate behaviour so behaviours can dictate thoughts - What CBT does - Not just being fake, cause we know phones are bad and that doesn’t change their effect on us, cues influence our thoughts We evolved to continually grow: - Unconditional positive regard: basic acceptance of a person regardless of what they say or do - Not everything is condoned, but means there is a commitment to accepting yourself with the capacity to grow - Painful feelings are cues for future growth in this context - Ex. dep is needed in response to loss but its purpose is for avoidance learning Trade offs: balance self love and accountability Create your own myth: - Value your own viewpoint - Your story and lessons are meaningful cause it’s a unique viewpoint - Integrate experiences as honestly as possible - Engage w dreams symbols and metaphors - Archetypes demonstrate how stories are connected and can decrease alienation Art and fiction: - People have felt like this before - Archetypes provide parallels to own life - Enables sim of other experiences - Fights alienation Evo lessons summary: - Genetics predispose by enviro defines, so be intentional about enviro - Meaning is derived from giving (ex. sacrificing short term gains) - Life is inevitable - In harnessing entropy, life speeds it up - Universe trends to disorder but we’re part of pocket of life