PSY124 Definitions - Psychological Disorders PDF

PSY124 DEFINITIONS    A screenshot of a computer screen Description automatically generated![A diagram of a model Description automatically generat...

PSY124 DEFINITIONS    A screenshot of a computer screen Description automatically generatedA diagram of a mental disorder Description automatically generated A diagram of a therapy Description automatically generated  Mental illness / psychopathology Mental health a person's psychological and emotional wellbeing Mental health problems a range of emotional, cognitive, or behavioural "issues" that can affect people Mental/psychological disorder clinically recognizable set of signs, symptoms, syndromes, and behaviours that may cause distress to the individual and/or impair their ability to function 3 4 Why do people develop psychological disorders? There are many different causes for psychological disorders, and different individuals may develop the same condition for different reasons Alternatively, different individuals may experience the same reasons for a condition, but have different outcomes Two models that help explain psychopathology: Biopsychosocial model Diathesis-stress model 26/29/22 Biopsychosocial model Mental health and disorders are influenced by several interlinking factors Biological factors Genetics, hormone and neurotransmitter imbalances Psychological factors Cognitive biases, coping skills, maladaptive thought patterns Social factors Social support, experience of interpersonal trauma/stress 5 Diathesis-stress model Disorders can be triggered when people with pre-existing vulnerabilities experience some sort of acute or chronic stressor. These work in a cumulative fashion: The greater the diathesis, the less stressors are needed to trigger an event Diathesis: individuals possess some sort of internal factor (i.e., genetic, cognitive, etc.) which predisposes them to a psychological disorder Stress: an internal or external event that triggers the psychological disorder 6 36/29/22 What is "abnormality"? Statistical infrequency 7 8 What is "abnormality"? Personal distress The experience of extreme anxiety, sorrow or pain Often the subjective experience that suggests to an individual that they may require psychological treatment Limitations: Not all those who are distressed have a psychological disorder Not all those who have a psychological disorder are distressed Some forms of distress are not "abnormal" 46/29/22 What is "abnormality"? Impairment/Dysfunction Reduced capacity for everyday functioning: Cognitively Socially Emotionally Occupationally, and so on Limitations: Other (non-psychological) disorders and diseases Personality traits 9 Diagnostic issues Cultural differences Some disorders are specific to certain cultures (culture-specific disorders): Wendigo psychosis (Native America) Depression, homicidal or suicidal thoughts, and a delusional, compulsive wish to eat human flesh Most psychological disorders are universal 10 56/29/22 Diagnostic issues Common misconceptions/controversies Diagnosis reduces the individual to their disorder Diagnoses are too unreliable to be useful Diagnosis is only descriptive and therefore meaningless Diagnoses stigmatise people 11 Psychological diagnosis Advantages Helps professionals communicate quickly Helps client to understand what is going on for them Helps to inform a treatment Disadvantages Not everyone fits into a diagnostic category A lot of people have distressing symptoms that do not meet criteria for a 'disorder' Stigma Helps to normalise symptoms for a client 12 Can be distressing for a client 6 **WEEK 4 Psychological Disorders 3** **Learning outcomes** By the end of this module you should be able to: 1. Define and describe the symptoms of Autism Spectrum Disorder 2. Define and describe the symptoms of Alzheimer's Disease 3. Define and describe the symptoms of Post Traumatic Stress Disorder What is trauma? An event (or events) that cause extreme distress or disturbance What is a stressor? An environmental circumstance (e.g.social or physical), which causes fear, frustrations, sadness. Many disorders can be triggered by stress and trauma, but stress and trauma is not always present --e.g.some people with anxiety disorders can trace the cause back to a stressor/trauma, but others with the same disorder have no history of stress/trauma. But, exposure to trauma and/or stress is **[always]** a key feature in this category of disorder **[Post traumatic and stress disorder ]** Diagnosis requires the following 5 factors to be present: 1. The person was exposed to: death, threatened death, actual or serious injury or sexual violence, as follows (1 required) Direct exposure Witnessing, in person Indirectly --learning a close friend/relative exposed Repeated or extreme indirect exposure via professional duties (not e-media, TV, videos, movies) And for at least one month following the trauma, the person experiences: 2\. Persistent re-experiencing of the traumatic event (e.g.nightmares, flashbacks) 3\. There is persistent avoidance of the stimuli associated with the traumatic event and a numbing of general responsiveness 4\. Negative alterations to cognition or mood (eg excessive guilt or blame of self or others, feeling alienated, inability to enjoy activities previously enjoyed) 5\. Persistent symptoms of heightened arousal (eg hypervigilance, irritable behaviour, exaggerated startle response) PTSD symptoms usually begin within 3 months of the trauma, but delays of months and even years have been reported. Prevalence among high riskgroups at 3-58% (combat veterans, victims of bushfires, victims of criminal violence/assault) 7.8% of people have experienced PTSD at some point, but 60-70% of population experience a traumatic event as described in point 1 --so most people do not develop PTSD after trauma. While stress and trauma might contribute to many psychological disorders, it is always the key cause of trauma and stressor related disorders Post Traumatic Stress Disorder is one of the more common disorders in the category It is important to remember that not everyone responds the same way to trauma and stress --many people exposed to serious stress and trauma do not develop PTSD or related disorders. **Neurodevelopmental Disorders**--a class of disorders that are commence during childhood or prenatal development. Includes: Intellectual disability Communication Disorders (egstuttering) Autism Spectrum Disorder Learning Disorders (egdyslexia) Attention-Deficit/Hyperactivity Disorder **[Autism spectrum disorder- ]** Requires presence of the following: 1. Persistent deficits in social communication and interaction, including: Inability to engage in social emotional reciprocity Difficulty expressing and interpreting non-verbal behaviour Difficulty understanding and forming relationships 2\. Restricted, repetitive behaviours, interests or activities, demonstrated by at least two of the following: Stereotypes/repetitive motor movements, use of objects, or speech. Insistence of sameness, inflexibility, ritualized behaviour Narrow, fixated interests that are excessively intense Extreme sensitivity or limited sensitivity to environmental stimuli (egindifference to pain, excessive touching of objects) Prevalence:.6% -2% of children 4 x more common in males Appears to have a strong genetic component --Twin concordance rates range from 37% to 90% Pruning hypothesis -Lack of neuronal pruning during developmental periods? Honda, Shimizu, & Rutter (2005) Investigated the incidence rate of ASD before and after the cessation of the MMR vaccine programme in Japan. Just coincidental that the same age of vaccination received is same age as diagnosis. Very discredited diagnosis has no relation to vaccine. Increase is due to more awareness for diagnosis/. Neurodevelopmental disorders vary in terms of when they develop, but all occur during childhood (even if not diagnosed until later) There are a range of different areas of impairment intellectual function, communication., learning, social skills etc Autism Spectrum Disorder in one of the more common neurodevelopmental disorders --its severity ranges from mild to very severe, but has two key features difficulty with social and emotional interactions, and the presence of repetitive or restricted behaviours **[Neurocognitive Disorders]** -- a class of disorders in which the predominant symptom is cognitive impairment (deficits in memory, learning, thought). Some common causes are: Advanced Age (egAlzheimer's Disease) Illness (eg HIV related dementia) Injury (eg Traumatic Brain Injury) Genetics (eg Huntington's Disease) What is the Difference Between Dementia and Alzheimer's Disease? **[Dementia]**-- an umbrella term that covers a range of disorders in which there is a steady, usually irreversible, pattern of cognitive decline. Can affect memory, language, thought, behaviour. Whilst some forms are treatable (eg those due to infection), most are irreversible (eg Alzheimer's Disease) Onset is typically insidious. So, Alzheimer's disease is one of a number of types of dementia. **[Alzheimer's Disease]** Degenerative brain disorder that involves progressive cognitive decline. Culminates in widespread cognitive failure and death. AD is the most commonly diagnosed form of dementia, but technically can only be confirmed post mortem, so classified as either: Probable Alzheimer's Disease if there is a family history and/or there is significant cognitive decline. Possible Alzheimer's Disease if there is no family history, but there is steady cognitive decline which cannot be explained by other medical history Prevalence: 13% in 65 + 42% in 85 + Average lifespan following diagnosis = 10 years Tends to be more frequent in females (even after longevity differences between sexes is accounted for) AD is characterised by the presence of neurofibrillary tangles, senile (aka amyloid) plaques and neuron loss, typically concentrated in specific regions of the brain Neurofibrillary Tangles: Threads of protein that occur within a neuron. Senile Plaques (aka Amyloid Plaques): Deposits caused by debris from degenerating neurons and build-up of protein. Alzheimer's Disease Progression Neuroanatomical The damage associated with AD usually commences in specific brain regions, then spreads in a predicable pattern. We can therefore predict in many cases what functions will become impaired during the progression of the disease Alzheimer's Disease Progression -- Cognitive Often starts with general confusion and irritability, speech deficits. As the condition progresses the memory impairments become increasingly noticeable. Memory loss follows pattern of structural deterioration. Occurs in all types of memory ▪ Episodic (memory of events that have happened) ▪ Semantic (general knowledge) ▪ Procedural (how to make a cup of tea Recent memories are first to be lost, and there is a chronological progression backwards: Eg--forget grandchildren's names, then children's, then partners, then siblings etc. Alzheimer's Disease Progression - Other As well as memory decline, there is a number of other changes: Mood --depression often see in early stages Mood --can become combative/argumentative Language impairment Restlessness/Motor agitation Motor impairment -- eg difficulty walking Psychosis Lose social inhibition Genetic Factors: There is strong evidence that a number of genes influence likelihood of developing AD Medical History: Previous experience of a traumatic brain injury increases risk of developing AD Certain other conditions (eg Downs Syndrome) are associated with greater risk of AD There are a range of neurocognitive disorders, some of which occur early in life, others (e.g. dementia) tend to be more common later in life Dementia is an umbrella term covering a range of disorders where serious memory impairment is a key feature. Alzheimer\'s Disease is the most common type of dementia Unlike most disorders in the DSM5, there are clear and predictable changes to the structure of the brain in most neurocognitive disorders, which often lead to predictable changes in cognitive and behavioural function Sadly, there is not an effective treatment for many types of dementias Week 5 Psychological treatment     **Learning outcomes** By the end of this module you should be able to:
 Describe the basic premise of psychodynamic therapy, and its limitations Describe the basic premise of humanistic therapy, and its limitations Describe some of the techniques used in behavioural therapy, and its limitations Develop an understanding of the premise underpinning Cognitive Behavioural Therapy (CBT), its limitations, and some of the techniques used.       **[Psychotherapy:]**  term covering the wide and disparate range of techniques used in an attempt to enhance psychological and emotional well-being.   Different treatments vary in terms of efficacy (how useful they are), and in terms of their scientific rigour (how well supported by evidence they are).  Treatment can also be biased--it might work better for some groups/populations than others.     Not just done by psychologists: Social Workers Counsellors Nurses GPs Psychiatrists In a range of settings: Practitioner rooms/surgeries Workplaces Support services (egDrug and Alcohol, Relationships Australia) Group/family settings (Alcoholics Anonymous) Hospitals Schools Online/over the phone   But!  Not everyone is qualified to use the same psychotherapeutic tools.  For example; There are psychological scales/tests that only a qualified and registered psychologist can use (e.g. IQ tests) Psychiatrists and GPs can prescribe medication psychologists (and others) can't It is important (and ethical) to know the boundaries for a given role   What makes a good therapist?   Training and experience is a good starting point.  But evidence suggests other traits (characteristics) are also important: Warmth Ability to develop a good therapeutic alliance (working relationship with the client) Focus on the key issues Able to align treatment approach with the person Willing to get feedback from client, supervisor and colleagues Keep up to date with research And of course, therapists are expected to behave in an ethical manner. ** ** **Therapy needs to be based on evidence.** **The Science-Practitioner Model** This is an important model for psychotherapy.  However, it does have limitations --egif we focus on applying evidence based-practice, are we exploring new approaches?     The term psychotherapy covers a range of 'talking therapies' While many professions do some form of psychotherapy, some tools/procedures are only done by certain medical professionals Good therapy is about training + individual traits All therapy should be evidence based -- the science practitioner model is the model used in psychology     **[Psychodynamic Therapies]** Founded by Freud Based on the assumption that psychopathology develops when people remain unaware of their true motivations and fears. Such people can be restored to healthy functioning only when they become conscious of what has been represented (kept in the unconscious). Psychodynamic therapy is contingent on two principles:  1. Insight--the client's capacity to understand their own psychological processes. 2\. Therapist-Client alliance--crucial in effective change to the disordered psychological processes.   The 5 Core Beliefs of Psychodynamic Therapies 1\. Most behaviour is driven by unconscious wishes, impulses, drives and conflicts.  2. There is a meaningful explanation/cause for abnormal behaviour, which can be discovered by the therapist. 3\. Current issues are based on childhood experience. 4\. To overcome problem, emotional expression and reliving of past emotional experiences is crucial. 5\. Once the client understands and has emotional insight into the unconscious drives/material, the symptoms are understood and therefore often resolve themselves.   Psychodynamic Therapies Stages of Psychoanalysis   1\. Free Association The client is encouraged to give free rein to thoughts and feelings and to verbalise whatever comes to mind, with the intent of uncovering of unconscious material. 2\. Interpretation The technique of interpretation comes into play as presumably unconscious material begins to surface. The therapist points out to the patient their defences and the underlying meaning of behaviours, thoughts, desires, or even dreams. 3. Dream Analysis The therapist interprets dreams in the context of what is occurring in life for the person. Looks at the dream's manifest (actual dreamt events) and tries to determine the latent (hidden) meaning. 4\. Resistance: Resistanceor blockages to free association are thought to arise from unconscious control over sensitive areas.  These areas are sought and targeted for exploration by the therapist.  5. Transference: The process by which people experience similar thoughts, feelings, fears, wishes and conflicts in new relationships as they did in previous relationships. Clients might transfer feelings they have for a person to the therapist and engage in a relationship with the therapist that resembles a prior relationship. (cfCounter-transference) 6\. Working Through Therapist assists the person in processing the information and insights gained during therapy.  Also involves continued identification of arising conflicts and resistance.   Criticisms of Psychodynamic Approach Sample Bias -Freud based approach on rich, intelligent, successful individuals. Confirmation Bias --selecting pieces of information that support claims and disregarding information that doesn't support claims. Long term = expensive. Do we really need insight to resolve problems? Lack of scientific rigour in some situations --circular arguments.   Humanistic-Existential Psychotherapy Like psychodynamic therapy, humanistic therapy requires the client to develop insightinto the problem. Believe that human nature is inherently positive and good, and that we all have the ability to reach our full potential. Focus of these therapies is on the phenomenology of the client.  Phenomenology: The way each person consciously experiences the self, relationships and the world. The aim :Help people get in touch with their feelings, with their 'true selves' and with a sense of meaning in life.   **Humanistic therapies** often considered as one of the 3 main approaches to psychological therapy (others are Behaviourism and Psychoanalysis). Largely created by Abraham Maslow --who viewed psychology as too concerned with the neurotic and disturbed (psychoanalysis) or with those that could be explained by a mechanistic approach (behaviourism). Humanistic therapies are concerned with how a person experiences: self, relationships with others, and the world.   **Person-Centred Therapy (**aka Client-Centred) Devised by Carl Rogers who rejects the notion of a disease-model --iepeople come to therapy to help solve problems notto be "cured" of their disorder. Core traits of the therapist:  1. The therapist must be authentic and genuine (sometimes referred to as congruence). 2. The therapist must express unconditional positive regard (non-judgemental acceptance of the client and their feelings). 3\. The therapist must relate to client with empathetic understanding.     **Person-Centred Therapy** (aka Client-Centred) Rogerianassumptions: 1\. People can be understood only from the vantage point of their own perceptions and feelings. 2\. Healthy people are aware of their own behaviour. 3\. People are innately good and effective, they become ineffective and disturbed only when faulty learning intervenes 4\. Behaviour is purposive and goal-directed. 5\. Therapists should not attempt to manipulate events for the individual --rather they should create conditions which will facilitate independent decision making by the client.   Criticisms of Humanistic Existential Psychotherapy   Lack of scientific rigour in some situations --difficult to measure self awareness. Positive regard and empathy may not be necessary for effective counselling. Efficacy is variable --some evidence suggests not more beneficial than simply talking to a non-professional about problems. Cultural bias?  Some argue that humanistic approach is based on Western individualistic values   Behavioural and Cognitive Behavioural Therapy (CBT)         Psychodynamic and humanist perspectives focus on insightand emotionas the pathway to improvement  Behavioural therapy and Cognitive-Behavioural Therapy (CBT) evolved as a result of the development of Behaviourism and Cognitive Psychology from the 1940's onwards. Both have their basis in scientific explorations rather than clinical practice.     A.  Basic Principles 1\. Short-term therapy. 2\. Therapeutic focus is the current behaviour/cognitions, not on past (e.g. childhood) experiences or inferred motives. 3\. Therapy commences with a behavioural analysis. 4\. Therapy targets problematic behaviours, cognitions, and emotional responses.   Used to treat phobias, anxiety triggered responses. Involves confronting the client with the stimulus they fear. The way in which this confrontation occurs determines the type of exposure used.  Exposure techniques include: Systematic desensitisation Flooding techniques Virtual reality exposure The crucial element in all exposure techniques is that in exposing the client to the feared stimulus they are prevented from escaping the stimulus, whilst anxiety levels subside.     **Exposure-** Anxiety reactions decay over time due to the energy requirements for maintenance. By preventing the capacity to flee or fight the person experiences anxiety decay and is therefore "reconditioned".   **Systematic Desensitisation** Is specifically aimed at the alleviation of maladaptive anxiety, particularly phobias. Involves pairing relaxation with imagery of anxiety provoking scenes or stimuli -a counterconditioning process.        **Flooding** Client is exposed immediately to feared experience Response prevention:  The therapist stops the person from engaging in their typical avoidance responses --both behavioural (egleaving) and cognitive (egthinking about something else). **Virtual Reality** The client views computer generated images of the feared experience. **Modelling** Modelling & Skills Training Learning theory (Bandura) developed in the 1960's and has influenced heavily how clinical psychologists explain how disorders develop as well as develop new therapeutic approaches to treatment. It is well established that children and adults model the behaviour of others, often unconsciously (watch your friend eating when you are eating). Can learn both maladaptive (egphobia) and adaptive (egeffective coping) behaviours. Client modelling the behaviour of the therapist can be used either implicitly (client will learn over time the responses and reactions of the therapist and use them externally), or explicitly (role play, role reversal).   **Social Skills Training** Emphasis is on assisting clients with interpersonal/social problems (egsocial phobia, shyness, lack of assertiveness). Direct skills training from the therapist, followed by role playing with self-examination of behaviour, followed by rehearsal are the common steps. Virtual Reality technology is also being used to assist in the skill-based training for social interactional problems. Can be used to improve social interactions in people with schizophrenia, depression, autism.  However when used in this manner cannot be considered to 'cure' the disorder   **Operant conditioning** involves the use of reward based systems to counteract maladaptive behaviours, emotions, or cognitions. Rewards can be explicit (lollies, chocolate) or implicit (praise, attention) all of which are positive reinforcers. The rewards can also be withdrawn or retracted, either explicitly (no lolly given) or implicit (no attention, eye contact, interaction) when the behaviour is inappropriate --negative punishment. Such techniques are widely used in dealing with anxiety disorders, especially in children or in high-needs environments Token Economy: use star chart or similar  to promote desired behaviour and discourage unwanted behaviour.  Often used with children, but can also be used in adult setting (egpsychiatric units) **Aversion Therapies:**  pairing of unpleasant stimuli with unwanted behaviour.  Not commonly used, however still useful in some situations   Criticisms of Behavioural Therapies Most behaviourist approaches ignore the role of any internal processes (egcognition and emotion). Insufficient consideration of personal relationships. While psychodynamic approaches might have focussed too much on historical factors (e.g. childhood), perhaps behaviourism is too dismissive of their role?   Both behavioural and cognitive behavioural therapy focus on modifying current, maladaptive behaviours. Behavioural therapy focuses on changing behavioural responses, and whilst 'hard line' behaviourism has fallen out for favour as a good explanation for all human behaviour, many of the therapies egexposure therapy are still useful, and incorporated into cognitive behavioural therapy.   **Cognitive Behavioural Therapy (CBT**   Behavioural therapy focuses on increasing adaptive actions and behavioural responses.  Change tends to be at a physiological/behavioural response level Cognitive-behavioural extends on this and incorporates cognitive response to a greater level Behavioural techniques such as exposure and desensitisation are also included in CBT     3 key assumptions: 1. Cognitions can be identified and measured 2\. Cognitions underpin both adaptive and maladaptive psychological function 3\. Through therapy and practice, maladaptive thought processes and behaviours can be changed into adaptive processes A screenshot of a diagram Description automatically generated       **RET; Rational Emotive Therapy** --Albert Ellis (AKA REBT) Emotional reactions are caused by internal sentences that people repeat to themselves. RET is designed to eliminate the incorrect (irrational) beliefs of a disturbed person through a process of rational examination of those beliefs. Key element of RET is the A-B-C theory of psychopathology.  Ellis later added a D & E.   A diagram of mental health Description automatically generated   Beck's Cognitive Therapy Beck's version of cognitive therapy was devised specifically for the treatment of depression. Beck believed that depression in particular is caused by the negative patterns in which individuals think about themselves, the world, and the future.    Behavioural Exercise -   A screenshot of a computer Description automatically generated Behavioural activation Aim is to increase engagement by scheduling pleasant activities It also helps the client re-engage in activities they have been avoiding It is important to set tasks that are achievable The first step is to get client to recognise the connection between inactivity and low mood This involves the client monitoring what they do during the day and also noting their mood at that time (0 = Low mood, 10 = Excellent mood) Gradually the client is asked to start implementing pleasant events by scheduling activities   Criticisms of Behavioural and Cognitive Behavioural Therapies Some therapies require a moderate-high level of motivation by client Negative thoughts can be realistic The relationship between changing thoughts and changing behaviour may be exaggerated (egchange in though but still engage in maladaptive behaviour) Insufficient consideration of personal relationships/background?     Both behavioural and cognitive behavioural therapy focus on modifying current, maladaptive behaviours. Cognitive Behavioural extends on behavioural to target maladaptive thinking as well as behaviour/response  CBT is the main approach currently used in many countries   **Week 6 Psychological treatment 2** Psychopharmacotherapy - Psychotropic Medication Drugs that act on specific brain functions. Broadly includes any pharmaceutical agent that is able to cross the blood-brain barrier and exert a direct influence on CNS cellular function. - Neurons transmit messages through the release of neurotransmitters. Too little or too much of a neurotransmitter may lead to psychological or physiological dysfunction - Neurotransmitters are inactivatedby: 1.Reuptake 2.Inactivation 3.Drifting away Antianxiety medications (anxiolytics) Broadly derived from a class of benzodiazepines which appeared in the 1960's and replaced the use of barbiturates (highly addictive). Examples of potential side effects: Drowsiness, dizziness, low BP. Some are addictive. Antidepressants Antidepressants first emerged in the 1950's, with the SSRI's appearing in the late 1980's. SSRI's now the dominant antidepressant (but watch this space --Moncrieff et al 2022) lower risk of side effects and safer to use (than MAOI's). SNRIs are also now gaining popularity Examples of potential side effects: Nausea, headaches, increased appetite, sexual dysfunction, drowsiness. Mood Stabilisers Used primarily to treat bipolar and related disorders, and the mood dysfunction that can occur with schizophrenia. Examples of potential side effects: Weight gain, tremors, fatigue, digestive problems Antipsychotic medications (AKA neuroleptics) A class of drugs used to treat Schizophrenia as well as other disorders involving episodes of psychoses. Examples of potential side effects: Drowsiness, rapid heart beat, weight gain. Older drugs caused tremors, tardive dyskinesia Psychostimulants Used to treat attentional disorders, such as ADHD, and disorders such as narcolepsy. Most work by increasing dopamine Examples of potential side effects: decreased appetite, sleep disturbances, and headache. Some have risk of addiction Cautions - Often have side effects --some at commencement of treatment, others if taken for a long period of time Individual Differences --people vary greatly in response to drugs (including susceptibility to addiction), depending on various factors such as weight, age etc. Misconceptions regarding needfor drugs, efficacyand appropriateness: Not always necessary to treat a biological disorder with drugs. Nonpharmaceutical therapies can alter neurobiology. Not a 'cure all' --egsome drugs may work in some age groups and not others, and may need to also use non-pharmain conjunction with pharmafor best outcomes (egMDD --start with antidepressant but also use CBT or similar) Overprescriptionand Polytherapy - **Psychopharmacological drugs are those which impact on psychological function by altering brain function (neurotransmitter activity)** - ** We don't always know how they work** - ** They can be an effective tool when used appropriately, but often have side effects (mostly short term)** **\ Surgical treatments-** Psychosurgery Involves the neurosurgical destruction of brain tissue to "cure" mental illness. Lobotomies (especially frontal lobotomies) were carried out rather extensively in the 1920-1960's. The procedure disappeared with the advent of effective psychotropic medications. Dr Walter Freeman --trans-orbital (aka 'ice pick') lobotomies. Psychosurgery is now rare, involves highly selective lesions to specific brain structures, and only performed in extreme cases. Psychosurgery example Capsulotomy: Specific lesions to reduce the symptoms of severe medication-resistant OCD Ruck et al (2008) --long term outcomes (approx10 years after surgery) in 25 patients Approx50% had very good recovery However, also some side effects: Weight gain Some executive/short term memory dysfunction Severe disinhibition (less common). **ECT (Electroconvulsive Therapy)** Involves the application of a brief electrical current to the head of a person. The duration and intensity of the current are sufficient to induce a seizure in the individual. Used in intractable MDD. Despite its inappropriate and indiscriminate use in the 1920's-1970's; research has led to the appropriate use of ECT. ECT is currently used in cases of very severe depression that are unresponsive to other therapies, as well as severe depression with psychotic features **rTMS--Repetitive Trans-magnetic Stimulation** Similar to ECT, except that a magnetic pulse is used instead of electrical charge Non-invasive --a magnetic coil is placed on the skull and delivers pulses to specific regions Patient remains conscious, no need for pain relief or prolonged recovery period Found to be effective for people with medication resistant MDD (Berlim, Van den Eynde& Daskalakis, 2012) **Deep Brain Stimulation -DBS (**Kern & Kumar, 2007) An alternative to psychosurgery Similar to pacemaker, but provides electrical pulses to specific areas of the brain via implanted electrode Initially used in Parkinson's Disease, now also used for intractable OCD and MDD Cautions - Can have serious side effects, some of which may be life-long Mechanisms of action remain unclear for ECT, DBS, and rTMS Only appropriate where other measures have failed and the person is continuing to experience significant and distressing levels of impairment - **Surgical treatment can seem quite confronting for psychological disorders, but in some circumstances it is appropriate.** - ** It is generally only used as a last resort, and always with the consent of the person.** - ** There have been huge advances, and contemporary psychosurgery is nothing like the historical treatments -it is much more specific, much more sophisticated, much less used.** **Treatment Efficacy-** Factors relating to efficacy --it's not all about the therapy. Efficacy varies depending on: Thetypeoftherapy The type of disorder Theclinician's ability/characteristics Theclient's ability/characteristics **Psychodynamic Therapy** ▪ There is some evidence that both long-term and short-term psychotherapy can be as effective as CBT and other therapies, however there is less empirical evidence to support psychodynamic therapy. ▪ Patients with severe psychopathology (egschizophrenia) do not do as well as those with anxiety or depressive disorders. **Behavioural Therapy Techniques** ▪ Experimental studies demonstrate that systematic desensitisation results in behaviour change, especially for anxiety disorders & PTSD. ▪ Operant conditioning & token economies have a wealth of research evidence supporting their use in long-term behaviour change, but results are more variable than initially reported in the 1950's --1960's **Cognitive Behavioural Therapy** Highly effective in reducing risk of relapse from depression, anxiety, trauma-related disorders, and a number of other disorders. Outcome studies into Becks Cognitive Therapy report: ▪ is at least as effective as the use of anti-depressant medication in the treatment of acute phases of depression. **Psychopharmacotherapy** Well established benefits for certain disorders: approximately 60% of patients with Schizophrenia who are treated with antipsychotic medication show a complete remission of symptoms within 6 weeks (only 20% do with a placebo). Anti-depressants are effective in alleviating the acutesymptoms of depression, however, relapse following cessation of medication is a significant risk. Anxiolytics are also effective in alleviating the acutesymptoms of anxiety --however with cessation of medication there is a high rate of relapse **Combining Psychotherapy and Pharmacotherapy** ▪ CBT and anti-depressant medication when used alone are equally effective in treating acute phases of depression. ▪ Combining the two approaches reduces risk of relapse from depression following cessation of medication. ▪ Similar findings exist for the treatment of anxiety disorders with a combination of medication and CBT. **Eclectic psychotherapy**-involves combining techniques from different therapeutic approaches to fit a specific client's needs (egcombining CBT with anxiolytic medication). A word of caution... Many studies fail to consider individual differences such as age, cultural background, gender, SES. Often there is not much difference between therapies in terms of efficacy. About 5% of people experience negative outcomes after therapy Evaluating the efficacy of treatments- The appropriateness of the therapy for the condition in question, and the specific client Abilityof the therapist: ▪Well trained and up-to-date with techniques ▪Empathic and able to establish rapport Evidence suggests that effective therapy depends on: Client traits: ▪Some anxiety can facilitate willingness to change ▪Level of self awareness ▪Willingness to take responsibility and action Why do we believe in ineffective therapies? Ineffective therapies often appear to work due to a number of factors: 1.Spontaneous remission --many disorders fluctuate or are cyclical 2.The placebo effect --just talking about problem may lead to improvement 3.Regression to the mean --often extreme behaviours will naturally become closer to 'normal' over time 4.Self serving biases --clients may want the therapy to work and so may exaggerate improvement or downplay continuing issues 5.Confirmation bias --clinicians may look for evidence to support improvement, and ignore evidence to the contrary - **It is important to be aware of the efficacy of given therapy, and the factors which influence it. Clinicians and clients can both think treatment is working when in fact either there is not genuine improvement, or the improvement is not due to treatment This is why it is important to both be up to date with literature, and to have some understanding of the statistics which can demonstrate efficacy (or lack thereof)** **Clinical Ethics -** Ethics in Clinical Practice Ethics can be defined as beliefs about what is right conduct Ethics are moral principles adopted by a group or individual to provide rules for right conduct. Ethics represents the ideal standards set by a profession They are enforced by professional associations and government boards that regulate them The professional association for psychologists in Australia is Australian Psychological Society (APS) The regulatory body for psychologists is Australian Health Practitioner Regulation Agency (AHPRA): Psychology Board of Australia (PsyBA) The professional association for psychologists in Australia is Australian Psychological Society (APS)-The role of the APS is to support, protect and provide resources for its psychologist members. The regulatory body for psychologists is Australian Health Practitioner Regulation Agency (AHPRA): Psychology Board of Australia (PsyBA)-The role of the Board is to protect the community and consumers (or clients) of psychologists Good standards of practice require: professional competence, Egkeeping up to date with research/treatment approaches good and appropriate relationships with clients and colleagues Eghaving appropriate supervision, not having dual roles observance of professional ethics Egadhering to the code of ethics in your area Three general principles of the APS Code of Ethics Respect for the rights and dignity of people and peoples: includes informed consent, avoiding discrimination, confidentiality and privacy... Propriety: includes the need for clinicians to be competent, keep good records, provide services in a professional manner... Integrity:need to act in the best interest of clients, engage in reputable and honest behaviour, avoid conflicts of interest, be aware of power imbalances... In addition to each general principle there are ethical standards that guide behaviour Why do we need to have such strict standards to guide behaviour? Protect client Protect clinician Protect profession **Th Psychology Board of Australia (which sits in APHRA) is designed to support and protect clients by ensuring anyone who claims to be a psychologist is appropriately qualified.** - **The Australian Psychological Society is designed to support and protect psychologists.** - ** Clinicians are bound by a set of ethical principles. Breaching ethical responsibilities can have serious consequences for the client, the clinician, and/or the profession of psychology.** - - **Week 7 Stress and Coping** - - **Learning Outcomes** - 
By the end of this module you should be able to:
 Explain the effects of stress on an individual's mental and physical wellbeing
 Explain and evaluate coping styles and interventions that can be effective and ineffective
 Evaluate different behaviour change techniques  - - - Stress An internal process that we experience as we adjust to certain events and circumstances Stressors The events and circumstances that we adjust to Can be both positive and negative - Any event that forces us to adjust to new circumstances or introduces significant change in our life can be a psychological stressor. Daily hassles Chronic problems Life changes and strains Catastrophic (traumatic) events - - Stress reactions Emotional-- low mood, crying, distress Cognitive-- poor concentration Behavioural-- changes in eating habits, avoidance Physical-- rapid heart rate, sweating, nausea - - Emotional reactions Fear Anger Sadness Irritability, etc - Cognitive reactions. Rumination Attention Decision-making, etc. - Behavioural reactions (mal)adaptive avoidance Substance (mis)use Decreased physical activity Sleep disturbances, etc. - - Trauma- and stressor-related disorders 1. Reactive Attachment Disorder 2. Disinhibited Social Engagement Disorder 3. Posttraumatic Stress Disorder 4. Acute Stress Disorder 5. Adjustment Disorders 6. Other Specified Trauma- and Stressor-Related Disorder 7. Unspecified Trauma- and Stressor-Related Disorder - - Posttraumatic Stress Disorder (PTSD) Experience of a Criterion A traumatic event Characterised by: Intrusive memories Persistent avoidance Negative alterations in cognitions and mood Alterations in arousal and reactivity - - - Not everyone develops ptsd after a trauma - - Perception of stressors Stress is a highly subjective experience Stressors can be a transaction between people and their environments 1. Primary appraisal: does the person perceive the stressor as potentially threatening 2. Secondary appraisal: how well the person thinks they can cope - How we appraise a stressor and our ability to cope with it can depend on: Perception of control Believing in control can reduce the effects of stress Intolerance of uncertainty Inhibitory intolerance of uncertainty Prospective intolerance of uncertainty - - Coping with stressors Problem-focused coping A coping strategy of tackling problems head on More likely to use this type of coping when we are optimistic and think we can achieve our goals Emotion-focused coping A coping strategy used in order to reduce painful emotions More likely to use this type of coping when we are dealing with situations that we cannot avoid/control - - Cognitive styles and stress Disease-prone personalities Appraise stressors as catastrophic Frequently ruminate on stressors Use emotion-focused coping strategies Disease-resistant personalities View stressors as temporary challenges to overcome Display dispositional optimism Use problem-focused coping strategies - - Coping with stressors Perception and outlook regarding a stressor can have a significant effect on resulting psychological and physiological stress. Optimism is associated with reduced stress and avoidant coping in advanced-stage cancer patients Sumpio et al. (2017). Oncology Nursing Forum. Sense of humour is associated with reduced depression and anxiety and greater quality of life in patients with chronic obstructive pulmonary disease - - Social support Presence of others in whom one can confide and from whom one can expect help and concern A strong social support network can have the effect of: Reducing anxiety Improving optimism Increasing perception of control Improving immune system function - - Effects on psychological distress Social support reduces depression and anxiety Lack of social support can, in itself, be a stressor Anonymous disclosure can be an important mediator between a stressor and poor psychological and physical wellbeing - - Effects on physiological wellbeing Biological responses to stress can be lower when: A companion is present There is a belief that support is available In the presence of a pet Anonymous disclosure can be associated with: Better immune system functioning Reduced reliance on health services - What can we do after a severe stressor/trauma? Psychological/crisis debriefing? Critical Incident Stress Debriefing 1. Introduction Phase (Mitchell, 1983) Explanation of the session 2. Fact Phase What happened? 3. Thought Phase Thoughts during/after event 4. Reaction Phase Express current emotions 5. Symptom Phase Current psych/phys symptoms 6. Teaching Phase Suggestions for stress reduction 7. Re-Entry Phase Is this effective? Summary of session - - Promoting healthy behaviours- - - Health psychology and behaviour change Health psychology is largely concerned with developing programs to: Prevent smoking onset Help people quit smoking Curb alcohol consumption Achieve healthy weight Follow healthy lifestyle practices (e.g., exercise) Stick to prescribed medical regimes Etc. - - Psychologists use data to decide where promotion of is most needed eg lower socio-economic levels associated with higher smoking levels - Behaviour change and smoking Smoking treatment and prevention is a high priority for health psychologists Stop smoking approaches: Education about health consequences Stress management Identify and avoid high-risk situations Successful with 25-35% of long-term smokers - - Research suggests that exercise can relieve depression and anxiety Carek et al. (2011). The International Journal of Psychiatry in Medicine. Regular exercise can: Lower blood pressure Decrease risk of CHD Improve lung function Relieve symptoms of arthritis Decrease diabetes risk - - 30-70% of patients do not take their doctor's medical advice 80% do not follow recommendations in relation to: Diet Exercise Smoking Prescribed medications - - Barriers to lifestyle changes - Personal inertia Trying something new can be hard Many self-destructive habits do not create an imminent health threat - Mis-estimating risk We underestimate certain risks to our health and overestimate others - Feeling powerless Habitual behaviours can feel impossible to change Self-efficacy Doubting own ability to change - Health belief models Beliefs about the risks of a negative behaviour, and the costs of changing that behaviour dictate the likelihood of change. Rosenstock (1974) health beliefs model 1. Perception of personal threat 2. Perception of illness seriousness 3. Perception of behaviour change effectiveness 4. Perceived costs and benefits of changing behaviour and expected benefits - Beliefs about the risks and costs of behaviours and behaviour change is one thing, but how ready is the person to make lifestyle changes? Stages of readiness (Prochaska et al., 1992) 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance - Prevention programs Prevention is clearly preferable given the difficulty of modifying habitual behaviours Importance of educating young people about: Risks and negative consequences of obesity, smoking, excessive drinking, unsafe sex, etc. Benefits of good nutrition, regular exercise, positive friend groups Recognising and resisting peer pressure to engage in unhealthy behaviours Effective coping skills for daily living and dealing with stressors - Cognitive coping strategies - Involves identifying negative thought processes And then developing and practicing more effective thoughts Not used to remove stressors but to increase the perception that they can be tackled head on - Emotional coping strategies - Social support is perhaps the best coping strategy for dealing with negative emotions Dealing with negative emotions is better addressed via: cognitive, behavioural, and physical strategies - - Behavioural coping strategies Changing behaviours in subtle ways to make a stressor seem less threatening Developing time management plans is one of the most common behavioural coping strategies to deal with stress Avoiding toxic personalities - - Physical coping strategies Prescription medications can reduce feelings of stress Risks of tolerance and dependence issues Healthy nutrition and eating habits Regular exercise (HIIT, yoga, pilates, etc.) Mindfulness and breathing techniques - - - - - **Week 8 intelligence** **Learning outcomes** By the end of this module you should be able to:   1. Understand the issues associated with defining intelligence, including cultural interpretations of intelligence  2. Describe the key elements of the intelligence theories  3. Describe the early development of IQ tests  Definitions of Intelligence Ability to carry out abstract thinking (Terman, 1916). Power of good responses from the point of view of truth or fact (Thorndike, 1921). Adjustment or adaption of the individual to his total environment (Freeman, 1955). Ability to plan and structure one's behaviour with an end in view (Das, 1973). Ability to resolve genuine problems or difficulties as they are encountered (Gardner, 1983). Error-free transmission of information through the cortex (Eysenck, 1986). Reflects survival skills of species, beyond those associated with basic physiological processes (Sattler, 2001). 3 3 What do 'real' people think? Sternberg et al. (1981) asked non-psychologists and psychologists to define what is important for intelligence: Non-psychologists Practical problem solving ability Verbal ability Social competence Psychologists Verbal intelligence Problem solving ability Practical intelligence Some Polynesian navigators still travel long distances only with the information they carry in their heads!-- Have familiarity with the weather, waves, and celestial signs-- Need to be sensitive to every movement the boat makes-- Must measure the height and width of the approaching waves Yet, when these navigators were given tests of reasoning ability, they were unable to complete simple reasoning tasks commonly performed by 12-year-olds Other Polynesians non-navigators, who lived on the same island, but attended high school on another island were able to complete the reasoning tasks with relative ease. Solving puzzles and navigating the ocean both require skills associated with abstract thought But -- each requires a different set of acquired knowledge and problem solving skills Cross-cultural applicability If intelligence helps people adapt and manage tasks, it should be cross-culturally applicable But what a society understands as intelligence is linked to their particular ecology and social structure Different cultures = different circumstances that people need to adapt to The nature of intelligence Each culture provides individuals with the most appropriate and efficient ways to solve everyday challenges. These strategies then become part of people's cognitive processes. Therefore: Intelligence is the application of cognitive skills and knowledge to learn, solve problems and obtain ends that are valued by an individual or culture Intelligence is thus-- Multifaceted-- Functional-- Defined and shaped by culture Evolutionary perspective Consider context of evolution of intelligence Problems are solved to allow adaptation and thus survival and reproduction The social nature of humans may have influenced the development of intelligence Ability to experience own feelings and behaviours →better position to imagine others' feelings and behaviour Theories of intelligence Spearman\'s Two-Factor Theory Arose from correlation and factor analysis of different intellectual tasks. Found correlations between individuals' scores on different ability tests. Some groups of tasks intercorrelate more strongly than others Spearman's Two-Factor Theory: General + specific abilities General ability: a single latent factor that underlies all other abilities and is predictive of test scores. Specific ability: a range of specific abilities, such as mathematical or verbal ability. Spearman\'s 2-Factor Theory An individual's performance on an intelligence test is determined by two factors: 1. (g) - general intelligence-- General ability for complex mental work 2. (s)- specific ability-- unique to a test/sub test; e.g. maths or verbal skills. Spearman was less concerned about studying s, as it varied for each test of intellectual ability Thurstone\'s 7 Primary Mental Abilities Years of debate on the relative importance of g and s factors. 1930s: L.L. Thurstone: too much emphasis on Spearman's g. Too little diagnostic info on tasks contributing to overall score Instead formulated model of primary mental abilities Thurstone proposed 7 abilities, each relatively independent of g: word fluency verbal comprehension spatial ability perceptual speed numerical ability inductive reasoning memory At the end of his career, Thurstone acknowledged that his proposed seven primary mental abilities were correlated No longer completely opposed to Spearman\'s concept of g. \"there seems to exist some central energizing factor which promotes the activity of all these special abilities.\" Cattell and Horn A new structure of intelligence Raymond Cattell (1941), John Horn (1965) and others argued for a quite different structure: Fluid vs. crystallised intelligence Fluid Intelligence (Gf) Inherent, non-verbal capacity to learn and to solve problems Used to adapt to new situations Relatively free of cultural elements such as schooling, training, life experience Crystallised Intelligence (Gc) Accumulation of abilities learned through schooling or life experience Learned, habitual responses, heavily dependent on schooling or life experience e.g., vocabulary test, tool-identification test for motor mechanics Cattell-Horn-Carroll (CHC) Theory of cognitive abilities Amalgam of Cattell's & Horn's Gf-Gc theory and Carroll's (1993) Three-Stratum Theory. Hierarchical model:-- 10 broad fluid + crystallised components at the top-- \> 70 sub-components below (e.g., visual & auditory organisation, perceptual speed, specific memory capacities) very complex model reflects notion of multiple intelligences The Information-Processing Approach Examine the processes that underlie intelligent behaviour:-- Speed of processing: how rapidly a person can perform a mental task-- Knowledge base: information stored in longterm memory-- Ability to acquire and apply mental processes: can a person acquire and use new mental strategies? Assumes performance is normally distributed across a variety of intelligence relevant capacities Assumes performance on one capacity is weakly to moderately related to performance on other capacities Therefore, person 1 might be better at A and B but person 2 might be better at C and D Contemporary Approaches to Intelligence More recently: expanded view of how intelligence is seen Intelligence tests measure intellectual, scholastic abilities But what about more practical, social, and emotional skills?  Gardner: Multiple Intelligence Theory Different societies value different intelligences-- Western society: mathematical/logical and linguistic/verbal--Polynesian navigators: spatial and bodily/kinaesthetic intelligences--Collectivist societies: interpersonal intelligence Are the intelligences separate? Gardner's research suggests a pattern of strong, intermediate and weak correlations Criticisms of Gardner's MI theory Too broad No test has been developed to measure this Confounds talent with intelligence Ignores correlations between conceptually distinct functions Doesn't describe underlying processes May reflect personality factors Sternberg (2000) needs more empirical validation blurry line between intelligence and talent. Emotional intelligence - Goleman Related to Howard Gardner's concept of interpersonal and intrapersonal intelligence, refers to the ability to: -- perceive, appraise, and express emotions accurately and appropriately-- use emotions to facilitate thinking-- understand and analyse emotions and use emotional knowledge effectively-- regulate emotions to promote both emotional and intellectual growth Has been argued that EI can predict educational and occupational performance-- e.g., a popular measure of leadership skills However, a meta-analysis found a weak (r =.23) relationship between EI and job performance (Van Rooy& Viswesvaran, 2004). Established EI measures are only useful for specific occupations. For EI to be generalised across multiple occupations, further theoretical development is needed. The emergence of IQ tests - Alfred Binet Hired by French Government to devise test to identify children with special education needs. Tested reasoning and logic. Test had reasonable predictive validity and spread through Europe and the US Binet's criteria for selecting an item Item has to relate to \'common sense\'. Item has to be part of daily life. Item must separate 'dull' from 'bright' children. Item must be practical and easy to administer Sample Items Binet/Simon 1908 Year 5 Compare 2 boxes of different weight. Copies a square. Repeats a sentence of ten syllables Counts 4 sous Puts together two pieces in a game of patience Year 8 Reads selection and retains two memories. Counts 9 sous (3 single, 3 double). Names four colours. Counts backwards from 20. Compares 2 objects from memory Writes from dictation. Binet and Simon devised a test to measure intellectual development in children Mental age = average age at which children achieve an actual score-- An intellectually disabled child would not be able to answer questions typical for his or her chronological age-- e.g. a 7-yr-old who could only answer questions typical of a 5-yr-old = MA of 5 Calculated Mental Age Case 1: (C.A. 5.0 years)-- passes 5 tests at 5-year-old level so basal mental age = 5 years-- passes 2 tests at 6-year-old level so mental age = basal mental age (5) + 2/5 = 5.4 years. Case 2: (C.A. 5.0 years)-- passes 0 tests at 5-year-old level-- passes 5 tests at 3-year-old level-- passes 1 test at 4-year-old level-- mental age = 3.2 years Modern Tests of Intelligence 7 Louis Terman 1916 revised Binet and called it the Stanford-Binet (still in use today, but not as much as other tests) Revised items that didn\'t perform as expected. Added adult items Introduced use of the Intelligence Quotient To allow for comparison of test scores among persons, Terman and Stern devised the concept of the intelligence quotient (IQ): IQ = (MA/CA) x 100 MA = mental age CA = chronological age IQ= Mental Age x100 over chronological age Case 1 (C.A. 5 years) mental age 5 and 2/5 chronological age Allows direct comparison between children of different ages. I.Q = 5.4 /5 X 100 I.Q. = 108 9 e.g. Is a 7-year-old who gets all items for 9-year-olds right as intelligent as an 11-yearold who gets all items right for 9-year-olds? Problems with Stern\'s I.Q. Calculating IQ works well for children abilities are still developing Development slows in adolescence Development stabilises in adulthood. Comparing mental age to chronological age makes little numerical sense for adults. David Wechsler (WAIS) 1939 developed a test specifically for adults Test had 11 groups of similar items or sub-tests, e.g., vocabulary Developed tests for children (WISC) based on the WAIS Attempted to remove the biases associated with earlier intelligence Where we are now - Wechsler Intelligence Scales IQ is measured on a number of subtests which distinguish between-- Verbal Intelligence-- Non-verbal Intelligence Wechsler scales allow psychologists to identify areas of strength and weakness within individuals, and are the most commonly used IQ tests in western cultures today Week 9- issues with intelligence testing Current DSM levels- Mild intellectual disability IQ 50 to 70 Slower than typical in all developmental areas No unusual physical characteristics Able to learn practical life skills Attains reading and math skills up to grade levels 3 to 6 Able to blend in socially Functions in daily life 3 Moderate intellectual disability IQ 35 to 49 Noticeable developmental delays (i.e. speech, motor skills) May have physical signs of impairment (i.e. thick tongue) Can communicate in basic, simple ways Able to learn basic health and safety skills Can complete self-care activities Can travel alone to nearby, familiar places Severe intellectual disability IQ 20 to 34 Considerable delays in development Understands speech, but little ability to communicate Able to learn daily routines May learn very simple self-care Needs direct supervision in social situations Profound intellectual disability IQ less than 20 Significant developmental delays in all areas Obvious physical and congenital abnormalities Requires close supervision Requires attendant to help in self-care activities May respond to physical and social activities Not capable of independent living Intellectual Developmental Disorder (Intellectual Disability) Defined in DSM-V - TR by 3 dimensions: 1) deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, standardised IQ test 2) Concurrent impairment of adaptive functioning 3) Onset of deficits in the developmental period May be due to different origins-- May be genetic in origin: e.g., Down Syndrome-- May be biological in origin: e.g., Traumatic brain injury-- May be environmental in origin: Exposure to teratogens, e.g., Foetal Alcohol Syndrome Three areas of adaptive functioning are considered: 1.Conceptual-- language, reading, writing, math, reasoning, knowledge, memory. 2.Social-- empathy, social judgment, communication skills, the ability to follow rules and the ability to make and keep friendships. 3.Practical-- independence in areas such as personal care, job responsibilities, managing money, recreation, and organizing school and work tasks. Extremes: Giftedness Can reflect academic, musical, social or athletic ability. Often associated with an IQ of over 130 but there is no clinically agreed cutoff Associated stereotypes: Physically weak Mentally unstable Reclusive/Eccentric Compensation - talent in one area is accompanied by deficit in another Renzulli: 3 intersecting components of true giftedness (genius)- Exceptional intelligence in specific domain, exceptional motivation and exceptional creativity. Creativity Ability to produce valued outcomes in a novel way. Measured through divergent thinking:-- ability to generate multiple possibilities in a given situation. And convergent thinking ---- finding the best idea from the range of ideas generated through divergent thinking Sternberg includes creativity in his triarchic model, but it is generally considered a separate to ability Ch 8 definitions-  WEEK 10 CULTURE What is culture? "It is generally agreed that culture and our sense of identity are mutually constructed. That is, we both construct and are constructed by, our cultural context." Bernstein et al. (2021) 3 1What is culture? Culture is a set of shared meanings and ideas that are transmitted across generations Culture includes artefacts such as symbols, art, dance and language, and values Culture guides the ways in which we think and feel about ourselves and those we interact with Culture helps us to orientate ourselves towards an increasingly complex world 4 Why do we have culture? Terror management theory: Culture acts as a buffer against general anxiety Being a member of a culture reduces this feeling Creation of a shared reality: Humans have a basic desire to believe that others think and feel about certain issues in the same way By-product of human interaction: By interacting, we share beliefs and behaviours, culture can result from repeated interactions 5 Characteristics of a culture Language Dress and appearance Food and eating habits Music, dance and art Relationship with time Interpersonal relationships Beliefs, attitudes and values 6 2How is culture transmitted? Enculturation is the process of absorbing and internalising the rules of our culture, typically through intergenerational teaching Family Community Institutions Peers Elders?\... 7 How is culture transmitted? 8 What culture is NOT Ethnicity Refers to membership of a group linked by race, nationality, language or a common cultural heritage Race A socially defined population that is derived from distinguishable physical characteristics 9 3How does culture affect behaviour Ecological factors Social factors Biological factors Enculturation via Family Community Culture Institutions 10 Dimensions of culture? Individualist vs. collectivist cultures Individualist cultures place emphasis on the autonomy of the individual Focus on personal goals and achievement Greater prevalence of loneliness Collectivist cultures place emphasis on the interrelatedness of all members and their collective endeavours Consider oneself as part of a group Greater prevalence of fear of rejection 11 What is culture? Dimension Hofstede's dimensions Definition Individualism/collectivism The extent to which people are motivated to act as individuals or members of a community or group Power/distance Uncertainty/avoidance Masculinity How much people are prepared to bear differences in wealth and power The ways in which people and groups cope with or tolerate uncertainty The extent to which common characteristics of the stereotype of males as providers, competitors and strong dominators the more 'feminine' characteristics such as nurturing, caring and providing Long-term/short-term orientation 12 The extent to which a culture values a long-term versus a short-term view of the future Psychological processes: Attitudes Values Beliefs Opinions Worldviews Norms Behaviours 4Alternatives to Hofstede's dimensions Tight cultures Have strong social norms and a low tolerance of deviant behaviours Loose cultures Have weak social norms and a high tolerance of deviant behaviours 13 Cultural and cross-cultural psychology Cultural psychologists study the ways in which people are affected by the culture they live in (individual psychological processes are shaped by cultural context) Cross-cultural psychologists compare the similarities and differences in behaviour across different societies or cultures 14 Theoretical issues Absolutism Assumes that psychological phenomena are identical across different cultures Relativism Assumes that all human behaviour is culturally determined Universalism Assumes that there are basic principles underlying behaviour, but that culture determines the display of these principles 15 5Universalism? Emotional experiences are similar, but display is different 16 Research methods There are two broad perspectives: Emic perspective: is culture-specific and involves focusing on one cultural group and examining particular psychological aspects of that group. Etic perspective: is cross-cultural and involves the search for commonalities or differences across cultures 17 Approaches to cultural research Goldberger and Veroff (1995) Study of individual cultures Comparison of behaviour across cultures Study of the interaction between peoples of different cultures 18 6Specific methods Cross-cultural comparison studies involve comparing two or more different cultures in relation to a particular psychological variable Cross-cultural validation studies examine whether a psychological variable in one culture can be applied and have meaning in another culture Unpackaging studies try to explain why cultural differences may occur 19 Cross-cultural comparison studies Cultural influences on problem-solving Chinese and American college students asked to solve two logical problems (Chen et al., 2004) 20 Challenges The problems of: 1. Research methods 2. Equivalent samples 3. Interpreting results 4. Researcher bias 5. Sensitive issues 6. Non-equivalent phenomena across cultures 21 7WEIRD psychology W estern E ducated I ndustrialised R ich D emocratic An issue that plagues much of psychological research Based on convenience of the research sample Age missing from this list 22 8 Culture and Identity and Indigenous Psychology Dr Daniel Zuj 1 Lecture outline What does culture mean for our identity? Types of cultural identities Cultural contact Indigenous psychology Reading Bernstein et al. (2021). Chapters 15 & 16. 2 Culture and identity It is impossible to imagine a sense of self without the cultural backdrop through which identity is formed and continuously develops We learn through the process of enculturation (cultural socialisation) from our family Remote enculturation (Ferguson et al., 2016) Ethnocentrism 3 1Ethnic and racial identity Janet Helm's (1994) White racial identity development model 1. Contact 2. Disintegration 3. Reintegration 4. Pseudo-independence 5. Immersion and emersion 6. Autonomy Evaluated recently by Moffitt et al. (2021) 4 Ethnic and racial identity Criticisms of Janet Helm's (1994) White racial identity development model Empirical evidence is somewhat lacking Little explanation for progression through stages Ethnic racial identity must be understood in the context of experiences across the lifespan 5 Ethnic and racial identity Phinney's (1989) Ethnic identity development stage model Development of ethnic identity begins during adolescence, with three stages. 1. Unexamined 2. Exploration 3. Achievement 6 2Identity of transnational adoptees What about the identity development of transnational adopted children? 7 Identity of transnational adoptees Transnational adoptees face the unique experience of potential connection to two cultural backgrounds: 1. The heritage culture (ethnic identity) 2. The host-country culture (national identity) Bicultural identity integration is dependent on ethnic identity development, resulting in better psychological well-being (Ferrari et al., 2015) 8 Cultural contact Culture shock - Acculturation 9 3Cultural contact Berry's (1990) typology Positive relationship to dominant society YES Retention of cultural identity YES NO 10 Culture and identity Cultural contact can result in: Racism Ethnocentrism Discrimination Prejudice Stereotypes Integration Assimilation Genocide and moral exclusion But also, cultural competence 11 Indigenous psychology What do we mean by indigenous people? Identity Self-identification History Shared languages, cultural practices, beliefs Links to territories and natural resources What is the importance of discussing indigenous people separately? To avoid homogenising 12 NO Segregation Marginalisation 4Indigenous psychology in Australia Aboriginal and Torres Strait Islander people The original first people of Australia Among the oldest cultures on Earth Distinct cultural groups but with many shared experiences and resulting health consequences: Dispossession Marginalisation Racism The Stolen Generation 13 Indigenous psychology in Australia History of colonisation 1. Invasion and colonisation (1788-1890) 2. Protection and segregation (1890s-1950s) 3. Assimilation (1940s-1960s) 4. Integration, self-determination and selfmanagement (1967-1990s) 5. Reconciliation (1991-present) 14 Working with Indigenous peoples Considering whiteness Reference and Indigenous Terms of Developing Indigenous cultural competence Element Knowledge Details Understanding of culture and its importance in behaviour and identity. Values Skills Attributes Understanding our own values and beliefs, and the willingness to challenge them. Collaboration, teamwork, consultation and self-reflection. Critical understanding of our personal attributes, informed by issues such as whiteness, racism, cultural blindness, etc. 15 5Cultural aversion (destructiveness) Cultural incompetence (incapacity) Cultural blindness Cultural pre-competence Cultural competence Cultural proficiency Culture and health Cultural considerations in psychological assessment Impact of psychological assessment on identity Reading Bernstein et al. (2021). Chapter 15 & 16. 2 Culture and health Different cultures perceive different models of health 3 1Culture and health The health of individuals is nested within community health and attitudes (Berry, 1998) Levels of analysis Categories of health phenomena Cognitive Community (cultural) Individual (psychological) Health conceptions and definitions Affective Health norms and values Behavioural Social Health practices Health roles and institutions Health knowledge and beliefs 4 Health attitudes Health behaviours History of cross-cultural assessment Henry H. Goddard (1866-1957) Translated the Binet Intelligence test from French to English Classified 83% Jews, 80% Hungarians, 79% Italians, 87% Russians as "feeble-minded" Interpersonal relationships Terman (1916) pointed out that using a translated version of the Binet overestimated the "mental deficiency" rate in native English speakers, let alone immigrants! 5 Issues of cross-cultural assessment Language and the use of translators Non-verbal communication Speed of task completion (pace of life) Standards of evaluation 6 2Issues of cross-cultural assessment Cultural dimensions important for assessments Cultural identity Cultural explanations of illness Cultural factors associated with psychosocial and environmental functioning Cultural issues in the relationship between the client and the practitioner Overall cultural assessment 7 Assessment of Indigenous peoples 1. Pro-active steps before the assessment 2. The outset of the assessment 3. The assessment process 4. The interpretation and reporting of results Adams, Drew & Walker (2014) 8 Assessment of Indigenous peoples Assessments with Indigenous people should also be: Qualitative and functional Undertaken from an Indigenous perspective, not 'indigenised' 9 3Does 'normal' and 'abnormal' cross cultures? Is psychopathology cross-culturally absolute? Most psychological/psychiatric disorders evident across cultures, but there are a few culture-bound disorders 10 The DSM-IV and culture-bound syndromes Amok--Malaysia and Indonesia Withdrawal, rage, dissociative episodes, paranoia Sufferers can attack and kill others Piblokto (Arctic hysteria)-- Arctic Circle Dissociative episode followed by extreme excitement, then a seizure, coma and amnesia Lasts from a few minutes to hours May be related to vitamin A toxicity 11 The relationship between psychological assessment and identity An important distinction: The role of identity in psychological disturbances The role of psychological disturbances in identity 12 4Identity in the DSM-5 The role of identity in psychological disturbances "...experience of oneself as unique, with clear boundaries between self and others; stability of selfesteem and accuracy of self-appraisal; capacity for, and ability to regulate, a range of emotional experience" DSM-5 (APA, 2013) Diagnostic criteria for: Borderline personality disorder Dissociative identity disorder 13 Identity in the DSM-5 Long-known symptoms of disorders such as major depression, bipolar disorder, dysthymia, and borderline and avoidant personality disorders: Low self-esteem Feelings of worthlessness Unstable self-image These are all distortions of identity 14 Psychological diagnosis and identity Psychological diagnosis has the important benefits of: Facilitating access to resources and treatment Appropriate diagnostic labels can positively affect help-seeking and symptom management 'Common language' can streamline communication between different services 15 5Psychological diagnosis and identity Psychological diagnosis also has important implications for a young person's: Self-concept An individual's set of beliefs about himself/herself Social identity Portion of the self-concept that derives from membership of social groups 16 Psychological diagnosis and identity Positives of diagnosis Sense of relief that symptoms result from a real disease entity Negatives of diagnosis Diagnosis can provoke further feelings of worthlessness and despair Diagnosis can validate the authenticity and severity of symptoms Can protect self-image by lessening personal culpability resulting from undesirable behaviour Diagnosis disclosure can result in more lenient treatment Diagnosis may distort previous sense of self-image Diagnosis may function as a self-fulfilling prophecy Diagnosis disclosure may exacerbate stigma of mental illness symptoms Diagnosis can introduce a community of similar people 17 Disclosure may result in disadvantages in different settings O'Connor et al. (2018) Psychological disturbances and stigma The field of psychological assessment and testing is shaped by a number of ethical and moral obligations, such as: Receiving the least stigmatizing label 18 6Psychological disturbances and stigma Chronic schizophrenia Poorly understood by the public and often met with fear, mistrust, and prejudice Posttraumatic stress disorder Stigmatization contributes to reduced chance of spontaneous remission, greater symptom severity, and reduced treatment response Week 11 personality **Learning outcomes** At the completion of this module, you should be able to: 1. Explain the psychodynamic (both Freudian and Neo-Freudian) approach to personality 2. Explain the social-cognitive theory of personality 3. Explain the humanist theory of personality 4. Evaluate the strengths and limitations of these personality theories 1\. Drive theory  2\. Psychosexual development  3\. Topographical model  4. Structural model What is personality? 'The unique pattern of enduring thoughts, feelings and actions that characterise a person." Bernstein et al. (2021) Can often be conceptualised as a cluster of traits: Relatively stable and long-lasting tendencies that influence behaviour across environments (as opposed to states) The study of personality focuses on two broad areas: Nomothetic: understanding individual differences in particular personality characteristics Assess individual differences in personality Idiographic: understanding how the various parts of a person come together as a whole Construct general theories of personality Sigmund Freud (1856-1939) Austrian neurologist Founder of psychoanalysis and the psychodynamic theory of personality Developed theories related to the repression of stressful/sexual experiences Accused of 'suggestion' in sessions with clients Freud and the Psychodynamic Approach Freud developed a number of models of personality Topographic Drive Developmental Structural Three core assumptions: 1\. Psychic determinism: we are at the mercy of our underlying drives and conflicts, which shape our behaviour. Although hidden, they can be seen through Freudian slips and dreams. 2\. Symbolic meaning: all actions (even minor) reveal our underlying drives 3\. Unconscious motivation: we are mostly unaware of our motivations Freudian Slips Parapraxis Error in speech, memory or physical action In Freudian terms believed to be caused by the unconscious mind Psychological conflict bubbling to the surface Thoughts are (un)consciously repressed and then unconsciously released Three types of mental processes Conscious: rational, goal-directed, centre of awareness Preconscious: could become conscious at any given time (e.g., knowledge base) Unconscious: irrational, not based in logic, repressed and, thus, considered inaccessible Still plays a role in governing behaviour Freud's Drive (Instinct) model Based on Darwin's work, Freud suggested human behaviour is motivated by two drives (or instincts): Aggressive Drive Sexual (Libido) Drive Libido refers to pleasure-seeking and sensuality as well as desire for intercourse 11 Freud's Developmental model Libido follows a developmental course during childhood: Stages of psychosexual development Fixed progression of change from stage to stage Notion of fixation at a particular libidinal stage Freud's Structural model Id: Our basic desires and drives Ego: Interacts with the 'real world' and makes decisions Superego: Sense of right and wrong, directing us to behave morally Defence mechanisms People regulate their emotions and deal with conflicts by employing defence mechanisms Unconscious: Aim is to strengthen or reinforce positive emotion and protect from negative or unpleasant emotion The use of defence mechanisms is normal Can be healthy as a temporary coping mechanism Defence mechanisms Repression: memories or thoughts kept out of conscious awareness Denial: Refusal to acknowledge external reality Displacement: Emotions directed towards a substitute target 17 Defence mechanisms Regression: Return to an earlier stage of psychosexual development Reaction formation: Unacceptable feelings or impulses turned into opposites Rationalisation: Actions explained away to avoid uncomfortable feelings Assessing unconscious patterns Projective Tests: Assume that when presented with a vague stimulus, people will 'project' their own impulses and desires into a description of the stimulus Rorschach Inkblot Test Thematic Apperception Test (TAT Neo-Freudian perspectives Alfred Adler - Primary motive is not sex or aggression but to strive for superiority Origin of the phrase: "inferiority complex" A basic feeling if inadequacy and insecurity, deriving from actual or imagined physical or psychological Carl Jung - Collective unconscious ancestral memory that explains similarities in beliefs across cultures People develop differing degrees of introversion and extraversion Karen Horney Feminist perspective Womb envy vs. penis envy Erich Fromm, Erik Erikson, Harry Stack Sullivan Crave social connection once biological needs are met- escape from freedom Contributions and Limitations -- Acknowledgement of unconscious forces and their potential influence on behaviour Importance of childhood experiences in determining adult personality Human thought and action -- meaning Inadequate scientific base and poor testability Sexism Behavioural approaches -- Differences in our personalities stem largely from our learning histories Personalities are bundles of habits acquired by classical and operant conditioning Personality is controlled by genes and contingences. Conditioning. Social-cognitive theories The way people encode, process and think about information determines their personality Several necessary conditions for a behaviour: Situation encoded as relevant and meaningful Belief in own ability and actual ability Self-regulation of ongoing activity Albert Bandura -- Social Learning Theory We learn to be the person we are by watching other people and seeing who/what gets rewarded and why A child who sees others involved in helping and being rewarded will emulate this behaviour 5 Albert Bandura -- Social Learning Theory Reciprocal Determinism Personality is a constant interplay between environment, behaviour and our own beliefs Social-cognitive -- Locus of Control (Rotter) Internal locus of control Life outcomes are under personal control Positively correlated with self-esteem Internals use more problem-focused coping External locus of control Luck, chance, and powerful others control behaviour Social-cognitive -- Locus of Control (Rotter) Sample locus of control scale items Answering "true" to items 1 and 3 would score toward an external LoC Answering "false" would count toward an internal LoC Items 2 and 4 score in the opposite direction. Cognitive-affective theory (Mischel) Cognitive person variables Encodings: beliefs about the world and other people Expectancies: self-efficacy, and what can be expected following actions Affects: feelings and emotions Goals and values: what a person believes in and wants to achieve Competencies and self-regulatory plans: things a person can do and the ability to thoughtfully plan and control goal-directed behaviour Contributions and Limitations Focus on the role of thought, memory and experiences in personality Readily testable Emphasises rationality at the expense of emotion Assumes people consciously know what they think, feel and want Humanistic approaches Emerged as an alternative to psychoanalysis and behaviourism Focus on those aspects that are distinctly human Trying to find the meaning in life Being true to the self Maslow --Hierarchy of Needs Self-actualisation Maslow said that self-actualised people tend to be creative, spontaneous and accepting of themselves and others Can come off as difficult to work with or aloof Prone to peak experiences Carl Rogers Rejected notion of determinism and embraced free will Proposed self-actualisation as core motive of personality Carl Rogers' model Three major components of personality: 1\. The organism (innate, genetic blueprint) 2\. The self (set of beliefs about who we are) 3\. Conditions of worth (expectations we place on ourselves -- can result in incongruence) Evaluations of humanistic approaches Has resulted in the development of parent education programs designed to help children maximise their potential by avoiding conditions of worth Emphasises the uniqueness of the individual Naïve view of human personality Better at describing personality than explaining it