Clinical Psychology PDF

Clinical psychology  Barlow Chapter 1 just having a abnormal behavior in historical context dysfunction is not...

Clinical psychology  Barlow Chapter 1 just having a abnormal behavior in historical context dysfunction is not enough to meet the psychological disorder: a psychological dysfunction within an individual criteria for a associated with distress or impairment in functioning and psychological a response that is not typical or culturally expected disorder phobia: a psychological disorder characterized by marked and persistent fear of an object or situation abnormal behavior: a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected psychological dysfunction: a breakdown in cognitive, emotional, or behavioral functioning distress or impairment defining psychological disorder by distress alone is not enough. Most disorders are simply extreme expressions of otherwise normal emotions, behaviors, and cognitive processes. atypical or not culturally expected An accepted definition behavioral, psychological, or biological A criterion that is important but insufficient dysfunctions that are unexpected in their to determine if a disorder is present by cultural context and associated with present itself. Deviating from the average does not distress, and impairment in functioning, or work well as a definition for problematic increased risk of suffering, death, pain, or abnormal behavior impairment. It is never easy or determine what represents dysfunction. The science of Psychopathology Psychopathology: the scientific study of psychological disorders. Scientist practitioners: a scientific approach to clinical work and may function as mental health practitioners. Presenting problem: why the person came into the clinic Clinical description: represents the unique combination of behaviors, thoughts, and feelings that make up a specific disorder. prevalence: how many people in the population as a whole have the disorder incidence: stats on how many new cases occur during a given period Most disorders follow a individual pattern or course. Ex: schizophrenia follows a chronic course while mood disorders follow an episodic course acute onset: begins suddenly insidious onset: develops gradually prognosis: the anticipated course of a disorder developmental psychology: study of changes in behavior developmental psychopathology: study of changes in abnormal behavior Causation, Treatment, and Etiology Outcomes Etiology: the study or origins; why a disorder begins or what causes it and includes biological,psychological, and social dimensions.  Historical conceptions of abnormal behavior three models: the supernatural, the biological, and psychologicalm Hippocrates Galen et al assumed normal brain functioning was related to four bodily fluids or humors; blood, black bile yellow bile, and phlegm. Physicians believed that disorders resulted from too much or too little one of the humors. These are related to the Greek conception of the four basic qualities of heat, dryness, moisture, and cold. Syphilis STD that induces delusion of persecution, delusion of grandeur, and other bizarre behaviors. Penicillin cures syphilis, but with the malaria cure, madness and associated behavioral and cognitive symptoms for the first time were traced directly to a curable infection. John P Grey: the most influential American psychiatrist of the time his position was that the causes of insanity were always physical and the mentally ill should be treated as physically ill. psychosocial treatment: approaches to the causation of psychopathology focusing on psychological factors and social and cultural factors moral therapy: psychosocial approach in the 19th century that involved treating patients as normally as possible in normal environments Asylum reform and the decline of moral therapy mental hygiene movement: mid 19th century effort to improve care of the mentally disordered by informing the public of their mistreatment. Dorothea Dix began this movement psychoanalysis: psychoanalytical assessment and therapy which emphasizes exploration of and insight into unconscious processes and conflicts pioneered by Sigmund Freud behaviorism: explanation of human behavior, including dysfunction, based on principles of learning and adaptation derived from experimental psychology Psychoanalytic theory Breuer and Freud had discovered the unconscious mind and its apparent influence on the production of psychological disorders. catharsis: rapid or sudden release of emotional tension thought to be an important factor in psychoanalytic therapy psychoanalytic model: complex and comprehensive theory originally advanced by Sigmund Freud that seeks to account for the development and structure of personality as well as the origin of abnormal behavior based on inferred inner entities and forces The structure of the mind id: the source of our strong sexual and aggressive feelings or energies ; unconscious, animalistic instinct and pleasure principle libido: the energy or drive within the id operates according to the pleasure principle with an overriding goal of maximizing pleasure and eliminating tension or conflict irrational and illogical process the devil ego: finds realistic and practical ways to satisfy id drives; sense of self and is consciously accessed operates according to the reality principle logic and reason (secondary process) mediates conflict between the id and the superego you  superego: internalized moral principles of parents and society; unconscious, preconscious, and conscious; conscience and moral principles the angel counteracts potential dangerous aggressive and sexual drives of the id intrapsychic conflict: the struggles among the id, superego, and ego the id and the superego are unconscious and we are fully aware only of the secondary processes of the ego. defense mechanisms common patterns of behavior often adaptive coping styles when they occur in moderation observed in response to particular situations. In psychoanalysis these are thought to be unconscious processes originating in the ego psychosexual stages of development psychosexual stages of development: oral, anal, phallic, latency, genital. The sequence of phases a person passes through during development. Each stage is named for the location on the body where id gratification is maximal at that time castration anxiety: the fear in young boys that they will be mutilated genitally because of their lust for their mother neurosis: obsolete psychodynamic term for psychological disorder thought to result from unconscious conflicts and the anxiety they cause. carl later developments in psychoanalytic thought jung ego psychology: emphasizes the role of the ego in : development and attributes psychological disorders to failure introduced of the ego to manage impulses and internal conflicts. Also collective unconscious : known as self psychology a wisdom accumulated object relations: the study of how children incorporate the images, memories, and values of a person who was important by society and culture that is to them and to whom they are emotionally attached. stored deep in individual memories and passed down fromgen to gen introversion / extroversion psychoanalytic psychotherapy Spiritual/religious drives free association: patients are instructed to say whatever comes to mind without the usual socially required censoring; intended to reveal emotionally charged material that may be repressed because it is too painful or threatening to the conscious. dream analysis: therapist interprets the content of dreams, supposedly reflecting the primary process thinking of the id and relates the dreams to symbolic aspects of unconscious conflicts. transference: psychoanalytic concept suggesting that clients may seek to relate to the therapist as they do to important authority figures, particularly their parents psychodynamic psychotherapy: contemporary version of psychoanalysis that still emphasizes unconscious processes and conflicts but is briefer and more focused on specific problems  humanistic theory self actualizing: process emphasized in humanistic psychology in which the behavioral model people strive to achieve their highest potential against difficult life experiences also known as the cognitive behavioral model or social learning model brought the systematic person centered therapy: the client rather than the counselor primary directs development of a more scientific approach to the course of discussion, seeking self discovery and self responsibility psychological aspects of psychopathology unconditional positive regard: the complete and almost unqualified acceptance of most of the clients actions and feelings Humanistic therapists believed that relationships, including the therapeutic relationship, were the single most positive influence in facilitating human growth pavlov and classical conditioning extinction: learning process in which a response classical conditioning: a type of learning in which a maintained by reinforcement in operant conditioning or neutral stimulus is paired with a response until it pairing in classical conditioning decreases when that elicits that response reinforcement or pairing is removed; also the procedure of removing that reinforcement or pairing the beginning of behavior therapy systematic desensitization: behavioral therapy technique to diminish excessive fears involving gradual exposure to the feared stimulus paired with a positive coping experience usually relaxation behavior therapy: array of therapy methods based on the principles of behavioral and cognitive science as well as principles of learning as applied to clinical problems. It considers specific behaviors rather than inferred conflicts as legitimate targets for change B F Skinner and Operant Conditioning Shon B watson reinforcement: consequences for behavior that strengthen it or increase its frequency. Positive reinforcement involves the contingent delivery of a desired consequence. Negative reinforcement is the contingent escape from an aversive consequence. Unwanted behaviors may result from their the founder of reinforcement or the failure to reinforce desired behaviors behaviorism · Albert shaping: the development of a new response by reinforcing successively more similar versions of that response. Both desirable rat study and undesirable behaviors may be learned in this manner · peter rabbit study What is a Psychological disorder? Accepted DSM-5 definition of Abnormal Psychology: Psychological dysfunction: disturbances in cognition, emotion regulation, or behavior Cultural context: unexpected in cultural context, outside cultural norms Distress/impairment: personal distress and or substantial impairment in functioning Breakdown in cognition (how/what we think) behavioral (what we do) emotional (how we feel) Neurobiological functioning how our brain and body functions ex: disturbances in how different parts of the brain communicate with one another to help you regulate your emotions Cultural context response is not typical or culturally expected Distress and impairment in functioning distress or impairment to self or others History and models of psychopathology: the supernatural tradition Three dominant traditions have existed in the past and still today to explain abnormal behavior supernatural biological psychological etiology: cause or reason for something The supernatural tradition a number of different theories about mental illness are considered part of the supernatural tradition idea was that deviance= battle of good vs evil ex: mass hysteria, =emotion contagion If you thought unusual behavior came from demons, witches, or bad spirits, how would you try to treat people? Trepanation has been used since ancient times to release demons, exorcism was thought to get rid of the demons causing illness, blaming bizarre or inexplicable behavior on witches led to the Salem Witch trials in the late 1600’s Other worldly causes such as the moon or gravitational pull (astrology): what treatment does this suggest? History and models of psychopathology: the biological tradition The search for physical mechanisms of and treatments for mental illness. It is the basis of much of what we will discuss Hippocrates (460-377 BC) Galen: second figure, proposed normal functioning related to the four bodily fluids or humors, psychiatric differences were related to in balances in humors. Regulated environment to regulate the humors were thought to treat differences The biological tradition demonstrated that mental disorders have biological mechanisms Syphilis: an early example that changed thinking std caused by bacteria; in late stages can present with psychosis-like symptoms Louis Pasteur’s germ theory developed ~1870’s Early biological treatments: ECT (1938), trans orbital lobotomy (1936, Freeman and Watts) Psychotropic medications the 1950’s; increasingly available the 1980’s: selective serotonin, reuptake inhibitors (prozac) Neuroleptics (thorazine) Benzodiazepines (valium) Tricyclics (imipramine) Mood stabilizers (lithium) Does therapy have a place in the biological tradition? Behavioral changes can influence biological functioning Cognitive activities can influence biological functioning (often via behavior) The psychological tradition The psychological tradition reflects the change toward viewing mental illness as having a cognitive, behavioral, and social etiology and context early proponents: plato, aristotle etiology: eg early learning environment treatment: provide new learning experiences through rational discussion moral therapy (first half of the 19th century) Philippe pinel and jean baptiste pussin asylum reform and the decline of moral therapy moral therapy declines in the mid 19th century dramatic increases in number of patients why so many more patients? in part: mental hygiene movement another factor: the prominence of the biological model after the decrease in moral therapy, the psychological tradition was dormant until two new approaches emerged in the 20th century 1. psychoanalysis (see modern incarnations, including psychodynamic therapy which often incorporates humanistic/existential perspectives) 2. behaviorism Psychoanalysis major contributions of Freud Human behavior can be influenced by unconscious forces 1. conscious 2. pre conscious 3. unconscious Proposed that all of our thoughts, feelings, and impulses are caused by unconscious desires Proposed that it is therapeutic to recall and process emotional trauma that has been made unconscious, therapy releasing tension (catharsis) As the ego conflicts with the id and super ego, it can Freud’s Tripartite Theory of the Mind use defense mechanisms that allow it to keep functioning. ( these are still influential ideas) “coping mechanisms” Psychoanalytic Psychotherapy Modern day: Psychodynamic therapy is the modern incarnation; includes principles of psychoanalysis (as well as humanistic/ existential approaches) The behavioral model is an attempt to to bring a systematic, scientific approach to psychological aspects of psychopathology pavlov: classical conditioning skinner: operant conditioning behavior therapy Classical conditioning CS (bell) - US (food) - UR (drooling) - CR (drooling to bell) Test if the conditioned stimulus grants a conditioned response unconditioned: things that happen naturally, before training conditioned: things that happen as a result of training Acquisition Classical conditioning basic repeatedly pairing a CS with a US to produce a CR principles (possible to develop CR after a single CS US pairing but less stimulus generalization: After a likely) CR has been paired with a CS, Extinction the same CR will likely occur After conditioning occurs, repeatedly showing the CS without with similar stimuli without the US will make the CR weaker and disappear added training Greater similarities will operant conditioning produce stronger responses A specific action ( an operant response ) increases or decreases depending on the consequences in the environment stimulus discrimination: subject responds to CS but not to a similar stimulus because operant change in change in the CS was paired with a US response environment response but the similar stimulus was presented without the US rat pushes lever skinner defined operant learning as rat pushes lever gets food again voluntary and goal directed controlled by it’s consequences strengthened if rewarded (reinforced) or weakened if punished reinforcers increase behavior  Operant conditioning consequence procedure behavior behavior increases decreases positive Stimulus positive reinforcement punishment ( get something good) I get applied something aversivel Stimulus negative reinforcement negative removed I remove something punishment negatives I remove something good ( shaping: breaking down desired behavior into smaller sub steps that are reinforced until desired behavior is reached. psychopathology and learning theory psychology symptoms and disorders arise from maladaptive learning either through operant conditioning, classical conditioning, or both systematic desensitization might be a treatment systematic desensitization create fear hierarchy: list of scary situations with feared stimulus from mildly to highly scary create coping plan: a list of intentional responses eg breathing exercises, adaptive cognitive responses engage in each activity in fear hierarchy from least to most scary; use coping skills, evaluate each step with therapist biological, social, and psychological factors act on and are influenced by Integrative models one another to produce or shape defining and studying psychopathology requires a broad approach psychiatric health multiple, interactive influences biological, psychological, social factors scientific emphasis neuroscience cognitive, behavioral sciences  multidimensional integrative approach: Study of Barlow chapter 2 psychopathology that holds psychological disorders as always being the products of multiple interacting casual factors hupothes is that The diathesis stress model: an inherited tendency (vulnerability) and specific stressful conditions are required to produce a disorder. diathesis/vulnerability Diathesis is genetically based and the stress is environmental. They must interact to produce a disorder. gene-environment correlation model: hypothesis that with a genetic predisposition for a disorder may also have a genetic tendency to create environmental risk factors that promote the disorder. epigenetics: the study of factors other than inherited DNA sequence such as new learning or stress that alter the The structure of the brain phenotypic expression of genes the brain stem and the forebrain. The lowest part of the brain stem, the hindbrain Neuroscience and its contributions to contains the medulla, pons, and cerebellum. The Psychopathology hindbrain regulates many automatic activities such as neuroscience: study of the nervous system and its role m breathing, heartbeat, and digestion. The cerebellum behavior, thoughts, and emotions controls motor coordination The mid brain: contains parts of the reticular central nervous system: brain and spinal cord activating system which contributes to processes peripheral nervous system: somatic nervous system and of arousal and tension such as when we are autonomic nervous system awake or asleep. The top of the brain stem: the thalamus and the neurons: individual nerve cell responsible for transmitting hypothalamus; involved broadly with regulating information behavior and emotion. action potentials: short periods of electrical activity at the membrane of a neuron., responsible for transmission of signals within the neuron. terminal button: the end of an axon of a neuron where neurotransmitters are stored before release. synaptic cleft: space between nerve cells where chemical transmitters act to move impulses from one neuron to the next neurotransmitters: chemicals that cross the synaptic cleft between nerve cells to transmit impulses from one neuron to the next. Their excess or deficiency is involved in several psychological disorders. excitatory: activating inhibitory: suppressing  Cingulate gyrus Pineal gland Frontal lobe Thalamus Cerebral cortex Parietal lobe Corpus Superior callosum colliculus Thalamus Tissue Inferior Midbrain dividing colliculus lateral Tectum ventricles Occipital lobe Nucleus Tegmentum accumbens Superior and inferior colliculi Pons Hypothalamus Midbrain Pituitary gland Cerebellum Posterolateral Pons Medulla view of Medulla brain stem Spinal cord Central canal of spinal cord E FIGURE 2.7B Major structures of the brain. (Reprinted, with permission, from Kalat, J. W. (2009). Biological Psychology, 10th edition, © 2009 Wadsworth.) Cingulate gyrus Anterior Fornix thalamic nuclei Septal nuclei Mamillary bodies E FIGURE 2.7C Frontal lobe Hippocampus The limbic system. (Reprinted, with Olfactory bulb Parahippocampal permission, from Kalat, J. W. (2009). gyrus Biological Psychology, 10th edition, Amygdala (limbic lobe) © 2009 Wadsworth.) Caudate nucleus Thalamus Globus Putamen pallidus (lateral) (medial) Amygdala E FIGURE 2.7D The basal ganglia. (Reprinted, with permission, from Kalat, J. W. (2009). Biological Psychology, 10th edition, © 2009 Wadsworth.) 46 CHAPTER 2 A N I N T E G R AT I V E A P P R O A C H T O P S Y C H O PAT H O L O G Y Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 lobes: temporal, occipital, parietal, and frontal temporal: hearing /advanced visual processing parietal: touch/body position occipital lobe: vision frontal/prefrontal cortex: thinking, reasoning, and planning, and long term memory The peripheral nervous system somatic nervous system: controls muscles autonomic nervous system: sympathetic nervous system+ parasympathetic nervous system regulates the cardiovascular system and the endocrine system as well as digestion and body temp endocrine system: produces hormones and releases them directly into the bloodstream. The adrenal glands produce epinephrine aka adrenaline. The thyroid gland produces thyroxine which facilitates metabolism and growth. The pituitary gland produces a variety of regulatory hormones. The gonadal glands produce sex hormones such as estrogen and testosterone. agonist: increase activity of a neurotransmitter antagonist: decrease or block a neurotransmitter Two major neurotransmitters glutamate: excitatory transmitter that turns on many different neurons, leading to action. GABA: inhibitory neurotransmitter; inhibits/regulates the transmission of information and action potentials. third monoamine norepinephrine dopamine (monoamine) Basic Neuroscience Initially we thought the brain is just a lump of uniform tissue. Then we came up with Phrenology. The brain Cells in the Brain 3lbs neurons and glial cells 80-100 billion neurons different types of each thousands of synaptic connections Neurons=cellular computers per neuron > 100 billion neurons in the brain each neuron fires 5-50x per second Glial Cells= support functions for neurons multiple downstream and there may be up to 10x as many glial cells as neurons upstream effects each time a neuron fires and doesnt fire neurons are also located outside the brain;nerve cells Neurons (unipolar, bipolar, multipolar) Most axons of neurons are surrounded by a myelin sheath made up of glial cells, allowing electrical signals to jump The Neuron across the axon. soma (cell body) Dendrites Axon Axon terminals or terminal buttons Synapses Neurons operate electrically but can communicate chemically neurotransmitters are the chemical messengers Neurons come in many shapes and sizes (morphologies) GABA > amino acids neurotransmitters are synthesized in the cell body Glutamate Gaba-main inhibitory neurotransmitter Glutamate-main excitatory neurotransmitter Serotonin monoamines Norepinephrine > serotonin: mood,appetite, sleep, and function of GI tract. Dopamine Involved in plasticity and memory consolidation Norepinephrine: “ fight” or “flight” sympathetic NS response. Plays roles in alertness, attention, and memory. Dopamine: motor, reward, associative learning as well as reward and aversion related cognition, working memory. Acetylcholine: Neuromuscular junction and autonomic nervous system Neuromodulator: plasticity, arousal, attention and reward processing The signal we measure in fMRI is based on oxygen in the blood Protection: meninges Layers of tissue around the brain. Cerebrospinal fluid: encases the brain and allows the brain to float protecting neurons. Directions of the brain Central and Peripheral Nervous System CNS: Command and control center, processes all information received from our sense organs and evaluates goal relevance, retrieves memories, and reacts to initiate behavioral responses. Brain Spinal Cord PNS: relays sensory information about the world to the CNS, carries commands from the CNS to muscles and organs. Consists of: Somatic Nervous System (controls muscles) Cranial Nerves Spinal Nerves Autonomic Nervous System (regulate cardiovascular and endocrine systems, and digestion and regulate body temp. Sympathetic Nervous System Fight/flight Parasympathetic Nervous System rest / digest Somatic NS Carries sensory information to the CNS relays motor commands to the periphery (muscles) Control of voluntary movement Cranial Nerves 12 pairs of nerves Bring information from the sense organs to the brain Control muscles Connect to glands or internal organs Spinal Nerves 31 pairs of nerves Grouped by regions of the spine Carry sensory, motor, and autonomic signals between periphery and CNS Autonomic NS regulation of involuntary bodily functions. eg digestion, pupil contraction, heart rate. operates automatically, without conscious control  hindbrain: (lowest part of the brainstem) includes myenlencephalon, metencephalon, includes the pons, medulla (regulate cardiac, respiratory, and skeletal muscle tone. Includes the cerebellum (generating smooth and coordinated movement). Midbrain: aka mesencephalon coordinates movement with sensory input contributing to arousal and tension dopamine starts in the midbrain. Forebrain: includes diencephalon, telencephalon includes the thalamus (relays signals from other brain regions such as pain audio and sight) and hypothalamus (sleep, hunger, thirst, sex, sleep wake cycles) cerebral hemispheres: cortex, basal ganglia, limbic system ( hippocampus; seahorse, amygdala; almond, cingulate gyrus; girdle) amygdala: emotion, emotional memory, arousal, salience processing, turning on the stress response. basal ganglia hippocampus: formation of new episodic memories, turning off stress response, sensitive to deprivation of oxygen, neurogenesis of the brain other than the olfactory bulb. limbic system cingulate gyrus: wraps around the corpus “colosseum”. integrates information, regulates emotions, connects the two hemispheres, relays information to other parts of the cortex. ↓ im bic system amygdala activates in response to something scary or stressful, sends signals to the hypothalamus to turn ON stress response. hypothalamus signals to the adrenal gland in two ways: directly through autonomic nerves which stimulate the release of epinephrine/ norepinephrine from the adrenal medulla the fast stress response: sympathetic nervous system hypothalamus signals to the adrenal gland in two ways: SLOW (hypothalamic pituitary adrenal axis) indirectly through the pituitary gland The pituitary gland releases a hormone into the blood stream that signals the adrenal cortex. The adrenal cortex releases cortisol into the bloodstream. Cortisol moves throughout the body and back to the brain and bind to the hippocampus. basal ganglia what does the cortex do? Striatum primary and secondary regions and motor cortex, keep tabs on how ventral striatum the body is doing, execute voluntary movement, integrate these nucleus accumbens processes with “higher order” functions (associative cortex) T olfactory tubercle dorsal striatum language caudate nucleus putamen learning (memory and prospection, skill learning, knowledge) globus pallidus in-the-moment urges, survival, long term goals, executive subthalamic nucleus functioning (higher order cognitive functions) substantia nigra (black substance) consciousness Cortex it can’t do all of this alone! large tissue crumbed up grove (sulcus) bump (gyrus) Stress systems: net effects sensor cortex turn sensor thalamus ↑ A ↓ turn & ! off hippocampus amygdala emotional Stimulus I I ↑ > - ↑ ahor T ↓ liver , heart , muscles epi/ norepis adrenal medulla ~ adrenax Y lireenoids What regulates the stress response? lateral prefrontal cortex: active when you are keeping your attention on goals, resisting distraction and impulses lateral (and medial) prefrontal cortex syncs up with the amygdala to help regulate stress Assessing Psychological Disorders Clinical assessment: systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. Diagnosis: process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder from the DSM-5 reliability: the degree to which a measurement is consistent. validity: whether something measures what it is designed to measure The clinical interview gathers information on on current and past behavior, attitudes, emotions, etc 1. appearance and behavior 2. thought process 3. mood and affect 4. intellectual functioning 5. sensorium (general awareness of surroundings) behavioral assessment: direct observation to formally assess an individuals thoughts, feelings, and behavior in specific situations or contexts. Target behaviors are identified and observed with the goal of determining the factors that seem to influence them. personality inventories: self-report questionnaires that assess personal traits. neuropsychological tests: measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills etc taxonomy: classification of entities for scientific purposes nosology: classification and naming system for medical and psychological phenomena nomenclature: the names or labels of the disorders that make up the nosology EEG: measures of electrical activity patterns in the brain taken through electrodes placed on the scalp categorical and dimensional approaches the classical categorical approach: classification method founded on the assumption of clear cut differences among disorders each with a different known cause dimensional approach: note the variety of cognitions, moods, and behaviors with which the patient presents and qualify them on a scale prototypical approach: identifies certain essential characteristics of an entity so you can classify it and also allows certain nonessential variations that do not change the classification. familial aggregation: the extent to which the disorder would be found among the patients relatives Assessment and Diagnosis Diagnostic and Statistical Manual of Mental Disorders: DSM-5 Categorical vs Dimensional Approaches Categorical approach: individuals with four or more symptoms receive the diagnosis of Generalized Anxiety Disorder ~ one or other I yields Me esuit] ↑ yor more Symptoms Dimensional Approach: Everyone has generalized anxiety on some part of the curve T on a Scale N ↑ N ↑ High GAD low GAD If you have purely categorical perspective what do you think of someone who falls here? N 3, 2 , or none would all be prouped Together as not having GAD  Many medical disorders are considered to be at the extreme end of a continuum eg hypertension, obesity, diabetes, and anaemia. A categorical division is imposed at the point at which it seems useful, to initiate treatment Purposes of clinical assessment understand the individual predict behavior plan treatment evaluate treatment outcome something can “funnel” “multidimensional” be reliable Reliability: the degree to which a measurement is consistent WIO test-retest: consistency over time inter-rater: how often clinicians come to the same diagnosis validity Validity: how well the assessment measures what you are trying to measure Concurrent or discriminant: comparing results of one assessment with another Construct: the extent to which the item measures something unmeasurable Predictive: how well the assessment predicts what will happen in the future Face: the extent to which the test questions look reasonable and valid Standardization: the same measurement tool could be administered by different clinicians in different locations in the same way and achieving similar results. eg: structured scoring Forms of Assessment Neuropsychological tests assess broad base of skills and abilities Clinical Interview brain behavior relations Questionnaires assets and deficits Behavioral Observations Projective Measures Research Concepts and Methods Computerized Axial Tomography (CAT/CT) Clinical Interview X rays of the brain structured clinical interview for DSM-V SCID Pictures in slices from different angles Go methodically through diagnostic criteria for all major illnesses, takes 2+ hours, highly Magnetic Resonance Imaging: MRI standardized Uses magnetic fields and radio waves to construct 3D image Questionnaires Structural MRI: brain shape and size and can locate MASQ (mood anxiety questionnaire) structural abnormalities Individual can fill out at home or in waiting room fMRI: functioning of the brain Behavioral Assessment magnetic field use direct observation to formally assess a patients blood=oxygen= brighter signal in that region of the thoughts, feelings, and behavior in specific brain in the fMRI picture situations or contexts brief changes in brain activity eg: for people who cant verbally provide can measure activity while performing a task or information like babes while resting Mary Ainsworth baby attachment styles assessment s can statistically test the difference in activation between individuals with mental illness and unaffected individuals Projective Tests Go Rorshach Inkblot Test Thematic Apperception Test (explain whats happening in images, usually not reliable or standardized thus not valid Positron Emission Tomography (PET) Injection of radioactive isotopes. Can show which brain regions have neurons that respond to neurotransmitters like dopamine, or have high levels of inflammation, etc Animal Models Animal models are an important component or research in psychopathology genetic models studies of neurotransmitter function behavioral models development Genetic research techniques: determining heritability adoption studies family studies twin studies other methods that identify specific genetic variations involved in disorders Important issues in research responsible conduct of research human the Belmont 3 principles : respects for persons, beneficence, justice, informed consent, do not harm, minimize risks, costs benefits, opportunities distributed equitably Animal the 3 r’s: replace, reduce, refine Mood disorders: unipolar depressive disorders Meet criteria for at least one major depressive episode but no episodes of mania/hypomania Two types of “course” single episode recurrent onset risk low until early teens, then increases dramatically 18% to 35% lifetime prevalence increasing sex differences? other demographic risk factors? Persistent Depressive Disorder onset= usually early 20s Early onset: before 21 6.0% lifetime prevalence Additional information to describe depressive disorder: psychotic features, anxious distress, mixed features, melancholic features, catatonic features, rare, atypical features, peripartum onset, seasonal pattern specifier unipolar depressive disorders/anxiety disorders often occur together depression is the leading cause of disability Risk factors of suicide family history of suicide female preexisting psychological disorders alcohol use and abuse past suicidal behavior experience of a severe stressor suicide contagion Depression tends to be heritable but it is not deterministic triggers for mood disorders : environmental factors Models of depression cognitive model: 3 levels of thinking depressive core beliefs core negative beliefs shape maladaptive cognitive style core negative beliefs give rise to negative automatic thoughts uncontrollability as a key dimension of those negative perceptions attribution style: internal, stable, global negative perceptions of the self, personal world, future behavioral models eg : learned helplessness preclinical behavioral models of depression Bipolar disorders Presence of at least 1 manic episode. 2.1% of population meets criteria for Bipolar 1 or 2 age of onset risk period is approximately same as MDD/MDEs bipolar 2 disorder presence of one or more MDE presence of at least one hypomanic episode no manic episode symptoms cause a change in functioning impairment related to major depression not hypomania risk factors for bipolar illnesses: reward activating events can you have bipolar disorder without depression: yes, single episode of mania is there anything good about mania? getting treatment for mania or hypomania will not make you less creative chapter 7 terms mood disorders: group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression major depressive episode: most common and severe experience of depression, including feelings of worthlessness, disturbances in bodily activities such as sleep, loss of interest, and inability to experience pleasure, persisting at least two weeks mania: period of abnormally excessive elation or euphoria, associated with some mood disorders mixed features: condition in which the individual experiences both elation and depression or anxiety at the same time maintenance treatment: combination of continued psychosocial treat, medication, or both designed to prevent relapse following treatment therapy mood stabilizing drug: particularly bipolar disorder that is effective in preventing and treating pathological shifts in mood hypomanic episode: less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders persistent depressive disorder: persistently depressed mood with low self esteem, withdrawal, pessimism, or despair, present for at least two years with no absence of symptoms for more than two months double depression: typified by major depressive episodes superimposed over a background of persistent dysthymic mood catalepsy: motor movement disturbance seen in people with some psychoses and mood disorders in which body postures are waxy and can be sculpted to remain fixed for a long time seasonal affective disorder: mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring in the winter premenstrual dysphoric disorder: clinically significant emotional problems that can occur during the premenstrual phase of the reproductive cycle of women disruptive mood dysregulation disorder: a child has chronic negative moods such as anger and irritability without any accompanying mania bipolar 2 disorder: alternation of major depressive episodes with hypomanic episodes (no mania) bipolar 1 disorder: alternation of major depressive episodes with full manic episodes cyclothymic disorder: chronic mood disorder with alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes learned helplessness theory of depression: depression is the result of perceived or real absence of control over the outcome of an undesirable situation. mood stabilizing drug: particularly in bipolar disorder that is effective in preventing and treating pathological shifts in mood ECT: biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures cognitive therapy: identifying and altering negative thinking styles and replacing them with more positive beliefs and attitudes and adaptive behaviors and coping styles chapter 5 terms anxiety: Mood state characterized by marked negative affect and bodily symptoms of tension in which a person apprehensively anticipates future danger or misfortune. Anxiety may involve feelings, behaviors, and physiological responses. panic attack: Abrupt experience of intense fear or discomfort accompanied by a number of physical symptoms, such as dizziness or heart palpitations. behavioral inhibition system (BIS) Brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety. generalized anxiety disorder (GAD) Anxiety disorder characterized by intense, uncontrol- lable, unfocused, chronic, and continuous worry that is distressing and unproductive, accompanied by physical symptoms of tenseness, irritability, and restlessness. panic disorder: Recurrent unexpected panic attacks accompanied by concern about future attacks and/or a lifestyle change to avoid future attacks. panic control treatment (PCT) Cognitive- behavioral treatment for panic attacks, involving gradual exposure to feared somatic sensations and modification of perceptions and attitudes about them. social anxiety disorder (also called social phobia) Extreme, enduring, irrational fear and avoidance of social or performance situations. post traumatic stress disorder (PTSD) Enduring, distressing emotional disorder that follows exposure to severe helplessness or a fear- inducing threat. The victim reexperiences the trauma, avoids stimuli associated with it, and develops a numbing of responsiveness and an increased vigilance and arousal. acute stress disorder Severe reaction immediately following a terrifying event, often including amnesia about the event, emotional numb- ing, and derealization. If symptoms persist beyond one month, victims are diagnosed with posttraumatic stress disorder. attachment disorders Developmentally inap- propriate behaviors in which a child is unable or unwilling to form normal attachment rela- tionships with caregiving adults. obsessive-compulsive disorder (OCD) Disorder involving unwanted, persistent, intrusive thoughts and impulses, as well as repetitive actions intended to suppress them. obsessions Recurrent intrusive thoughts or impulses the client seeks to suppress or neu- tralize while recognizing they are not imposed by outside forces. compulsions Repetitive, ritualistic, time- consuming behaviors or mental acts a person feels driven to perform to suppress obsessions body dysmorphic disorder (BDD) Disorder featuring a disruptive preoccupation with some imagined defect in appearance (“imag- ined ugliness”). Now classified among obsessive-compulsive and related disorders; previously grouped with DSM-IV somato- form disorders. neurochemistry of depression pure norepinephrine reuptake inhibitors are also antidepressant newest generation of antidepressants “dual mode” antidepressants specific serotonin/norepinephrine reuptake inhibitors (SNRIs) new antidepressants that target dopamine; possibly especially useful for anhedonic depression ( the type characterized by loss of pleasure/ interest) monoamine hypothesis increasing synaptic serotonin, norepinephrine, dopamine increases mood BUT some monoamine drugs might not treat everyone’s depression and simply changing your neurochemistry is not enough and the drugs take months to work caveats to SSRIs/SNRIS/MAOIS placebo effect side effects are troubling may improve symptoms but not “cure” depression treating depression : other strategies psychotherapy ( lower relapse rates ) no side effects behavioral activation therapy ( identify maladaptive patterns of withdrawal/isolation ) cognitive behavioral therapy: focus on identifying maladaptive thoughts > - medications that specifically target other monoamines beside serotonin also have mood boosting effects > - medications that inhibit the breakdown of serotonin also inhibit the breakdown of other monoamines , which means they have non specific effects increase monoamines in the brain cure depression > - there is a theraputic lag between When we start and when people start better 16-8 weeks ( medication feeling > - medications that work on monoamines don't have antidepressant effects for everyone neurochemistry of mania neurotransmitter dysregulation many neurotransmitters implicated in disorder dopamine, serotonin, norepinephrine, GABA, Glutamate drug treatments in BD acute depression : ssris naois acute manic: lithim, anti epileptic, valproic acid, etc lithium decreasing neuronal excitability, decreasing glutamate and NE and increasing GABA doesn’t tend to help with depressive symptoms dopamine released primarily into basal ganglia (striatum) mesolimbic pathway links VTA to ventral striatum: role in reinforcement/ reward ventral fegmental area frontal lobe mesocortical system links VTA to PFC : role in short term memory, planning, and problem solving dopamine and mood disorders bipolar disorders: increased sensitivity to dopamine over time unipolar depression: decreased availability of or sensitivity to dopamine predictors of mania disruptions of social rhythms psychosocial treatments cognitive therapy improve relationships sleep regulation/ circadian rhythm stabilizing daily routines better intrapersonal functioning  Anxiety, stress, fear Anxiety disorders Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances Anxiety disorders panic disorder agoraphobia specific phobia generalized anxiety social anxiety used to be considered anxiety disorders now have their own categories, still share overlapping features obsessive compulsive disorders post traumatic stress disorder stress and performance stress can help us meet challenges, and can be useful sometimes eg: studying what happens when you are anxious spend attention tracking threat or danger, heart raving, physiological changes fear vs anxiety fear: flight or fight for survival, in the moment anxiety: fear of uncontrollability and unpredictability, fear of future potential threat, persistent worrying cognitive vulnerabilities+fear= anxiety some individuals may have cognitive vulnerabilities in the form of biases toward certain stimuli and interpretations repeated exposure to stress may trigger fear (biological and emotional fear response) which is “filtered” through those cognitive biases and ultimately leads to anxiety pharmacological medications benzodiazepines: gaba agonist, more inhibition of neurons in hypothalamus, hypothalamus LESS likely to signal norepinephrine antagonists block receptors where norepinephrine likes to bind LESS stimulation of peripheral systems (heart etc) blocks physiological symptoms of anxiety panic disorder and agoraphobia panic attack Caribbean: ataques de nervios latin america: susto panic disorder although 8-12% of people have experienced at least one panic attack in the last twelve months, only a portion of those go on to develop an anxiety disorder ~2.7%in any given 1 year period 4.7% life female: male 2:1 similar rates across the world and different ethnic groups acute onset ages 21-23 how might uncued panic attacks become cued : classical conditioning cognitive contributions catastrophic thoughts: tendency to view bodily sensations as dangerous  specific phobia situational phobia blood-injection injury phobia fear of specific situations decreased heart rate and blood pressure transportation inherited vasovagal response closed places onset= late childhood ~9 years old onset early to mid twenties animal phobia natural environment phobia fear of one or more specific animals fear of one or more specific dogs snakes, mice, spiders or others natural environmental cues onset late childhood ~age 7 heights, storms, water onset late childhood ~ age 7 specific phobias an overview statistics 12.5% life 8.7% in a given 1 year period female to male 4:1 true prevalence in males may be masked by social norms on avg tend to begin late childhood (but depends on type) treatment learning theory informs the B in cognitive behavioral therapy systematic desensitization panic disorder: exposure treatment, is it just extinction? cognitive restructuring puts the c in cbt maladaptive cognitions interpretation of stimuli/situations and self directed thinking expectation that the worst will probably happen techniques: identify patient- specific maladaptive thinking model adaptive interpretations, test probability assumptions generalized anxiety disorder adults 3 or more gad versus normal worry topics of worry: immediate obligations stats on gad vs things you cant control is anxiety prevelanve rate 3.1% of population in the usa in a given year 5.7% at duration of worry: hour or more per some point in lifetime day for half a year or longer in the us F:M ~2:1 impairment: gets in the way of actions but in other countries/cultures gad may be more prevalent in males toward goals typical age of onset around 30 but may be gradual cbt: automatic thoughts, emotions, alternative response, outcome medication treatments behavioral techniques eg breathing exercises and thought benzodiazepines (boosting gaba in techniques hypothalamus) a short term fix antidepressants target serotonin a neurobiological vulnerability for gad might be lower responsiveness to acute stressors social phobia/ social anxiety disorder stats prevalence 6.8% of population in a given year 13.1% at some point in lifetime in the us, ratio of F:M 1:1 typical age of onset around age 3 relatively more common in russian and us samples, lowest in asian samples (the fear of someone else being embarrassed by your actions) vs centered on fear of personal embarrassment in eastern countries cbt: adaptive thoughts and relaxation techniques attention biases toward negative social cues is a part of the psychological/cognitive biopsychosocial model  ocd used to be classified as anxiety disorder in DSM4 but in DSM5 is now in the obsessive compulsive related disorders category common types of obsessive thoughts common types of compulsive behaviors need for symmetry ordering, arranging forbidden thoughts or actions repeating routine activities mental contamination process (counting) hoarding checking reassurance seeking washing/cleaning collecting items with little or no actual or sentimental value prevalence rate can experience ~1% of population in the us in a given year 1.6-2.3% at some point obsessive thoughts in lifetime without comprisions in the us F:M 1:1 age of onset varies quite a bit in males may be 12-14 in females 20-24 consistent presentation across the world ptsd stats lifetime prevalence 6.8% 1 year prevalence of 3.5% likelihood of developing ptsd after trauma exposure varies same “dose” of trauma and similar environment- some people develop ptsd and some don’t. risk: predisposed to heightened stress, differences in hippocampus comorbidity major depressive disorder alcohol use disorder associated with elevated risk of suicide social support = resilience ptsd and hippocampus reduced hippocampi volume - a vulnerability factor eating disorders: anorexia nervosa major categories of eating disorders AN -the anorexia nervosa most deadly bulimia nervosa 1 for the ind) of all mental binge eating disorders disorders what is common versus distinct? weight/shape concerns in common differences in behaviors associated with weight/shape concerns