An Integrative Approach to Psychopathology Lesson 2 PDF

An Integrative Approach to Psychopathology LESSON 2  Judy: The Girl Who Fainted at the Sight of Blood Judy, a 16-year-old, was referred to our anxiety disorders clinic after increasing episodes of fainting. About 2 years earlier, in Judy’s first biology class, the teacher had shown a movie of a...

An Integrative Approach to Psychopathology LESSON 2  Judy: The Girl Who Fainted at the Sight of Blood Judy, a 16-year-old, was referred to our anxiety disorders clinic after increasing episodes of fainting. About 2 years earlier, in Judy’s first biology class, the teacher had shown a movie of a frog dissection to illustrate various points about anatomy. This was a particularly graphic film, with vivid images of blood, tissue, and muscle. About halfway through, Judy felt a bit lightheaded and left the room. But the images did not leave her. She continued to be bothered by them and occasionally felt slightly queasy. She began to avoid situations in which she might see blood or injury. She stopped looking at magazines that might have gory pictures. She found it difficult to look at raw meat, or even Band-Aids, because they brought the feared images to mind. Eventually, anything her friends or parents said that evoked an image of blood or injury caused Judy to feel lightheaded. It got so bad that if one of her friends exclaimed, “Cut it out!” she felt faint.  Judy: The Girl Who Fainted at the Sight of Blood Beginning about 6 months before her visit to the clinic, Judy actually fainted when she unavoidably encountered something bloody. Her family physician could find nothing wrong with her, nor could several other physicians. By the time she was referred to our clinic she was fainting 5 to 10 times a week, often in class. Clearly, this was problematic for her and disruptive in school; each time Judy fainted, the other students flocked around her, trying to help, and class was interrupted. Because no one could find anything wrong with her, the principal finally concluded that she was being manipulative and suspended her from school, even though she was an honor student Judy was suffering from what we now call blood– injection–injury phobia. Her reaction was quite severe, thereby meeting the criteria for phobia, a psychological disorder characterized by marked and persistent fear of an object or situation. But many people have similar reactions  Judy: The Girl Who Fainted at the Sight of Blood that are not as severe when they receive an injection or see someone who is injured, whether blood is visible or not. For people who react as severely as Judy, this phobia can be disabling. They may avoid certain careers, such as medicine or nursing, and, if they are so afraid of needles and injections that they avoid them even when they need them, they put their health at risk One Dimensional vs Multidimensional Models  One Dimensional Model  Single paradigm or conceptual approach  Problems occur when information from other areas is ignored  Multidimensional Model  Interdisciplinary, integrative  “System” of influences that cause and maintain suffering  View abnormal behavior as multiply determined Multidimensional Models of Abnormal Behavior  Biological Influences  Behavioral Influences  Emotional Influences  Social Influences  Developmental Influences Multidimensional Models of Abnormal Behavior Genetic Contributions to Psychopathology  Heredity plays a role in most behavior  Genes  Carriers of genetic information (DNA)  Impacted by environmental influences  e.g., stress, relationships, culture  Relationship between genes and environment is bidirectional – Nature via nurture (Ridley, 2003) Important Genetic Terms  Gene expression  Proteins influence whether the action of a specific gene will occur  Polygenic transmission  Multiple gene pairs vs. single gene  Heritability  Extent to which variability in behavior is due to genetic factors  Heritability estimate ranges from 0.00 to 1.00  Group, rather than individual, indicator Environmental Effects  Shared environment  Events and experiences that family members have in common  Nonshared environment  Events and experiences that are unique to each family member Behavior Genetics  Study of the degree to which genes and environmental factors influence behavior  Genotype  Genetic material inherited by an individual  Unobservable  Phenotype  Expressed genetic material  Observable behavior and characteristics  Depends on interaction of genotype and environment Molecular Genetics  Identifies particular genes and their functions  Alleles  Different forms of the same gene  Polymorphism  Difference in DNA sequence on a gene occurring in a population  SNPs (Single Nucleotide Polymorphisms) – Identify differences in sequence of genes  CNVs (Copy Number Variations) – Identify differences in structure of genes; can be additions or deletions in DNA within genes  Knockout studies Gene-Environment Interaction  Gene-environment interaction  One’s response to a specific environmental event is influenced by genes  Epigenetics  Study of how the environment can alter gene expression or function  Cross-fostering adoptee method  Rats born to mothers with low parenting skills who were raised by mothers with high parenting skills showed lower levels of stress reactivity (Francis et al., 1999)  Environment (mothering) was responsible for turning on (or turning up) the expression of a particular gene Reciprocal Gene-Environment Interaction  Genes predispose individuals to seek out situations that increase the likelihood of developing a disorder.  Adolescent girls with genetic vulnerability for depression more likely to experience events that can trigger depression (Silberg et al., 1999)  Dependent life events influenced by genes (Kendler and Baker, 2007 The Diathesis-Stress Model  Diathesis–stress model, individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress.  Each inherited tendency is a diathesis, which means, literally, a condition that makes someone susceptible to developing a disorder.  When the right kind of life event, such as a certain type of stressor, comes along, the disorder develops.  For example, according to the diathesis–stress model, Judy inherited a tendency to faint at the sight of blood. This tendency is the diathesis, or vulnerability. It would not become prominent until certain environmental events occurred. For Judy, this event was the sight of an animal being dissected when she was in a situation in which escape, or at least closing her eyes, was not acceptable. The Diathesis-Stress Model  Integrative model that incorporates multiple causal factors  Genetic, neurobiological, psychological, and environmental  Diathesis  Underlying predisposition  May be biological or psychological  Increases one’s risk of developing disorder  Stress – Environmental events  May occur at any point after conception  Triggering event  Psychopathology unlikely to result from one single factor Neuroscience and Its Contributions to Psychopathology  The field of Neuroscience  The role of the nervous system in disease and behavior  The Central Nervous System (CNS)  Brain and spinal cord  The peripheral nervous system (PNS)  Somatic and Autonomic Branches Neuroscience and Its Contributions to Psychopathology  Examines the contribution of brain structure and function to psychopathology  Mental disorders are linked to aberrant processes in the brain.  Three major components:  Neurons and neurotransmitters  Brain structure and function  Neuroendocrine system Divisions of the nervous sysem Neuroscience and the Central Nervous System  The Neuron  Soma – cell body  Dendrites – Branches that receive message from the other neurons  Axon – Trunk of neuron that send messages to other neurons  Axon Terminals – Buds at the end of axon from which chemical messages are sent  Synaptic cleft –small gaps that separate neurons  Neurons function electrically, but communicate chemically  Neurotransmitter are the chemical messengers The transmission of information from one neuron to another The Neuron: Basic Unit of the Nervous System  Neurons  Cells of the nervous system  Four major parts  Cell body  Dendrites  Axons  Terminal buttons  Nerve Impulse  Dendrites or cell body stimulated  Travels downs axon to terminal  Synapse  Gap between neurons Neurotransmitters  Neurotransmitter  Chemicals that allow neurons to send a signal across the synapse to another neuron  Receptor sites on postsynaptic neuron absorb neurotransmitter  Excitatory  Inhibitory  Reuptake  Reabsorption of leftover neurotransmitter by presynaptic neuro Neurotransmitters and Psychopathology  Serotonin and dopamine – Implicated in depression, mania, and schizophrenia  Norepinephrine – Implicated in anxiety and other stress-related disorders  Gamma-aminobutyric acid (GABA) – Inhibits nerve impulses – Implicated in anxiety  Possible mechanisms – Excessive or inadequate levels – Insufficient reuptake – Excessive number or sensitivity of postsynaptic receptors – Second messengers help neurons adjust receptor sensitivity after periods of high activity  Agonist drugs stimulate neurotransmitter receptor sites Antagonist drugs dampen neurotransmitter receptor sites Brain Structure and Function  Two cerebral hemispheres  Connected by corpus callosum  Sulci (fissures) define regions or lobes of the cerebrum (gray matter):  Frontal (Reasoning, Problem Solving, Emotion Regulation)  Parietal (Sensory-Spatial)  Occipital (Vision)  Temporal (Sounds Brain Slice Through Medial Plan  White Matter Interior  Ventricles – filled with cerebrospinal fluid  Myelinated (sheathed) nerve fibers  Thalamus  Sensory relay station (except olfactory)  Brain Stem  Pons and medulla oblongata  Cerebellum  Responsible for balance, posture, equilibrium Subcortical Structures of the Brain  Limbic System :  Often implicated in psychopathology  Involved in the expression of emotions  Amygdala is key brain structure for psychopathology researchers due to role in attending to emotionally salient stimuli and in emotionally relevant memories The HPA Axis of the Neuroendocrine System  HPA (hypothalamic-pituitary-adrenal) axis involved in stress  Hypothalamus triggers release of corticotropin-releasing hormone (CRF)  Pituitary gland releases adrenocorticotropic hormone (ACTH)  Adrenal cortex triggers release of cortisol, the stress hormone  Takes 20-40 minutes for cortisol to peak  Takes up to 1 hour for cortisol levels to return to baseline The Neuroendocrine System  Psychoneuroimmunology – the study of how psychological factors impact the immune system  Two types of immunity:  Natural immunity  Specific immunity  The link between stress and the immune system has several direct implications for overall health. Neuroscience Approaches to Treatment  Psychoactive drugs alter neurotransmitter activity  Antidepressants  Antipsychotics  Benzodiazepenes  A neuroscience view does not preclude psychological interventions Evaluating the Neuroscience Paradigm  Reductionism  View that behavior can best be understand by reducing it to its basic biological components  Ignores more complex views of behavior  Behavioral and Cognitive Science  Roots in learning principles and cognitive science  Behavior is reinforced by consequences  Attention  Escape or avoidance  Sensory stimulation  Access to desirable objects or events  To alter behavior, modify consequences – Time out  Systematic desensitization  Relaxation plus exposure  Imaginal or in vivo  Important treatment for anxiety disorders Cognitive Science  Behaviorism criticized for ignoring thoughts and emotions  Cognition  A mental process that includes: Perceiving, recognizing, conceiving, judging, and reasoning  Schema  Organized network of previously accumulated knowledge  We actively interpret new information  Role of attention in psychopathology – Anxious individuals more likely to attend to threat or danger Role of the Unconscious  Contemporary theorists have attempted to study the unconscious scientifically  Implicit memory  The unconscious may reflect efficient information processing rather than being a repository for troubling material Cognitive Behavior Therapy (CBT)  Attends to thoughts, perceptions, judgments, self-statements, and unconscious assumptions  Cognitive Restructuring  Change a pattern of thinking  Changes in thinking can change feelings, behaviors, and symptoms  Beck’s Cognitive Therapy  Initially developed for depression  Depression caused by distorted thoughts  Nothing ever goes right for me!  Information-Processing Bias  Attention, interpretation, and recall of negative and positive information biased in depression  Help patients recognize and change maladaptive thought patterns Emotions and Psychopathology  Emotions play an enormous role in our day-to-day lives and can contribute in major ways to the development of psychopathology (Barrett, 2012; Gross, in press; Kring & Sloan, 2010; Rottenberg & Johnson, 2007)  The emotion of fear is a subjective feeling of terror, a strong motivation for behavior (escaping or fighting), and a complex physiological or arousal response. To define “emotion” is difficult, but most theorists agree that it is an action tendency (Barlow, 2002; Lang, 1985, 1995; Lang, Bradley, & Cuthbert, 1998); that is, a tendency to behave in a certain way.  Sociocultural Factors  Gender, race, culture, ethnicity, and socioeconomic status  May increase vulnerability to psychopathology  e.g., women more likely to experience depression than men  Some disorders specific to certain cultures  Hikikomori in Japanese culture Interpersonal Factors and Psychopathology  Object relations theory – Longstanding patterns of relating to others  Attachment theory – Type and style of infant’s attachment to caregivers can influence later psychological functioning  Relational self – Individuals will describe themselves differently depending upon which close relationships they are told to think about  Interpersonal therapy (IPT)  Impact of current relationships on psychopathology  Unresolved grief; Role transitions; Role disputes; Social deficits Questions? Thank you! Prepared by: Ma. April F. Arcilla, MAPsy