PSY 419 Exam 3 Study Guide and Essay Prompts PDF

PSY 419 Unit 3 Study Guide: Topics 9, 10, 11 Topic 9: Externalizing Externalizing Disorders o Disorders that involve problematic behaviors, directed outward like aggression, rule breaking, impulsivity, and behavioral disinhibition (similar to impulsivity – w...

PSY 419 Unit 3 Study Guide: Topics 9, 10, 11 Topic 9: Externalizing Externalizing Disorders o Disorders that involve problematic behaviors, directed outward like aggression, rule breaking, impulsivity, and behavioral disinhibition (similar to impulsivity – which is acting without thinking through the consequences - except disinhibition is broader and implies violating social norms and regard for other people) Diagnoses and Constructs o Attention-Deficit/Hyperactivity Disorder  Persistent pattern of inattention and/or hyperactivity, significantly more frequent or severe than typically observed in individuals of the same level of development  Some symptoms must be present before 12 years old  Problem areas: Inattention Hyperactivity Impulsivity o Oppositional Defiant Disorder  Pattern of negative, hostile, and defiant behavior lasting at least 6 months (need 4+ of the following)  Loses temper, argues with adults, defying adult requests, deliberately annoying others, blaming others for own mistakes, easily annoyed, angry, spiteful/vindictive (note generally presents as problem with authority figures, angry and pessimistic) o Addictive disorders, often synonymous with Substance Use Disorders  Alcohol  Opioid, cannabis, etc.  Gambling  Implies continued use despite consequences o Conduct disorder  Pattern of behavior in which basic rights of others or major age- appropriate societal norms or rules are violated (more severe than oppositional defiant disorder)   Symptoms must be present before 15 years old, only get diagnosed as a child or retrospectively (adults don’t have this)  Symptoms: Aggression to people & animals (torture/hurting) Destruction of property (e.g. arson) Deceitfulness or theft Serious rule violation (e.g. leaving home, excessive/egregious school cutting)  Seen as a precursor to Antisocial Personality Disorder (and potentially psychopathy), but many cases do not persist and turn into ASPD.  Seen in 6-16% of males, 2-9% of females o Antisocial personality disorder – a DSM 5 Diagnosis describing a pattern of criminality and disinhibition, related to but different from psychopathy (psychopathy appears to have greater validity, but is also more abstract, and less behavioral, and so is not a diagnosis) Etiology of Externalizing Disorders o Research methods spotlight: Introducing RDoC – Research Domain Criteria  A transdiagnostic, dimensional framework created by leaders at the National Institute for Mental Health (NIMH) for studying mental disorders  Looks at array of ‘units’ or ‘levels’ of analysis ranging from very “micro” like molecular level to very “macro” like the behavioral level  See PowerPoint for a graphic of the RDoC framework, essentially assesses the (below) domains across micro to macro systems, from neural (genes, molecules, cells, circuits, physiology) to behavioral (behavior, self-reports)  Domains: Negative Valence Positive Valence Cognitive Systems Systems for Social Processes Arousal/Regulatory system Sensorimotor systems o Genetics  Twin research on Externalizing Genetics are a big chunk of latent externalizing (latent = general externalizing, not a specific disorder), about 50-60%  Environment takes up the rest o “Common environment” is 10-20%: shared experiences between two twins like school quality, neighborhood, general characteristics of family, and income level o “Unshared environment” is 20-40%: unique experiences only one of the two twins has All this is ignoring gene-environment interactions (this is just additive, what part is genetics and what is environmental) o Gene environment interaction – life experiences impact people differently according to different genetic make- up  Externalizing genetics structure Genes between ADHD and addiction are largely shared, with some differences that were specific to each (e.g. the genetic component is not identical, just similar) Common factor to all externalizing behaviors measured fit well in a study we discusssed in lecture, but having 2 different factors where one is externalizing and one is addiction also worked (though even there, the two factors were very highly correlated) o Individual Differences: Temperament & Traits  Implicated temperaments High negative affectivity, especially irritability Poor development of empathy Low effortful control - meaning trouble inhibiting the practiced or “prepotent” (default/easy) response  Implicated Traits Low trait anxiety – less fear of punishment, which is a risk factor because fear of punishment helps individuals learn and eventually internalize social morals Callous-unemotional traits are related to premeditated (i.e. planful) aggression Trait impulsivity o Negative urgency – tendency to act rashly when experiencing negative emotions  Research methods spotlight: Individual differences  People vary a lot in their trait-like psychological characteristics, just like people differ in physical characteristics Height, weight, and other physical chacteristics can be individual differences, but in psychology we are focused on psychological variables that differ between people: Personality traits, intelligence, values Can predict illness/diagnoses (which if this is the case, allows identification of effective preventative measures) as well as differential treatment response (how well treatments work may vary based on something we can measure, i.e. personalized medicine) Noteworthy: individual differences research area had its earliest beginnings in the eugenics movement (1880 and forward), which mistakenly believed that it could improve the health of a nation by selecting fitter people. This movement was associated with forced sterilization in some cases. o Sex Differences  Males experience 2x as many externalizing disorders than females (but recall that females experience about 2x as many internalizing disorders – we do not have great models to explain this currently).  Some bio basis for self-control, empathy, and fear  Females have more of all of these traits, which may lead to this lower externalizing rate o Neural Mechanisms  Midbrain & Dopamine system Mesolimbic system – dopamine neurons in ventral tegmental area project to other regions like the amygdala (emotion, threat processing), hippocampus (learning & memory), and nucleus accumbens (motor functioning and reward functioning, among other things) Mesolimbic system is compromised in those with impulse control deficits o Dopamine has both “tonic” (baseline) and “phasic” (short reactions to surprise rewards) levels. In people with impulse control problems, there are both low tonic and low phasic levels.  Dopamine is involved in reward functioning and initiating behavior, motor functioning, as well as prefrontal control—in other words, all systems related to goal pursuit Overall, low dopamine in these reward/behavior control systems leads to higher seeking of more intense rewards to boost a chronic low mood state Note: neural mechanisms being a component does not imply that this is uncontrollable  Prefrontal cortex (PFC) and Impulsivity Variety of errors erode optimal communication between prefrontal cortex and the midbrain regions o Particularly the anterior cingulate cortex (ACC), which is a hub of combining cognitive and emotional processes to produce complex behaviors The PFC-ACC miscommunication impacts 3 processes: o Delay-discounting: tendency to value immediate rewards more than delayed rewards o Response inhibition: ability to control one’s actions, lower with less PFC-ACC communication o Affective decision-making: affects risk taking, where less PFC-ACC means more risk taking o Cognitive Mechanisms  Hostile Attribution Biases  Social info processing – attending, interpreting, clarifying goals, appraising impact Schemas – info is trimmed into simpler sets Problems in social information processing leads to social maladjustment  Attribution Biases Other-blaming in hostile attribution No differences in hostile attribution in ADHD versus controls ODD: those with hostile attributions had worse prognosis Hostile attributions also predicted aggressive behaviors in kindergarteners o Environmental: Maltreatment, Socialization  Coercive (harsh) parenting Like:  o Physical threats/aggression o Verbal disparagement o Emotional manipulation Undermines healthy, strong parenting practices, like: o Limit setting and discipline o Instruction and positive contingencies to shape skilled behavior o Communication and mutual problem solving, then monitoring what’s going on, who kiddo is spending time with As a translational theory: o Translational means using theory to develop a treatment/intervention o Coercion theory -> social interaction learning o SIL: reduces parent coercion and conflict, increases good parenting practices  Deviant peers Coercion in kiddos – even in preK age kids who get their way with peers by using emotional manipulation, aggression, etc. reinforced this behavior and increases it’s use in future exchanges Contagion – problem behaviors ‘spread’ between kids through friendships thru 2 mechanisms o Deviancy straining – reinforcing rule-breaking behavior via laughing and positive affect o Coercive joining – individuals join together to inflict harm on others Early onset conduct disorder will ‘recruit’ other kids who have a later onset conduct disorder, i.e. start them on the path using the above mechanisms o Early onset cases tend to be persistent (i.e. not go away) while later onset does tend to get better with age Positive peer influences (empathy/warmth) helps kiddos recover from conduct disorder  Neighborhood factors  High concentration of SES disadvantage leads to social disorganization (i.e. more opportunities for criminal behavior/deviancy) o Note this is a systemic, policy issue Relationship between impulsivity and criminal behavior is stronger in boys in low SES neighborhoods – impulsive boys in high SES neighborhoods lack opportunities o Impulsivity x SES interaction  Early adversity: Dimensional Model of Diversity and Psychopathology The specific nature of adversity experienced by kids is more influential than the amount or dose of adversity Early adversity is one of 2 dimensions: o Threat experiences: like emotional, physical, and sexual abuse. Predicted to be more linked to anxiety and depression o Deprivation experiences: like a lack of appropriate stimulation, interaction, and resources due to neglect or lack of resources available. Contributes to externalizing outcomes (more than internalizing) through a lack of inhibitory control Topic 10: Psychopathy Definitions: o Note that psychopathology and psychopathy are different things  Psychopathology is the study of all mental illnesses  Psychopathy refers to the personality traits related to being a psychopath, though it is not a diagnosis. Psychopathy is a valid construct, just not a diagnosable disorder o Antisocial personality disorder– diagnosable disorder, behavioral but lacking interpersonal and emotional features that psychopathology has (i.e. charm, low anxiety, and lack of empathy) o Sociopathy – depends on who you ask, some think it is technically slightly different than psychopathy, but Dr. VS says psychopathy really covers it (there are not really two separate constructs here to split up!) o Antisocial vs unsociable  Antisocial – hurts others, violence, etc.   Unsociable – introverted, not violent (colloquially, people say ‘antisocial’ to mean just not wanting to be social when objectively not wanting to be social is ‘unsociable’) History of Psychopathy o We are not concerned with most names and dates here – the important takeaways are: o Scholars have recognized something similar to psychopathy for a very long time, o But they also tended to define it very broadly such as encompassing all of externalizing and even psychosis o And Cleckley was really the first to provide a “diagnostic checklist" for the modern conceptualization of psychopathy (even though it is not a diagnosis!), which was defined as functional features (low anxiety, social adeptness) that mask persistent, reckless, and impulsive behavior What is Antisocial Personality Disorder o Adult extension of Conduct Disorder, diagnosed over 18+ but requires symptoms of CD before age 15 o 3% in males, 1% in females in the general population and higher in incarcerated populations o Criteria: Pattern of disregard for and violation of rights of others, e.g.,  Illegal behavior  Deceit/manipulation  Impulsivity  Irritable and aggressive  Recklessness and risk taking  Irresponsibility (disregard of debts)  Lack of remorse – a lack of care about the harm caused to others Review: 16 ‘diagnostic’ criteria for psychopathy o Superficial charm/typical to above average intelligence o Absence of delusion/irrational thought o Absence of nervousness o Unreliable o Dishonest o Lacks remorse/shame o Poorly motivated antisocial behavior (rule breaking/commiting crimes without a reason to do so) o Failure to learn from experience o Egocentricity/incapacity to love others  o Poverty of emotions (flat affect) o Lack of insight into ones own behavior o Unresponsive interpersonally o Fantastic (wild), uninviting behavior o Suicidality is rare (this has since been shown to not be accurate but it’s what Cleckley predicted) o Impersonal sex life o Failure to follow a life plan Hare’s Psychopathy Checklist-Revised (PCL-R) o Based on Cleckley’s 16 “diagnostic” traits o 20 item measure that is clinician-rated based on an interview and institutional file records review with incarcerated people. This is not a self- report questionnaire. o Summed to yield a total psychopathy score, with a cutoff of 30 out of 40 points indicating psychopathy o Research shows...  Scores on this are highly correlated with symptoms of Antisocial PD  Strong, positive correlations with measures of behavioral aggression, self-reported substance use difficulties, and trait impulsivity and aggression  Near zero or slight positive associations with: Anxiety Neuroticism Negative affect Suicidality o PCL-R focuses on 2 factors:  Factor 1: Interpersonal/Affective factor Covers the charm, grandiosity, absence of remorse, low affect, blame of others, and conning Unique variance (meaning after accounting for Factor 2) correlates negatively with anxiety and other internalizing Positively associates with social dominance and in some cases positive affect and achievement  Factor 2: Impulsive-Antisocial factor Covers early behavior problems, impulsivity, proneness to boredom, irresponsibility, parasitism (i.e. chronic  unwillingness to work and contribute to family, AKA taking advantage of others), and aggression Uniquely correlates to more trait anxiety and internalizing, symptoms of ASPD, impulsivity, aggression, sensation seeking, and substance use o Prevalence of psychopathy according to the PCL-R in correctional and forensic populations is 15-25%  Much lower rate than Antisocial PD in the same population  Estimated prevalence in entire population is around 1-2%, but this measure was not created to measure a typical population  PCL-R only identifies.3-.7% of women in community samples Comorbidity of psychopathy (when measured using the PCL-R) o Antisocial PD o Substance use disorders o Borderline PD o Narcissistic (grandiose, self-focus) and Histrionic (self-focus but in a dramatic, boisterous way) PD o Mixed associations with anxiety and depression, see the 2 Factor section above Neurobiology o Attenuated subcortical fear reactivity  Reduced skin conductance reactivity to stressors (like a small shock) indicating low reactivity when anticipating stress  Interpretated as a basic deficiency in fear response  Failure to show a normal startle blink reflex when watching aversive pictures (startle response should be more extreme when viewing aversive stimuli, but those high in psychopathy don’t seem to have this)  Startle reflex is thought to be driven by the amygdala Community self-report scales for psychopathy (keeping in mind the PCL-R is for incarcerated populations) o Old self-report measures more looked at antisocial than psychopathy o New measures look more at the 2-factor model of psychopathy o Psychopathic Personality Inventory (PPI) from Lilienfeld is our main focus, one of the newer self-report measures  There were others (which you are not being tested on, see the PowerPoint if you’re curious)  PPI o 8 scales, which load onto 2 factors (Fearless Dominance and Impulsive Antisociality) + Cold Heartedness which did not fit well with either of those factors  Stress Immunity – Nonaxiousness (fearless/dominance factor)  Fearlessness – low fear (fearless/dominance factor)  Social Potency – interpersonal dominance (fearless/dominance factor)  Carefree Nonplanfulness – impulsivity (Impulsive Antisocial Factor)  Rebellious Nonconformity – oppositionality (Impulsive Antisocial Factor)  Blame Externalization – alienation (Impulsive Antisocial Factor)  Machiavellian Egocentricity – aggressive/exploitative (Impulsive Antisocial Factor)  Cold-heartedness – lack of empathic concern (note, this does not load onto either factor) o PPI factors informed the Triarchic Model  Goal was to reconcile disparities in the literature by having 3 distinct, intersecting dispositions: Disinhibition Boldness Meanness  Not bound to any assessment tool or approach, more of a conceptual model  There is a Triarchic Psychopathy Inventory, but the goal of this model was to be universal Triarchic Model o Disinhibition – intersection of impulsivity and negative emotion  Covers: Impulse control problems, Lack of planfulness, Immediate gratification (rather than delayed), Difficulty controlling emotion, Problems controlling behavior  Behaviorally: looks like impatience, impulsive actions with extreme consequences, distrust, alienation, angry and reactive aggression, rule and law-breaking including substance use  Model says disinhibition alone is just externalizing! not enough to be psychopathy. Model says that Psychopathy requires at least one of the other two factors (boldness or meanness)  o Boldness – intersection of dominance, stress immunity, and adventure seeking  Covers: Social assurance, self-confidence, calmness, rapid recovery from aversive experiences, preference for risk  Also called: ‘fearless temperament’, ‘fearless dominance’, ‘heartiness’, and ‘resilience’  Behaviorally: social assertiveness, persuasiveness, imperturbability, venturesomeness, courageous action, failure to learn by experience o Meanness -  Covers: deficient empathy, lack of close relationships, uncooperativeness, exploitative of others, self-empowerment through cruel and destructive acts  Also called ‘callous-unemotionality’, ‘antagonism’, ‘coldheartedness’  Interpersonal traits: high dominance, low affiliation, and low nurturance of others  Disaffiliated agency – actions are goal directed and resource directed, but either disregarding or at the expense of others  Behaviorally: Disdain for others, Arrogance, Rebellious defiance, Lack of close relationships, Harsh competitiveness, Exploitation of others for personal gain, Planful/predatory aggression (i.e. instrumental aggression), Cruelty towards people/animals, Destruction for excitement/fun o See PowerPoint for structural equation modeling of the Triarchic Model – there is general support Dark Triad: Largely from industrial/organizational psychology research on abusive business leadership. Note that machiavellianism may be PART of psychopathy (meanness factor), so it’s unclear whether dark is a fully valid model o Narcissism – egotism (self-orientation), grandiosity, self-orientation o Machiavellianism – manipulate others for personal gain o Psychopathy (see above) Alternative Model of Personality Disorders (AMPD) o Outside of Antisocial PD, psychopathy can be captured by other DSM-V disorders (partially) o AMPD – new, dimensional, trait-based system for diagnosis of PDs  First, measure and diagnose personality disturbance (dysfunction in conceptualization of the self) or social relationships with others that is consistent across time and contexts   Then, examine for extreme levels of traits in 5 domains (similar but not QUITE the same as the Big 5 Personality Traits) to determine nature of the disorder is: Negative affect (neuroticism) Disinhibition (opposite of conscientiousness) Antagonism (opposite of agreeableness) Detachment (doesn’t really have a good Big 5 counterpart) Psychoticism (Extremely high openness) o AMPD has counterparts for only 6 of the 10 personality disorders in the DSM- 5 but you do not need to be able to list them o What does Psychopathy look like in AMPD? Antisocial PD daignosed with teh following trait measures  Evidence of high Egocentrism in the identity disturbance measure.  Self-directedness with goals focused on self and dominance  Lack of empathy, lack of remorse  Lack of intimacy, including exploitative relationships  High Antagonism Manipulative, deceitful, callous, hostile  High Disinhibition Irresponsibility Impulsivity Risk taking o AMPD has a ‘psychopathic features’ specifier for that can be applied to a diagnosis of Antisocial PD, with a combinations of trait levels that indicate a low anxiety, socially efficacious type of ASPD. This is the closest we get to diagnosing psychopathy in the DSM Topic 11: Addiction Substance use and misuse observed across time, cultures, and even species Substance Use Disorder Review o In the DSM-V, specify what substance (X Use Disorder) or Polysubstance use o Problematic pattern of use of a substance leading to impairment/distress o Needs 2 of the following 10 over a 12-month period:  More use than planned regularly (plans to go out for drinks, end up closing out bars)  Desire to cut down (want to stop, but cannot)   Spending lots of time (including using, being under the influence, AND time to recover from substance use)  Cravings  Prevents fulfilling role obligations (missing class/work, interfering with familial/friend obligations, etc.)  Using despite relationship problems (despite conflict with family/friends about substance use, still using)  Using despite risk to physical health (operating heavy machinery, driving under influence, under the influence when taking care of children, etc.)  Using despite health problems (substance use contributes to a physical or mental health problem, but use continues)  Tolerance (amount of substance taken to achieve the same effect increases/use of the same amount of a substance provides a lower effect over time)  Withdrawal (when use stops, symptoms heighten which looks differently depending on substance) Withdrawal can be fatal o Severity level depends on number of symptom criteria endorsed  2-3: Mild  4-5: Moderate  6-10: Severe o Pros and Cons of these DSM 5 criteria  Pros Current DSM has dropped a problematic ’legal problems’ criterion, which was less valid in some racial groups than others (due to those groups being policed more, not necessarily more problematic use) Craving criteria added to match the International Classification of Diseases (the rest of the world’s) system  Mixed DSM-IV had separate diagnoses for abuse and dependence, where some folks would ‘fall between the cracks’ of the two diagnoses and get missed. Now they do not o Statistically, all this stuff loads onto one factor. But genetically, it looks like there are two separate factors  Cons  2 out of 10 symptoms over the course of a full year is all that’s needed for a mild substance use disorder, which is quite a low bar leading to some false positives Heterogeneity: 2000 possible combinations to meet criteria, with 55 to meet even the lowest criteria. Heterogeneity in theories of substance use because of this Natural history of substance use disorder o Experimentation, which leads to frequent use, ending up at development of a pathological pattern of abuse  The pathological pattern is where we see neurological adaptations that can lead to: Withdrawal Alteration of hedonic set point: due to chemical changes in brain, enjoyment of doing other things that should be fun (playing a game, spending time with friends) is reduced. Feels as though nothing compares to the use of the substance Compulsive use: despite bad consequences, use continues o Can be hard to attribute the negative consequences to substance use – people can make bad choices without substances too Etiology o As a two-step process:  1. etiological factors predicting initial substance use  2. etiological factors predicting misuse after use begins o Two steps have distinct and overlapping risk factors o Some people argue to conceptualize substance use disorders as just prolonged heavy use Societal factors o Poverty – as a stand-alone factor is a weak predictor of substance use  But poverty related factors that are hard to escape like disorganized neighborhoods and high crime do predict substance use Robust across cultures Time spent exposed to these factors (in poverty) and initial age entering/leaving poverty matters (i.e. dose-response relationship)  Economic instability in middle childhood to adolescence was greatest risk   Risk does remain for adults o Peers  Friends using/misusing substances is a risk factor  Amount of time spent with friends modeling deviancy, lack of achievement, and depressed mood are particular risk factors  Conduct disorder predicts substance use as well Do more delinquent friends model/reward substance use, or do teens already at-risk self-sort into groups that would lead to more use? Support for both.  Type of socializing matters: Unstructured time “just hanging out” paired with substance use seems to be the problem Peer delinquency is the strongest environmental risk factor for risky drinking (even accounting for genetics) As peer deviancy increases, genetic contributions matter less and environmental influence matter more (TL:DR peer contribution is very strong) o Family factors  Genetic piece to externalizing, which is still true with addiction A factor, but not deterministic  Modeling – watching parents use substances teaches “this is how we cope”  Availability of substances is a risk, if you can’t get it, you can’t use it, but if it’s easily accessible risk goes up  Permissive parental attitudes predict use problems in teens (Example of the “just a sip study” in the US where permission to sample alcohol at home predicts later problems, which may not apply to other cultures and countries).  Low parental monitoring – parents do not know what their child is up to, who they are with, what they do (opposite of helicopter parent)  Poor parental emotional support  Harsh, coercive, and inconsistent discipline  Parent-child conflicts o Positive family environments reduce substance disorders  Positive (NOT conflict free, just positive) marital relationships  Distance from delinquent peers  High parental warmth   Religious involvement – note this is more about community, positive models, structure, and support than it is about any specific doctrine  High monitoring Biological Contributions to Substance Use o Midbrain dopamine pathways are integral  Dopamine is important but not only chemical  Degree of dopamine stimulation from a substance or activity predicts ‘addictiveness’ of that thing  Serotonin and naturally occurring cannabinoids and opioids in the body play a role o Reward system uses dopamine to encourage ‘good’ evolutionary behaviors (like eating and socializing)  Addictive substances/activities flood this pathway with dopamine at artificially high levels  Leads to the feeling that naturally occurring rewards do not feel as good (hedonic set point effect)  Tolerance happens as brain gets used to high bursts of dopamine in the system, and it lowers both dopamine levels and number of dopamine receptors to compensate. Prevention and Intervention o Policy Level Prevention  Substance Use is the only disorder linked to use of something, so prevention of use has gotten a lot of attention by gov’t - to mixed effects  National or local policies restrict access, limit who can use (age requirement), make it harder to obtain (taxes), minimize harm from use (DWI laws)  Policy interventions that reduce use are called ‘universal’ as they apply to everyone and thus can be pretty effective  Are not very theory-informed, just derive from the basic understanding that if you stop or limit use you can stop or limit misuse (this works, though, since it applies to everyone at once)  Decrease in lung cancer due to policy changes over the past 50 years, and lower fatal alcohol related motor accidents due to policy changes in DWI punishment o Policy Failures  School based psycho-education (e.g., DARE)   Ad bans (limits of advertising, can only show a certain number of bottles in alcohol commercials)  Public media campaigns  Sometimes either don’t work or have adverse effects “This is your brain on drugs” DARE educates students about substances, but does not act on use and has been ironically co-opted by drug culture o Policy: MACH Trial NIH Gaffe & Safe Level of Alcohol  Moderate Alcohol and Cardio health (MACH) trial to determine what a safe level of alcohol use was, collaboration between alcohol industry and NIH Alcohol companies agreed to fund it to serve commercial interests and they biased the study design, and when this was exposed, the study was canceled  Outside of that, the data-driven conclusion from World Health Org and NIH is now that science does not support a specific safe level – meaning all use slightly increases risks – all we can say is “less use means less risk” Helps some systems, hurts others (a *little* wine may have some benefits for cardiac health, but is a carcinogen all the same so hurts other systems) o Motivational Interviewing Intervention  Lay definition – a collaborative conversation style for strengthening a person’s own motivation and commitment for change  More advanced – person-centered (i.e. client centered, not about therapist recommendations) counseling style for addressing the common problem of ambivalence (having mixed feelings) about change  Motivational Interviewing is between a ‘directive’ style (telling someone what to do) and ‘following’ style (passively letting client guide everything). Takes a ‘guiding’ style in the middle, encouraging and eliciting  Spirit of motivational interviewing Rogerian spirit of GREW for all people o Genuineness o Empathy o Respect  o Warmth Importance of accurate empathy 4 key components o Acceptance – of the client o Evocation – raise possibility/elicit of change o Collaboration – between client and clinician o Compassion – i.e. not allowed to use motivational interviewing for marketing 4 overlapping stages o Engaging – getting to know client o Focusing – what are we working on o Evoking – desire for change o Plan – how are we going to do that  Zooming in on some of the stages Engaging o What matters to the client, what is important to you, what are your values? o The goal here is to create a space that is safe enough to explore someone’s values and have them evaluate whether they are acting according to those Focusing o Often clients have multiple problems they are coping with, and often with some that are more important to them than cessation of substance use (housing, medical issues, etc.) o Pick some stuff you might have to tackle first – it's not necessarily what the clinician would choose first o DONTs in exchanging information  “I am the expert, so you listen”  “I collect information for diagnosis”  “I’m here to correct gaps in knowledge”  “I tell you what to do and you do it”  “Substance use is scary and here’s why...” o DOs  “I have some expertise, and my client is the expert on themself”   “I find out what clients want and need, and match information to those”  “Clients tell me what is helpful information” Evoking o Let the client talk THEMSELF info change o This is more easy for clients to follow through on, as people are more likely to follow through on things they say aloud to others o Promote change talk in clients  Change talk – Maybe I can, I want to change, I want things to be better, etc.  Sustain talk – Change is hard, I don’t want to change, who cares anyways, etc. o How do we promote change talk? o Acronym: DARN CATS (we’re just covering DARN)  Desire – I want to do this, I can see things being better  Ability – I can do this, here’s how  Reasons – I know why I need to (note: without saying the word ‘why’)  Need – I need to do this right now (urgency/importance) Essay Bank FOUR of the following SIX will appear on the exam, and we will ask you to answer TWO essay questions. Describe processes related to deviant peers in externalizing broadly and Conduct Disorder specifically. Strong answers will include concepts such as a definition of coercion, discussion of two mechanisms of coercion contagion, how coercion builds in young kids, and how time of onset of conduct disorder predicts outcomes. Discuss the impact of adverse experiences in childhood on adolescents, according to Sheridan et al. (2017). Be sure to discuss the general influence of these experiences on the brain, as well as how threat and deprivation experiences operate differently in psychopathology. Be sure to describe the mechanism of deprivation on externalizing.  Describe your understanding of psychopathy and antisocial personality disorder. Which is more valid as a construct and why? Which is the diagnosis in DSM 5 and why? What are the three components in the Triarchic Model of Psychopathy – and say what each one means. We discussed Perkins et al. (2022) in class. Describe the aim of Perkins et al regarding disinhibition and callousness regarding externalizing disorders. Define disinhibition and callousness. In this context, what do “general” and “specific” risk factors refer to? Provide a summary of what the study found. Describe the treatment of substance use called Motivational Interviewing (MI). Ensure to name the 4 stages and discuss details of the 3 covered in-depth class. In your response, include some results from Ewing et al. (2021) on the efficacy of MI or mechanisms by which MI is effective. Discuss the differences and similarities amongst externalizing disorders. Consider their common or differentiating symptoms, risk factors (including genetic, biological, and/or social factors), associated personality traits, and treatment aspects. In your response, include at least 2 of the following: Conduct Disorder, Oppositional Defiant Disorder, Antisocial Personality Disorder, Attention Deficit- Hyperactivity Disorder, Substance Use Disorder, and/or Psychopathy.