Mental Health and Disorders - PDF

**Mental Health \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Mental health:** A person's psychological and emotional wellbeing. **Mental health problems:** a range of emotional, cognitive, or behavioural "issues" that can affect people. **Mental/psycholog...

**Mental Health \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Mental health:** A person's psychological and emotional wellbeing. **Mental health problems:** a range of emotional, cognitive, or behavioural "issues" that can affect people. **Mental/psychological disorder:** a clinically recognizable set of signs, symptoms, syndromes, and behaviours that may cause distress to the individual and/or impair their ability to function. There are many different causes for psychological disorders, and different individuals may develop the same condition for different reasons. Alternatively, different individuals may experience the same reasons for a condition, but have different outcomes.    **[Biopsychosocial model ]** Mental health and disorders are influenced by several interlinking factors.  **Biological factors:** Genetics, hormone and neurotransmitter imbalances. **Psychological factors:** Cognitive biases, coping skills, maladaptive thought patterns.  **Social factors:** Social support, experience of interpersonal trauma/stress.   **[Diathesis-stress model]** Disorders can be triggered when people with pre-existing vulnerabilities experience some sort of acute or chronic stressor. These work in a cumulative fashion, the greater the diathesis, the less stressors are needed to trigger an event   - **Diathesis**: individuals possess some sort of internal factor (i.e., genetic, cognitive, etc.) which predisposes them to a psychological disorder - **Stress:** an internal or external event that triggers the psychological disorder **"Abnormality" \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **[Statistical infrequency]** Is the behaviour particularly common? - if it is common, it is probably not a psychological disorder. If it is very rare (1-2% of the population) then we might consider it to be \"abnormal\". **Limitations:** - Not all rare behaviours are psychological disorders. - Not all psychological disorders are rare (depression, anxiety). **[Personal distress ]** The experience of extreme anxiety, sorrow or pain. Often the subjective experience that suggests to an individual that they may require psychological treatment. **Limitations:** - Not all those who are distressed have a psychological disorder. - Not all those who have a psychological disorder are distressed. - Some forms of distress are not "abnormal".   **[Impairment/Dysfunction]** Reduced capacity for everyday functioning: - Cognitively - Socially - Emotionally - Occupationally **Limitations:** - Other (non-psychological) disorders and diseases. - Personality traits. **Psychological diagnosis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Advantages:** - Helps professionals to communicate quickly. - Helps client to understand what is going on for them. - Helps to inform a treatment. - Helps to normalise symptoms for a client. **Disadvantages:** - Not everyone fits into a diagnostic category. - A lot of people have distressing symptoms that do not meet criteria for a 'disorder'. - Stigma - Can be distressing for a client. **[Diagnostic issues ]** **Cultural differences:** Some disorders are specific to certain cultures (culture-specific disorders): - Wendigo psychosis (Native America): Depression, homicidal or suicidal thoughts, and a delusional, compulsive wish to eat human flesh.   **Common misconceptions/controversies:** - Diagnosis reduces the individual to their disorder. - Diagnoses are too unreliable to be useful. - Diagnosis is only descriptive and therefore meaning **Learning Theory and Psychological Disorders \_\_\_\_\_\_\_\_\_\_\_\_\_** Some (not all) psychological conditions can be partly a learned response. Anxiety disorders are an example of one type of disorder that can be partly explained by a learning theory. If a disorder is associated with a learned response, then we can unlearn that response too. This is a key element in some therapies. **[Classical conditioning ]** \"A process where a previously neutral stimulus elicits a response after being paired with a stimulus that automatically elicits a response\". Unconditioned Stimulus (US) can be paired with the Conditioned Stimulus (CS) to trigger the same Unconditioned Response (UR) which becomes a Conditioned Response (CR). **[Operant conditioning ]** **Reinforcement** Any event or consequence that occurs which increases the likelihood of the behaviour occurring again. - **Positive reinforcement:** the delivery of a pleasant consequence following the behaviour. Behaviour is likely to increase in order to achieve the pleasant/ rewarding outcome/ consequence again.   - **Negative reinforcement:** the removal of an unpleasant stimuli when a - desired behaviour occurs. Removing unpleasant stimuli are considered reinforcements as this should increase the likelihood of the same behaviour occurring again as the organism tries to remove or escape from the unpleasant situation.   **Punishment** A stimulus/ environmental consequence which decreased the likelihood of a behaviour occurring again. - **Positive punishment:** the introduction of an unpleasant stimulus (or consequence) following a behaviour. The behaviour should decrease as the organism tries to avoid experiencing the negative stimulus in the future. - **Negative punishment**: the removal of a pleasant stimuli/ environment, or the failure to provide a positive consequence following the behaviour. The behaviour should decrease as the organism tries to maintain the pleasant stimuli/ environment. **Anxiety Disorders \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** Anxiety is \"a negative mood state characterised by bodily symptoms of physical tension and by apprehension about the future". **[How it is different to fear ]** **Anxiety:** Apprehension about future problem, worry about encountering a snake in the future. **Fear:** Reaction to an immediate danger, encountering a dangerous snake.   **[Fight or flight response]** Anxiety if often considered to be triggered or associated with excessive activation of our flight of fight system. Prepares us to respond to environmental stimuli (essentially an arousal response) Inbuilt system in our bodies that prepares us to: - Fight off danger. - Flight: run away from a threat.   But this system also triggers two other 'F' responses: - Freeze. - Fornicate (arousal response). Not everyone has the same fight or flight response when presented with a threat. Anxiety and fear are normal, and are usually adaptive. But when these responses become maladaptive, we need to consider if there is an anxiety disorder. **[Theories of anxiety disorders ]** **Cognitive Processes** - Interpretation of information and/or physiological arousal as threatening. - Coping strategies and personality type. - Appear important in most anxiety disorders.   **Environmental Factors** - Stressful life events are associated with development of anxiety disorders such as Panic Disorder and PTSD. **Genetic Factors** - Different gene types can influence biology/physiology of the brain, e.g. increase brain reactivity to perceived threats. - Appears important in OCD, GAD some phobias. **[Panic Attack]** Peaks within 10 minutes, and involves 4 + of the following symptoms: - Heart palpitations/racing pulse - Shortness of breath/difficulty breathing - Chest pain/discomfort - Hot/cold flashes - Choking sensation - Dizziness - Fear of imminent death - Numbness/tingling sensations - Derealisation/depersonalisation - Nausea/Abdominal discomfort - Sweating - Trembling - Fear of loss of control/going insane **Panic Disorder** Characterised by unexpected and repeated panic attacks. To diagnose, at least one of the attacks must have been followed by one month (or more) of one or both of the following: - Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, going "crazy"). - A significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks). **Generalised Anxiety Disorder (GAD)** Chronic, excessive anxiety that occurs for at least 6 months, for more days than not. Characterised by presence of at least 3 of the following: - Restlessness or feeling keyed up or on edge - Being easily fatigued - Difficulty concentrating or mind going blank - Irritability - Muscle tension - Sleep disturbance **[Phobias ]** **Agoraphobia** Fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of having unexpected panic-like symptoms.   **Social Phobia** A fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others and feels they will act in an embarrassing manner. Exposure to the feared social situation provokes anxiety, which can take the form of a panic attack. **Specific Phobia** Chronic excessive fear that is cued by the presence or anticipation of a specific object or situation. 4 main types: - Animal - Situational - Natural environment - Blood, injection, injury Anything can become the object of a specific phobia. **Depressive and Bipolar Disorders \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Depressive disorders:** characterised by persistent sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's capacity to function. **Bipolar disorders:** characterised by swings between depressive symptoms and manic or hypomanic symptoms.   - **Depression:** negative, lowered mood state. - **Mania:** an intense, but unwarranted, mood state of elation, irritation or expansiveness. **Symptoms of depression** - Sad, depressed mood, most of the day, nearly every day. - Loss of interest and pleasure in usual activities - Difficulties in sleeping (insomnia or hypersomnia) - Shift in activity level (psychomotor retardation / psychomotor agitation) - Poor appetite and weight loss, or increased appetite and weight gain. - Loss of energy and great fatigue - Negative self-concept with feelings of worthlessness and guilt along with self-reproach and self-blame. - Complaints or evidence of difficulty in concentrating (slowed thinking and indecisiveness). - Recurrent thoughts of death or suicide. **Symptoms of mania** - Inflated self-esteem or grandiosity. - Decreased need for sleep. - More talkative than usual or pressure to keep talking. - Flight of ideas or subjective experience that thoughts are racing. - Distractibility - Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity). - Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).   **Manic episode:** 3 or more symptoms lasting at least 1 week for most of the day, nearly every day.  **Hypomanic episode:** 3 or more symptoms lasting at least 4 consecutive days and present most of the day, nearly every day. For bipolar to be diagnosed, there also needs to be a major depressive episode (5+ symptoms present during the same 2 week period) **[Bipolar I Disorder]** Characterised by the presence of a manic episode and an episode of depression. Is a recurring disorder: 90% have a second episode. Majority resume normal functioning between episodes. Equally common in men and women. Research (twin/adoption studies) indicates a strong genetic link. Lifetime prevalence of about 1.5%. **[Bipolar II Disorder ]** Characterised by the presence of a hypomanic episode and an episode of depression. **[Cyclothymia ]** Presence of hypomanic symptoms and depression symptoms, but not enough of either to fit the criteria (i.e. less than 3 manic symptoms, less than 5 depression symptoms) for at least 2 years. These must have been present for at least half the time and symptoms not absent for more than 2 months at a time. **[Major Depressive Disorder (MDD) ]** Requires the presence of at least 5 of the symptoms of depression for a period of at least 2 weeks. Major Depression is twice a common in women than in men, and it occurs most frequently in young adults. Major depression has a lifetime prevalence of 10-25% (women), 5-12% (men). At any given time 5.1% of adults have MDD: 3.4% for men, 6.8% for women.  **Major Depressive Disorder tends to recur:** - 80% of those who experience a single episode will have another within 1 year. - 15% of those with Major Depression develop a chronic form with multiple recurring episodes of depression.  **[Dysthymic Disorder (Persistent Depressive Disorder)]** A less severe, but more chronic form of depression. Requires the presence of 2 or more symptoms (but not meet criteria for MDD) for a period of at least 2 years.   Dysthymia has a lifetime prevalence of 6-8% (women) and 5% (men). At any given time 3% of population have dysthymia. Tends to start in adolescence, and average duration is 5 years (but can persist as long as 20 years). **[Theories of depression disorders:]** **Behavioural Model (Lewinsohn)** - Lack of reinforcement when engaging in social/pleasurable activities leads to withdrawal, thus reducing likelihood of reward even more. - May become positively reinforced for withdrawing (others initially show increased concern and empathy). - Therefore, this model suggests depression can be reduced simply by re-engaging in social/pleasant activities (although this may require considerable effort).  **Biological Causes** - **Genetic Factors:** Where MD or PDD are more recurrent or severe, there seems to be a higher genetic contribution (Nguyen et al 2022). - **Neurotransmitter Function:** Reduction/Imbalance in neurotransmitters (the brain's chemical messengers) such as serotonin, dopamine and noradrenaline. **Life Events/Environmental Factors** Psychosocial stressors in the environment of children and adults are associated with the development of depressive symptoms. Risk factors include: - Disruptive, hostile and negative home environment. - Death of family member (when a child). - Parental divorce. - Loss of employment. - High levels of expressed emotion within the family. - Lack of an intimate relationship. **Seligman's theory of learned helplessness** Seligman\'s theory of learned helplessness suggests that individuals who experience uncontrollable and inescapable adverse events may develop a sense of helplessness, perceiving that they have no control over their circumstances. This perception can lead to a state of learned helplessness, where they stop trying to change their situation, even when opportunities for change are available. **Cognitive Model: Beck's Theory of Depression** Beck's cognitive model focuses on the role of negative thoughts in the development and maintenance of depression. He proposed that depression is characterized by a cognitive triad of negative thoughts about the self, the world, and the future: - Negative Self-View: Depressed individuals often have a poor self-image and see themselves as worthless or inadequate. - Negative World View: They tend to interpret their experiences in a negative light, believing that the world is unfair or hostile. - Negative Future View: They have a pessimistic outlook on the future, expecting that things will not improve. **Suicide \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Suicide Ideation:** having thoughts about suicide. **Suicide Attempt:** behaviour aimed as taking one's own life. **Suicide/Death by Suicide:** talking one's own life.   Using 'commit' implies criminality (you commit a crime) 'Un/successful', 'completed' and 'failed suicide attempt' are also problematic as they imply suicide is some form of achievement. Depressive and Bipolar disorders are strongly associated with increased risk of death by suicide.   Moitra et al (2021) reviewed risk of suicide associated with mental health disorders: - Major Depressive Disorder: x 7 - Persistent Depressive Disorder: x 4 - Bipolar Disorders: x 6 Suicide accounts for 1.4% of deaths in Australia. More males die by suicide than females, more females attempt suicide than males.   **Psychological factors** - Depression - Hopelessness - Other disorders such as schizophrenia, PTSD, AD, some personality disorders   **Socio-cultural factors** - Gender (male more likely to suicide) - First Nations/cultural minorities - Rural/regional areas   **Substance Abuse** - Chronic, painful or disfiguring illness - Recent loss of loved one, through divorce, death, etc - Auditory hallucinations: Voices commenting, Voices conversing - Somatic/tactile hallucinations - Olfactory Hallucinations - Visual Hallucinations   - Persecutory delusions - Grandiose delusions - Religious delusions - Somatic delusions - Delusions of reference - Delusions of being controlled - Delusions of mind reading - Thought broadcasting - Thought insertion - Thought withdrawal **Thought Disorder Symptoms** Tendency of thought to move along associative lines, rather than being controlled, logical or purposeful Some examples: - Derailment: ideas slip off track onto obliquely related areas - Circumstantiality: speech stays on track but very delayed in reaching goal - Distractible speech: speech changed mid-sentence in response to a stimulus **Negative Symptoms** Symptoms that reflect a reduction or disappearance of abilities, emotions or drives that are usually present Some examples: - 'Blunting': unchanging expression - Alogia: Poverty of speech, very slow to respond - Avolition: poor hygiene, low motivation **[Course of Schizophrenia ]** Typically begins in early adulthood (males = 18 years old females 25 years old). The lifetime course of schizophrenia varies greatly -- some have a few episodes then recover, for others it occurs for entire adult life. **[Theories of the development of schizophrenia ]** **The Dopamine Hypothesis** Dopamine is a neurotransmitter - a chemical that occurs in the brain and is involved in transmitting messages by moving from one neuron (brain cell) to another. Appears to influence thought, emotions, motivation and behaviour. A drug that reduces dopamine (Chlopromazine) was found to reduce some symptoms. So is schizophrenia caused by too much dopamine? - Not that simple -- when chlorpromazine was used, only positive symptoms were reduced. Negative symptoms were made worse. - Dopamine imbalance? do some pathways have too much dopamine and others not enough? - Or is it something about the way the neurons 'collect' dopamine? **Diathesis-Stress Model** Suggests that people with an underlying biological vulnerability may develop schizophrenia either directly or as a result of experiencing additional stressors. **Obsessive Compulsive Disorders (OCD) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Obsessions:** Persistent, intrusive ideas, impulses or images that are unwanted and inappropriate, and that cause distress.   **Compulsions:** Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. OCD is a disorder in which the mind is flooded with persistent and uncontrollable thoughts (obsessions) or the individual is compelled to repeat certain acts (compulsions) again and again, causing significant distress and interference with everyday functioning.   **Common types:** - Cleaning and contamination - Forbidden thoughts or actions - Symmetry - OCD affects 2-3% of the population. OCD is equally common in women and men. **Obsessive-Compulsive Related Disorders** There are a range of disorders that are in the category of Obsessive-Compulsive Related Disorders; all have some form of obsession and compulsion, but can vary greatly in how that is expressed.   These disorders can be very overwhelming and life changing, and are often associated with very high levels of distress. - Obsessive-Compulsive Disorder (OCD) - Body Dysmorphic Disorder - Hoarding Disorder - Trichotillomania **Personality Disorders \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** Personality disorders are a group of disorders where there are a number of personality traits (characteristics) which are extreme, maladaptive, and cause distress (to the person, or others, or both). We would not consider someone to have a personality disorder unless there is very strong evidence of group of personality traits and associated behaviours that are clearly causing significant negative outcomes for the person and/or those close to them. This dysfunction needs to have occurred for a long period of time, and across a wide range of areas/settings. - Culturally determined expectations of "normal" E.g. Introversion vs. extraversion. - Need to consider context of behaviour Is it consistent, or only in some contexts? - Need to observe longitudinally. - Issues with self-report Social desirability bias, lack of insight Difficulties defining "disordered" personality traits means low reliability in diagnosis. - Personality traits first appear by adolescence. - Traits are inflexible, stable, and expressed in a wide variety of situations (although more pronounced when under stress). - Traits lead to distress or impairment for individual/others. - Rarely diagnosed before age 18 years Show substantial comorbidity with other disorders such as anxiety, depression, etc. **[Current issues]** **High levels of comorbidity:** There is some debate regarding the distinction between some disorders -- often a high level of co-morbidity (presence of 2 or more PDs) **Frequency of unspecified diagnosis:** Often several criteria are met for a number of PDs, but the person doesn't meet sufficient number of criteria for one PD (e.g. 3 symptoms of borderline, 3 paranoid personality disorder) 10 types of Personality Disorder listed in the DSM, grouped into three "clusters" based on broad symptom types. - **Cluster A:** Odd, eccentric cluster: most common disorder is paranoid personality disorder. - **Cluster B:** Dramatic, emotional, erratic cluster: most common disorder is borderline personality disorder. - **Cluster C:** Anxious, fearful cluster: most common disorder is dependent personality disorder.   **[Cluster A: Paranoid Personality Disorder ]** Pervasive distrust and suspiciousness of others. Assume others' intentions are malevolent. Requires at least 4 of the following: - Unfounded suspicion of others -- assumes others intend to deceive, harm or exploit - Preoccupied with doubts about loyalty or trustworthiness of friends/family - Unwilling to confide in others - Interprets positive or neutral remarks as being offensive or threatening - Constantly bears grudges - Perceives personal attacks where others do not, and is excessively defensive/aggressive in response - Constant unjustified suspicions that partner is unfaithful   **[Cluster B: Borderline Personality Disorder]** Long term instability of relationships, self-image and mood. Requires presence of at least 5 of the following: - Frantic efforts to avoid abandonment (real or imaginary) - Unstable, intense relationships that swing between idolising and devaluing the other person - Unstable sense of self - Impulsive in at least two areas (eg spending, sex, substance use, binge eating) - Recurrent self-harm and/or suicidal behaviour - Emotionally volatile -- extreme mood swings and find it difficult to regulate emotions, particularly anger, sadness, fear. - Chronic feelings of emptiness - Anger problems (inappropriate anger, inability to control anger) - Short term paranoid thoughts and/or severe dissociative symptoms A pattern of 'stable instability' 2% general population. mostly diagnosed in females. High co-morbidity with mood disorders and substance disorders. Thought to often be associated with childhood abuse and/or trauma. Tendency to improve in mid-life.   **[Cluster C: Dependent Personality Disorder]** Constant and extreme need to be taken care of, that leads to submissive/clingy behaviour and fear of separation. Requires five or more of following: - Difficulty making everyday decisions without advice or reassurance - Wants others to assume responsibility for major life choices - Fears disagreeing with others even when chance of anger/retribution minimal - Lacks confidence to initiate activities - Takes extreme steps to get support/approval from others (e.g. volunteer for unpleasant tasks) - Feels uncomfortable when alone because scared they will need to look after themselves - Frantically seeks new relationships when one ends - Preoccupied with fears of being left to look after themselves   0.4 - 0.6% of population, more frequent in females, although also evident in males. Most frequently reported Personality Disorder in clinical settings. Need to consider developmental appropriateness of diagnosis -- children are dependent on caregivers, but this is not a personality disorder. **Trauma and stress related disorders \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Trauma:** An event (or events) that cause extreme distress or disturbance. **Stressor:** An environmental circumstance (e.g. social or physical), which causes fear, frustrations, sadness. Many disorders can be triggered by stress and trauma, but stress and trauma is not always present -- e.g. some people with anxiety disorders can trace the cause back to a stressor/trauma, but others with the same disorder have no history of stress/trauma. But, exposure to trauma and/or stress is always a key feature in this category of disorder. **[Post-Traumatic Stress Disorder (PTSD)]** **Diagnosis requires the following 5 factors to be present:** The person was exposed to: death, threatened death, actual or serious injury or sexual violence, as follows (1 required) - Direct exposure - Witnessing, in person - Indirectly -- learning a close friend/relative exposed - Repeated or extreme indirect exposure via professional duties (not e-media, TV, videos, movies) And for at least one month following the trauma, the person experiences: - Persistent re-experiencing of the traumatic event (e.g. nightmares, flashbacks) - There is persistent avoidance of the stimuli associated with the traumatic event and a numbing of general responsiveness. - Negative alterations to cognition or mood (e.g. excessive guilt or blame of self or others, feeling alienated, inability to enjoy activities previously enjoyed). - Persistent symptoms of heightened arousal (e.g. hypervigilance, irritable behaviour, exaggerated startle response).   PTSD symptoms usually begin within 3 months of the trauma, but delays of months and even years have been reported.   Prevalence among high risk groups at 3-58% (combat veterans, victims of bushfires, victims of criminal violence/assault) 7.8% of people have experienced PTSD at some point, but 60-70% of population experience a traumatic event as described in point 1 -- so most people do not develop PTSD after trauma. While stress and trauma might contribute to many psychological disorders, it is always the key cause of trauma and stressor related disorders. Post Traumatic Stress Disorder is one of the more common disorders in the category. It is important to remember that not everyone responds the same way to trauma and stress -- many people exposed to serious stress and trauma do not develop PTSD or related disorders. **Neurodevelopmental Disorders \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Neurodevelopmental:** a class of disorders that are commence during childhood or prenatal development. Includes: - Intellectual disability - Communication Disorders (e.g. stuttering) - Autism Spectrum Disorder - Learning Disorders (e.g. dyslexia) - Attention-Deficit/Hyperactivity Disorder   **[Autism spectrum disorder ]** Previously separated into several disorders including autistic disorder and Asperger's disorder. Whilst there may be a range of severity, symptoms must be present in early development, and cause significant impairment in social and/or occupational functioning. **Requires presence of the following:** Persistent deficits in social communication and interaction, including: - Inability to engage in social emotional reciprocity - Difficulty expressing and interpreting non-verbal behaviour - Difficulty understanding and forming relationships Restricted, repetitive behaviours, interests or activities, demonstrated by at least two of the following: - Stereotypes/repetitive motor movements, use of objects, or speech. - Insistence of sameness, inflexibility, ritualized behaviour - Narrow, fixated interests that are excessively intense - Extreme sensitivity or limited sensitivity to environmental stimuli (e.g. indifference to pain, excessive touching of objects) **Prevalence:**.6% -2% of children. 4 x more common in males Appears to have a strong genetic component -- Twin concordance rates range from 37% to 90%. Pruning hypothesis - Lack of neuronal pruning during developmental periods?   Neurodevelopmental disorders vary in terms when they develop, but all occur during childhood (even if not diagnosed until later). There are a range of different areas of impairment -- intellectual function, communication., learning, social skills etc.   Autism Spectrum Disorder in one of the more common neurodevelopmental disorders -- its severity ranges from mild to very severe, but has two key features: - Difficulty with social and emotional interactions - The presence of repetitive or restricted behaviours **Neurocognitive Disorders \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Neurocognitive:** a class of disorders in which the predominant symptom is cognitive impairment (deficits in memory, learning, thought). Some common causes are: - Advanced Age (e.g. Alzheimer's Disease) - Illness (e.g. HIV related dementia) - Injury (e.g. Traumatic Brain Injury) - Genetics (e.g. Huntington's Disease)   **Dementia:** an umbrella term that covers a range of disorders in which there is a steady, usually irreversible, pattern of cognitive decline. Can affect memory, language, thought, behaviour. Whilst some forms are treatable (e.g. those due to infection), most are irreversible (e.g. Alzheimer's Disease) Onset is typically insidious. So, Alzheimer's disease is one of a number of types of dementia.   **[Alzheimer's Disease (AD)]** Degenerative brain disorder that involves progressive cognitive decline. Culminates in widespread cognitive failure and death. AD is the most commonly diagnosed form of dementia, but technically can only be confirmed post mortem, so classified as either: - **Probable Alzheimer's Disease:** if there is a family history and/or there is significant cognitive decline. - **Possible Alzheimer's Disease:** if there is no family history, but there is steady cognitive decline which cannot be explained by other medical history   Prevalence: 13% in 65 + 42% in 85 + Average lifespan following diagnosis: 10 years Tends to be more frequent in females (even after longevity differences between sexes is accounted for) AD is characterised by the presence of neurofibrillary tangles, senile (aka amyloid) plaques and neuron loss, typically concentrated in specific regions of the brain.   **[Causes ]** **Genetic Factors:** There is strong evidence that a number of genes influence likelihood of developing AD. **Medical History:** Previous experience of a traumatic brain injury increases risk of developing AD. Certain other conditions (eg Downs Syndrome) are associated with greater risk of AD. **[Alzheimer's Disease Progression ]** **Neuroanatomical:** - The damage associated with AD usually commences in specific brain regions, then spreads in a predicable pattern. - We can therefore predict in many cases what functions will become impaired during the progression of the disease.   **Cognitive:** - Often starts with general confusion and irritability, speech deficits. - As the condition progresses the memory impairments become increasingly noticeable. - Memory loss follows pattern of structural deterioration. - Occurs in all types of memory : Episodic (memory of events that have happened). Semantic (general knowledge). Procedural (how to make a cup of tea) - Recent memories are first to be lost, and there is a chronological progression backwards: E.g. forget grandchildren's names, then children's, then partners, then siblings etc. As well as memory decline, there is a number of other changes: - Mood: depression often see in early stages - Mood: can become combative/argumentative - Language impairment - Restlessness/Motor agitation - Motor impairment: e.g. difficulty walking - Psychosis - Lose social inhibitions    **Neurofibrillary Tangles (NFTs):** Threads of protein that occur within a neuron. **Senile Plaques (aka Amyloid Plaques):** Deposits caused by debris from degenerating neurons and build-up of protein. **Psychological treatment \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Psychotherapy:** term covering the wide and disparate range of techniques used in an attempt to enhance psychological and emotional well-being. Different treatments vary in terms of efficacy (how useful they are), and in terms of their scientific rigour (how well supported by evidence they are). Treatment can also be biased -- it might work better for some groups/populations than others. **Who does psychotherapy** Psychotherapy is not just done by psychologists: - Social Workers - Counsellors - Nurses - GPs   **Psychiatrists In a range of settings:** - Practitioner rooms/surgeries - Workplaces - Support services (eg Drug and Alcohol, Relationships Australia) - Group/family settings (Alcoholics Anonymous) - Hospitals - Schools - Online/over the phone   But! Not everyone is qualified to use the same psychotherapeutic tools. For example: - There are psychological scales/tests that only a qualified and registered psychologist can use (e.g. IQ tests) - Psychiatrists and GPs can prescribe medication -- psychologists (and others) can't - It is important (and ethical) to know the boundaries for a given role **[What makes a good therapist ]** Training and experience is a good starting point. But evidence suggests other traits (characteristics) are also important: - Warmth - Ability to develop a good therapeutic alliance (working relationship with the client) - Focus on the key issues - Able to align treatment approach with the person - Willing to get feedback from client, supervisor and colleagues - Keep up to date with research And of course, therapists are expected to behave in an ethical manner.   **[The Science-Practitioner Model ]** "The scientist-practitioner model of education and training in psychology is an integrative approach to science and practice wherein each must continually inform the other. This model represents more than a summation of both parts. Scientist-practitioner psychologists embody a research orientation in their practice and a practice relevance in their research." (O'Gorman, 2001, p 164)   This is an important model for psychotherapy. However, it does have limitations -- e.g. if we focus on applying evidence based-practice, are we exploring new approaches? **Psychodynamic therapies \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** Founded by Freud Based on the assumption that psychopathology develops when people remain unaware of their true motivations and fears. Such people can be restored to healthy functioning only when they become conscious of what has been represented (kept in the unconscious). Psychodynamic therapy is contingent on two principles: - **Insight:** the client's capacity to understand their own psychological processes. - **Therapist-Client alliance:** crucial in effective change to the disordered psychological processes.   **The 5 Core Beliefs of Psychodynamic Therapies** - Most behaviour is driven by unconscious wishes, impulses, drives and conflicts. - There is a meaningful explanation/cause for abnormal behaviour, which can be discovered by the therapist. - Current issues are based on childhood experience. - To overcome problem, emotional expression and reliving of past emotional experiences is crucial. - Once the client understands and has emotional insight into the unconscious drives/material, the symptoms are understood and therefore often resolve themselves.   **[Stages of psychoanalysis ]** - **Free Association:** The client is encouraged to give free rein to thoughts and feelings and to verbalise whatever comes to mind, with the intent of uncovering of unconscious material. - **Interpretation:** The technique of interpretation comes into play as presumably unconscious material begins to surface. The therapist points out to the patient their defences and the underlying meaning of behaviours, thoughts, desires, or even dreams. - **Dream Analysis:** The therapist interprets dreams in the context of what is occurring in life for the person. Looks at the dream's manifest (actual dreamt events) and tries to determine the latent (hidden) meaning. - **Resistance:** Resistance or blockages to free association are thought to arise from unconscious control over sensitive areas. These areas are sought and targeted for exploration by the therapist. - **Transference:** The process by which people experience similar thoughts, feelings, fears, wishes and conflicts in new relationships as they did in previous relationships. Clients might transfer feelings they have for a person to the therapist and engage in a relationship with the therapist that resembles a prior relationship. (Counter-transference). - **Working Through:** Therapist assists the person in processing the information and insights gained during therapy. Also involves continued identification of arising conflicts and resistance.   **Criticisms of Psychodynamic Approach** - Sample Bias: Freud based approach on rich, intelligent, successful individuals. - Confirmation Bias: selecting pieces of information that support claims and disregarding information that doesn't support claims. - Long term = expensive. - Do we really need insight to resolve problems? - Lack of scientific rigour in some situations -- circular arguments. **Humanistic-Existential Psychotherapy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**  Like psychodynamic therapy, humanistic therapy requires the client to develop insight into the problem. Believe that human nature is inherently positive and good, and that we all have the ability to reach our full potential. Focus of these therapies is on the phenomenology of the client.   **Phenomenology:** The way each person consciously experiences the self, relationships and the world.   **The aim:** Help people get in touch with their feelings, with their 'true selves' and with a sense of meaning in life.   Humanistic therapies often considered as one of the 3 main approaches to psychological therapy (others are Behaviourism and Psychoanalysis). Largely created by Abraham Maslow -- who viewed psychology as too concerned with the neurotic and disturbed (psychoanalysis) or with those that could be explained by a mechanistic approach (behaviourism). Humanistic therapies are concerned with how a person experiences: self, relationships with others, and the world.   **[Person-Centred Therapy (Client-Centred)]** Devised by Carl Rogers who rejects the notion of a disease-model -- i.e. people come to therapy to help solve problems not to be "cured" of their disorder. **Core traits of the therapist:** - The therapist must be authentic and genuine (sometimes referred to as congruence). - The therapist must express unconditional positive regard (non-judgemental acceptance of the client and their feelings). - The therapist must relate to client with empathetic understanding. - People can be understood only from the vantage point of their own perceptions and feelings. - Healthy people are aware of their own behaviour. - People are innately good and effective, they become ineffective and disturbed only when faulty learning intervenes. - Behaviour is purposive and goal-directed. - Therapists should not attempt to manipulate events for the individual -- rather they should create conditions which will facilitate independent decision making by the client.   **Criticisms of humanistic- existential psychotherapy** - Lack of scientific rigour in some situations -- difficult to measure self awareness. - Positive regard and empathy may not be necessary for effective counselling. - Efficacy is variable -- some evidence suggests not more beneficial than simply talking to a non-professional about problems. - Cultural bias? Some argue that humanistic approach is based on Western individualistic values **Behavioural therapy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Behavioural and cognitive-behavioural therapies** Psychodynamic and humanist perspectives focus on insight and emotion as the pathway to improvement Behavioural therapy and Cognitive- Behavioural Therapy (CBT) evolved as a result of the development of Behaviourism and Cognitive Psychology from the 1940's onwards. Both have their basis in scientific explorations rather than clinical practice.   **Basic Principles** - Short-term therapy. - Therapeutic focus is the current behaviour/cognitions, not on past (e.g. childhood) experiences or inferred motives. - Therapy commences with a behavioural analysis. - Therapy targets problematic behaviours, cognitions, and emotional responses.   **Exposure:** Used to treat phobias, anxiety triggered responses. Involves confronting the client with the stimulus they fear. The way in which this confrontation occurs determines the type of exposure used. Exposure techniques include: - Systematic desensitisation - Flooding techniques - Virtual reality exposure The crucial element in all exposure techniques is that in exposing the client to the feared stimulus they are prevented from escaping the stimulus, whilst anxiety levels subside.   Anxiety reactions decay over time due to the energy requirements for maintenance. By preventing the capacity to flee or fight the person experiences anxiety decay and is therefore "reconditioned".   **[Exposure techniques ]** **Systematic Desensitisation:** Is specifically aimed at the alleviation of maladaptive anxiety, particularly phobias. Involves pairing relaxation with imagery of anxiety provoking scenes or stimuli - a counterconditioning process. **Flooding:** Client is exposed immediately to feared experience. **Response prevention:** The therapist stops the person from engaging in their typical avoidance responses -- both behavioural (e.g. leaving) and cognitive (e.g. thinking about something else). **Virtual Reality**: The client views computer generated images of the feared experience.   **Modelling & Skills Training:** Learning theory (Bandura) developed in the 1960's and has influenced heavily how clinical psychologists explain how disorders develop as well as develop new therapeutic approaches to treatment.  **Modelling** - It is well established that children and adults model the behaviour of others, often unconsciously (watch your friend eating when you are eating). - Can learn both maladaptive (e.g. phobia) and adaptive (e.g. effective coping) behaviours. - Client modelling the behaviour of the therapist can be used either implicitly (client will learn over time the responses and reactions of the therapist and use them externally), or explicitly (role play, role reversal). **Social Skills Training** Emphasis is on assisting clients with interpersonal/social problems (e.g. social phobia, shyness, lack of assertiveness). Direct skills training from the therapist, followed by role playing with self-examination of behaviour, followed by rehearsal are the common steps. Virtual Reality technology is also being used to assist in the skill-based training for social interactional problems. Can be used to improve social interactions in people with schizophrenia, depression, autism. However when used in this manner cannot be considered to 'cure' the disorder. **[Conditioning techniques]** Operant conditioning involves the use of reward based systems to counteract maladaptive behaviours, emotions, or cognitions. Such techniques are widely used in dealing with anxiety disorders, especially in children or in high-needs environments   **Token Economy:** use star chart or similar to promote desired behaviour and discourage unwanted behaviour. Often used with children, but can also be used in adult setting (e.g. psychiatric units).   **Aversion Therapies:** pairing of unpleasant stimuli with unwanted behaviour. Not commonly used, however still useful in some situations. **Criticisms of Behavioural Therapies** - Most behaviourist approaches ignore the role of any internal processes (e.g. cognition and emotion). - Insufficient consideration of personal relationships. - While psychodynamic approaches might have focussed too much on historical factors (e.g. childhood), perhaps behaviourism is too dismissive of their role? **[Cognitive behavioural therapy ]** Behavioural therapy focuses on increasing adaptive actions and behavioural responses. Change tends to be at a physiological/behavioural response level. Cognitive-behavioural extends on this and incorporates cognitive response to a greater level. Behavioural techniques such as exposure and desensitisation are also included in CBT.   **3 key assumptions:** - Cognitions can be identified and measured - Cognitions underpin both adaptive and maladaptive psychological function - Through therapy and practice, maladaptive thought processes and behaviours can be changed into adaptive processes   **[RET; Rational Emotive Therapy: Albert Ellis (AKA REBT)]** Emotional reactions are caused by internal sentences that people repeat to themselves. RET is designed to eliminate the incorrect (irrational) beliefs of a disturbed person through a process of rational examination of those beliefs. **[Beck\'s cognitive therapy]** Beck's version of cognitive therapy was devised specifically for the treatment of depression. Beck believed that depression in particular is caused by the negative patterns in which individuals think about themselves, the world, and the future. **Behavioural exercise: Behavioural activation** - Aim is to increase engagement by scheduling pleasant activities - It also helps the client re-engage in activities they have been avoiding - It is important to set tasks that are achievable - The first step is to get client to recognise the connection between inactivity and low mood - This involves the client monitoring what they do during the day and also noting their mood at that time (0 = Low mood, 10 = Excellent mood) - Gradually the client is asked to start implementing pleasant events by scheduling activities   **Criticisms of Behavioural and Cognitive Behavioural Therapies** - Some therapies require a moderate-high level of motivation by client - Negative thoughts can be realistic - The relationship between changing thoughts and changing behaviour may be exaggerated (e.g. change in though but still engage in maladaptive behaviour) - Insufficient consideration of personal relationships/background? **Psychopharmacology \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Psychotropic Medication** Drugs that act on specific brain functions. Broadly includes any pharmaceutical agent that is able to cross the blood-brain barrier and exert a direct influence on CNS cellular function. 1950's: - Thorazine found to be effective in treating psychosis - Lithium used in bipolar disorder Now: - Medications for psychological disorders are the most commonly prescribed of all medications - 170+ different medications **[Commonly used medications]** **Antianxiety medications (anxiolytics):** Broadly derived from a class of benzodiazepines which appeared in the 1960's and replaced the use of barbiturates (highly addictive). **Potential side effects:** Drowsiness, dizziness, low BP. Some are addictive. **Antidepressants:** Antidepressants first emerged in the 1950's, with the SSRI's appearing in the late 1980's. SSRI's now the dominant antidepressant (but watch this space -- Moncrieff et al 2022) lower risk of side effects and safer to use (than MAOI's). SNRIs are also now gaining popularity. **Potential side effects:** Nausea, headaches, increased appetite, sexual dysfunction, drowsiness. **Mood Stabilisers:** Used primarily to treat bipolar and related disorders, and the mood dysfunction that can occur with schizophrenia. **Potential side effects:** Weight gain, tremors, fatigue, digestive problems.   **Antipsychotic medications (neuroleptics):** A class of drugs used to treat Schizophrenia as well as other disorders involving episodes of psychoses. **Potential side effects:** Drowsiness, rapid heartbeat, weight gain. Older drugs caused tremors, tardive dyskinesia.   **Psychostimulants:** Used to treat attentional disorders, such as ADHD, and disorders such as narcolepsy. Most work by increasing dopamine. **Potential side effects:** decreased appetite, sleep disturbances, and headache. Some have risk of addiction. **[Pharmacotherapy cautions ]** - **Often have side effects:** some at commencement of treatment, others if taken for a long period of time. - **Individual Differences:** people vary greatly in response to drugs (including susceptibility to addiction), depending on various factors such as weight, age etc. - **Misconceptions regarding need for drugs, efficacy and appropriateness:** Not always necessary to treat a biological disorder with drugs. Nonpharmaceutical therapies can alter neurobiology. Not a 'cure all' -- eg some drugs may work in some age groups and not others, and may need to also use non-pharma in conjunction with pharma for best outcomes (eg MDD -- start with antidepressant but also use CBT or similar) - **Overprescription and Polytherapy** **[How it works ]** A diagram of a pharmacotherapy Description automatically generated **Surgical treatment \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **[Psychosurgery]** Involves the neurosurgical destruction of brain tissue to "cure" mental illness. Lobotomies (especially frontal lobotomies) were carried out rather extensively in the 1920-1960's. The procedure disappeared with the advent of effective psychotropic medications. Dr Walter Freeman -- trans-orbital (aka 'ice pick') lobotomies. Psychosurgery is now rare, involves highly selective lesions to specific brain structures, and only performed in extreme cases. **Psychosurgery example: Capsulotomy** Specific lesions to reduce the symptoms of severe medication-resistant OCD Ruck et al (2008) -- long term outcomes (approx 10 years after surgery) in 25 patients Approx 50% had very good recovery However, also some side effects: - Weight gain - Some executive/short term memory dysfunction - Severe disinhibition (less common)   **[ECT (Electroconvulsive Therapy) ]** Involves the application of a brief electrical current to the head of a person. The duration and intensity of the current are sufficient to induce a seizure in the individual. Used in intractable MDD. - Despite its inappropriate and indiscriminate use in the 1920's-1970's; research has led to the appropriate use of ECT. - ECT is currently used in cases of very severe depression that are unresponsive to other therapies, as well as severe depression with psychotic features.   **[rTMS (Repetitive Trans-magnetic Stimulation) ]** Similar to ECT, except that a magnetic pulse is used instead of electrical charge - Non-invasive -- a magnetic coil is placed on the skull and delivers pulses to specific regions - Patient remains conscious, no need for pain relief or prolonged recovery period - Found to be effective for people with medication resistant MDD (Berlim, Van den Eynde & Daskalakis, 2012)   **[Deep Brain Stimulation - DBS (Kern & Kumar, 2007) ]** - An alternative to psychosurgery - Similar to pacemaker, but provides electrical pulses to specific areas of the brain via implanted electrode - Initially used in Parkinson's Disease, now also used for intractable OCD and MDD     **Surgical treatment cautions** - Can have serious side effects, some of which may be life-long - Mechanisms of action remain unclear for ECT, DBS, and rTMS - Only appropriate where other measures have failed and the person is continuing to experience significant and distressing levels of impairment **Efficacy \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Efficacy varies depending on:** - The type of therapy - The type of disorder - The clinician's ability/characteristics - The client's ability/characteristics   **Ineffective therapies often appear to work due to a number of factors:** - Spontaneous remission: many disorders fluctuate or are cyclical - The placebo effect: just talking about problem may lead to improvement - Regression to the mean: often extreme behaviours will naturally become closer to 'normal' over time - Self-serving biases: clients may want the therapy to work and so may exaggerate improvement or downplay continuing issues - Confirmation bias: clinicians may look for evidence to support improvement, and ignore evidence to the contrary **[Evidence suggests that effective therapy depends on:]** The appropriateness of the therapy for the condition in question, and the specific client   **Ability of the therapist:** - Well trained and up-to-date with techniques - Empathic and able to establish rapport Evidence suggests that **Client traits:** - Some anxiety can facilitate willingness to change - Level of self-awareness - Willingness to take responsibility and action   **[Efficacy of treatment for psychological disorders ]** **Behavioural Therapy Techniques** Experimental studies demonstrate that systematic desensitisation results in behaviour change, especially for anxiety disorders & PTSD. Operant conditioning & token economies have a wealth of research evidence supporting their use in long-term behaviour change, but results are more variable than initially reported in the 1950's -- 1960's   **Cognitive Behavioural Therapy** Highly effective in reducing risk of relapse from depression, anxiety, trauma-related disorders, and a number of other disorders. Outcome studies into Becks Cognitive Therapy report: is at least as effective as the use of anti-depressant medication in the treatment of acute phases of depression.   **Psychopharmacotherapy** Well established benefits for certain disorders: - approximately 60% of patients with Schizophrenia who are treated with antipsychotic medication show a complete remission of symptoms within 6 weeks (only 20% do with a placebo). - Anti-depressants are effective in alleviating the acute symptoms of depression, however, relapse following cessation of medication is a significant risk. - Anxiolytics are also effective in alleviating the acute symptoms of anxiety -- however with cessation of medication there is a high rate of relapse.   **Combining Psychotherapy and Pharmacotherapy** - CBT and anti-depressant medication when used alone are equally effective in treating acute phases of depression. - Combining the two approaches reduces risk of relapse from depression following cessation of medication. - Similar findings exist for the treatment of anxiety disorders with a combination of medication and CBT. **Eclectic psychotherapy:** involves combining techniques from different therapeutic approaches to fit a specific client's needs (eg combining CBT with anxiolytic medication). **Ethics** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Ethics can be defined as beliefs about what is right conduct - Ethics are moral principles adopted by a group or individual to provide rules for right conduct. - Ethics represents the ideal standards set by a profession - They are enforced by professional associations and government boards that regulate them - The professional association for psychologists in Australia is Australian Psychological Society (APS) - The regulatory body for psychologists is Australian Health Practitioner Regulation Agency (AHPRA): Psychology Board of Australia (PsyBA)   The professional association for psychologists in Australia is Australian Psychological Society (APS) - The role of the APS is to support, protect and provide resources for its psychologist members.   The regulatory body for psychologists is Australian Health Practitioner Regulation Agency (AHPRA): Psychology Board of Australia (PsyBA) - The role of the Board is to protect the community and consumers (or clients) of psychologists   **Good standards of practice require:** - **Professional competence**, Eg keeping up to date with research/treatment approaches - **Good and appropriate relationships with clients and colleagues** Eg having appropriate supervision, not having dual roles - **Observance of professional ethics** Eg adhering to the code of ethics in your area **Three general principles of the APS Code of Ethics** - **Respect for the rights and dignity of people and peoples:** includes informed consent, avoiding discrimination, confidentiality and privacy... - **Propriety:** includes the need for clinicians to be competent, keep good records, provide services in a professional manner... - **Integrity:** need to act in the best interest of clients, engage in reputable and honest behaviour, avoid conflicts of interest, be aware of power imbalances... **Stress \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** An internal process that we experience as we adjust to certain events and circumstances. **Stressors** - The events and circumstances that we adjust to. - Can be both positive and negative.   Any event that forces us to adjust to new circumstances or introduces significant change in our life can be a psychological stressor. - Daily hassles - Chronic problems - Life changes and strains - Catastrophic (traumatic) events   **Stress reactions** - Emotional: low mood, crying, distress - Cognitive: poor concentration - Behavioural: changes in eating habits, avoidance - Physical: rapid heart rate, sweating, nausea  **[Psychological stress reactions ]** **Emotional reactions** - Fear - Anger - Sadness - Irritability   **Cognitive reactions** - Rumination - Attention - Decision-making,   **Behavioural reactions** - (mal)adaptive avoidance - Substance (mis)use - Decreased physical activity - Sleep disturbances     **Trauma- and stressor-related disorders** - Reactive Attachment Disorder - Disinhibited Social Engagement Disorder - Posttraumatic Stress Disorder - Acute Stress Disorder - Adjustment Disorders - Other Specified Trauma- and Stressor-Related Disorder - Unspecified Trauma- and Stressor-Related Disorder **Stress mediators and coping** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **[Posttraumatic Stress Disorder (PTSD) ]** Experience of a Criterion A traumatic event Characterised by: - Intrusive memories - Persistent avoidance - Negative alterations in cognitions and mood - Alterations in arousal and reactivity   Stress is a highly subjective experience. Stressors can be a transaction between people and their environments. - **Primary appraisal:** does the person perceive the stressor as potentially threatening. - **Secondary appraisal:** how well the person thinks they can cope.   How we appraise a stressor and our ability to cope with it can depend on: **Perception of control** - Believing in control can reduce the effects of stress **Intolerance of uncertainty** - Inhibitory intolerance of uncertainty - Prospective intolerance of uncertainty   **[Cognitive styles and stress ]** **Disease-prone personalities:** Appraise stressors as catastrophic Frequently ruminate on stressors Use emotion-focused coping strategies **Disease-resistant personalities:** View stressors as temporary challenges to overcome Display dispositional optimism Use problem-focused coping strategies **[Coping with stressors]** **Problem-focused coping** - A coping strategy of tackling problems head on - More likely to use this type of coping when we are optimistic and think we can achieve our goals   **Emotion-focused coping** - A coping strategy used in order to reduce painful emotions - More likely to use this type of coping when we are dealing with situations that we cannot avoid/control   Perception and outlook regarding a stressor can have a significant effect on resulting psychological and physiological stress.   Optimism is associated with reduced stress and avoidant coping in advanced-stage cancer patients   Sense of humour is associated with reduced depression and anxiety and greater quality of life in patients with chronic obstructive pulmonary disease **[Social support ]** Presence of others in whom one can confide and from whom one can expect help and concern A strong social support network can have the effect of: - Reducing anxiety - Improving optimism - Increasing perception of control - Improving immune system function   **Effects on psychological distress** Social support reduces depression and anxiety. Lack of social support can, in itself, be a stressor. Anonymous disclosure can be an important mediator between a stressor and poor psychological and physical wellbeing.   Biological responses to stress can be lower when: - A companion is present - There is a belief that support is available - In the presence of a pet   Anonymous disclosure can be associated with: - Better immune system functioning - Reduced reliance on health services    **Critical Incident Stress Debriefing (Mitchell, 1983)** 1. **Introduction**: Explanation of the session. 2. **Fact phase**: What happened. 3. **Thought phase**: Describe thoughts during and after the event. 4. **Reaction phase**: Express current emotions. 5. **Symptom phase**: Discuss Psychological/ Physical symptoms. 6. **Teaching phase**: Suggestions for stress reduction. 7. **Re-entry phase**: Summary of session. **Promoting healthy behaviours \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Health psychology and behaviour change** Health psychology is largely concerned with developing programs to: - Prevent smoking onset - Help people quit smoking - Curb alcohol consumption - Achieve healthy weight - Follow healthy lifestyle practices (e.g., exercise) - Stick to prescribed medical regimes     **[Behaviour change and smoking ]** Smoking treatment and prevention is a high priority for health psychologists. Stop smoking approaches: - Education about health consequences - Stress management Identify and avoid high-risk situations   Successful with 25-35% of long-term smokers   **[Behaviour change and exercise ]** Research suggests that exercise can relieve depression and anxiety Regular exercise can: - Lower blood pressure - Decrease risk of CHD - Improve lung function - Relieve symptoms of arthritis - Decrease diabetes risk   30-70% of patients do not take their doctor's medical advice 80% do not follow recommendations in relation to: - Diet - Exercise - Smoking - Prescribed medications   **[Barriers to lifestyle changes ]** **Personal inertia** - Trying something new can be hard - Many self-destructive habits do not create an imminent health threat **Mis-estimating risk** - We underestimate certain risks to our health and overestimate others **Feeling powerless** - Habitual behaviours can feel impossible to change **Self-efficacy** - Doubting own ability to change **[Health belief models ]** Beliefs about the risks of a negative behaviour, and the costs of changing that behaviour dictate the likelihood of change. **Rosenstock (1974) health beliefs model** 1\. Perception of personal threat 2\. Perception of illness seriousness 3\. Perception of behaviour change effectiveness 4\. Perceived costs and benefits of changing behaviour and expected benefits Beliefs about the risks and costs of behaviours and behaviour change is one thing, but how ready is the person to make lifestyle changes? **Stages of readiness (Prochaska et al., 1992)** 1\. Precontemplation 2\. Contemplation 3\. Preparation 4\. Action 5\. Maintenance **[Prevention programs ]** Prevention is clearly preferable given the difficulty of modifying habitual behaviours Importance of educating young people about: - **Risks and negative consequences** of obesity, smoking, excessive drinking, unsafe sex, etc. - **Benefits** of good nutrition, regular exercise, positive friend groups - **Recognising and resisting** peer pressure to engage in unhealthy behaviours - **Effective coping skills** for daily living and dealing with stressors **Cognitive coping strategies** Involves identifying negative thought processes. And then developing and practicing more effective thoughts. Not used to remove stressors but to increase the perception that they can be tackled head on. **Emotional coping strategies** Social support is perhaps the best coping strategy for dealing with negative emotions. Dealing with negative emotions is better addressed via: cognitive, behavioural, and physical strategies. **Behavioural coping strategies** Changing behaviours in subtle ways to make a stressor seem less threatening. Developing time management plans is one of the most common behavioural coping strategies to deal with stress. Avoiding toxic personalities.  **Physical coping strategies** Prescription medications can reduce feelings of stress. Risks of tolerance and dependence issues. Healthy nutrition and eating habits. Regular exercise (HIIT, yoga, Pilates). Mindfulness and breathing techniques. **Intelligence \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Definitions of Intelligence:** - Ability to carry out abstract thinking (Terman, 1916). - Power of good responses from the point of view of truth or fact (Thorndike, 1921). - Adjustment or adaption of the individual to his total environment (Freeman, 1955). - Ability to plan and structure one's behaviour with an end in view (Das, 1973). - Ability to resolve genuine problems or difficulties as they are encountered (Gardner, 1983). - Error-free transmission of information through the cortex (Eysenck, 1986). - Reflects survival skills of species, beyond those associated with basic physiological processes (Sattler, 2001).   **What 'real' people think** Sternberg et al. (1981) asked non-psychologists and psychologists to define what is important for intelligence: **Non-psychologists** - Practical problem solving ability - Verbal ability - Social competence Psychologists **Psychologists** - Verbal intelligence - Problem solving ability - Practical intelligence   **Cross-cultural applicability:** - If intelligence helps people adapt and manage tasks, it should be cross-culturally applicable - But what a society understands as intelligence is linked to their particular ecology and social structure - Different cultures = different circumstances that people need to adapt to   **The nature of intelligence** Each culture provides individuals with the most appropriate and efficient ways to solve everyday challenges. These strategies then become part of people's cognitive processes.   Therefore: Intelligence is the application of cognitive skills and knowledge to learn, solve problems and obtain ends that are valued by an individual or culture   **Intelligence is thus** - Multifaceted - Functional - Defined and shaped by culture   **Evolutionary perspective** - Consider context of evolution of intelligence - Problems are solved to allow adaptation and thus survival and reproduction - The social nature of humans may have influenced the development of intelligence - Ability to experience own feelings and behaviours →better position to imagine others' feelings and behaviour  **Theories of intelligence \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **[Spearman\'s Two-Factor Theory ]** - Arose from correlation and factor analysis of different intellectual tasks. - Found correlations between individuals' scores on different ability tests. - Some groups of tasks intercorrelate more strongly than others   **General + specific abilities** **General ability:** a single latent factor that underlies all other abilities and is predictive of test scores. **Specific ability:** a range of specific abilities, such as mathematical or verbal ability.   An individual's performance on an intelligence test is determined by two factors: - **(g) - general intelligence:** General ability for complex mental work - **(s) - specific ability:** unique to a test/sub test; e.g. maths or verbal skills.   Spearman was less concerned about studying s, as it varied for each test of intellectual ability   **[Thurstone\'s 7 Primary Mental Abilities ]** Years of debate on the relative importance of g and s factors. 1930s: L.L. Thurstone: - too much emphasis on Spearman's g. - Too little diagnostic info on tasks contributing to overall score Instead formulated model of primary mental abilities   **Thurstone proposed 7 abilities, each relatively independent of g:** - word fluency - verbal comprehension - spatial ability - perceptual speed - numerical ability - inductive reasoning - memory   At the end of his career, Thurstone acknowledged that his proposed seven primary mental abilities were correlated. No longer completely opposed to Spearman\'s concept of g. \"there seems to exist some central energizing factor which promotes the activity of all these special abilities.\"   **[Cattell and Horn: A new structure of intelligence ]** Raymond Cattell (1941), John Horn (1965) and others argued for a quite different structure: Fluid vs. crystallised intelligence.   **Fluid Intelligence (Gf)** - Inherent, non-verbal capacity to learn and to solve problems - Used to adapt to new situations - Relatively free of cultural elements such as schooling, training, life experience   **Crystallised Intelligence (Gc)** - Accumulation of abilities learned through schooling or life experience - Learned, habitual responses, heavily dependent on schooling or life experience - e.g., vocabulary test, tool-identification test for motor mechanics   **[Cattell-Horn-Carroll (CHC) Theory of cognitive abilities ]** Amalgam of Cattell's & Horn's Gf-Gc theory and Carroll's (1993) Three-Stratum Theory. Hierarchical model: - 10 broad fluid + crystallised components at the top - 70 sub-components below (e.g., visual & auditory organisation, perceptual speed, specific memory capacities) very complex model. Reflects notion of multiple intelligences.     **[The Information-Processing Approach ]** Examine the processes that underlie intelligent behaviour: **Speed of processing:** how rapidly a person can perform a mental task **Knowledge base:** information stored in long term memory **Ability to acquire and apply mental processes:** can a person acquire and use new mental strategies?   - Assumes performance is normally distributed across a variety of intelligence relevant capacities. - Assumes performance on one capacity is weakly to moderately related to performance on other capacities. - Therefore, person 1 might be better at A and B but person 2 might be better at C and D     **[Contemporary Approaches to Intelligence ]** - More recently: expanded view of how intelligence is seen - Intelligence tests measure intellectual, scholastic abilities - But what about more practical, social, and emotional skills?     **[Gardner: Multiple Intelligence Theory ]** Different societies value different intelligences: - Western society: mathematical/logical and linguistic/verbal - Polynesian navigators: spatial and bodily/kinaesthetic intelligences - Collectivist societies: interpersonal intelligence Are the intelligences separate? Gardner's research suggests a pattern of strong, intermediate and weak correlations. **Criticisms of Gardner's MI theory:** - Too broad - No test has been developed to measure this - Confounds talent with intelligence - Ignores correlations between conceptually distinct functions - Doesn't describe underlying processes - May reflect personality factors - Sternberg (2000) needs more empirical validation     **[Emotional intelligence - Goleman ]** Related to Howard Gardner's concept of interpersonal and intrapersonal intelligence, refers to the ability to: - perceive, appraise, and express emotions accurately and appropriately - use emotions to facilitate thinking - understand and analyse emotions and use emotional knowledge effectively - regulate emotions to promote both emotional and intellectual growth   - Has been argued that EI can predict educational and occupational performance -- e.g., a popular measure of leadership skills - However, a meta-analysis found a weak (r =.23) relationship between EI and job performance (Van Rooy & Viswesvaran, 2004). - Established EI measures are only useful for specific occupations. - For EI to be generalised across multiple occupations, further theoretical development is needed. **[Sternberg's Triarchic Theory]** Posits that intelligence is composed of three distinct components: - **Analytical Intelligence**: The ability to analyse, evaluate, and make decisions. This type of intelligence is often linked to academic problem-solving and critical thinking. - **Creative Intelligence**: The ability to handle new situations by drawing on past experiences and current skills. It involves imagination, invention, and innovation. - **Practical Intelligence**: The ability to adapt to everyday life by using existing knowledge and skills. This form of intelligence is crucial for understanding and managing real-world tasks and challenges.  **Early tests for intelligence \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **[The emergence of IQ tests - Alfred Binet ]** - Hired by French Government to devise test to identify children with special education needs. - Tested reasoning and logic. - Test had reasonable predictive validity and spread through Europe and the US   **Binet's criteria for selecting an item** - Item has to relate to \'common sense\'. - Item has to be part of daily life. - Item must separate 'dull' from 'bright' children. - Item must be practical and easy to administer.   **Sample Items Binet/Simon 1908** **Year 5:** - Compare 2 boxes of different weight. - Copies a square. - Repeats a sentence of ten syllables - Counts 4 sous - Puts together two pieces in a game of patience **Year 8:** - Reads selection and retains two memories. - Counts 9 sous (3 single, 3 double). - Names four colours. - Counts backwards from 20. - Compares 2 objects from memory. - Writes from dictation.   Binet and Simon devised a test to measure intellectual development in children. Mental age = average age at which children achieve an actual score. - An intellectually disabled child would not be able to answer questions typical for his or her chronological age. - e.g. a 7-yr-old who could only answer questions typical of a 5-yr-old = MA of 5   **[Modern Tests of Intelligence: Louis Terman ]** - 1916 revised Binet and called it the Stanford-Binet (still in use today, but not as much as other tests) - Revised items that didn\'t perform as expected. - Added adult items - Introduced use of the Intelligence Quotient **Intelligence Quotient** To allow for comparison of test scores among persons, Terman and Stern devised the concept of the intelligence quotient (IQ): - IQ = (MA/CA) x 100 - MA = mental age - CA = chronological age   **[Problems with Stern\'s I.Q. ]** - Calculating IQ works well for children: abilities are still developing - Development slows in adolescence - Development stabilises in adulthood. - Comparing mental age to chronological age makes little numerical sense for adults. **[David Wechsler (WAIS) ]** - 1939 developed a test specifically for adults - Test had 11 groups of similar items or sub-tests, e.g., vocabulary - Developed tests for children (WISC) based on the WAIS - Attempted to remove the biases associated with earlier intelligence tests   **Wechsler Intelligence Scales** IQ is measured on a number of subtests which distinguish between - Verbal Intelligence - Non-verbal Intelligence Wechsler scales allow psychologists to identify areas of strength and weakness within individuals, and are the most commonly used IQ tests in western cultures today. **The Weschler Adult Intelligence Scale (WAIS) \_\_\_\_\_\_\_\_\_\_\_\_\_** **Weschler** - 1939 developed a test specifically for adults - Developed tests for children (WISC) based on the WAIS - Attempted to remove the biases associated with earlier intelligence tests - Wechsler scales allow psychologists to identify areas of strength and weakness within individuals, and are the most commonly used IQ tests in western cultures today **History of Wechsler Intelligence Tests** - Wechsler-Bellevue: 1939 - Wechsler-Bellevue II: 1946 - Wechsler Adult Intelligence Scale: 1955 - WAIS-R: 1981 - WAIS-III: 1997 - WAIS-IV: 2008   **3 forms of Wechsler IQ scales, according to age:** - WPPSI (young children : 2 years 6 mths, 7 yrs 3 months): WPPSI-IV - WISC (children/young: 6-16 years): WISC-V - WAIS (Adults, 16-89 years): WAIS-IV   **[Wechsler Adult Intelligence Scale: WAIS IV]** - **Verbal Comprehension Index (VCI):** A measure of verbal abilities requiring reasoning, comprehension and conceptualisation. - **Perceptual Reasoning Index (PRI):** A measure of nonverbal reasoning and perceptual organisation. - **Working Memory Index (WMI):** An explicit measure of working memory; specifically sequential and simultaneous processing, attention and concentration. - **Processing Speed Index (PSI):** A measure of speed of mental and motor processing.   **Verbal comprehension subtest:** - **Similarities**- between words - **Vocabulary**- what it means - **Information**- questions **Perceptual reasoning subtests:** - **Block design** - **Matrix reasoning** - **Visual puzzles** **Working memory subtests:** - **Digit span**-forward, backwards, sequencing - **Arithmetic** **Processing speed subtest:** - **Symbol search** - **Coding**- symbols paired with numbers   **WAIS Standardisation Group** - Original sample of 2,200 adults (16:0 -- 99:11 yrs of age) from the USA, stratified sampling to match age, sex, race/ethnicity, level of education, and geographic location derived from 2005 US Census. - Sample divided into 13 age groups: 16-17, 18-19, 20-24, 25-29, 30-34, 35-44, 45-54, 55-64, 65- 69, 70-74, 75-79, 80-84, 85-90:11 (each with n = 200 except oldest 4 groups with n = 100). - Males=Females in all but 5 oldest age groups (where females\>males consistent with census data).   Raw scores from each test are converted to scaled scores by using the norms obtained from the standardisation group.   **Full Scale IQ (FSIQ)** is obtained by adding all scaled scores together: - FSIQ = VCI Scaled Score + PRI Scaled Score + WMI Scaled Score + PSI Scaled Score. - FSIQ: mean = 100; SD = 15 - So, if you score between 85 and 115, you have an average IQ **The Range of Intelligence \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** A diagram of a normal distribution with Ryugyong Hotel in the background Description automatically generated **[Current DSM levels ]** **Mild intellectual disability: IQ 50 to 70** - Slower than typical in all developmental areas - No unusual physical characteristics - Able to learn practical life skills - Attains reading and math skills up to grade levels 3 to 6 - Able to blend in socially - Functions in daily life   **Moderate intellectual disability: IQ 35 to 49** - Noticeable developmental delays (i.e. speech, motor skills) - May have physical signs of impairment (i.e. thick tongue) - Can communicate in basic, simple ways - Able to learn basic health and safety skills - Can complete self-care activities - Can travel alone to nearby, familiar places   **Severe intellectual disability: IQ 20 to 34** - Considerable delays in development - Understands speech, but little ability to communicate - Able to learn daily routines - May learn very simple self-care - Needs direct supervision in social situations   **Profound intellectual disability: IQ less than 20** - Significant developmental delays in all areas - Obvious physical and congenital abnormalities - Requires close supervision - Requires attendant to help in self-care activities - May respond to physical and social activities - Not capable of independent living     **[Intellectual Developmental Disorder (Intellectual Disability) ]** Defined in DSM-V - TR by 3 dimensions: - deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, standardised IQ test - Concurrent impairment of adaptive functioning - Onset of deficits in the developmental period **May be due to different origins** - May be genetic in origin: e.g., Down Syndrome - May be biological in origin: e.g., Traumatic brain injury - May be environmental in origin: Exposure to teratogens, e.g., Foetal Alcohol Syndrome   **Adaptive Functioning** Three areas of adaptive functioning are considered: - **Conceptual:** language, reading, writing, math, reasoning, knowledge, memory. - **Social:** empathy, social judgment, communication skills, the ability to follow rules and the ability to make and keep friendships. - **Practical:** independence in areas such as personal care, job responsibilities, managing money, recreation, and organizing school and work tasks.     **Extremes: Giftedness** - Can reflect academic, musical, social or athletic ability. - Often associated with an IQ of over 130 but there is no clinically agreed cutoff **Associated stereotypes:** - Physically weak - Mentally unstable - Reclusive/Eccentric - Compensation - talent in one area is accompanied by deficit in another   **Characteristics of the Gifted** Terman started collecting data in 1921 - 1500 children with IQ over 150. - Follow ups published in 1959, 1990, 1992. - Above average height, strength, emotional maturity and other variables as children. - Health, emotional stability and satisfaction above average in adulthood.   - Aust. study by Gross (1999): IQ=160+ could lead to social isolation in school need for gifted programs.     **Creativity** Ability to produce valued outcomes in a novel way. - Measured through divergent thinking: ability to generate multiple possibilities in a given situation. - And convergent thinking: finding the best idea from the range of ideas generated through divergent thinking - Sternberg includes creativity in his triarchic model, but it is generally considered a separate to ability **Critiques of Intelligence Tests \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Psychometrics in relation to IQ** Psychometrical approach normally starts with a theory, then we design a test that should measure the construct of interest, and use statistics to check that it does. Intelligence tests are unusual in science - measures of intelligence were developed first - theories of intelligence evolved to fit those measures.   **[Criticisms of IQ Tests ]** **Lack of a theoretical basis** (no underlying construct was used to devise tests): Focus on cognitive domains while ignoring creativity, working memory, etc. **Cultural bias:** Scores depend on language, cultural experiences -- Biased towards Western, white, middle-class education system   **Do IQ scores predict real world outcomes** - Pen-and-paper general IQ tests are popular tools for job selection as they are relatively cheap and easy to administer - Performance on IQ tests is related to job placement: "People who score high on IQ tests are more likely than those who score low to end up in high status jobs" (Weiten, 2004). - IQ tests are good predictors of future school performance - School performance is linked to attaining certain jobs - Correlations between general intelligence and job performance are often weak - suggests a single representative score (g) is not always useful - Using more practical forms of intelligence (numerical, mechanical, spatial abilities) may be more appropriate.   **Abuse of Intelligence Tests** Appear straightforward, easily administered and interpreted, but - Limitations and assumptions must be understood if tests are to be appropriately used. Worst abuses: eugenics movements - \"mental defectives\" isolated, sterilised or exterminated. Profession has strict guidelines for access to and use of tests.    **[The Corruption of Binet's Work ]** - Goddard translated the Simon-Binet scale in 1910 - Researching "feeble minded" children - Wanted a diagnostic tool - Thought children who were feeble minded should be segregated so as not to "contaminate"   Binet died 1911, just prior to the notion of IQ sweeping the US Simon was said to deplore the concept of IQ. He claimed it was a "betrayal" of their original humanistic motivations - 1910 Goddard invited to assess immigrants - Government wanted to make this examination more accurate - Became convinced that "feeble mindedness" was common in immigrants - Congress allowed immigration staff to be trained in using intelligence tests   - Initially, Goddard interpreted results with caution - Then, claimed that minimal research would be needed to confirm his original findings - Concluded by saying that average intellect of immigrants was low, "perhaps of moron grade" - Due to environmental deprivation - Advocated deportation of immigrants - Claimed they could be used as laborers, if properly trained     **[Culture-free/culture-fair tests ]** - Original purpose of intelligence tests: to provide valid, objective, socially unbiased measurement of intellectual ability. - However, tests can never reveal innate intelligence or culture-free knowledge Intelligence tests are just sample of what people know and can do. - Knowledge is based in culture and develops over time   - 'Culture-fair' tests should include items that would measure common skills and knowledge across cultures. - Limited success - Intelligence tests thus need to be considered within a culture **Biology and Intelligence \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Does Brain Size Matter** - There is a slight correlation between brain size and intelligence. - But -- is this due to more activity, better nutrition etc...   **Is intelligence influenced by other cognitive abilities** - There is a relationship between memory and intelligence -- remember the WMI? - But -- working memory is different to long term memory, and you can have poor memory and above average intelligence   **Is intelligence influenced by abilities like reaction time** - Galton didn't have success in demonstrating a link between speed of processing sensory information and intelligence, more recent and sophisticated studies suggest a modest relationship - Faster brain response to visual stimuli correlates with non-verbal I.Q. (Raven\'s Progressive Matrices test).   **Biological factors associated with intelligence** - Intelligence may rest partly on efficiency of the brain\'s information processing, but reaction time does not appear to be a useful or practical physiological index of I.Q. - Despite more sophisticated measurement these days, same conclusion: - Intelligence is complex and multifaceted - Can't be reduced to a single denominator   **Nature vs Nurture and intelligence** - To what degree is intelligence inherited? - To what degree is it learned?   **[Individual differences in intelligence: genetic explanations ]** **Heritability:** percentage of variability in a trait across individuals that is due to genetic inheritance - **Twin studies:** compare IQ scores in MZ (identical) and DZ (fraternal) twins. - **Adoption studies:** compare similarity of IQ scores of adopted children with adopted family and with biological family. **Calculating heritability: caveats** Formulas used to assess heritability were developed some 60 years ago, for agricultural eugenics - Assumption: Subjects do not choose environment or mate - Problem with applying to humans: - We gravitate to appealing environments - We choose mates with similar culture/IQ Shared environment might play a larger role   Twin studies have almost all used literate, middleclass samples - Heritability estimates would drop with more varied samples - Genetic influences seem to be smaller in determining IQ of children in less educated environments  **Group Differences in Intelligence \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Individual differences in intelligence: environmental factors** Best positive predictors of children's performance on IQ and language tests: - Enriched home environment - Encouraging interest and exploration - Mother's knowledge about child rearing   **Risk factors for lower IQ:** - Poor maternal education - Maternal mental illness - Minority status (and its correlates) - Larger family size - Poverty - Poor nutrition   **Education:** higher education is associated with greater brain connectivity - Maybe people develop stronger connections, and greater intelligence due to exposure to better education? - Or maybe people with better connections and greater intelligence enjoy study more and so stay in education longer?   **Socio-cultural Disadvantage** - Factors in lower SES upbringing: children may fail to develop full intellectual potential. - I.Q. differences between highest and lowest social class = 20 to 30 points. - **Stereotype threat** -- belief about your group → greater anxiety → self-fulfilling prophecy - Access to education - Access to good health care and nutrition **Controversies: Group differences in intelligence** Arthur Jensen (1969): Racial genetic difference causes I.Q. difference. - Claims heritability ratio for I.Q. 80%. - Therefore, 20% of intelligence variation attributable to environment. Other researchers - estimates range from 50 - 70%. Consensus - heritability of intelligence about 60%   The assumption behind these claims is that if there are racial differences, this must be due to genetic differences between different ethnic groups.   - **Within group heritability:** the extent to which a trait varies within a specific group, due to genetic influences - **Between group heritability:** the extent to which differences in a trait between groups is genetically influenced   But, just because something varies within a group, it doesn't mean that group differences are associated with genetic differences.   **Example** - High estimates of heritability don't guarantee that cultural differences are due to genetic differences, e.g., - Increasing height of Japanese males - Height is an inherited attribute - But increase is mainly due to changes in diet - Can't use heritability estimates from one group to interpret between-group differences   Racial differences in IQ test scores are due to deprived environment. - Ethnic minorities: history of discrimination. - Plus, consider the overlap between distributions: **Culture \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** "It is generally agreed that culture and our sense of identity are mutually constructed. That is, we both construct, and are constructed by, our cultural context." Bernstein et al. (2021) - Culture is a set of shared meanings and ideas that are transmitted across generations - Culture includes artefacts such as symbols, art, dance and language, and values - Culture guides the ways in which we think and feel about ourselves and those we interact with - Culture helps us to orientate ourselves towards an increasingly complex world **Characteristics of a culture:** - Language - Dress and appearance - Food and eating habits - Music, dance and art - Relationship with time - Interpersonal relationships - Beliefs, attitudes and values   **What culture is not:** - **Ethnicity:** Refers to membership of a group linked by race, nationality, language or a common cultural heritage - **Race:** A socially defined population that is derived from distinguishable physical characteristics   **[Why we have culture ]** **Terror management theory:** - Culture acts as a buffer against general anxiety - Being a member of a culture reduces this feeling **Creation of a shared reality:** - Humans have a basic desire to believe that others think and feel about certain issues in the same way **By-product of human interaction:** - By interacting, we share beliefs and behaviours, culture can result from repeated interactions   **How culture is transmitted** **Enculturation:** is the process of absorbing and internalising the rules of our culture, typically through intergenerational teaching - Family - Community - Institutions - Peers - Elders   A diagram of a culture Description automatically generated     **[How culture affects behaviour: ]**    **[Individualist vs. collectivist cultures ]** **Individualist** cultures place emphasis on the autonomy of the individual - Focus on personal goals and achievement - Greater prevalence of loneliness **Collectivist** cultures place emphasis on the interrelatedness of all members and their collective endeavours - Consider oneself as part of a group - Greater prevalence of fear of rejection     **[Hofstede's dimensions]** - **Individualism/collectivism:** The extent to which people are motivated to act as individuals or members of a community or group - **Power/distance:** How much people are prepared to bear differences in wealth and power - **Uncertainty/avoidance:** The ways in which people and groups cope with or tolerate uncertainty - **Masculinity:** The extent to which common characteristics of the stereotype of males as providers, competitors and strong dominators the more 'feminine' characteristics such as nurturing, caring and providing - **Long-term/short-term orientation:** The extent to which a culture values a long-term versus a short-term view of the future   **Alternatives to Hofstede's dimensions** - **Tight cultures:** Have strong social norms and a low tolerance of deviant behaviours - **Loose cultures:** Have weak social norms and a high tolerance of deviant behaviours     **Cultural psychologists** study the ways in which people are affected by the culture they live in (individual psychological processes are shaped by cultural context)   **Cross-cultural psychologists** compare the similarities and differences in behaviour across different societies or cultures     **Theoretical issues** - **Absolutism:** Assumes that psychological phenomena are identical across different cultures - **Relativism:** Assumes that all human behaviour is cult