PSYC 323- Exam 1 Review.pdf

What is Normal Vs. Abnormal? - Normal- "conforming to a standard; usual, typical, or expected" Abnormal- "deviating from what is the normal or usual, typically in a way that is undesirable or worrying" The APA is moving away from using the term "abnormal" as this phrase carries a great deal of sti...

What is Normal Vs. Abnormal? - Normal- "conforming to a standard; usual, typical, or expected" Abnormal- "deviating from what is the normal or usual, typically in a way that is undesirable or worrying" The APA is moving away from using the term "abnormal" as this phrase carries a great deal of stigma Much of the population will be diagnosed with one of the conditions covered in class- if this is the case, then how can these conditions be described as being "abnormal" Textbooks and their continued use of the term "abnormal" has stalled progress in the field- people should not be reduced to a label Clinical Psychology - What is clinical psychology? This is the scientific study of symptoms, causes of mental conditions, and available treatments Objectives of the field Describe, explain, predict, and modify behaviors associated with mental conditions People who work in the field strive to alleviate distress and life disruption of those with mental conditions Lifetime Prevalence of Mental Conditions In College Students From Eight Countries - Over 1/3 of a group of 14,000 students reported having experienced a mental health condition during their lifetime Many celebrities and productive people also struggle with mental health conditions, too Describing Behavior- Psychodiagnosis - This is attempts to describe, assess, and understand one's particular situation and the possibility one might be experiencing a mental disorder Describing Behavior- Treatment Plan - This is a proposed course of therapy, which is developed collaboratively by a therapist and a client Here, the main focus is the most distressing mental health symptoms an individual is experiencing (it is vital to get an idea of one's safety as well as the urgency of certain issues) Etiology - These are the possible causes for abnormal behavior This topic is of high priority for mental health professionals Important factors when considering etiology Human behavior is complex No single explanation adequately accounts for the complex behavior of humans Both normal and abnormal behaviors occur along a continuum Behavior results from interactions among various biological, psychological, social, and sociocultural factors Modifying Behavior- Psychotherapy - This is a program of systematic (not random) intervention Objectives Improve a person's behavior, emotional, or cognitive state Identify problematic symptoms and understand the causes of distress Work with the client to plan and apply treatment There are many types of therapies and professional helpers Multipath Model of Mental Disorders - This considers a multitude of factors researchers have confirmed are associated with each condition from a holistic framework This is comprised of the following dimensions: 1. Biological influences- genetics, epigenetic, brain anatomy, biochemical processes, central nervous system functioning, autonomic nervous system reactivity 2. Psychological influences- personality, cognition, emotions, learning, coping skills, self-esteem, self-efficacy, values, early experiences 3. Social influences- family, interpersonal relationships, social support, belonging, love, marital status, community 4. Sociocultural influences- race, gender, sexual orientation, religion, socioeconomic status, ethnicity, culture Assumptions About the Multipath Model of Mental Disorders - 1. No one theoretical perspective is adequate to explain the development of mental conditions 2. Multiple pathways and influences contribute to the development of any single condition 3. The same triggers or vulnerabilities may cause different conditions 4. Not all dimensions contribute equally to the etiology of a condition 5. The multipath model is integrative and interactive Resilience Model - Resilience is best described as our ability to recover from stressful or challenging circumstances Enhancing and using our strengths and relying on positive supports within our environment may decrease the likelihood that we develop a mental disorder 1. Biological influences- low genetic vulnerability, low exposure to environmental toxins low consumption of substances 2. Psychological influences- positive outlook, coping skills, mindfulness (non-judgemental awareness), cognitive flexibility, emotional regulation, meaning and purpose, perceived control 3. Social influences- meaningful relationships, healthy connection with loved ones, ability to seek support, community involvement, social media literacy 4. Sociocultural influences- spirituality/ religion, cultural group identification, supportive social institutions (education, government, etc.) and communities Biological Factors- The Human Brain - This is the center of consciousness including thoughts, memories, and emotions Biological Factors- The Human Brain: Cerebral Cortex - This consists of layers of specialized nerve cells, called neurons, that transmit information throughout the body This contains the Prefrontal cortex Which helps us manage our attention, behavior, and emotions This is also in charge of executive functioning, making good decisions and looking at the immediate consequences of actions Biological Factors- The Human Brain: Limbic System - A group of deep brain structures associated with emotions, decision making, and the formation of memories This has also been found to control basic human drives and motivation Contains both the hippocampus and the amygdala The Hippocampus Helps us form, organize, and store memories The Amygdala Helps us recall our emotional memories and guides our response to potential threats Biological Factors- The Human Brain: Hypothalamic- Pituitary-Adrenal (HPA) Axis - This is a system that is activated under conditions of stress or emotional arousal Biochemical Processes Within The Brain and The Body - There is a link between biochemical dysfunction and psychopathology The brain is composed of: Neurons- a nerve cell that transmits messages throughout the body Dendrites- brings information to the body of the cell Cell Body Axon- carries information away from the cell Neurotransmitters- any group of chemicals that help transmit messages between neurons Dopamine - This is a major neurotransmitter This influences motivation and reward seeking behaviors This also regulates movement, emotional responses, attention, and planning Epinephrine (adrenaline) and Norepinephrine (noradrenaline) - These are major excitatory neurotransmitters Excitatory functioning includes regulation of attention, arousal and concentration, dreaming, and moods Influences physiological reactions related to stress response Gamma-Aminobutyric Acid (GABA) - This is a major inhibitory neurotransmitter (it reduces neural communication) This calms the nerves and regulates mood and muscle tone Serotonin - This is a major inhibitory neurotransmitter Its effects regulate temperature, mood, appetite, sleep Reduced levels of this can increase impulsive behaviors and aggression Cortisol - This is a steroid hormone (hormones are regulated by the endocrine system) This is released in response to stress This regulates energy, memory, and concentration Melatonin - This is a hormone which regulates circadian sleep and wake cycles Neuropplasticity - This is the ability of the brain to evolve and adapt This involves neurogenesis- the birth of new neurons Some forms of psychotherapy can produce positive neuroplastic changes via neurogenesis Chronic stress has been shown to result in negative changes in brain activity Heredity - This is the genetic transmission of traits Research shows that this plays an important role in the development of mental disorders Genetic Mutations - Genetic characteristics can also result from this division of cells This changes the outcome of the genetic coding Some are helpful, some have no noticeable outcome, and others result in biological dysfunction Polymorphisms - These are common genetic variations in which some mental disorders are influences by People will inherit various forms (or alleles) of a particular gene Epigenetics - These are chemical compounds outside of the genome control gene expression Essentially, genes are "turned on" or "turned off" by atoms added to the DNA molecules A variety of biochemical processes, triggered by the environment, shape the path this development takes Psychological Factors - Four major perspectives: 1. Psychodynamic 2. Behavioral 3. Cognitive 4. Humanistic 5. Existential Psychological Factors- Psychodynamic Model - This model views mental disorders as the result of childhood experiences and unconscious conflicts Early development of this model is credited to Freud Psychodynamic Model- The Components of the Personality - Freud developed a model suggesting that al behavior is a product of interactions between three personality component 1. ID 2. Ego 3. Superego Psychodynamic Model- ID - This operates from the pleasure principle, which is the impulsive, pleasure-seeking aspect of our beings This seeks immediate gratification Psychodynamic Model- Ego - This represents the realistic and rational part of the mind This is influenced by the reality principle, which is an awareness of the demands of the environment and of the need to adjust behavior to meet these demands This serves as the intermediary between the ID and the Superego Psychodynamic Model- Superego - Moralistic considerations are the domain of this part of the personality The conscience is part of this, it instills guilt in us and helps prevent us from engaging in immoral or unethical behavior Psychodynamic Model- Psychosexual Stages - Freud believed that the human personality develops through a sequence of five of these stages 1. Oral 2. Anal 3. Phallic 4. Latency 5. Genital The importance of each of these stages for later development lies in whether fixation occurs during that phase Psychodynamic Model- Defense Mechanisms - According to the psychodynamic theory, we often use these to distance ourselves from uncomfortable feelings associated with unpleasant thoughts or other internal conflicts These include: 1. Repression 2. Reaction Formation 3. Projection 4. Rationalization 5. Displacement Defense Mechanisms- Repression - This defense mechanism that prevents forbidden or dangerous thoughts or desires from entering one's consciousness Part of the psychodynamic theory Defense Mechanisms- Reaction Formation - This defense mechanism would entail acting in manner that is opposite to one's unconscious wishes or feelings Part of the psychodynamic theory Defense Mechanisms- Projection - This defense mechanism would entail distancing oneself from unwanted desires or thoughts by attributing them to others Part of the psychodynamic theory Defense Mechanisms- Rationalization - This defense mechanism would entail explaining one's behavior by giving socially acceptable reasons unrelated to one's true motives Part of the psychodynamic theory Defense Mechanisms- Displacement - This defense mechanism wold entail direction an emotion, such as hostility or anxiety, toward a substitute target This would occur when you take emotions and place them onto someone you feel more comfortable with Part of the psychodynamic theory Therapies Based on the Psychodynamic Model- Psychoanalysis - The objective of this form of the psychodynamic model is to uncover material that is blocked from one's unconsciousness This would include: 1. Free association 2. Dream analysis 3. Effects of experiences with early attachment figures 4. Resistance 5. Transference 5.5 Countertransference Psychoanalysis- Free Association - This occurs when one says whatever comes to their mind, regardless of how illogical or embarrassing it may seem (this is in response to a prompt/ thought) This is also an example of a projective personality test Psychoanalysis-Dream Analysis - This is a technique focused on interpreting the hidden meanings in dreams Psychoanalysis-Resistance - This occurs when one's unconscious attempts to impede therapy and prevent exposure to conflicts you are repressing This may show itself when a client suddenly changes the subject, misses appointments, etc. Psychoanalysis-Transference - This occurs when a client's reactions, such as love or anger, becomes directed towards the therapist and are signs of relationship issues with early attachment figures (or another person the client had a deep relationship with) The client is encouraged to work through the true meaning of their reactions Psychoanalysis-Countertransference - This occurs when the therapist may respond to the client in a way of someone from their personal life (may be embedded in prior relationships) Criticism of the Psychodynamic Models and Therapies - Critiques include: 1. Freud relied on case studies and self-analysis 2. Patients in this perspective represented a narrow spectrum of society 3. This fails to address cultural and social influences 4. This may not be useful to certain people (especially those who are less talkative) 5. There are far fewer outcome studies that exist based on this compared to other models Psychological Factors- Cognitive-Behavioral Models - These models link psychopathology with irrational and maladaptive assumptions and thoughts Cognitive- Behavioral Models- A-B-C Theory of Emotional Disturbance - This was developed by Albert Ellis and describes how we develop irrational thoughts A- Activating event C- Person's emotional/ behavioral reaction (consequence) B- A person's beliefs about A causes reaction C Interconnected Nature of our Feelings, Behaviors, and Thoughts- CBT Practice - In response to not getting a job offer from the company you hoped to work for Feeling- sadness Behavior- isolate Thoughts- no one cares about me In cognitive-behavioral therapy, a therapist would wonder how they could challenge their client's irrational thoughts Psychological Factors- Humanistic Models - These models emphasize the whole person and acknowledge the role of free will Carl Rogers stated that are basically good and have inherent inner capacity for growth Maslow's concept of self-actualization- the inherent tendency to strive for full potential Humanistic Models- Self-Actualization - This is Maslow's concept that humans have the inherent tendency to strive toward our full potential When circumstances allow us to reach our full potential, we avoid mental illness Humanistic Models- Person-Centered Therapy - This form of therapy is what Carl Rogers engaged in Rogers believed humans had a need for an unconditional positive regard This form of therapy provides an accepting therapeutic environment to reactivate the potential for self- actualization Humanistic Models- Unconditional Positive Regard - Proposed by Carl Rogers This approach believes that a therapist should accept their client fully as they are, unconditionally respecting one's integrity Criticism of the Humanistic- Existential Therapies - Critiques include: 1. This form of therapy has a fuzzy, ambiguous nature 2. There is a lack of scientific grounding and is not suited to scientific investigation 3. This form of therapy relies on people's unique, subjective experiences 4. This form of therapy doesn't explain many mental conditions 5. This form of therapy doesn't address cultural diversity or acknowledge social factors such as poverty, discrimination, and prejudice 6. There is limited application of these perspectives to the treatment of mental illness; they only seem helpful for those with mild distress or adjustment concerns Social Factors- Social Relational Models - These models believe that healthy relationships are important for human development and functioning These models also believe that relationships provide many intangible benefits (and tangible one, too) When relationships are dysfunctional or absent, individuals are are more vulnerable to mental distress Group Therapy - In this form of therapy, the therapy-goers are initially strangers that share certain life stressors or mental conditions This form of therapy allows participants to become involved in social situations, develop communication skills, and feel less isolated This form of therapy provides a supportive environment and opportunity to try out different ways of interacting This form of therapy allows the therapist to observe a patient's social interactions Group Therapy- Doppelgänger - Someone who reflects similar traits to you (like stress response, communication style, etc.) Seeing yourself in another person can help one gain psychological insight Group Therapy- Blanket Views - These tend to reflect how we tend to see other people Example- "The majority of the people in this group are untrustworthy" Group Therapy- Others' Insights Into Behavior - In group therapy, everyone feels comfortable to share and provide insights on your behavior Group Therapy- Difficulties Coordinating Everything Happening At The Same Time - There are 8 people in group therapy sessions The leader is responsible for facilitating insights among therapy-goers The leader thinks about what has been said, what has not been said, and makes connections between people Sociocultural Factors - These emphasize the importance of several factors in explanations for mental conditions 1. Ethnicity 2. Gender 3. Sexual Orientation 4. Religious Preference 5. Socioeconomic Status 6. Other factors It is important to go deeper than labels as they tend to be static and don't consider heterogeneity Sociocultural Factors- Socioeconomic Status - A lower SES is associated with.... 1. A limited sense of personal control over one's life 2. Poorer physical health 3. Higher incidences of depression (as stress is a major component of its etiology) Life in poverty subjects people to multiple stressors which may make it hard to fulfill one's basic needs Multilevel interventions are necessary to reduce chronic environmental stressors Sociocultural Factors- Immigration and Acculturative Stress - Acculturative stress would refer to the challenges associated with moving to a new country During this time, there is.... 1. A loss of social support 2. Educational, language, and employment challenges 3. Loss of status and a sense of powerlessness These feelings are most common among first-generation immigrants and their children This is often compounded by racism, discrimination, and sometimes concerns about deportation Sociocultural Factors- Gender Factors - Women have higher prevalence of many mental health conditions Women face more societal role stress than men, increased risk of physical and sexual victimization/ harassment Women are also subjected to socialization processes regarding the importance of physical appearance Projective Personality Tests - These are tests involving responses to ambiguous stimuli, such as inkblots, pictures, or incomplete sentences These tests presumably tap into a person's unconscious needs and motivations Problems With Projective Personality Tests - These tests do not meet reliability and validity standards Analysis and interpretation of responses is subject to wide variation These tests may have limited cultural relevance Rorschach Inkblot Test - In this projective personality test, 10 cards are shown that display symmetrical inkblot designs Responses are supposed to be symbolic of inner promptings, motivations, and conflicts This test relies on psychoanalytic theory and the assumption that certain answers are associated with particular unconscious conflicts Interpretation of these signs have been found to be unreliable and highly subjective to clinician bias Thematic Apperception Test (TAT) - In this projective personality test, 20 picture cards are shown depicting two human figures Here, the examiner will ask one to tell a story about what is going on in each picture, what leader up to it, and what the outcome will be Responses to the 20 picture cards are supposed to provide insight on your personality, unconscious conflicts, worries, or motives Sentence-Completion Test(s) - In this projective personality test, a person is given a list of partial sentences and then asked to finish each one The examiner will then try to interpret the meaning of the responses Assessment - This involves gathering information and drawing conclusions about the traits, skills, emotional functioning, and psychological problems of an individual Four main methods: 1. Interviews 2. Observations 3. Psychological tests and inventories 4. Neuropsychological measures Assessment- Interviews - Here, one would observe a client and collect data about the person's life history, current situation, and personality During these, one must analyze: 1. Verbal and nonverbal behavior (body language, posture, eye contact, especially on specific topics, affect (wondering if one's affect is flat, appropriate to content, etc.) 2. Specific information shared by the client 3. Can explore social and sociocultural factors Interviews can vary in degree of structure and formality: 1. Structured interviews 2. Unstructured interviews Assessment- Observations - These can be either formal or informal ways to observe one's behavior These can provide key information Sometimes, these are highly structured and specific Example- a school psychologist observing children in the classroom for off-task events These can also be less formal and more subjective Example- a school psychologist observing a child on the playground interacting with others Mental health professionals will informally observe behaviors when they interview or work with clients Assessment- Mental Status Examination - The objective of this form of assessment is to evaluate a client's... 1. Cognitive functioning 2. Psychological functioning 3. Behavioral functioning This form of assessment uses... 1. Structured questions 2, Open-ended inquiries 3. Observations 4. Tasks (recalling words to test memory, naming the current president, explaining common sayings, etc.) Mental Status Examination- Appropriateness of the Client's Responses - Based on the components of this form of assessment, a clinician will assess the appropriateness of the client's responses The clinician will then form a tentative opinion of diagnosis and treatment needs based on.... 1. Appearance (did the client look disheveled or well-groomed?) 2. Mood (does the client appear to be depressed, sad, etc.?) 3. Affect (is the client's affect limited or flat?) 4. Speech (is the client's speech pressured?) 5. Thought process (is the client's thought process linear, switching directions, circulatory? 6. Thought content (is the client in touch with reality?) 7. Memory 8. Abstract thought (is the client taking everything literally?) 9. General knowledge (does the client know what year it currently is?) Many aspects of this type of exam are subjective and one's cultural background can influence the assessment Example- a client's eye contact and posture may reflect cultural factors as opposed to poor psychological functioning Assessment- Psychological Tests and Inventories - This form of assessment uses standardized tools that measure characteristics such as personality, social skills, intellectual abilities, or vocational interests Psychological Tests and Inventories- Self-Report Inventories - This form of assessment is used to assess personality, depression, anxiety, or emotional reactivity This may involve the completion of open-ended questions or responding to a list of self-descriptive phrases Self-Report Inventories- Minnesota Multiphasic Personality Inventory (MMPI-3) - This is self-report personality inventory features true/false questions which gauge how a person's responses map onto clinical cases This aims to describe one's personality as clear as possible Self-Report Inventories- Beck Depression Inventory- II (BDI-II) - This is a self-report personality inventory This is composed of 21 items that measure various aspects of depression, such as mood, appetite, functioning at work, suicidal thinking, and sleeping patterns Psychological Tests and Inventories- Self-Report Inventories Limitations - Though widely used, self-report inventories have limitations 1. There are a fixed number of answer choices 2. Interpretations of the responses of people from different cultural groups may be inaccurate Diagnosing Mental Conditions - After gathering assessment data, clinicians formulate diagnoses using a classification system Psychiatric Classification System This is similar to a catalogue, featuring detailed descriptions of each condition Here, patterns of behavior are distinctly different Each category accommodates symptom variations (example- it is required to have three of the five in order to be diagnosed- an individual can meet the criteria for 1,2,3, or 3,4,5, etc.) Diagnosing Mental Conditions- The Diagnostic and Statistical Manual of Mental Conditions (DSM) - This is a widely used classification system which lists all the officially designated mental disorders and the characteristics or symptoms needed to confirm a diagnosis The diagnostic criteria incudes the physical, behavioral, and emotional characteristics associated with each condition For all disorders, the symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning The History of this Classification System DSM-1 (1952)- identified 106 mental conditions With revisions made to the classification, both reliability and validity increase Interrater Reliability of the DSM-5 Diagnostic Categories - This would refer to the agreement between clinicians about the same diagnosis It is important to remember that individuals with the same diagnosis don't always look the same Interpretations of Cohen's Kappa Adult Diagnoses: Major neurocognitive disorder and Post-traumatic stress disorder have the highest levels of agreement between clinicians for adults Generalized anxiety disorder (GAD) and Antisocial personality disorder have the lowest levels of agreement/ reliability between clinicians for adults Child Diagnoses: Autism spectrum disorder has the highest level of agreement between clinicians for children Major depressive disorder and disruptive mood dysregulation disorder have the lowest levels of agreement between clinicians for children Post-traumatic stress disorder is less reliably diagnosed in children than in adults Diagnosing Mental Conditions- The International Classification of Disease (ICD, 11e) - This classification system covers all health conditions, including mental disorders Dimensional Perspective - The DSM-5 is a categorical model (either/ or system) which some professionals believe to be ineffective for diagnosis It is important to remember that individuals with a specific diagnosis often display a range of symptoms and that some diagnostic categories have overlapping symptoms In this type of classification system... 1. Conditions reside on a continuum from normal to severe forms of a condition 2. Condition-based experiences don't constitute an "either-or" phenomenon Other Attributes of the DSM-5 - The DSM-5 remains a categorical system; however, some concessions were made to those advocating for a dimensional perspective.... 1. Subtypes 2. Specifiers 3. Cross-cutting measures 4. Comorbidity Subtypes - Distinctly different subgroups within a diagnostic category Example- Anorexia Nervosa Restricting Subtype vs. Anorexia Nervosa Binge-eating/Purge Subtype Specifiers - This allows clinicians to indicate whether a person has certain characteristics associated with a diagnostic category They are not mutually exclusive These allow for a clinician to indicate if a disorder is in full or partial remission (a significant improvement of the symptoms of a disorder) or if someone had an early or late onset of a disorder, a factor that affects prognosis (the prediction of the probable outcome of a disorder, including full chances of recovery) Example- Depression and "seasonal pattern of depression" specifier Cross-Cutting Measures - These "cut across" diagnostic boundaries These assess common symptoms that are not specific to one disorder Example- somatic symptoms (pain, dizziness, digestive issues, fatigue) Sleep issues are common in a variety of conditions Comorbidity - The presence of two or more disorders in the same person (can refer to both mental and physical health) Example- depression is often accompanied by generalized anxiety disorder Depression is often accompanied by cardiovascular disease Cultural Factors in Assessment - The DSM-5 TR includes culture and gender-related diagnostic issues Here, there is a core formulation interview which features 16 questions to help determine the possible impact of culture on a client's symptoms It is important to not make cultural assumptions, but rather simply make hypothesis Objections to Classifying and Labeling - Labeling a person can lead to overgeneralization, stigma, and stereotypes to form Labeling may also lead to a person to believe they possess the characteristics associated with the label However, health care organizations often require labels A mental health diagnosis does not necessarily provide useful information, though Evidence- Based Practice - These are treatment decisions based on the best current research combined with clinical judgement and client needs Treatment decisions should consider: 1. High-quality research, such as randomized controlled studies (randomly assign experimental group to undergo CBT, and have the control group undergo no therapy) 2. Clinician judgement and experience 3. Client culture, values, needs, and perspectives This has become increasingly emphasized Internal Validity - The degree to which changes in the dependent variable are due solely to the effect of changes in the independent variable Simply put, this is confidence that one thing causes another Example- CBT is causing the difference; it is important to isolate the independent variable *CBT) and ensure it is driving the change Studies That Provide The Strongest Evidence - Some types of studies provide stronger evidence: 1. Randomized Controlled Designs These are the "gold standard" in research These can provide information regarding cause and effect relationships 2. Group Research Designs These would include correlational studies, single-participant experiment designs There is less internal validity in these measures 3. Expert Opinion and Case Studies Placed the lowest Single-Participant Experiment - This is an experiment performed on an individual in which some aspect of the person's behavior is used as the control or baseline for comparison with future behaviors Single-Blind Design - In this design, participants in an experiment are unaware of the purpose of the research Double-Blind Design - In this design, neither the individual working directly with the participant (such as the therapist or the physician) nor the participant is aware of the experimental conditions The impact of both experimenter and participant expectations is reduced The effectiveness of this design is dependent on whether both experimenters and participants are truly "blind" Clinical Significance - This is based on how meaningful the results of a study/experiment are in a clinical setting (would reflect in a noticeable change in the quality of one's life) It is important to remember that statistically significant findings aren't always clinically significant Example- HAM-D (features a 0-54 range) Not clinically Significant- 3 point decrease (this decrease could be statistically significant, though) Clinically Significant- movement from a 22 (moderate to severe) to a 14 (mild to moderate) Base Rate - This is the rate of natural occurrence of a phenomenon in the population studied These are helpful in several situations: 1. When two things have very high base rates, don't over-interpret correlations and causality Example- knowing that both sexual abuse and eating disorders occur with high frequency in females ensures that we don't mistakenly assume one causes the other 2. Interpreting symptoms within cultural context Example- many people in certain cultures report experiencing hallucinations during religious ceremonies, this does not mean that they are schizophrenic Genetic Linkage Studies - The goal of this study is to determine whether a disorder follows a genetic pattern If a disorder is genetically linked, individuals who are closely related to the person with the disorder (proband) are more likely top display a disorder or a related disorder Procedure for Identifying Probands - To identify a proband (individuals who are closely related to the person with a disorder)... 1. Identify the proband 2. Evaluate the psychiatric history of family members 3. Conduct a formal assessment on the family members Endophenotypes - These are measurable characteristics, such as atypical cognitive functioning, that can give use clues regarding the specific genes involved in disorders This, simply put, is the intermediary between one's genotype (genetic makeup) and one's phenotype (physical manifestation of that gene) The Criteria to be Consdiered an Endophenotype - In order to be considered an endophenotype, characteristics must be: 1. Heritable (can be inherited) 2. Seen in family members who do not have the disorder 3. Occur more frequently in affected families than in the general population Example- Schizophrenia and irregularities in eye-tracking objects 80% of those diagnosed with schizophrenia maintain irregularities in eye-tracking objects 45% of close relatives with a family member diagnosed with schizophrenia maintain irregularities in eye-tracking objects 10% maintain irregularities in eye-tracking objects in families without schizophrenia Anxiety Disorders and the Multipath Perspective - This is the most common cluster of mental health conditions in the United States Before the COVID-19 pandemic, the past year prevalence for this in the United States was 23% for women and 14.3% for men Anxiety Disorders - Fear or anxiety symptoms that interfere with an individual's day-to-day functioning and produced clinically significant distress This is the most common mental health condition in the United States This is characterized by an "unfounded" (irrational) fear Lifetime Prevalence of Anxiety Disorders in Adults and Children in the United States - 1. Specific phobias are the most prevalent disorder of this cluster of disorders- for both adults and children 2. Agoraphobia is the least prevalent condition of this cluster of disorders- for both adults and children 3. Social phobias are much more prevalent in adults than children Biological Dimension of Anxiety Disorders- Fear Circuitry in the Brain - The prefrontal cortex, amygdala, and the hippocampus are the main players in this Fear Circuitry in the Brain-Fast, More Primal Path To Fear: The Amygdala - This plays a central role in triggering a state of fear or anxiety This causes HPA axis, activity, which triggers one's "fight or flight" response, and in some cases a "freeze" response These primitive, more survival- oriented response may take over and interfere with one's rational thinking Over time, its reactivity increases ("neurons that fire together, wire together) A reduction of GABA in the hippocampus and amygdala (a neurotransmitter which inhibits brain activity) has been linked to anxiety and fear Some medications and therapies have been found to reduce its activity Fear Circuitry in the Brain- Slower, More Advanced Path To Fear: Prefrontal Cortex - The prefrontal cortex develops later than the amygdala Sensory signals from environmental stimuli travel to the hippocampus and prefrontal cortex The prefrontal cortex processes sensory input and evaluates danger Higher- level mental processing (from the prefrontal cortex) may result in signals to the amygdala to stop the HPA axis' response Some therapies have been found to strengthen the connectivity between the prefrontal cortex and the amygdala Psychological Dimension of Anxiety Disorders- Anxiety Sensitivity - This is the tendency to interpret physiological changes in the body as signs of danger People who have this are particularly vulnerable to developing anxiety symptoms Recall emotion models that say emotions are interpretations of physiological changes Psychological Dimension of Anxiety Disorders-Negative Appraisal - This occurs when one interprets events, even ambiguous ones, as threatening Those who have this have an increased likelihood of developing an anxiety disorder Psychological Dimension of Anxiety Disorders-Skill of Reappraisal - This skill is present when one is able to minimize negative responses by looking at a situation from various perspectives People who have this skill demonstrate fewer anxiety symptoms Both a sense of control and someone who has mastered reducing anxiety have a lower vulnerability to anxiety as well Social and Sociocultural Dimensions of Anxiety Disorder - Culture can influence how anxiety is expressed Examples: 1. In Western (individualistic) cultures, social anxiety involves the fear of embarrassing oneself 2. In some Asian countries (collectivistic), social anxiety involves worries about being offensive to others Phobia - This is a strong, persistent, and unwarranted fear of some specific object or situation Here, extreme anxiety or panic is expressed when the phobic stimulus is encountered Most adults are able to recognize that the fear is excessive, but children may not possess the ability to do this This is the most common mental disorder in the United States Categories: 1. Social Anxiety Disorder 2. Specific Phobias 3. Agoraphobia Phobias- Social Phobia (Social Anxiety Disorder) - In order to be diagnosed with this condition, one must experience... Substantial anxiety or fear regrading a social situation (such as public speaking, meeting new people, eating while being watched) Fear that others will notice the symptoms of anxiety Anxiety or fear must occur immediately almost every time the individual is faced with the feared social situation The individual either avoids feared social situation or suffers serious anxiety or fear in its presence The anxiety is irrational, doesn't fit with the realistic harm or threat posed by the situation The above must be present for 6+ months The above causes significant distress or impairment in educational, social, or occupational functioning Social Phobia (Social Anxiety Disorder)- Gender and Comorbidities - Women are twice as likely than man to have social anxiety disorder Social anxiety disorder is often comorbid with major depression, substance-use disorders, and suicidal thoughts/ attempts Phobias- Specific Phobia - In order to be diagnosed with this condition, one must experience... Substantial fear regarding a situation or object (examples- flying, heights, injections, animals, blood, etc.) The fear must occur immediately almost every time the individual is faced with the feared situation/ object The individual either avoids the feared situation/object or suffers serious anxiety in its presence The fear is irrational, doesn't fit with the realistic harm or threat posed by the situation/ object The above must be present for 6+ months The above causes significant distress or impairment in educational, social, or occupational functioning Primary Types of Specific Phobias - 1. Living creatures (example-spiders) 2. Environmental conditions (example-heights) 3. Blood/injection or injury (example- needles) 4. Situational factors (example-flying) Phobias- Agoraphobia - This is an intense fear of at least two of the following: 1. Being outside of the home alone 2. Traveling via public transportation 3. Being in open spaces 4. Being in stores or theaters (closed spaces) 5. Standing in line or being in a crowd These situations are feared because escape/help may not be readily available In some cases, people refuse to leave their home due to the concern that they may have a panic attack Cognitive Behavioral Treatment for Phobias - CBT treatments for phobias would include: 1. Exposure therapy 2. Systematic desensitization 3. Cognitive Restricting 4. Modeling Therapy CBT for Phobias- Exposure Therapy - This form of CBT for phobias would include introducing the individual to the feared situation or object until the fear dissipates- gradually and increasingly difficult Smartphone apps and virtual reality therapy have offered more options for this type of therapy Gradual Exposure This is a systematic form of treatment where one creates a list ranking the most feared components of the feared situation (example- one would create a list where a picture of a spider would be at the bottom of their list, and a spider being on them would be at the top of the list) Flooding Introducing an individual to the feared situation or object at a maximum intensity Effectiveness of flooding is dependent on the feared stimulus CBT for Phobias-Systematic Desensitization - This form of CBT for phobias would include exposure to the feared situation or object combined with relaxation (systematic relaxation, mindfulness) CBT for Phobias-Cognitive Restructuring - This form of CBT for phobias would include identifying and challenging irrational or anxiety-arousing thoughts associated with the phobia Here, a therapist would ask their client to provide evidence for their thoughts/fears CBT for Phobias-Modeling Therapy - This form of CBT for phobias would include viewing another person's successful interactions with the feared situation or object Panic Disorder - This is recurrent, minutes-long episodes during which four or more of the following appear unexpectedly and quickly escalate: Psychological: 1. Heart rate increases/ palpitations 2. Sweating 3. Trembling 4. Perceived difficulty breathing 5. Perceived choking 6. Chest pain 7. Nausea 8.Perceptions of dizziness 9. Perceived changes in body temperature (chills) 10. Perceived numbness Cognitive: 11. Sensing that one is outside of one's (depersonalization) or that the current moment isn't real (derealization) 12. Perceived loss of control 13. Perceived imminent death In order to be diagnosed, one must have... 1+ occasion of fearing these episodes will reoccur and/or changing behavioral patterns to avoid perceived triggers of these episodes This must occur for 1+ month after the initial symptoms occur Panic Disorder- Gender and Comorbidities - Many individuals diagnosed with this also develop agoraphobia There are also cultural variations in the symptoms that are experienced: 1. Caucasians are more likely to report cardiac and respiratory symptoms 2. African Americans are more likely to report numbing sensations in their extremities as well as the fear of dying 3. Native Americans are more likely to report a pounding heart, dizziness, and altered perceptions of time Cultural variations may be explained by the cultural acceptability of one's symptoms The past-year prevalence rate of this disorder in the United States was 2.7% This disorder is twice as common in women than in men Obsessive Compulsive Disorder (OCD) - Primary symptoms are obsessions and compulsions that consume at least 1 hour of time per day and cause significant distress or impairment in life activities Obsessive Compulsive Disorder (OCD)- Obsessions - These are consistent, anxiety producing thoughts or images Examples- contamination, errors or uncertainty, unwanted impulses, orderliness Obsessive Compulsive Disorder (OCD)- Compulsions - This is the overwhelming need to engage in activities or mental acts to counteract anxiety or prevent occurrences of the dreaded event Examples- hand washing, checking (such as the locks on a door), ordering objects Obsessive Compulsive Disorder (OCD)- Prevalence - OCD is more common among boys during childhood OCD is more common among girls during adolescence and adulthood Exposure and Response Prevention (ERP) Treatment of Obsessive Compulsive Disorder - This consists of: 1. Behavioral treatment 2. Gradual exposure or flooding to the feared stimuli 3. Response prevention (preventing one from engaging in compulsions) Generalized Anxiety Disorder (GAD) - Also known as "free floating" anxiety In order to be diagnosed with this condition, one must experience... Uncontrollable, high levels of anxiety or worry about a number of life domains the majority of the time (i.e.- worrying more than 50% of the days about home, school, work, and/or family) The anxiety or worry must: 1. Cause significant distress or reduced functioning 2. Last 6+ months 3. Be accompanied by 3+ of the following... -Change in sleep (either substantially more/less sleep or difficulty falling asleep -Restlessness -Fatigue -Concentration difficulties -Irritability -Muscle tension Generalized Anxiety Disorder (GAD)- Prevalence and Comorbidity - This is highly comorbid with depression About 2.7% of the United States adult population is affected by this disorder Lifetime prevalence of this disorder among adolescents is 2.2% Women and girls are nearly twice as likely to receive thus diagnosis compared to men and boys The Etiology Generalized Anxiety Disorder (GAD)-Biological Dimension - There is a small but significant heritably factor (31%) Serotonin or GABA (stop cap) abnormalities or overactivity of the HPA axis Irregularities with the limbic system and prefrontal cortex (decreased cortical control) The Etiology Generalized Anxiety Disorder (GAD)-Psychological Dimension - According to cognitive theories, this disorder is caused by dysfunctional thinking and beliefs: 1. Automatic attentional bias for negative information, and impaired attentional control 2. Lower threshold for uncertainty 3. Use of worrying as coping The Etiology Generalized Anxiety Disorder (GAD)-Social and Sociocultural Dimensions - Mothers with anxiety may be less engaged with their infants This is associated with an increased likelihood of a child developing GAD Stressors influence GAD Being a victim of bullying, poverty (twice as prevalent among those with low income), separation or loss of a romantic partner (death or divorce) There is a higher prevalence of GAD among African Americans and Latinx Americans