Abnormal Psych - A comprehensive PDF of my lecture notes from the entire semester. PDF

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A comprehensive PDF of my lecture notes from the entire semester....

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Examples & Definitions of Abnormal Behavior (Jan. 5th) Monday, January 5, 2015

5:52 PM

Abnormal psychology • Psychopathology ○ Pathology of the mind study of the nature, development, and treatment of psychological disorders • Abnormal psych ○ The application of psychological science to the study of disorders  Includes the study of mental disorders, patterns of abnormal behaviors, and ways to help • Mental disorders/illnesses = psychological disorders Abnormal behavior: myths and misconceptions • What's psychologically normal? ○ Behaviors at certain ages ○ People who act differently from us • What's not? • How do we describe people with mental illness? ○ Lazy, crazy, dumb ○ Insane ○ Weak in character ○ Dangerous ○ Lost cause, hopeless Case #1 • Tom's uncomfort with escalators ○ Questions to consider for diagnosis  What culture is he from?  How intense is the fear/uncomfort?  How much does is actually interfere with his life? Case discussion take home points • Explore cases fully before making snap judgments • Complexity of teasing apart normal and abnormal behavior ○ Continuum between normal and abnormal Heterogeneity in experience • • Using appropriate language • Challenges to the study of psychopathology ○ Maintaining objectivity ○ Avoiding preconceived notions ○ Reducing stigma Defining abnormal behavior • Personal distress ○ Look at if person sees their own behavior as problem  Certain disorders, person may not view symptoms as a problem ○ Looking for distress in their life in general ○ Distressed with consequences of behavior • Statistically unusual ○ What is statistically abnormal in the population  If behavior falls in extreme of that spectrum • Harmful dysfunction (Jerome Wakefield) ○ The condition results from inability of some internal mechanism (mental or physical) to perform its natural function  Cognitive

□ Thinking you are president  Emotional □ Fear around family members  Communication □ Unable to communicate with others  Etc. ○ The condition causes harm to person  Defined by the individual's culture ○ The DSM-5 definition places primary emphasis on the consequences of certain behavior syndromes  Mental disorders are defined by clusters of persistent, maladaptive behaviors that are associated with personal distress Classification of psychological disorders • Diagnostic and statistical manual (DSM) ○ Constant revision and remodification ○ Outlines criteria for disorders using a categorical approach ○ Prototypes/typical profiles • International statistical classification of diseases Recognizing the presence of a disorder • Mental disorders are defined by a set of features ○ Presence of multiple symptoms ○ Durations: persistent maladaptive behaviors ○ Interference with functioning  Personal distress  Impairment in psychosocial function  Violation of social norms • Diagnosis ○ No lab tests to confirm presence of a mental disorder ○ Observations and clinical interview remain an important tool How common is mental illness? • Epidemiology ○ The scientific study of the frequency and distribution of disorders within a population • Incidence ○ The number of new cases of a disorder that appear in a population during a specific period of time • Prevalence ○ The total number of active cases, both old and new, that are present in the population during a specific time period  Point prevalence  Lifetime prevalence □ How many people in lifetime will have certain disorder Mental health professions • Psychological problems are treated in difference settings by difference service providers ○ 40% by specialized mental health professions ○ 34% by primary care physicians ○ 26% by social agencies and self-help groups A brief history of abnormal psychology • Trephination ○ Dated back to pre-historic times ○ Evidence of surgical procedures found in old burials dated back to 4000-6000 BC • Hippocrates (460 - 377 BCE) ○ Founder of somatogenic perspective ○ Brain is the center of intelligence

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○ Mental illness causes by imbalance of bodily fluids  4 humours □ Phlegm □ Black bile □ Yellow bile □ Blood  Treatment □ Bloodletting □ Purging Creation of the asylum ○ Occurred during European middle ages  Mentally ill seen as lunatics or idiots  Marginal care ○ Individuals were the responsibility of family, not community ○ Treatment  Imprisonment or "human warehouses" aka early insane asylums (1600s-1700s) Moral treatment movement ○ During the industrialization period  Rise of "moral treatment movement"  Shift in view: mental illness can be treated □ Improvements in physical and moral treatment ○ Dorothea Dix  Advocate for prisoners and mentally ill  Urged improvement of institutions  Worked to establish several new hospitals  Hospitals staffed with physicians □ Led to demand of and creation of psychiatry Phrenology ○ Popular in the 19th century ○ Developed by Franz Joseph Gall (1758-1828) ○ Surface of skill reveals the "organs" of the brain ○ Brained proposed to be center of character, thoughts, and emotions ○ Now considered pseudoscience but had significant impact on fields of psychiatry and neuroscience Deinstitutionalization movement ○ Initiated because of societal changes  New psychiatric medications in 1950s  New social policy and a focus on community-based health care in 1960s  Financial incentive to shift aware from state-funded hospitals to federal budgets ○ Both positives and negative of deinstitutionalization

Causes of Abnormal Behavior (Jan. 12th) Monday, January 12, 2015

5:55 PM

Psychodynamic paradigm • Ego, id, superego ○ Id - subconscious, unorganized instinctual needs ○ Superego - balances ego and id ○ Ego - realistic, moral needs • Entire theory emphasized push and pull between conscious and subconscious • Defense mechanisms ○ Subconscious coping mechanisms to reduce any anxiety from id's impulses • A lot of focus from this perspective is on unconscious Cognitive-behavioral paradigm • Classical conditioning ○ Learning through association  UCS->UCR  CS+UCS->UCR  CS->CR  Extinction □ Occurs once a CS no longer elicits the CR ○ Baby Albert • Operant conditioning ○ Asserts that learned behavior is a function of its consequences and how they influence someone to use those behaviors  Positive and negative reinforcement  Punishment  Extinction Humanistic paradigm • Free will ○ Human behavior determined by actions and choices we make voluntarily  Focused on what we can do, making the most of our choices • Positive view of human nature ○ Abnormal behavior is because of society not because of the individual ○ The individual is inherently good Biological paradigm • Original perspective ○ John Haslam (1800s) gave hope that scientists would discover biological causes for mental disorders  Mental illness is the same as any medical/physical illness • Current perspective ○ Will a single cause ever be discovered?  Very unlikely □ Many factors go into mental illness, can't really pinpoint just one Limitations • Psychodynamic ○ Focuses on childhood and unconscious conflicts rather than present Cognitive-behavioral • ○ May overlook biological and social contexts • Humanistic ○ Can be anti-scientific • Biological ○ Overemphasizes medical model

Systems theory • Many psychologists do not subscribe to only one view ○ Take a more integrated approach  How can we integrate these different viewpoints together ○ Takes into consideration the individual level but also outside influences • Synonym for biopsychosocial model Equifinality vs. multifinality • Equifiniality ○ Multiple symptoms/roots/causes/factors that lead to one disorder • Multifinality ○ One symptom/cause/factor can lead to many different disorders  Same trauma doesn't necessarily lead to development of same disorder Systems theory • Diathesis-stress model ○ Diathesis (predisposition or vulnerability) paired with environmental stressor leads to development of disorder  Ian's biological predisposition to bipolar paired w/ S3 and S4 events leads to development of bipolar disorder (TV EXAMPLE) • Reciprocal causality ○ Bidirectional  Relationship isn't in one direction □ People who are depressed are at greater risk for cardiovascular disease, also goes the other way • Health psychology ○ Focus on psych and behavioral processes that are involved in health and the development of diseases • Developmental clinical psychology ○ Understanding diseases in comparison with typical stages of development; identifying factors that influence or interfere with stages of development Biopsychosocial model • How modern psychologists try to understand abnormal behavior • Biological factors ○ Brain structures ○ Structure and function of the neuron  CNS and PNS are made of integrated neurons □ Communication with one another and organs ○ Neurotransmitters  Chemical substances that serve as communication signals □ Many disorder theories focus on role of neurotransmitters  i.e., serotonin and depression ○ Psychophysiology and the endocrine system  Endocrine regulates hormone release in our bodies □ Cortisol and stress response Psychophysiology and psychopathology  □ Hyper-arousal or over-reactivity  anxiety □ Chronic under-arousal  Not reactive enough to certain stimuli ◊ Not reacting to certain social cues ○ Behavior genetics  Genotype: coded info contain in DNA  Phenotype: what actually emerges or gets expressed  Polygenic disorders: isn't just one gene involved with disorder

 Methods of studying behavior genetics □ Family incidence studies  Examine incidences of same disorders in relative of normal and ill probands □ Twin studies  Comparisons and identical and fraternal twins □ Adoption studies  Compare characteristics of adopted children with those of adoptive and bio parents • Psychological factors ○ Attachment  John Bowlby □ Infants for close attachments early in life which are special selective bonds with caregiver □ Every relationship are foundations for later relationships  Theorized 4 attachment styles (secure, avoidant, ambivalent, disorganized) □ Secure attachment - protective factors □ Insecure attachment - risk factors  Secure attachment □ As children  Can separate from parent  Seek comfort from parents when frightened  Greets return of parents with positive emotions  Prefer parents to strangers □ As adults  Have trusting, lasting relationships  Seek out social support  Are comfortable sharing thoughts and feelings with friends and partners  Have high self-esteem  Avoidant attachment □ As children  Avoid parents  Do not seek comfort or contact from parents  Shows little or no preference for parents over strangers As adults □  May have trouble with intimacy  Invest little emotion in social and romantic relationships  Unwilling or unable to share thoughts and feelings with others ○ Temperament  Characteristic styles of relating to the world □ Emotional reactivity □ Emotional regulation □ Interpretation of experiences ○ Learning and cognition  Operant and classical conditioning  Modeling □ Bandura and Bobo doll experiments  Social cognition □ Fundamental attribution error □ Hostile attribution bias □ Beck's cognitive triad ○ Developmental stages (theories)  Freud's psychosexual model

□ Emphasizes sexuality in development through adolescence  Erikson's psychosocial model □ Emphasizes social interactional tasks through the life span  Psychopathology can occur during stressful developmental transitions • Social factors ○ Relationships and psychopathology ○ Gender and gender roles ○ Race and poverty ○ Context of society's values Summary • Many approaches to the study of abnormal behavior • Rather than considering only one paradigm, we will examine combination of both biological, psychological, and social factors ○ Systems theory: biopsychosocial model • Dynamic and interactive processes ○ Important to consider factors from all angles

Treatments of Abnormal Behavior (Jan. 12th) Monday, January 12, 2015

7:30 PM

Psychotherapy • What is the aim? ○ Specific treatment to focus on mental disorders of the mind  Helping them to function more in society  Can be more than a single type of approach ○ Use of different psychological techniques and using therapist/client relationship to produce changes in one's emotions, cognitions, and behavior • Different treatments work better for different disorders • Adherents to different paradigms offer very different treatments ○ Most mental health pros describe themselves as eclectic • What are evidence-based treatments? ○ Research backing the treatment up that it is actually helpful for certain disorders  Outcome research □ How well treatment actually works  Process research □ Focused on understanding what is it about therapy that actually works Treatment: biological process • What is the aim? ○ Try and explain mental disorders/behaviors by focusing on physiology and cellular/molecular level • The ideal process ○ Step 1: determine a diagnosis ○ Step 2: what is the etiology? ○ Step 3: conduct experiments with carious treatments for preventing or curing disorder • The actual process? ○ Biological treatments like medication to try and decrease/control symptoms  Helps them to try and cope • Examples of psychosurgery ○ Prefrontal lobotomy: severs frontal lobes ○ Bilateral cingulotomy (1948)  Severs fibers of cingulum… Psychopharmacology • ○ Most popular biological treatment ○ Do these medications cure underlying causes or treat symptoms  Decrease symptoms but don’t cure any disorder ○ Psychotropic  Any chemical substance or medications that affect the psychological state • Shock therapy ○ Stigma as really gruesome  Some truth to stigma, but now is much safer and more regulated and is used in treatments for some people Treatment: psychodynamic approach • Foundation ○ Originated from Freud's work • Targets of this approach ○ Interested in having person just talk so therapist can judge what's going on unconsciously  Aim to help client develop insight • Freudian techniques ○ Free association

○ Interpretation ○ Transference • After Freud… emphasis still on the role of the ego ○ Ego analysts: Sullivan, Horney, Erikson ○ What did therapy focus on?  Still focused on similar things, but went from really focusing on just unconscious to focusing more on how that affects interactions What about modern day psychodynamic therapy? • ○ Much more intensive therapy  Probably recommend more than one appt a week Treatment: cognitive-behavioral approach • Theory drawn from behaviorism and learning theory ○ What is the aim of this approach?  Help someone develop skills to act and think in ways that are more helpful to them  Really focused on the present • CBT emphasizes ○ Collaborative therapist-client relationship ○ The present and behavior ○ New ways of thinking and behaving ○ Direct efforts to change problems  Assigns "homework" ○ Use of research-based techniques • One example ○ Identification and restructuring of thought distortions  Automatic negative thoughts • Examples of behavioral approaches ○ Exposure therapy  Flooding (A) ○ Systematic desensitization (B) ○ Aversion therapy ○ Contingency management ○ Social skills training Humanistic approach: client-centered therapy • Theory: people are essentially good and have the desire to reach their full potential (Carl Rogers, PhD) • Aim for client ○ Help client develop confident sense of self  Reaching full potential □ Not as structured as other therapies ○ Therapist supposed to develop trust-worthy relationship with client and show client that they really care about them • Emphasizes ○ Empathy, unconditional positive regard, congruence (focus on relating to client genuinely) • Interpersonal therapy (IPT) ○ Developed in 70s are Yale by Gerald Klerman, Myrna Weissman, and Eugene Paykel ○ Focuses primarily on people's relationships  Drawn from attachment theory, communication theory ○ Wants to help decrease psychiatric symptoms and understand conflicts in relationships with other people  Aim to help communicate better with people  Identify which relationships you care most about and how you're handling those relationships Other treatments: systems perspective

• Facilitate change in social systems ○ Couples therapy ○ Family therapy • Group therapy ○ Psychoeducational groups ○ Experiential group therapy • Self-help groups • Community services ○ Prevention programs Psychotherapy: outcome research • Does psychotherapy work? • Outcome research ○ Focused on the outcome ○ Research of studies that are conducted to test whether or not treatments achieve goals they set out to achieve • How do we test treatments ○ Randomly assigning patients to groups • Statistical vs. clinical significance ○ Always ask p-value and see if it's statistically significant ○ Just as important to think outside of numbers and decide if it's important, clinically speaking • Efficacy vs. effectiveness • Meta-analysis studies ○ Average client receiving psychotherapy is better off than 80% of those who are untreated ○ The average gain produced by many accepted medical treatments is much smaller ○ 2/3 of clients improve greatly in therapy  Although benefits diminish over time • What are some difficulties of studying treatments ○ People who are willing to consent to research might be more willing to respond and finish treatment ○ Following up and practicality is hard ○ People who are young, attractive, and well-off do better in therapy • What influences client improvement? ○ Young, attractive, successful, intelligent individuals are more likely to succeed ○ What the problem is  How sick they are, when they start therapy, etc. Psychotherapy: process research • Does one treatment approach work better than another ○ Dodo Bird Verdict: "everybody has won and all must have prizes"  Overall, there is no treatment that clearly comes out on top □ Really the client-therapist relationship that predicts outcome • What are common factors that can explain treatment efficacy across different approaches?

Classification of Abnormal Behaviors Monday, February 2, 2015

6:23 PM

Why do we need a classification system? • A diagnosis provides ○ Identification or recognition of a disorder on the basis of its characteristics ○ Enables the clinician to refer to the base of knowledge that has accumulated with regard to the disorder ○ Basically gives us a labeling system • However, in this field ○ Assigning diagnosis does not mean that etiology is known Designing a classification system • Where would you begin? ○ Notice behaviors that cluster together  If the label is true, then you should be able to repeatedly identify that cluster of symptoms in the population ○ Aim for predictive validity  Research has been done to come up with the diagnostic labels ○ Need criteria that are observable ○ Study treatment outcome Advantages of classification • Communication (a "common language") • Identification of prognosis • Treatment planning • Provides a foundation for advancements in research • 3rd Party Payments ○ Insurance will not cover treatments unless given a diagnostic code that treatment is needed Disadvantages of classification • Loss of individuality about the person • Labeling/stigma • Imperfection of symptoms ○ Systems are constantly changing • Categorical vs. dimensional Basic issues in classification • Categories versus dimensions ○ Categorical approach  Putting people in categories □ Yes or no □ Concrete distinct categories to put people into  Assumes someone in yes box is completely different then someone in no ○ Dimensional approach  A spectrum □ May ask how severe one's symptoms are on scale Two classification systems • DSM-5 published by American Psychiatric Association ○ What America uses International Classification of Diseases published by the World Health Organization • ○ What the whole rest of the world uses Basic characteristics of the DSM 5 • List specific criteria for each diagnostic category ○ Inclusion criteria  Symptoms that have to be present for diagnosis

○ Exclusion criteria  Different conditions or rules where diagnosis should be ruled out □ Ex. - if someone only shows signs of depression when drunk • Disorders defined mostly based on behaviors b...