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TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

ABNORMAL PSYCHOLOGY STUDY GUIDE – LEARNING OBJECTIVES Topic 1 - Classification, diagnosis and an integrative approach to psychopathology LO1: Define the key elements in the current conceptualisation of abnormality or psychological disorder Psychopathology: is the scientific study of psychological disorders. WHAT IS A PSYCHOLOGICAL DISORDER? Psychological Disorder: is a psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected. Phobia: a psychological disorder characterised by marked a persistent fear of an object or situation. PSYCHOLOGICAL DYSFUNCTION Psychological dysfunction refers to a breakdown in cognitive, emotional or behavioural functioning. Knowing where to draw the line between normal and abnormal dysfunction is often difficult. For this reason, these problems are often considered to be on a continuum or dimension rather than to be categories that are either present or absent. This too, is a reason why just having a dysfunction is not enough to meet the criteria for a psychological disorder.

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PERSONAL DISTRESS OR IMPAIRMENT 

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That the behaviour must be associated with distress to be classified as abnormal adds an important component and seems clear: the criterion is satisfied if the individual is extremely upset – by itself however this criterion does not define abnormal behaviour. Suffering and distress are a part of life. For some disorders, by definition, suffering and distress are absent. The concept of impairment is useful, although not entirely satisfactory. Psychological disorders are simply extreme expressions of otherwise normal emotions, behaviours and cognitive processes.

ATYPICAL OR NOT CULTURALLY EXPECTED   

Atypical behaviour is also insufficient in determining if a disorder is present by itself alone. Abnormal = occurs infrequently/deviates from average. Differences in degrees of difference from the average is not enough to determine disorder i.e. someone could be abnormally tall or short – this does not define a disorder Violating social norms is not enough to determine disorder – think for example politicians, their displays of dissident behaviour alone can not be granted enough to diagnose disorder.

OTHER THOUGHTFUL NOTES ON DEFINITION  

Harmful dysfunction might seem more appropriate – Jerome Wakefield (1999, 2009) Determining if the behaviour is outside of the individual’s control is also a useful notion

IMPORTANT FACTORS OF THE CLINICAL DESCRIPTION

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

Presenting problem – indication of why the person is attending treatment. Clinical description – represents unique combination of behaviours, thoughts and feelings that make up a specific disorder – What makes the disorder different from normal behaviours or from other disorders? Prevalence – how many people in the population have the disorder. Incidence - statistics on how many new cases occur during a given period. Course - Most disorders follow an individual pattern.   

Chronic course – tendency to last a long time / lifetime Episodic course – recovery is likely within a few months only to suffer reoccurrence at a later stage in life. Time-limited course – improvement without treatment in a relatively short space of time. Little or no risk of reoccurrence.

Onset patterns  

Acute onset – begins suddenly Insidious onset – develops gradually over extended period of time

Prognosis – the anticipated course of a disorder – ‘good’ or ‘guarded’ = probable outcome is not favourable. Age – psychological disorders present differently in children, adolescents and adults. Importance lies on these factors so that the clinician has a baseline for the disorder to predict the future, offer the best methods for treatment, have an indication of the anticipated course of the disorder and an understanding of the developmental psychopathological components of the disorder as represented throughout the lifespan. Ethology – why the disorder begins (what causes it). Includes psychological, biological and social dimensions. Treatment – method for treatment Psychopathology is rarely simple. The effect does not necessarily imply the cause.

CLASSIFICATION AND DIAGNOSIS 1994 – DSM-IV 2000 – DSM-IV-TR – revisions with respect to new information regarding the associated features and laboratory findings for disorders – no changes to diagnostic criteria 2013 – DSM-V European system – Mental and Behavioural Disorders section of the World Health Organisation’s International Classification of Disease. DSM-III-R and DSM-IV-TR – information regarding an individual was organised across five separate axes or domains. Axis I: - Clinical disorders and other conditions that may be a focus for clinical attention

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

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Used for reporting all disorders/conditions in DSM-IV except personality disorders and mental retardation

Axis II: - Personality disorders and mental retardation -

Long term/enduring conditions Impact functioning Separate axis to give adequate consideration in assessment’

Axis III: - General medical conditions -

Current medical conditions relevant to development/treatment of disorder

Axis IV: - Psychosocial and environmental problems -

Psychosocial problems impacting diagnosis/treatment/outcome of disorder

Axis V: - Global assessment of functioning -

DSM-V

Clinician’s perception of overall level of psychological, social and occupational functioning of an individual

Multi-axial system dropped – bring consistency between DSM-V and ICD-11 (International Classification of Diseases – ICD-11 released 18th June 2018 and comes into effect 1 Jan 2022 Axes I, I and III have been removed – personality disorders and medical conditions on same Axis Axis V gone (GAF scale) Revised structure for classifications of disorders Limited number of ‘new’ disorders – Hoarding Disorder, Skin-Picking Disorder and Agoraphobia and combining others Asperger’s and Autism

LO2: Describe the scientist-practitioner approach to psychopathology Development in recent history of psychopathology is in the adoption of scientific methods to learn more about the nature of psychological disorders, their causes and their treatment. Scientist-practitioner approach Scientist-practitioner – scientific approach to clinical work. Operates in 3 ways   

C - Keep up to date with latest research/developments = use the most current diagnostic and treatment procedures E - Evaluate their own assessments/treatment procedures and demonstrate the effectiveness of their methods. C - Conduct research that produces new information about disorders or their treatments = immunity from fads that plague the psychology field.

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

LO3: Describe the three major categories of focus underlying the study and discussion of psychological disorders Multidimensional integrative approach Biological dimensions

– causal factors from fields of genetics & neuroscience

Psychological dimensions

– causal factors from behavioural and cognitive processes.

Emotional, social, interpersonal and developmental influences also contribute largely to psychopathology. Each dimension is strongly influenced by others and development and all weave together in intricate and complex ways. One dimensional model – psychopathology is caused by either physical abnormality or by conditioning Systemic – A system or feedback loop, may have independent inputs at many different points, but as each input becomes part of the whole, it can no longer be considered independent.

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Vasovagal syncope – overreaction of a mechanism called the sinoaortic baroreflex which compensates for sudden increases in blood pressure by lowering it.

LO4: Discuss the limitations to one-dimensional models of psychopathology.

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

One-dimensional Model  Single cause – operating in isolation  Linear causal model  Ignore critical information

Multidimensional Model  Systemic  Several independent inputs that become interdependent  Causes cannot be considered out of context

LO5: Discuss the relationships between genes and behaviour, genes and environment, and the nongenomic “inheritance” of behaviour. Nature of Genes 46 chromosomes arranged in 23 pairs. 22 pairs give directions for body and brain development and the last pair gives directions for sex (sex chromosomes – X and Y). DNA molecules have a certain structure – double helix (2 spiral staircases travelling in opposite directions). Much of development, behaviour, personality and intelligence is polygenic – influenced by many genes. Quantitative genetics – summary of all the tiny effects across many genes without detailing which genes are responsible for effects. Molecular genetics – examines actual structure of genes at once and identifies networks of genes that may be contributing to a particular trait. 

Environmental factors can affect genes by ‘turning’ (them) ‘on’.  Learning affects genetic structure of cells - Activating dormant genes - Continued development within the brain

Eric Kandel (1983) – Speculated this process of learning affecting a change in generic structure. Fist to produce evidence to support this process. 

Plasticity vs. Hardwired

Diathesis-Stress Model Individuals inherit tendencies to express certain traits or behaviours, which may then be activated under conditions of stress.

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An inherited tendency – diathesis – (or vulnerability, a condition making someone susceptible to developing a disorder). Triggered by the right type of stressor brings about the onset of the disorder.

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

Diathesis (genetic) + Stress (environment) = interaction produces a disorder

The Gene-Environment Correlation Model Genetic endowment may increase the probability that an individual will experience stressful life events. These people may have a genetically predetermined tendency to create the very environmental risk factors that trigger a genetic vulnerability. e.g. Depression – suffers seek out difficult relationships or circumstances that lead to depression. Summary – Genes and Behaviour - 50% of personality traits and cognitive abilities are attributed to genetic influence. For psychological disorders genetic factors account for less than 50% of the explanation. Contributions to psychological disorders come from many genes, each having a small effect. Adverse life events can overwhelm the influence of genes. Diathesis- Stress Model – individuals inherit tendencies to express certain traits or behaviours, which may then be activated under conditions of stress. Each inherited tendency is a diathesis, which means a condition that makes you susceptible to developing a disorder. The greater the diathesis the less stress is needed to trigger a disorder and vice versa.

LO5: Describe the major neurotransmitter systems and their involvement in abnormal behaviour; Neuroscience – the science of nervous system and brain and the effects on behaviour, emotions and cognitive processes.

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Central Nervous System  Basic building blocks of the brain are neurons that form a complex network of information flow transmitted through electrical impulses (action potentials). Chemical communication via neurotransmitters. Neurons -

nerve cells that control thoughts and actions and transmit information throughout the nervous system.

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

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 Neurotransmitters of interest in psychopathology are; o Norepinephrine (noradrenaline) o Serotonin o Dopamine o Gamma-aminobutyric acid (GABA); and o Glutamate

The Peripheral Nervous System Made up of two major components – somatic nervous system and the automatic nervous system Primary duties of the autonomic nervous system are to regulate the cardiovascular system and the endocrine system (pituitary, adrenal, thyroid, and gonadal glands). Endocrine System - Produces hormones - Closely related to immune system - Implicated in a variety of disorders Adrenal glands – epinephrine (adrenaline) in response to stress. Thyroid glands – thyroxine – facilitates energy metabolism and growth. Pituitary gland – variety of regulatory hormones Gonadal glands – sex hormones (estrogen and testosterone)

Hypothalamic-pituitary-adrenocortical axis HPS axis -

Integration of the endocrine and nervous systems

Neurotransmitters

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

Neurons that are sensitive to one type of neurotransmitter cluster together and form paths from one part of the brain to the other. Changes in neurotransmitter activity may make people more or less likely to exhibit certain kinds of behaviour in certain situations without causing the behaviour directly. Agonists – increases the activity of a neurotransmitter by mimicking its effects. Antagonists – decreases or blocks a neurotransmitter. Inverse agonists - produces effects opposite to those produced by the neurotransmitter.

Main Neurotransmitters 

Glutamate and GABA o Excitatory transmitter “turns on” many different neurons – leads to action o GABA – inhibitory neurotransmitter (inhibit or regulate) transmission o Glutamate and GABA work to balance functioning in the brain o “The Chemical Brothers” o Fast acting o GABA – best know effect = reducing anxiety o Complex subsystems  Benzodiazepines – GABA molecules attach to receptors of specialised neurons making the consumer calmer (highly addictive)

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Serotonin o 5-hydroxytryptamine (5HT) o Monoamine category o Widespread, complex circuits o Regulates behaviour, mood and thought processes o Low levels = less inhibition, impulsivity, aggression o Low levels = vulnerability to problematic behaviour

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

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Norepinephrine (noradrenaline) o Stimulates (at least) two groups – alpha-adrenergic and beta-adrenergic receptors o Respiration, reactions alarm response o Bears a relationship with panic. (surge of adrenaline)

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Dopamine o Monoamine class o Implicated in pathophysiology of schizophrenia o Significant role in depression o “Switches” function in brain circuits o Interacts with other neurotransmitters o Motor control, motivation, arousal, reward, lactation, sexual gratification o Parkinson’s disease

LO6: Describe how psychosocial factors influence and interact with brain structure and function Psychosocial Influences on Brain Structure and Function Initiating factors – reasons why a problem develops Maintaining factors – reasons why a problem persists *** Typically, more important to know the maintaining factors than the initiating factors *** Brain-based disorders – do they require medical treatment? Psychological disorders – do they require psych treatment? “Review of evidence suggests (depending on the disorder) that psychotherapy results in either a normalization of abnormal patterns of activity, the recruitment of additional areas which did not show altered activation prior to treatment, or both”. Psychosocial influences on the brain -

Functional normalisation in OCD Placebo treatments – increase in hope or expectation that treatment will be effective Psychotherapy – CBT facilitated changing in thinking patterns affecting the emotional brain ‘Top-down’ change – originates in the cortex and works its way down to lower brain

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, David H. Barlow, Mark Durand, Stefan G. Hofmann

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Drugs have opposite effect ‘bottom-up’ – reaches upper regions of the brain last

LO7: Describe how the theories of conditioning, learned helplessness, social learning, and prepared learning are used to explain the origins of abnormal behaviour Conditioning (classical and operant) and cognitive processes are involved with learning. Learned helplessness – phenomenon which occurs when an organism encounters conditions in which they have no control.

CONCEPT CHECK 2.3 Brain structures and neurotransmitters 1.Movement, breathing, and sleeping depend on the ancient part of the brain which is present in most animals. Brain stem 2. Which neurotransmitter binds to neuron receptor sites, inhibiting postsynaptic activity and reducing overall arousal? GABA 3. Which neurotransmitter is a switch that turns on various brain circuits? Dopamine 4. Which neurotransmitter seems to be involved on our emergency reactions or alarm responses? Norepinephrine 5. This area contains part of the reticular activating system and coordinates movement with sensory output. Midbrain 6. Which neurotransmitter is believed to influence the way we process information, as well as to moderate or inhibit our behaviour. Serotonin 7. More than 80% of the neurons in the human CNS are contained in this part of the brain, which gives us distinct qualities. Cerebral cortex 8. This area is responsible for most of our memory, thinking, and reasoning capabilities and makes us social animals. Frontal lobe

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People faced with uncontrollable stress in their lives can become depressed. People became depressed if they ‘decided’ or ‘thought’ they could do little about the stress in their lives, even when it seemed to others that they could do. People make an attribution that they have no control and become depressed.

Learned optimism – (Seligman, ’98-’02) – if people faced with considerable stress in their lives nevertheless display an optimistic, upbeat attitude, they are likely to function better psychologically and physically. Social Learning - Albert Bandura – organisms do not have to experience an event to learn effectively. They can learn by observing. 

Modelling

TEXT: Abnormal Psychology: An Integrative Approach 8th Edition, Davi...