week 21 - Psychopathology and Therapeutic Orientations

antisocial PD

A pervasive pattern of disregard and violation of the rights of others. These behaviors may be aggressive or destructive and may involve breaking laws or rules, deceit or theft.

avoidant PD

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

borderline PD

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.

dependent PD

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

five-factor model

Five broad domains or dimensions that are used to describe human personality.

histrionic PD

A pervasive pattern of excessive emotionality and attention seeking.

narcisstic PD

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.

obsessive-compulsive PD

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

paranoid

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

personality

Characteristic, routine ways of thinking, feeling, and relating to others.

personality disorders

When personality traits result in significant distress, social impairment, and/or occupational impairment.

schizoid vs. schizotypal PD

Schizoid

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

Schizotypal

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as perceptual distortions and eccentricities of behavior.

______personality disorder combines the Five Factor traits of neuroticism and maladaptive agreeableness.

• Histrionic

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• Dependent

• State-trait

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• Obsessive-compulsive

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• Passive-aggressive

dependent

A structure in the brain associated with liking is the:

• hypothalamus

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• thalamus

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• nucleus accumbens

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• amygdala

nucleus accumbens

Why are personality disorders traditionally so difficult to treat?

• Personality disorders reflect a “different” kind of personality rather than one that is pathological, and thus treatment is not needed.

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• Insurance companies do not consider these conditions serious, and thus refuse to pay for the needed therapy.

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• Many people with such conditions end up in prison, where treatment is not offered.

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• The disorders involve well-established behaviors that are integral to a person’s self-image

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• There is no research into what treatments may be effective to help such clients.

• The disorders involve well-established behaviors that are integral to a person’s self-image

antisocial personality disorder

Counterpart diagnosis to psychopathy included in the third through fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2000). Defined by specific symptoms of behavioral deviancy in childhood (e.g., fighting, lying, stealing, truancy) continuing into adulthood (manifested as repeated rule-breaking, impulsiveness, irresponsibility, aggressiveness, etc.).

psychopathy

psychopathic personality adapted from the term “psychopathic”, used to designate mental disorders presumed to be heritable

triarchic model

Model formulated to reconcile alternative historic conceptions of psychopathy and differing methods for assessing it. Conceives of psychopathy as encompassing three symptomatic components: boldness, involving social efficacy, emotional resiliency, and venturesomeness; meanness, entailing lack of empathy/emotional-sensitivity and exploitative behavior toward others; and disinhibition, entailing deficient behavioral restraint and lack of control over urges/emotional reactions.

How does the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classify childhood psychopathology?

• as emotional retardation

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• as an emotional developmental delay disorder

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• as an explosiveness disorder

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• as a depersonalization disorder

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• as a conduct disorder

a conduct disorder

Criminal psychopathology has recently been characterized into two variants: primary (bold-disinhibited) and secondary (disinhibited-mean), based on ______.

• personality testing

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• IQ testing

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• physiological responses to questions

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• anxiety levels

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• past behaviors

anxiety levels

acceptance and commitment therapy

A therapeutic approach designed to foster nonjudgmental observation of one’s own mental processes.

automatic thoughts

Thoughts that occur spontaneously; often used to describe problematic thoughts that maintain mental disorders.

cognitive bias modification

Using exercises (e.g., computer games) to change problematic thinking habits.

CBT

A family of approaches with the goal of changing the thoughts and behaviors that influence psychopathology.

comorbidity

Describes a state of having more than one psychological or physical disorder at a given time.

Dialectical behaviour therapy (DBT)

A treatment often used for borderline personality disorder that incorporates both cognitive-behavioral and mindfulness elements.

dialectical worldview

A perspective in DBT that emphasizes the joint importance of change and acceptance.

free association

In psychodynamic therapy, a process in which the patient reports all thoughts that come to mind without censorship, and these thoughts are interpreted by the therapist.

integrative or eclectic psychotherapy

Also called integrative psychotherapy, this term refers to approaches combining multiple orientations (e.g., CBT with psychoanalytic elements).

mindfulness-based therapy

A form of psychotherapy grounded in mindfulness theory and practice, often involving meditation, yoga, body scan, and other features of mindfulness exercises.

person-centered therapy

A therapeutic approach focused on creating a supportive environment for self-discovery.

psychoanalytic therapy

Sigmund Freud’s therapeutic approach focusing on resolving unconscious conflicts.

psychodynamic therapy

Treatment applying psychoanalytic principles in a briefer, more individualized format.

reappraisal, or cognitive restructruing

The process of identifying, evaluating, and changing maladaptive thoughts in psychotherapy.

schema

A mental representation or set of beliefs about something.

unconditional positive regard

In person-centered therapy, an attitude of warmth, empathy and acceptance adopted by the therapist in order to foster feelings of inherent worth in the patient.

Why has it been difficult for research to establish a solid answer to the question of whether person-centered therapy (PCT) is, overall, an effective approach to treating clients?

• PCT is based on nonspecific treatment factors, without considering specific treatment factors to directly target a given mental problem.

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• The research that has examined PCT has only looked at conditions where therapy clients had very low (or less severe) forms of psychopathology.

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• PCT’s techniques can be applied by anyone, trained or untrained, and thus do not rise to the level of professional therapy.

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• PCT is based almost exclusively on a White, Western European, male-centric model of how therapy should be conducted.

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• Because the foundation of PCT is the use of 12-step anonymous programs, it is all but impossible to gather true data about the impact it has on its clients.

• PCT is based on nonspecific treatment factors, without considering specific treatment factors to directly target a given mental problem.

The foundational premise of cognitive behavioral therapy (CBT) is that:

• There is a fundamental mismatch between a person’s real self and ideal self, which leads to inappropriate actions.

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• Childhood conflicts and unconscious impulses exceed the capacity of defense mechanisms to keep them outside of consciousness.

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• People experience distress and unhappiness when they refuse to face painful or difficult experiences or memories from their lives.

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• Maladaptive actions are learned and can be unlearned and replaced with adaptive actions.

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• Thoughts, actions, and emotions interact and contribute to psychopathology.

• Thoughts, actions, and emotions interact and contribute to psychopathology.

Cognitive ______refers to the process of identifying, evaluating, and changing maladaptive thoughts in psychotherapy.

• restructuring

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• de-escalation

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• alteration

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• adaptation

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• development

restructuring

Which therapeutic strategy, that emphasizes simultaneous acceptance and change, is often used for the treatment of borderline personality disorder?

• Cognitive behavior therapy

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• Person-centered restructuring

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• Psychodynamic reappraisal therapy

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• Directive Gestalt therapy

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• Dialectical behavior therapy

dialectical behaviour therapy

describe the five-factor model that are used to describe human personality

• neuroticism - emotional stability

• extraversion - introversion

• openness - closedness

• agreeableness - antagonism

• conscientiousness - disinhibition

personality disorder not otherwise specified (PDNOS)

“wastebasket” category assigned when a clinician believes a patient has a personality disorder but the traits that constitute it are not well covered by one of the existing categories

Personality disorders are a constellation of ________ rather than just ___________ ▪ Because of this, they are considered “syndromes” ▪ There is something qualitatively unique about persons suffering from a personality disorder understood as a form of pathology in the sense of self and interpersonal relatedness considered distinct from personality

malaadaptive personality traits, one particualr personality trait

what are the three categroeis/clusters of personality disorders?

cluster A: eccentric/odd - schizoid, schizotypal, PDNOS

cluster B: extreme/harmful - borderline, histrionic, narcisstic, antisocial

cluster C: anxious/fearful - avoidant, depdendent, obessiev-compulsive

which three PDs are considered to have low validity due to their lack of empirical support than others?

Histrionic, schizoid, and paranoid PD

which three PDs are thought to be valid because of their empriical evidence?

borderline, antisocial, and schizotypal PD

why are PDs difficutl to treat?

they are Ego-Syntonic – most people are largely comfortable with their selves. They lack insight into the maladaptively of their personality as long as it is not negatively influencing their life. they involve well-established behaviours that can be integral to a client’s self-image.

how did early writers calssify psychopathy?

as an atypical form of mental illness in which rational faculties appeared normal but everyday behaviour and social relationships are markedly disrupted

who 16 diagnostic criteria from clinical case summaries, encompassing indicators of apparent psychological stability, symptoms of behavioural deviancy, and impaired affect and social connectedness?

cleckley

what did cleckley focus on is his definition of psychopathy?

Not characterized as inherently cruel, violent, or dangerous ▪ Greater emphasis is placed on symptoms of emotional coldness, aggression, and predatory victimization

how did mccord and mccord describe the condition?

as a lack of remorse and lack of attachment capacity

what is the main contemporary method for assessing psychopathy?

self-report scales and other rating instruments

psychopathic personlaity inventory (PPI)

developed to index personality dispositions embodied with historic conceptions of psychopathology

what are the two domains of the PPI?

• Subscales focus on two domains: • Fearless dominance (FD) factor reflecting social potency, stress immunity, and fearlessness

• Self-centered impulsivity (SCI) factor reflecting egocentricity, exploitativeness, hostile rebelliousness, and a lack of planning

how is psychopathy screened in child and adolescent cases?

• use of the PCL-R (Used for predicting greater severity and persistence of conduct problems termed “callous-unemotional” traits)

• use of the antisocial process screening device (APSD)(used with clinic-referred children ages 6-13 looking to measure Callous-Unemotional (CU) traits and Impulsive/Conduct Problems (I/CP)

what are the three core ingredients pf psychopathy?

disinhibition, boldness and meanness - the triarchic model

triarchic psychopathy meausre (TriPM)

measures problems and traits associated with externalizing psychopathy and index fearless tendencies

what are some theories on the causal facotrs of psychopathy?

• Theories emphasizing core deficits in emotional sensitivity or responsiveness o E.g. lack of normal enhancement of the startle blink reflex to abrupt noises occurring during viewing of aversive stimuli

• Theories posting basic impairments in cognitive-attentional processing 97 o E.g. reduced amplitude of brain potential response to intermittent target stimuli with cognitive performance tasks or deficits in basic subcortical reactivity to interpersonal distress cues

what are some triarchic model perspectives on long-debated issues regarding psychopathy?

• Whether psychological/emotional stability is characteristic of psychopathy

• Whether lack of anxiety is central to psychopathy

• Whether violent/aggressive tendencies are typical of psychopathic individuals and should be included in the definition of the disorder

• Whether criminal or antisocial behaviour more broadly represents a defining feature of psychopathy, or a secondary manifestation

• Whether differing subtypes of psychopaths exist

• Whether psychopathy differs in women as compared to men

• Whether “successful” psychopaths exist

what are the therpeutic orientations for psychopathy?

• psychoanalysis, which goes into psychoanalytic therapy

  • made famous by Sigmund Freud which stresses that mental health problems are rooted in unconscious conflicts and desires which can be resolved by identifying and addressing the unconscious struggles - done through exploration of childhood experiences that may have continuing repercussions on one’s mental health over course of years

describe a brief history of psychoanalytic therapy

• Initially, mental health problems were thought to arise from efforts to push inappropriate sexual urges out of conscious awareness

• Later, it was thought psychiatric problems are the result of tension between the id, ego, and superego - resolved through Psychoanalytic Therapy

what is the technique in psychoanalysis?

free asscoiation - process in which the patient reports all thoughts that come to mind, without censorship, and these thoughts are interpreted by therapist.

Interpretation of patient’s thought and behaviour based on clinical experience and psychoanalytic theory

• Transference – patient displacing feeling for people in their life onto therapist

• Countertransference – therapist displacing their own emotions onto the patient

what are some disadvantages of psychoanalytic therapy?

• Not appropriate for some types of patients

• Often expensive because treatment can last many years

• Lack of empirical support for effectiveness

what is person-centered therapy?

– focused on creating a supportive environment for self-discovery based on the belief that mental health problems result from an inconsistency between patients’ behaviour and their true personal identity

• Goal here is to create conditions where a patient can discover their self-worth, feel comfortable exploring their own identity, and alter their behaviour to better reflect this identity

who developed person centered therapy?

charles rogers

what is the main technique in person-centered therapy?

unstructured conversation between therapist and patient where the therapist takes a passive role, guiding the patient toward their own self-discovery

• unconditional positive regard: an attitude of warmth, empathy and acceptance adopted by therapist in order to foster feelings of inherent worth in the patient

what are some advnatges and disadvnatges of person-centered therapy?

• People tend to find the supportive, flexible environment very rewarding

• Some of its themes translate well to other therapeutic approaches

• Findings about its effectiveness are mixed

  • Unspecific Treatment Factors – rather than using therapeutic techniques specific to the patient and the mental problem, the therapy focuses on techniques that can be applied to anyone which may not fit well

what is CBT?

a family of approaches with the goal of changing the underlying thoughts and behaviours that influence psychopathology

what is the premise of CBT?

thoughts, behaviours, and emotions interact and contribute to various mental disorders

what is the focus of CBT?

• Therapist identifies how maladaptive thoughts lead to maladaptive emotions which lead to maladaptive behaviours reinforcing thoughts

• Present-focused, as opposed to focus on childhood experiences

• Uses goals to improve one’s mental illness which involve between-session “homework assignments” relevant to maladaptive cognitions and behaviours

• Relatively brief (12-16 weekly sessions) that is closely tailored to the nature of the psychopathology and treatment of the specific mental disorder

what’s the history behind CBT?

Beck and Ellis (mid-20th century) proposed some automatic thoughts seen in mental disorders arise from belief systems linked to maladaptive emotions and behaviour

what’s the main technique in CBT?

• Reappraisal/Cognitive Restructuring – the process of identifying, evaluating, and changing maladaptive thoughts

• It is the therapist’s job to point out when an inaccurate/maladaptive thought occurs so the patient can eliminate it or modify it to be adaptive

• Therapist and patient work together to develop healthy behavioural habits (often through “homework”), so the patient can break cycle of maladaptive thoughts and behaviours

what are some advnategs and disadvantages of CBT?

• Interventions tend to be fairly cheap due to the relatively brief treatment period

• Can be adapted to suit the needs of many different populations 102

• Involves significant effort of the patients’ part because they are active participant in treatment

• Abundance of empirical support for effectiveness and is often considered a first-line treatment for many mental disorders

what is the main premise of accepance and mindfulness-based approaches?

Mindfulness – process that reflects a nonjudgmental, yet attentive, mental state as a therapy that focuses on one’s awareness of bodily sensations, thoughts, and the outside environment

what are the 2 important components of mindfulness?

Self-regulation of attention ▪ Orientation toward the present moment

what are the main tehcniques used in mindfulness-based therapy?

• Acceptance and Commitment Therapy (ACT) – approaches designed to foster nonjudgmental observations of one’s own mental processes

• Mindfulness-Based Therapy (MBT) – form of psychotherapy grounded in mindfulness theory and practice, often involving meditation, yoga, body scan, and other features of mindfulness exercises as a way to encourage patients to more objectively evaluate their thoughts or as a way to focus on one’s thoughts and their associated emotions

• Dialectical Behaviour Therapy (DBT) – treatment often used for borderline personality disorder that incorporates techniques rom CBT and MBT

  • Distress Tolerance – ways to cope with maladaptive thoughts and emotions in the moment

  • Dialectical Worldview – perspective that emphasizes the joint importance of change and acceptance

what is one advnatge and one disadvantage of mindfulness based therapy?

• Acceptability and accessibility to patients • No clear consensus of effectiveness

what are some newer treatments for psychopathology?

• Internet-and mobile-delivered therapies

• CBT-enhancing pharmaceutical agents

Integrative and Eclectic Psychotherapy

– approaches combining multiple orientations • E.g. distress tolerance skills from DBT, cognitive reappraisal from CBT, and mindfulness-based meditation from MBT