ALL psych 105

How does mental health effect Canadians?

1 in 5 Canadians suffer from a mental disorder at some point in their lifetime.In any given week, at least half a million employed people in Canada are unable to work due to mental health problems.

Who Receives Treatment? 

•  About half of those requiring treatment for major depression received potentially adequate care.  

• Mental health needs were not fully met for 1 in 3 who received treatment.  

• Three-quarters of children in Canada with mental disorders do not access specialized care. 

•  Need has grown dramatically during the COVID-19 pandemic, but supports have not. 

Why so Many People Fail to Seek Treatment?

•  People may not realize they have a mental disorder that can be effectively treated.  

• Barriers to treatment such as beliefs and circumstances may keep people from getting help.  

• Structural barriers prevent people from physically getting to treatment. 

•  In Canada, evidence-based psychological services, delivered by psychologists and other professionals, are not typically publicly funded, and private coverage is generally only available to those with good employment. 

Psychotherapy:

Interaction between a socially sanctioned clinician and someone suffering from a psychological problem  Goal: Provide support or relief from problem

Eclectic psychotherapy:

Involves drawing on techniques from different forms of therapy. Therapy form depends on client and problem

Psychodynamic psychotherapies:

Explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems  

Psychoanalysis:

Assumes that humans are born with aggressive and sexual urges that are repressed during childhood by use of defense mechanisms  Goal is for clients to understand the unconscious in a process called developing insight.  Limited evidence for effectiveness

Interpersonal psychotherapy (IPT0:

Form of psychotherapy that focuses on helping clients improve current relationships  Grief, role disputes, role transitions, interpersonal deficits  

• Treatment focuses on Interpersonal functioning, believing symptoms will subside as interpersonal relations improve.  

• More effective, especially in depressive and anxiety disorder treatment

Humanistic and Existential Therapies:

Share the assumption that psychological problems stem from feelings of alienation and loneliness 

Humanistic approach:

Feelings can be traced to failure to reach one’s potential.  Person-centred therapy (client-centred)  

Existential approach:

Feelings stem from failure to find meaning in life

Gestalt therapy

• Goal is to help the client become aware of thoughts, behaviours, experiences, and feelings and owning or take responsibility for them  Real-time experiences and behaviour are focused on during therapy sessions.

• Techniques: Focusing; empty chair technique; putting feelings into actions

Behaviour therapy:

Involves changing maladaptive behaviour patterns  

• Assumes that disordered behaviour is learned and that symptom relief is achieved through changing overt, maladaptive behaviours into more constructive behaviours

Behaviour Therapy Techniques in Action  

• Eliminating unwanted behaviour: Operant conditioning  

• Promoting desired behaviour: Token economy  

• Reducing unwanted emotional responses:Exposure therapy

Cognitive therapy

Helps a client identify and correct any distorted thinking about self, others, or the world

Cognitive restructuring:

Teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative thinking with more realistic and positive beliefs  

Cognitive-behavioural therapy (CBT)

• Blend of cognitive and behavioural therapeutic strategies  Problem-focused  

• Action-oriented 

•  Encourages transparency between therapist and client  

• Substantial positive effects of CBT were found for clients presenting with various disorders.

Self-help and support groups:

Involve discussion or Internet chat groups that focus on a particular disorder or difficult life experience  

• Groups are often run by peers who have struggled with the same issues.  

• Examples of self-help and support groups:  Alcoholics Anonymous (AA)  Gamblers Anonymous  Cost-effective but can also encourage counter therapeutic behaviours

Kazdin and Blase think it time for a rebooting of psychotherapy research and practice.

What are their suggestions? 

• Development of portfolio of treatment delivery approaches that utilize recent advances in technology (i.e., computer and smartphone-based apps) 

•  On-line conferencing apps; remote treatment  Facebook; group-based CBT  YouTube; DBT  Program effectiveness not evaluated 

Antipsychotic medications:

Medications used to treat schizophrenia and related psychotic disorders  

• Chlorpromazine: One of the first antipsychotic drugs  

• Thioridazine (Mellaril) and haloperidol (Haldol) followed  

• Led to the deinstitutionalization of hundreds of thousands of people; major boost to the field of psychopharmacology

How do antipsychotic medications exert their effect?  

• Block dopamine receptors in certain parts of the brain, such as the mesolimbic pathway  

• Work well for positive symptoms, but not negative ones that require increase in dopamine at synapse  

• Conventional or typical antipsychotics  

• Newer drugs appear to affect both the dopamine and serotonin systems, blocking both types of receptors.  

• Atypical antipsychotics  

• Side effects are a concern for some.

Antianxiety medications:

Drugs that help reduce a person’s experience of fear or anxiety 

• Work by facilitating GABA action  

• Most common antianxiety medications are benzodiazepines.  

• Diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) 

•  Person can develop drug tolerance.  

• Tolerance, side effects, and withdrawal are issues.

Antidepressants

Help lift people’s mood  

• Two classes of antidepressants are used sparingly due to their side effects. 

•  Monoamine oxidase inhibitor (MAOI)  

• Tricyclic antidepressants  

Most commonly used antidepressants today:  

• Selective serotonin reuptake inhibitors (SSRI) 

• Serotonin and norepinephrine reuptake inhibitor (SNRI)

Mood Stabilizers Are Used for Bipolar Disorder 

•  Lithium and valproate are commonly used. 

•  In unipolar depression, lithium is sometimes effective when combined with traditional antidepressants in people who do not respond to antidepressants alone.  

• Antidepressants are not recommended for treating bipolar disorder.

Herbal and Natural Products

• Alternative medications are easily available over the counter, less expensive, and perceived as more “natural.” 

•  Include herbal medicines, megavitamins, homeopathic remedies, and naturopathic remedies 

•  Exempt from rigorous research to establish safety and effectiveness  

• Some studies show effectiveness, but evidence mixed  Omega-3 and lower depression and suicide rates  Usage should be monitored. 

•  Phototherapy: Involves repeated exposure to bright light  Used for people with SAD, depression

Combining Medication and Psychotherapy 

•  Effective combination of treatments depends on the individual and their disorder symptoms. 

•  Research demonstrates both therapy and medication affect brain regions associated with reaction to threat.  

• Coordination of both forms of treatment may require cooperation between psychologists and psychiatrists.

 Electroconvulsive therapy (ECT)  

• Sometimes used to treat severe mental disorders that do not respond to psychological treatment or medication  

• Treatment involves inducing a mild seizure by delivering an electrical shock to the brain.  

• May be used to treat severe depression and/or mania

Transcranial magnetic stimulation (TMS)

• Involves placing a powerful pulsed magnet over a person’s scalp, which alters neuronal activity in the brain  

• May be used to treat depression

Psychosurgery:

 Involves surgical destruction of specific brain areas to treat severe and unresponsive psychological disorders; rarely used today 

 Example: Severe cases of OCD; involves very precise destruction of brain tissue to disrupt the brain circuits known to be involved in generating obsession

•  Limited studies have shown that psychosurgery typically leads to substantial improvements in the short and long term for people with severe OCD. 

Deep Brain Stimulation (DBS):

Deep brain stimulation involves the insertion of battery-powered electrodes that deliver electrical pulses to specific brain areas believed to be causing a person’s mental disorder.

Natural improvement:

Tendency of symptoms to return to their mean or average level  

Placebo effects

Inert substance or procedure that has been applied with the expectation that a healing response will be produced

Reconstructive memory:

When the client’s motivation to get well causes errors in memory for the original symptoms

Treatment outcome studies:

 Designed to evaluate whether treatment works (often in comparison to another treatment or control condition). 

Which Treatments Work According to the Evidence?

• Hans Eysenck (1916–1997) reviewed the effectiveness of psychotherapy across studies and found that psychotherapy (particularly psychoanalysis) was not effective.  

• Today’s studies show the typical psychotherapy client is better off than three-quarters of untreated individuals.  

• Criteria for empirically validated treatments define two levels of support (APA, CPA)  Well-established treatments (high level of support  Probably efficacious treatments (preliminary support)

Iatrogenic illness:

 Disorder or symptom that occurs as a result of a medical or psychotherapeutic treatment itself  

• Therapy that leads clients to develop beliefs that do more harm than good  

• Example: Hypnosis and/or repeated suggestions and dissociative identity disorder

The ethical standards in Canada are based on four principles: 

• Respect for the dignity of persons, which includes protecting the welfare of vulnerable people and seeking fairness in treatment and avoiding biases;  

• Responsible caring, which includes striving to benefit clients and taking care to do no harm;  

• Integrity in relationships (promoting accuracy, honesty, and truthfulness);  

• Responsibility to society, which means that when psychological knowledge is used in the development of social policies, it will only be used for beneficial purposes (i.e., those that reflect the first three principles).

Mental disorder:

 Persistent disturbance or dysfunction in behaviour, thoughts, or emotions that cause significant distress or impairment; no universal agreement on precise definition

Medical model:

Abnormal psychological experiences are conceptualized as illnesses that, like physical illnesses 

Whats the difference between a disorder and a disease?

• Disorder: common set of signs and symptoms

• Disease: Pathological process affecting the body 

DSM (1952): Classification system 

• Describes the features used to diagnose each recognized mental disorder  

• Indicates how the disorder can be distinguished from other similar problems 

DSM-II (1968): First revision  

Provides common language for talking about disorders

DSM-III (1980) and DSM-IV (1994) 

• Moved from vague disorder descriptions  

• Provided detailed list of symptoms/diagnostic criteria for more than 200 disorders  

• Improved reliability in diagnosis of mental disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013; DSM-5-TR, 2022)  

• Includes the fully revised text and references of the DSM-5 and updated diagnostic criteria and ICD-10-CM insurance codes.  

• It also features a new disorder, Prolonged Grief Disorder, and codes for suicidal behaviour and nonsuicidal self- injury.  

Biopsychosocial perspective:

Mental disorders are the result of interactions among biological, psychological, and social factors.  

Diathesis–stress model:

Person may be predisposed to a mental disorder that remains unexpressed until triggered by stress.

Tendency to oversimplify mental disorders

Attributing them to single, internal causes 

Research Domain Criteria Project (RDoC)

New initiative to guide classification and understanding of mental disorders by revealing the basic processes that give rise to them  

• Long-term goal:

  • To better understand what abnormalities cause different disorders  

  • To classify disorders based on those underlying causes rather than on observed symptoms  

• Researchers study causes of abnormal functioning.  

  • Biological factors  

  • Psychological domains  

  • Social processes and behaviour

What are the dangers of Labelling?

• Psychiatric labels can have negative consequences because of their association with negative stereotypes and stigma.  

• May prevent seeking help  

• May create a negative self-view (hopeless; worthless)  

• May contribute to lower self-esteem and self- efficacy; higher levels of depressive symptoms  

• Applying labels to disorder and not the person with the disorder is important.

Anxiety disorder:

Class of mental disorders in which anxiety is the predominant feature  People usually experience more than one type of anxiety at a time, comorbid with depression. DSM-5-TR recognizes the following anxiety disorders: Phobic disorders, Panic disorder, Generalized anxiety disorder (GAD)

Phobic disorders

Characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations

Preparedness theory:

People are instinctively predisposed to certain fears, like snakes and spiders.

Generalized anxiety disorder (GAD)

• Chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance  

• 6% of North Americans have GAD – more common in women than men  

• Biological (heritability) and psychological factors contribute to GAD.  

• Neurotransmitter imbalance  

• Occurs more often in people who are in lower SES groups, live in large cities, and have unpredictable environments

Panic disorder

• Characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror; panic attacks  

• Shortness of breath, heart palpitations, sweating, dizziness, depersonalization, derealization, fear one is going crazy  

• 13% of adults have reported having a panic attack, but 2% have been diagnosed with panic disorder 

•  Hereditary component; twice as prevalent among women

• Experiments with sodium lactate 

•  May include hypersensitive to physiological signs of anxiety

Agoraphobia:

Specific phobia involving fear of public places: Fear something terrible will happen (e.g., panic symptoms) while they are I public and they will not be able to escape  

Obsessive-compulsive disorder (OCD):

Repetitive, intrusive thoughts (obsessions) Ritualistic behaviours (compulsions) designed to fend off thoughts interfere significantly with an individual’s functioning  

• Classified separately from anxiety disorders; has distinct causes and is maintained via different brain neural circuitry  

• Moderate to strong heritability; higher rate among women

• Cortical-striatal-thalamocortical loop

Posttraumatic stress disorder (PTSD)

characterized by chronic physiological arousal  

• Recurrent, unwanted thoughts or images of the trauma  

• Avoidance of things that call the traumatic event to mind

• Approximately 1 in 6 Canadian Armed Forces members serving in Afghanistan between 2001 and 2014 received support for PTSD.  

• Brain imaging techniques identified important neural correlates

  • Heightened amygdala activity  

  • Decreased medial prefrontal cortex activity  

  • Smaller hippocampus 

Mood disorders:

Mental disorders that have mood disturbances as their predominant feature. Two main forms  

• Depression (unipolar depression)  

• Bipolar depression

Major depressive disorder (or unipolar depression):

Characterized by a severely depressed mood that lasts 2 weeks or more; accompanied by: 

• Feelings of worthlessness and lack of pleasure  

• Lethargy  

• Sleep and appetite disturbances  

Persistent depressive disorder:

Same cognitive and bodily problems as in depression are present, but they are less severe and last longer, persisting for at least 2 years

Double depression 

• Occurs when major depressive disorder and persistent depressive disorder co-occur  

• Moderately depressed mood that persists for at least 2 years  Punctuated by periods of major depression 

Seasonal affective disorder (SAD)

Involves recurrent depressive episodes in a seasonal pattern  Pattern due to reduced levels of light in colder seasons; higher latitudes

Who is at risk for depression?

• Approximately 1 in 9 people in Canada and the United States meet the criteria for depression at some point. 

• Depression linked to gender, SES, hormones, and willingness to seek treatment.  

• Individuals with recurrent depression: More severe symptoms, higher rates of depression in their families, more suicide attempts, and higher rates of divorce

Aaron Beck (1967)  

• Dysfunctional attitudes and negative mood states in individuals who were depressed.  

• Updated cognitive model of depression  

• Negative schema characterized by biases  

• Interpretation of information, attention, memor

Helplessness theory:

occurs when someone repeatedly faces uncontrollable, stressful situations and does not exercise control when it becomes available.

Bipolar Disorder

Unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression)  

• Lifetime risk, 1/40, no gender difference  

• Common genetic risk factors  

• Biological causes  

• Stressful life experiences  

• Expressed emotions

• Bipolar disorder has one of the highest rates of heritability; concordance from 40% to 70% for identical twins and 10% for fraternal twins

Bipolar I Disorder:

At least one depressive and manic episode 

Bipolar II Disorder:

Depressive episode accompanied by a hypomanic episode  

Rapid cycling bipolar disorder

At least 4 mood episodes (manic or depressive) each year.

Schizophrenia:

Disorder characterized by profound disruption of basic psychological processes  

• Distorted perception of reality; altered or blunted emotion; and disturbances in thought, motivation, and behaviour 

Positive symptoms of schizophrenia: (things gained)

• Hallucinations  

• Delusions

Negative symptoms of schizophrenia: (things lost)

• Emotional and social withdrawal  

• Apathy  

• Poverty of speech  

• Other indications of the absence or insufficiency of normal behaviour, motivation, and emotion

Disorganized symptoms:

• disruptions or deficits of cognitive ability 

  • Disorganized speech 

  • Grossly disorganized behaviour: inappropriate 

  • Catatonic behaviour: decrease in all movements or increase in muscular rigidity or overreactivity

Dopamine hypothesis:

Schizophrenia involves an excess of dopamine activity.  

• Some believe the hypothesis is incomplete.  

• Many individuals with schizophrenia do not respond favorably to dopamine-blocking drugs.  

• Difference between rapid drug blocking action and patient beneficial response.  

• Other neurotransmitters implicated in schizophrenia.

Disorders of Childhood and Adolescence

• Autism spectrum disorder (ASD)  

• Attention-deficit/hyperactivity disorder  

• Conduct disorder  

• Intellectual disability  

• Learning disorders  

• Motor skill disorders  

• Communication disorders  

• Many others

Autism spectrum disorder (ASD):

Condition beginning in early childhood in which a person shows persistent communication deficits as well as restricted and repetitive patterns of behaviours, interests, or activities

• Current estimates: Approximately 1 in 44 children in the full range of disorders that now fall under the ASD umbrella in the DSM–5–TR 

• Boys have higher rates of ASD than girls (4:1)  

• Heterogeneous set of traits that cluster together in some families. High heritability  

• One current model 

  • Impaired capacity for empathizing  

  • Superior capacity for systematizing  

• Highly variable trajectories

Researchers have documented many instances in which some portion of children are diagnosed with autism in childhood but who no longer meet the criteria for ASD later in life. why?

Misdiagnosed; milder form of the disorder and/or were identified and treated earlier.  and Early detection and treatment can lead to positive outcomes for those with ASD.

Attention-Deficit/Hyperactivity Disorder:

 Attention-deficit/hyperactivity disorder (ADHD)  Persistent pattern of severe problems with inattention and/or hyperactivity or impulsiveness that cause significant impairments in functioning  

• Criteria for a diagnosis of ADHD three ways  

• Predominantly inattentive symptoms  

• Predominantly hyperactive/impulsive symptoms  

• Combined presentation (DSM–5–R)  

• Behaviours for at least 6 months in two settings  

• More common in boys (1/10) than girls (1/23)

• Children with ADHD often struggle in the classroom  

• Persists into adulthood for many  

• Genetics: high heritability (76%)  

• Structural and functional brain differences in brain imaging studies (areas associated with attention and inhibition)  

• Some effective drug treatments

Conduct disorder:

Persistent pattern of deviant behaviour involving aggression towards people or animals, destruction of property, deceitfulness or theft, or serious rule violations.  

• Range of genetic, biological, and environmental factors  

• Comorbidity with other disorders characterized by problems with decision making

Personality disorder:

Characterized by deeply ingrained, inflexible patterns of thinking, feeling, or relating to others or controlling impulses that cause distress or impaired functioning  

• DSM–5–TR lists 10 specific personality disorders that fall into three clusters  

• Odd/eccentric  

• Dramatic/erratic  

• Anxious/inhibited  

• Diagnosis controversial and complicated  

• Type or trait dimensions

Antisocial personality disorder (APD):

Pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood  

• History of conduct disorder before age 15  

• Occurrence is 3.6% of general population (occurs in men three times more than in women)  

• Sociopaths, psychopaths  

• Brain abnormalities may be present

Self-Harm Behaviours: Intentionally Injuring Oneself 

DSM–5–TR includes two self-destructive behaviours in Section III (disorders in need of further study)  

• Suicidal behaviour disorder  

• Nonsuicidal self-injury disorder

• Suicide is the second most common cause of death for people aged 15 to 34 in Canada  

• Large demographic differences in rate  

• Nonfatal suicide attempt  

• Potential harmful behaviour with some intention of dying; higher incidence than suicide deaths

• Nonsuicidal self-injury (NSSI)  

• Direct, deliberate destruction of body tissue in the absence of any intent to die  

• Absent in childhood; increases in adolescence; decreases across adulthood  

• Characterized by strong emotional and physiological responses to negative events  

• Understanding of genetic and neurobiological influences and effective medication is limited

Stressors

Sources of stress that can be either acute (highly stressful events) or chronic (ongoing issues and pressures).

Holmes and Rahe (1967)

Researchers who found a correlation between stressful life events and illness.

CUSS (College Undergraduate Stress Scale)

A scale adapted to assess stress events specific to college students.

Chronic Stressors

Sources of stress that occur continuously or repeatedly, often linked to social relationships.

Perceived Control

The belief in one’s ability to influence or manage the stressors they face.

General Adaptation Syndrome (GAS)

A three-stage physiological stress response: alarm, resistance, and exhaustion.

Telomeres

Protective regions at the ends of chromosomes that shorten with each cell division.

Psychoneuroimmunology

The study of the connection between psychological processes and the immune response.

Burnout

A state of physical, emotional, and mental exhaustion due to prolonged exposure to stress in demanding situations.

Rational Coping

A method of dealing with stress through acceptance, exposure, and understanding.

Social Support

Aid received from others in times of stress, often linked to better coping strategies.

Self-Regulation

The ability to control one's behavior, emotions, and thoughts in pursuit of long-term goals.

Sickness Response

A collection of physical and psychological responses to illness that can be triggered by stress.

Optimism

A personality trait associated with positive health outcomes and resilience in the face of stress.

Health Behavior

Actions taken for the purpose of improving or maintaining health, such as proper diet and exercise.

Procrastination

The act of delaying or postponing tasks, which can lead to increased stress.

Chronic Stressors can often be linked to:

Can be linked to environments (environmental psychology) - amygdala activity in response to stressors greater in cities vs towns

How does Perceived control relate to stress?

Lack of control over the situation can add to the stress.

Can Discrimination Cause Illness?

Discrimination can lead to elevated stress and negative health outcomes. Life expectancy is 5–10 years shorter for Indigenous people compared to other Canadians.