Clinical Psychology

Identical Twins

• Identical twins are more similar than non-identical twins in personality traits described the five-factor theory

• Novelty seeking linked to a gene associated with dopamine levels

• Genes interact w/ environment to produce general dispositions

• Cross cultural findings on age-related changes in personality independent of environmental influences

• Major life events can lead to changes in personality

Clinical Psychology

Investigating factors that cause psychological disorders and the methods to treat them

Psychopathology

• Disorder of the mind

• When life disrupted and distress caused over a long period

Psychopathology Characterization

1. Does it deviate from cultural norms for what is acceptable?

2. Is it maladaptive?

3. Is it self destructive?

4. Does it cause discomfort and concern to others?

Diathesis-Stress Model

• Disorder may develop as a result of an underlying vulnerability coupled with a precipitating event

Biopsychosocial Approach

• Biological aspect: Role of physiological factors (Brain, neurotransmitter, and genetics)

• Psychological aspect: Role of thoughts, emotions, personality, and learned experiences

• Sociocultural Factors: Family relationships, socioeconomic status, and the cultural context

Analyzing Disorders

1. Assess symptoms

2. Make a diagnosis by grouping symptoms (DSM)

3. Identify etiology

4. Identify possible treatments

DSM-5

• Systematic categorization of mental disorders since 1952

• Provides diagnostic criteria for mental disorders

• Describes 19 major categories of disorder

Dimensional Approach

• Mental disorders on a continuum (Degree vs. types)

Psychotherapy

• Treatment in which a therapist works with patients to help them understand their problems and work toward solutions

• Generally used to change patterns of thought and/or behavior

• Psychotropic medications

• Alternative treatments

Treatment Effectiveness

Assessed with empirical research using randomized trials

Psychodynamic Therapy

• Treatment in which a therapists works with patients to help them become aware of how their unconscious processes may be causing conflict and impairing daily functioning

• Only weak evidence for its effectiveness

• Sigmund Freud and Josef Breuer as pioneers of the psychoanalysis method

• Free association; Dream Analysis

Humanistic Therapy

Treatment in which a therapist works with patients to help them develop their full potential for personal growth through greater self-understanding

• Safe and comforting setting for patients

• Active listening

• Unconditional positive regard

Behavior Therapy

Treatment in which a therapist works with patients to help them unlearn behaviors that negatively affect their functioning

Cognitive Therapy

Treatment in which a therapist works with patients to help them change distorted thought patterns that produce maladaptive behaviors and emotions.

• Cognitive restructuring; Rational-emotive therapy

Cognitive-Behavioral Therapy

Treatment in which a therapist incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and maladaptive behaviors

• One of the most effective therapies for many types of psychological disorders

Group Therapy

• Significant variety in the types of patients enrolled in the group, the duration of treatment, the theoretical perspective of the therapist running the group, and the group size.

• Many groups are organized around a particular type of problem (Ex: Sexual abuse) or a particular type of client (Adolescents)

• Most obvious benefit: Cost

Family Therapy

• Systems approach according to which an individual is part of a larger context

• Any change in individual behavior will affect the whole system

• This effect is often easiest to see within families

Psychotropic Medications

• Drugs that affect mental processes (Alter neurochemistry)

• Most psychotropic medications fall into five categories

1. Anti-anxiety Drugs: Temporary sedative, calming effects (Valium, Ativan)

2. Antidepressants: Increase positive mood, decrease emotionality (Prozac, Zoloft)

3. Mood stabilizers: Evening out moods (Lithium)

4. Antipsychotics: Reduce positive/negative symptoms (Thorazine; Clozaril)

5. Stimulants: Decrease hyperactivity, increase attention (Ritalin; Adderall)

Electroconvulsive Therapy (ECT)

Treatment that involves administering a strong electrical current to the patient’s brain to produce a seizure

• Effective in some cases of severe depression

Transcranial Magnetic Stimulation (TMS)

Treatment that involves administering a magnetic field to interrupt function in specific regions of the brain

Deep Brain Stimulation (DBS)

Treatment that involves passing electricity through electrodes planted in the patient’s brain to stimulate the brain at a certain frequency and intensity

• Especially valuable for treating severe OCD and Depression

Anxiety Disorders

Excessive anxiety in the absence of true danger

• Continuous arousal of the autonomic nervous system which leads to bodily symptoms

Etiology

• Best explained using the biopsychosocial approach (Many fears are learned)

Types of anxiety disorders

• Phobias

• Generalized anxiety disorder

• Panic disorder

Phobia

Fear of a specific object or situation that is out of proportion with an actual threat

• Social anxiety disorder (Social phobia): Fear of being negatively evaluated by others

• Specific phobias: Concern particular objects/situations

• Agoraphobia: Fear of being in situations from which escape is difficult (Leaving the house)

Obsessive Compulsive Disorder

• Frequent intrusive thoughts that create anxiety and compulsive actions that temporarily reduce the anxiety

• Obsessions: Recurrent, intrusive, and unwanted thoughts, urgers, or mental images

• Compulsions: Specific acts that one feels driven to perform over and over again.

Etiology

• Biopsychosocial Approach: Evidence for biological factors (Genetic and from brain imaging)

Morbidity

• Begins in early adulthood

• Affecting 1% to 2% of the population; More common among women

Anxiety & OCD Treatment

Most adult anxiety disorders and OCD best treated with cognitive-behavioral therapy

• CBT effects persist long after treatment

• CBT more effective for OCD than antidepressants

• Anti-anxiety Drugs also beneficial in some cases of anxiety disorders due to their sedative effect

• Deep Brain Stimulation may also be an effective treatment for people with OCD

• Exposure: Therapy technique that involves repeatedly exposing patients to an anxiety-producing stimulus or situation, with the goal of reducing fear.

Recent alternative: Exposure without putting patients in danger by using computers to simulate the environments and the feared objects

• Systematic Desensitization: Therapy technique that involves exposing clients to increasingly anxiety-producing stimuli or situations while coaching them to relax

• Aversive Conditioning: Behavioral conditioning in which unpleasant stimuli are associated with undesirable behavior that is to be modified or abolished

Depressive Disorders

• Mood disorders with persistent and pervasive feelings of sadness

Etiology: Biopsychosocial

• Genetic component; Neural structures possibly involved

• Social relationships

• Self-perception, reverse self-serving bias

• Learned helplessness (Perception of self as unable to affect life events)

Morbidity

• Across multiple countries and contexts

• Twice as many women as men diagnosed

Internalization (women) vs. externalization (men) of feelings

Types of Depressive Disorders

1. Major depressive disorder

• Mood disorder with extremely depressed moods or lack of interest in normally pleasurable activities for 2 weeks or more

• 6% to 7% of Americans in any given year ‘

• 16% will experience major depression at some point in their lives

Persistent Depressive Disorder

• Mood disorder, with mildly or moderately depressed moods, that persists for at least 2 years

• Approximately 2% to 3% of population

Depressive Disorders

• No “best” ways to treat depression

Psychotropic drug treatment

• Since SSRIs have the fewest serious side effects, tend to be used as first-line medication

• Use of antidepressants based on belief that depression caused by neurotransmitters imbalance or problems with neural receptors

• 60 to 70% of patients who take antidepressants experience relief from their symptoms (vs. 30% with placebos)

Cognitive-Behavioral Treatment

• As effective as antidepressants at treating depression

1. Combination of CBT & antidepressant medication more effective than either approach alone

2. Alternative treatments (Phototherapy; ECTs, TMS, DBS) effective

Bipolar I Disorder

Mood disorder with extremely elevated moods during manic episodes

Bipolar II Disorder

Mood disorder with alternating periods of extremely depressed and mildly elevated moods

Bipolar and Related Disorders

Etiology

• Strong and complex genetic component

Morbidity

• Emerge during late adolescence or early adulthood

• 3% to 4% of the population will experience a bipolar disorder in their lifetimes

• Equally prevalent in women and men

BPD - Psychotropic Medications

Especially the mood stabilizer lithium

• Process by which lithium stabilizes mood not well understood

• Lithium has unpleasant side effects (Thirst, hand tremors, recessive urination, and memory)

• Combining lithium with antipsychotic (quetiapine) can improve treatment outcomes

Schizophrenia Spectrum and Other Psychotic Disorders: Schizophrenia

• Psychotic disorder with split b/w thought and emotion with difficulty distinguishing whether altered thoughts, perceptions, and conscious experiences are real or imagined

]Motor, cognitive, behavioral, and perceptual abnormalities

Impaired social, personal, or vocational functioning

Continuous signs of disturbances for at least 6 months

Etiology

• Biological: Role of genetics; brain disorder; potential abnormality in neurotransmitters

• Environmental: Stress

Morbidity

• More often diagnosed when people in their 20s/30s

• Less than 1%; Similar for men and women

Schizophrenia Spectrum and Other Psychotic Disorders: Schizophrenia Cont’d

Major symptoms

• Diagnosis requires 2 or more, with one of 1) to 3)

1. Delusions: False beliefs based on incorrect inferences

2. Hallucinations: False sensory perceptions experienced without an external source

3. Disorganized Speech: Speaking in an incoherent way with frequent topic changes and inappropriate considerations

4. Disorganized behavior: Acting in strange or unusual ways

5. Negative Symptoms: Marked by deficits in functioning (Apathy, lack of emotion, slowed speech)

Schizophrenia: Antipsychotic Medications

Psychotropic Drug Treatments

• Conventional Antipsychotics reduced the positive symptoms (Delusions, hallucinations, disorganized speech/behavior)

• Little to no effect on the negative symptoms

• Irreversible tardive dyskinesia (Involuntary movement of body parts) as side effect

Atypical Antipsychotics as beneficial in treating both the positive/negative symptoms

• Serious side effects (Seizures, heart rate problems, substantial weight gain, fatal reduction in white blood cells)

Schizophrenia: Behavior therapy

Can include social skills training to elicit desired behavior (Appropriate ways to act in specific social situations)

• If a patient’s self-care skills are poor, can focus on areas such as grooming and bathing, managing medications, and financial planning

Neurodevelopmental Disorders: Attention-Deficit/Hyperactivity Disorder

• Excessive activity or fidgeting, inattentiveness, and impulsivity

Morbidity

• 12.1% of boys and 5.5% of girls

• 4% of the adult population

• Symptoms before age 12 - First diagnosed b/w ages 5 and 7

Etiology

• Unknown

• Poor parenting? Social disadvantage?

• Connection b/w the frontal lobes and the limbic system impaired?

ADHD to be treated or not?

• Some diagnosed with ADHD as children do grow out of it;

• May continue to experience the disorder throughout adolescence and adulthood

Psychotropic Medication Treatment

• A central nervous system stimulant (Ritalin/Methylphenidate or Adderall)

• Drugs actions not fully understood

• Side effects: Sleep problems, reduced appetite, body twitches, and temporary slowing of growth

• Ideally supplemented by psychological behavior therapies

Neurodevelopmental Disorders: Autism Spectrum Disorder

Deficits in social interaction, impaired communication, and restricted, repetitive interests and behavior

• High-functioning autism sometimes called Asperger’s syndrome

Etiology

• Biological: Prenatal and/or early childhood events that may result in brain dysfunction; Brains with different wiring in a large number of areas

Morbidity

• 3-6 children out of 1,000 show signs of ASD, and males outnumber females 3 to 1

• From 1991 to 1997, dramatic increase (556%) in children diagnosis

Autism Spectrum Disorder: Structured Behavior Therapy

Applied Behavioral Analysis: An extensive behavior therapy based on operant conditioning

• Method used successfully

• Intensive approach of 40h/week of treatment (min.)

• Drawbacks: Time commitment; financial and emotional drains

Biological treatments

• Despite evidence that caused by brain dysfunction, neurobiology of autism spectrum disorder not well understood