Abnormal Psych Final Exam

A client is about to start exposure therapy for a phobia of heights. How would you explain the rationale of exposure therapy, a therapy that is quite uncomfortable in the moment. What is it? Why do we do it? How does it work? Be very specific; you may want to provide an example to show use of terms/concepts.

In exposure therapy, the client is repeatedly exposed to the situation that they fear. The client must experience the peak of anxiety and wait for the anxiety to go down, because this shows them that can survive the situation and that the anxiety won’t last forever. The peak of anxiety is reduced with each exposure. If the client is removed from the feared situation before the anxiety goes down, avoidance behaviors are produced, which maintain the phobia. Exposure therapy makes it easier for the person to interact with the feared object or situation in real life, as their anxiety is reduced to a manageable level.

2 types of exposure therapy:

• Systematic desensitization

  • Going from the bottom to the top of fear hierarchy

  • Gradual, uses relaxation

  • Example for heights: think about being on top of a short building, think about being on top of a taller building, go on top of a short building in real life, go on top of a tall building in real life

• Flooding

  • Start at the top of fear hierarchy; “rip off the bandaid”

  • Not gradual

  • Example for heights: go on top of a very tall building

You are a psychologist meeting with a client who has new-onset significant psychiatric symptoms, As a part of your intake process, you requrest that the client see either their primary care doctor or a psychiatrist for a medical evaluation. The client is quite surprised that you are making this request, stating “My problem isn’t medical! It is with how I feel. Won’t I be wasting my time and money going for a doctor for this?”

Respond to the client’s concerns. Within your answer explain 1) why medical evaluation is important to the intake process AND provide some specifics of what they could be looking for, and 2) address/explain the biological approach to psychological disorders (what is viewed as the cause and potential treatment of issues from this perspective)

Medical evaluation is important to the intake because:

• Medical/physical issues can be mistaken for mental illness

They might be looking for:

• Medication side effects

• Thyroid issues

• Seizures

  • Can be mistaken for hallucinations from schizophrenia

  • Not effective to give antipsychotics to someone who actually has seizures

Biological approach - causes

• Brain anatomy

• Brain chemistry

  • Imbalance of neurotransmitters

    • Dopamine - high levels associated with schizophrenia

    • Serotonin - low levels associated with depression

• Genetics

  • Higher chance of schizophrenia if a first degree relative has it, even higher if an identical twin has it

Biological approach - treatment

• Medication - increases/decreases level of neurotransmitters

  • Antidepressants, antipsychotics

• Electric shock therapy - mild shock to brain, effective for treatment-resistant depression

Mrs Doe

A) what would a humanistic psychologist say is the cause of her problems (be sure to use specific terms)?

B) What are at least 2 of the main components of therapy from the humanistic perspective (and explain each one)?
C) What would a cognitive psychologist say is the cause of her problems?

D) What are at least 3 main components of therapy from the cognitive perspective (explain each one)?

A) A humanistic psychologist would say that Mrs Doe’s problems have arisen because she has developed conditions of worth due to conditional positive regard early in life.

• Conditional positive regard - need to meet a condition to get love, care, and affection

• Conditions of worth - need to meet a condition to give yourself worth/love

  • She doesn’t cancel plans bc she fears people won’t like/accept her if she doesn’t meet the condition of going out

  • Hides her feelings bc she thinks she needs to meet the condition of appearing happy all the time

B) 2 main components of therapy from the humanistic perspective are:

• 1) Nondirective - the therapist doesn’t interpret anything or guide the client towards insights

• 2) Active listening - echoing (repeating what they said), restating, clarification (asking for more details/deeper explanation)

C) A cognitive therapist would say that Mrs Doe’s problems are caused by automatic thoughts that she has about herself and the world, and has come to honestly and by no fault of her own. Situation → thought → emotion → behavior

D) The 3 main components of therapy from the cognitive perspective are:

• Catch it - identify the thought

• Check it - evaluate if the thought is helpful or harmful, accurate or inaccurate

• Change it - modify the thought to be more helpful/constructive

  • Does not mean that all thoughts have to be positive

To meet Criteria A for an agoraphobia diagnosis, an individual needs to have marked fear or anxiety for two or more specific situations. Please identify at least two of the five situations listed in the DSM.

• Being in open spaces

• Being in enclosed spaces

• Using public transport

• Being in line or in crowds

• Going outside of the home alone

Describe what specific criteria your friend would need to meet that would determine that they have panic disorder

• Recurrent, unexpected panic attacks

• At least 1 panic attack followed by 1+ month of:

  • Persistent worry/concern about additional panic attacks or their consequences

  • Significant maladaptive changes in behavior related to the attacks (ie avoidance)

• Not attributable to physiological effects of substances or a medical condition

• Not better explained by another disorder

For PTSD, identify 2: pre-traumatic, peri-traumatic, and post-traumatic risk factors

Pre-traumatic

• Temperamental

  • Prior mental disorder

  • Childhood emotional problems

• Environmental

  • Low SES/education

  • Exposure to prior trauma

  • Childhood adversity - uncontrollable

  • Social support is protective

Peri-traumatic

• Military

  • Killing the enemy

  • Witnessing atrocities

• Interpersonal violence, particularly involving a caregiver

• Severity of trauma

  • Perceived life threat

  • Injury

Post-traumatic

• Temperamental

  • “Inappropriate” coping - anger/blame instead of active problem solving

  • Negative appraisals

• Environmental

  • Subsequent averse life events

  • Exposure to repeated, upsetting reminders

A) Identify and describe all components of either the Schneidman Cubic Model or Joiner Interpersonal Model

B) Explain how the implementation of means restriction could reduce suicide risk based on component(s) of the model

Schneidman Cubic Model

• Has 3 components that lead to completed suicide when all of them are high

Components:

• Psychological pain

  • “Psychache” - profound, seemingly unbearable suffering

  • Suicide occurs when the threshold for psychological pain is exceeded

  • Treatment: increase threshold or reduce pain

• Stress

  • Can be internal or external

  • Linked to feeling overwhelmed

  • Feeling that one is overwhelmed with psychological demands

• Agitation

  • Agitation - the impulsive desire to do something to change one’s seemingly unbearable state

  • The psychological energy behind suicide

Means restriction + how it relates to Schneidman Model

• Means restriction - limiting access to preferred lethal methods for suicide

  • Examples: nets on buildings, gun control laws such as waiting periods

• Suicide attempts decrease when access to the preferred method is limited

• Means restriction can help to lower agitation, and thus prevent suicide .If someone cannot access their preferred method, they might choose to delay their attempt. As time passes, their impulsive desire might fade, and they may choose not to attempt.