Psychopathology midterm

what is psychopathology?

the formal study of the nature and development of abnormal behaviour

Etiology

what contributes to the development of psychopathologyincluding biological, psychological, and environmental factors.

Treatment development + treatment outcome research

development: alleviate psychological suffering
outcome research: how do we know we've helped?

The process of creating effective interventions for mental health issues and evaluating their effectiveness in improving patient outcomes.

What are 3x myths in psychopathology?

1. mental health problems don't affect me (1/4 ppl are affected)

2. mental illness = weakness of character (it is a product of biopsychosocial factors)

3. once developed, recovery isn't possible

what is the definition of psychological (ab)normality?

no single definition

4x characteristics of stigma (vs physical illness)

- distinguishing label applied

- label--> undesirable attitudes

- people seen as different

- people with label DISCRIMINATED AGAINST

what is stigma

destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some way

how do you reduce stigma?

- contact

- familiarity (!! mixed results tho!)
- social media (raise awareness)
- public figures speak out (could increase health behaviour)

3Ds!!! Characteristics of Psychopathology

Dysfunction
Distress
Deviation

What is the first D of the 3 Ds of Psychopathology

(psychological/behavioral) Dysfunction

- impairment / disability

What is the second D of the 3 Ds of Psychopathology

(personal) Distress

--emotional pain + suffering

What is the third D of the 3 Ds of Psychopathology

Deviation (atypical/unexpectedness)

- response to stressors out of proportion to (/inconsistent with)a actual threat

DSM-5 definition of a psychological disorder (6x)

- within individual
- clinically significant studies !!!
- personal distress
- dysfunction in psych/neurobiological processes involved in mental functioning
- not culturally specific reaction to an event
- not result of social deviance/conflict w society (e.g gay)

what is a paradigm

a conceptual framework / approach within which a scientist works

--> set of basic assumptions
--> general perspective
--> approach to conceptualising study + how to interpret data

What questions are asked

• How research is done

• How data is interpreted

are paradigms beneficial?

can facilitate and hinder discoveries

-not one offers the best conceptualisation of psychopathology

what paradigms/models are there? (BCPH)

- Biological (genetic + neuro)

- Cognitive Behavioral

- Psychodynamic

- Humanistic

(diathesis stress model)

Biological- Genetic Paradigm

-all behaviour heritable to some degree

-environment shapes gene expression
--> bidirectional (nature VIA nurture)

Biological- Neuroscience Paradigm

Psychological disorders linked to aberrant brain processes
--> neurons/neurotransmitters
--> brain structure + function
--> neuroendocrine system

Biological model- treatment

- drug therapy

--brain stimulation (DBS- adjustable current w electrode permanently implanted in brain)
- psychosurgery

Cognitive Behaviour Paradigm

suggests that mental health problems arise from dysfunctional thinking patterns and maladaptive behaviors, which can be changed through therapy.

- Thoughts, Feelings, and Behaviors are Connected

-Maladaptive Thinking Leads to Psychological Disorders

-Behavior Reinforces Thoughts

-Learning and Conditioning Play a Role

How is behaviour altered through the cognitive paradigm

• Time-Out → Weakens undesirable behaviors by removing reinforcement.

• Behavioral Activation → Strengthens positive behaviors by increasing reinforcement.

• Exposure Therapy → Reduces fear-based behaviors by breaking avoidance patterns.

classical conditioning vs operant conditioning

classical- pairing neutral stimulus with conditioned response to provide a conditioned response to this neutral stimulus
operant- reinforcement/punishment to maintain behaviours (reinforce classical conditioning)

cognitive focused therapy

interview style

change thinking patterns

to alter emotions and behaviors.

Psychodynamic model

behaviour is determined by underlying unconscious psych. forces

--> unconsciousness, + dynamic (= forces interact w each other)

what is the (psychodynamic) structure of the mind

Id- needs, drives, impulses

Ego- reason (defence mechanisms control unacceptable id impulses)

Superego- values + ideals

Defence mechanism- DENIAL

reject thought/feeling

Defence mechanism- SUPPRESSION

vaguely aware of thought or feeling, but try to hide it

Defence mechanism- REACTION FORMATION

turn feeling into its opposite

Defence mechanism- PROJECTION

think someone else has your thought or feeling

Defence mechanism- DISPLACEMENT

redirect feelings onto another target

Defence mechanism- RATIONALISATION

come up with explanations to justify situation, denying own feelings

Defence mechanism- INTELLECTUALISATION

rationalisation but more intellectualised

works to reduce anxiety by thinking about events in a

cold, clinical way

Defence mechanism- UNDOING

Undoing is a defense mechanism in which a person tries to cancel out or remove an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior. For example, after thinking about being violent with someone, one would then be overly nice or accommodating to them

-e.g give professor an apple

Defence mechanism- ISOLATION OF AFFECT

you 'think' the feeling but don't really feel it

the individual blocks out painful feelings by recalling a traumatic event without experiencing the emotion associated with it.

Defence mechanism- REGRESSION

revert to old pattern of behaviour to ventilate your feeling

Defence mechanism- SUBLIMATION

redirect feeling --> socially productive activity

defense mechanisms

in psychoanalytic theory, the ego's protective methods of reducing anxiety by unconsciously distorting reality

what are all the defense mechanisms

Suppression
Reaction Formation
Projection
Displacement
Rationalisation
Intellectualisation
Undoing
Isolation of Affect
Regression
Sublimation

Psychodynamic Therapy

uncover past trauma + inner conflict resulting from it

- free association
- interpretation
- analysis of transference

1. what is free association

psychodynamic therapy

--> person says whatever comes to mind w/o censoring

2. what is interpretation (in therapy)

psychodynamic therapy

---> analyst points out meaning of certain behaviours of person

3. what is analysis of transference

psychodynamic therapy

---> person's response to what analyst says
=
--> attitudes + ways of behaviour towards important people in their past

!! ANALYST HELPS PERSON UNDERSTAND + INTERPRET RESPONSE

Humanistic Model + therapy

people are driven to self-actualise

client-centered therapy

warm + supportive approach

what is the therapist like using a humanistic model

unconditional positive regard

accurate empathy

genuineness

affirmations

diathesis-stress model

- Integrative paradigm (takes into consideration genetic, neurobiological, + environmental factors)

- explain why only some people develop disorders

--> diathesis:
- underlying predisposition (bio or psych)
- increase risk of disorder development (but no guarantee)

--> stress:
- environmental / life disturbance
- triggering event

--> combination of factors !!!

diathesis (diathesis-stress model)

- underlying predisposition (bio or psych)

-increase risk of disorder development (but no guarantee)

Cup analogy for diathesis stress model

person has certain diatheses and stressors in life, but adding too many stressors can cause the cup to 'overflow' and display disorders

Sociocultural factors in psychopathology

- Gender, race, culture, ethnicity, and socioeconomic status

- all countries + cultures have psychopathology
--> conceptualisation + meaning of symptoms can vary

- drugs can have different effects on different ethnicities

- poverty--> antisocial personality disorders, anxiety, depression

environmental factors + culture on psychopathology influence

!!! ENV FACTORS--> TRIGER/EXACERBATE SYMPTOMS OF DISORDERS

!!! CULTURE influences symptom expression, treatment availability, + willingness to seek treatment

DSM-5

Diagnostic and Statistical Manual of Mental Disorders

Published by American Psychiatric Association

classification + diagnosis (meet criteria for x time)

Revised 6x (change wording to prevent stigma + diagnostic wording to maintain high diagnostic threshold)

Diagnosis

classification of disorders by symptoms + signs

what are other classification manuals besides the DSM-5?

ICD-II --> International Classification of Diseases (WHO)

RDoC --> Research Domain Criteria: start treating each symptom, not disorder

ICD II:

-Producer
- Disorders
- Criteria
- Application
- Area of Use

International Classification of Disorders (WHO)

- WHO
- Psych/med
- brief
- practice/research
- Wordwide

RDoC
-Producer
- Disorders
- Criteria
- Application
- Area of Use

Research Domain Criteria: start treating each symptom, not disorder

-NIMH
- Psych
- Neuro/biological
- research
- US

-a research framework for understanding disorders based on neuroscience and behavioral science rather than symptom based categories

*not designed for clinical diagnosis

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

-Producer
- Disorders
- Criteria
- Application
- Area of Use

-APA
- psych
- detailed
- practice/research
- North America

For each psychological disorder, the DSM-5 provides (3x)

--> diagnostic criteria

(+ detailed over time)

--> description of associated features
(lab findings etc): provides additional information about a disorder that is not part of the formal diagnostic criteria but often occurs in individuals with the condition. These features can help clinicians better understand the full presentation of a disorder and differentiate it from similar conditions

Example from DSM-5: Generalized Anxiety Disorder (GAD)

• Diagnostic criteria focus on excessive, uncontrollable worry for at least six months.

• Associated features may include muscle tension, restlessness, difficulty concentrating, irritability, and a tendency to be a perfectionist or overly cautious.
  
  --> summary of research literature
  (age of onset, course, prevalence, prognosis, risk, cultural+gender factors, differential diagnosis)

differential diagnosis

Differential diagnosis is the process of distinguishing a particular mental disorder from other conditions that have similar symptoms.

In the DSM-5, each disorder includes a Differential Diagnosis section, which helps clinicians rule out other possible conditions before making a final diagnosis.

The DSM-5 defines diagnoses based on

sympyoms

-> bc our knowledge base isn't strong enough to organise diagnoses around etiology

advantages of classification

- facilitates communication among professionals

-advances search for causes and treatment

Disadvantages of classification

- too many diagnoses
- categorical (y/n) vs dimensional (scale)
- reliability
- negative effect of diagnosis (stigma)

why is too many diagnoses a criticism of the DSM-5?

- increase in diagnoses: pathologising behaviour?

- comorbity: presence of a 2nd diagnosis (45% people meet criteria for an additional disorder)

what is comorbity, and what percentage of ppl have this?

presence of a 2nd diagnosis (45% people meet criteria for an additional disorder)

What is a solution for too many diagnoses

Research Domain Criteria !! (RDoC)

--> investigate psych variables relevant to many conditions
--> use basic science - new classification system

categorical vs dimensional classification

categorical

--> DSM-5
--> symptoms fitting categories?
--> thresholds w boundaries
--> provide helpful treatment guidance?

dimensional
--> degree of severity
--> describe sub threshold symptoms
--> in the DSM-5 : SEVERITY RATINGS WERE ADDED!

positives of dimensional vs categorical

dimensional systems--> capture individual's functioning better

categorical systems--> advantages for research + understanding

• Dimensional models are often better for understanding psychopathology and tailoring treatment.

• Categorical models are more practical for diagnosing, communicating, and structuring treatment plans.

Reliability of DSM in everyday practice- why is this a challenge?

--> Clinicians may adopt different definitions for symptoms (low interrater reliability- challenging)

interrater reliability

consistent scores are obtained no matter who measures or observes

stigma + diagnosis

labels can relieve stigma by providing explanation for symptomatic behaviour

but can also put people into boxes

harm of classification- pathologising

APA sells expensive DSM-5: v profit incentive

turn life struggles--> medicateable

--> harm on unnecessarily medicated
--> pull resources away from those who actually need and can benefit from it

how can culture influence psychopathology

risk factors

symptom experience
stigma
willingness to seek help
availability of treatments

DSM-5 cultural sensitivity

discussion of culture-related issues for disorders

cultural formation interview Qs for clinicians

description of how syndromes present across cultures

e.g ask if others in community think similar things or not

e.g if left homeland (immigrant) to escape war or oppression, the assessor might overlook

client's vulnerability to PT stress

Symptoms like hypervigilance, nightmares, and emotional numbness could be diagnosed as PTSD, but some cultures may normalize these reactions as a part of resilience or religious beliefs.

e.g if holds cultural beliefs strange to dominant culture, assessor might

mistinterpret cultural responses as pathology

what is a cultural hotspot, and give examples of types of cultural hotspots

cultural hotspot refers to areas in mental health assessment where cultural differences between the client and clinician can lead to misunderstanding, misdiagnosis, or bias.

immigrant client

ethnic minority client
dominant-culture assessor

diagnostic inflation

Diagnostic inflation refers to the expansion of diagnostic criteria, leading to an increase in the number of people diagnosed with mental disorders—sometimes unnecessarily. This can result in overdiagnosis, medicalization of normal behaviors, and an increase in the number of psychiatric conditions recognized in manuals like the DSM-5.

what is a clinical interview?

INTERPERSONAL encounter where LANGUAGE is used to gather INFO about a CLIENT

what does a clinical interviewer do?

pays attention to HOW clients answer questions posed

involve a degree of empathy for problems

highly structured or very informal (either)

what are the personality tests?

--> MMPI-2
(Minnesota Multiphase Personality Inventory-2)

--> Big Five Inventory

MMPI-2

Minnesota Multiphasic Personality Inventory

--> + widely used
--> 500 statements
--> profile of psych. functioning
--> WITH LIE VALIDITY SCALE (fake 'good/bad')

Big 5 Inventory (OCEAN)

assess broad 5x domains of personality

Openness (to experience)
Conscientiousness
Extraversion
Agreeableness
Neuroticism

informal projective tests

art

-draw a person test

Rorschach projective test

ask client what they see in the inkblot to give insight to unconscious processes

TAT

Thematic Apperception Test;

--> express inner feelings and interests through the stories they make up about ambiguous scenes

Replication Crisis in Psychology

failure to replicate psychological studies; only about 33% were able to replicate in a lab

analogue experiment

examine related but less severe phenomenon
--> bc experiments not always possible: ethical/practical constraints
KEY IS VALIDITY OF ANALOGUE

An analogue experiment is a type of research design where researchers study behaviors, conditions, or psychological processes in a controlled setting that resembles real-life situations but is not identical to them. The goal is to create an artificial or simulated environment to study phenomena that would be difficult, unethical, or impractical to observe directly.

how can an analogue experiment be achieved

- induce temporary symptoms

- recruit participants w similarities to diagnosable disorders (e.g college students who tend to be anxious)

-animal research

TLFB

Time Line Follow Back
--> for alcohol/drug use: use key dates to accurately log days of use

self monitoring for data collection

individuals monitor and track their own behaviour

types of self-monitoring

EMA: Ecological Momentary Assessment

ESM: Experience Sampling Method

--> collection of data in real time (via diaries or phones)
--> person signalled + enter responses directly into device in real time!

statistical significance + what is this influenced by

the probability of some result from a statistical test occurring by chance

--> influenced by n participants
--> larger sample size = more likely significance

clinical significance

is the relationship between variables large enough to matter?

--> statistically significant AND large enough effect (for prediction / treatment)

What factors contribute to therapy outcome?

Common Factors of therapy

--> events in client's life
--> specific therapy techniques
--> expectancy of success

dodo bird verdict

all therapies have equally effective outcomes

client-therapist relationship

part of common factors

transference

the patient's transfer to the analyst of emotions linked with other relationships

(patient thinks of therapist in a similar way to other important people in their life)

countertransference

Therapist has transference reaction to the patient

Example: Therapists could be overly protective of a patient who reminds them of their child

Describe two examples of issues in research methods that can contribute to a failure of replication (CONTRIBUTE TO REPLICATION CRISIS)

sampling bias

publication bias

What is replication? what are issues if it fails?

findings from one study hold up when it is repeated
--> reproducible findings

concerning crisis: reduce public trust + investment
- also inaccurate publications can misguide wave of science

issues in research methods that can lead to replication failures

- small samples

-unreliable measures
- methods not described well
- difference in methods between studies
- sketchy research practices

P-hacking

tweak data until significant findings are identified