PSYC 336 - Clinical

Epidemiology

The prevalence and distribution of a disorder in a population.

Etiology

The cause(s) of a disorder.

Pathology

The underlying psychological/ neurobiological features of a disorder.

Transdiagnostic

factor that is part of serval diagnosis

The essentialist approach to mental disorders

Mental disorders are natural categories whose true nature can be discovered and described
Categories represent empirically verifiable similarities among and differences between people

The social constructionist approach of mental disorders

Concepts of mental disorders (of categories) are social constructions

Syndrome Heterogeneity

different causal mechanisms may relate to the same disorder, and multiple outcomes of interest can occur within one individual.

Comorbidity

the co-occurrence of two or more disorders in a single individual

RDoC

Psychopathology research moving toward transdiagnostic domains of functioning that have a clear neurobiological/cognitive basis (bottom up)

acrophobia

two of the following symptoms
Public transportation
Open spaces
Enclosed spaces
Standing in line
Being in a crowd
Being outside of the home alone

interoceptive avoidance

Strong sensitivity to and avoidance of internal bodily symptoms associated with anxiety and panic
Exercise, sex, caffeine, alcohol, saunas, wearing neckties, anger, scary movies

safety behaviors

Behaviors intended to avoid disaster, dysfunctional emotion regulation strategies

Check pulse

Be near hospital

Carrying antianxiety medication

Having a safe person

Experiential avoidance

Person is unwilling to remain in contact with private experiences
Watching TV, Eating
Avoiding feelings

categories of obsessions

Contamination
Guilt and responsibility of harm
Uncertainty
Taboo thoughts about sex
Violence and blasphemy
Need for order and symmetry

Categories of compulsions

Decontamination
Checking
Ordering and arranging
Mental rituals

Body Dismorphic Disorder

Intrusive, distressing thoughts concerning one's appearance
Repeated checking

Two types of CBT

ERP
CT

exposure and response prevention

Entails confrontation with stimuli that provoke obsessional fear, but that objectively pose a low risk of harm

delivery of ERP

A few hours of assessment and treatment planning
Assessment of obsessions, compulsive rituals, avoidance strategies and anticipated consequences of confronting feared situations
15 hours of treatment sessions, about 90 minutes each

key requirements for ERP success

Physiological arousal and subjective fear must be evoked

Fear responses must gradually diminish during exposure

Initial fear response at the beginning of each exposure session
should decline across sessions

efficiency of ERP

Improvement rates 50-70%

Motivational Enhancement theory

a therapy designed to quickly produce internally motivated change, helps to develop internal motivation to change

in vivo exposure

Gradual exposure to feared situations in order to extinguish fear

Examples for panic disorder in vivo exposure:
Driving
Public Transporation
Bridges
Waiting in lines

Nomothetic

on average what happens in certain treatments and how they work

Idiographic

what is going to work for that particular person

Experiment to prove sub-threshold Psychopathology

2000 female twin pairs with symptoms of depression
Tested:
Risk of depression recurrence over 5 years
Risk of depression in co-twin over 5 years

Conclusion:
DSM diagnostic criteria are not reflective of natural discontinuity in depressive symptoms as experienced in the general population

Line separating no diagnosis from diagnosis is arbitrary - a convection not a fact

Traumatic stressors stats

quite common with a lifetime prevalence of trauma being 60.7% for men and 51.2% for women

strong predictors of unhealthy trauma recovery

- Severity of event
- Lack of social support
- Ongoing post-event stress

Acute Stress Disorder (ASD)

occurs within a month after exposure to traumatic stress

Sensory representations (S-reps)

Inflexible, involuntary, sensation bound, disintegrated from the autobiographical memory base and are connected to the superior partial areas, amygdala, insula areas of the brain

Memories of the trauma are over represented in S-reps

prolonged grief disorder

Prevent the individual from fully processing and accepting the loss of a loved one

Stress disorder

exposure based interventions for trauma

Help reduce trauma related distress by facilitating new learning about the meaning of the trauma and altering maladaptive beliefs about oneself, others, and the world
Prolonged exposure
In vivo exercise
Imagined exposure

ex:
EMDR
NET

Cognitive treatments for trauma

Changes in the person's understanding of the trauma and its meaning in their life

Update the trauma memory

Discussion of key themes:
Challenges to safety
Trust
Power
Self esteem

pre trauma

characteristics of the individual and environment that preceded trauma exposure

-Lower socio-economic status
-Lower intelligence
-Childhood trauma
-Prior adult or child trauma
-Prior worse adjustment

peri-trauma

Characteristics of the trauma and the environmental and individual response to the trauma

Things about the trauma that makes them likely to develop
- Trauma severity
- Perceived life threat
- Peri-traumatic emotions

post-trauma

Individual and environmental factors that occur after the trauma

Things that happened after event that makes them more likely to develop
- Ongoing life stress
- Lack of social support
- Negative cognitions

resilience factors to trauma development

Spirituality

Connections to family

Close bonds with others as a result of shared history, experiences, and culture

Nature of trauma memory

Intentional recall is poor:

- Trouble intentionally recalling complete memory of trauma

- Memory is poorly integrated into autobiographical memory base (no clear context in time, place, other memories)

Vivid unintentional recall:

- Involuntary and intrusive memories (flashbacks)

- Flashbacks experienced as if in the present

- Flashbacks experienced despite more recently learned contradictory info

- Flashbacks triggered by wide range of stimuli (fear generalization)

prolonged exposure

Exposure to trauma-related memories(imaginal exposure) and situations (in vivo exposure)

imaginal exposure

a part of prolonged exposure

Repeatedly tell story of trauma in as vividand detailed a manner as possible- emotional engagement (activate trauma memory)- habituation- cognitive restructuring

CISD (Critical Incident Stress Debriefing)

severe events are discussed within teams; peer driven process; confidential; after a major incident; conducted 24-72 hours after

does not work!!!!!