Clinical Psychology

What is considered to be abnormal psychology?

Includes states of mind and behavior that deviates from: 

• 1. Deviates from the statistical average 

• 2. From what Mental health professionals consider to be dysfunctional or a healthy psychological functioning 

• 3. Characterized by personal distress or impairment in function must also be present 

Negative aspects of the term “abnormal psychology” 

• Concerns about stigma 

• Societal attitudes often equate “normal” with “good” 

• Cultural and historical variability 

• Symptoms and prevalence of certain disorders varies across cultural context and over time 

• Course names change at many colleges

What is the DSM-5?

The Diagnostic and Statistical Manual of Manual Disorders, a guidebook providing the way that classifies mental disorders 

What are the eight categories of psychological disorders?

• 1. Substance-Use and Addictive Disorders 

• 2. Schizophrenia and other psychotic disorders 

• 3. Depressive and Bipolar Disorders 

• 4. Anxiety Disorders 

• 5. Obsessive-Compulsive Disorders 

• 6. Feeding and Eating Disorders 

• 7. Wake-Sleep Disorders 

• 8. Trauma and stressor-Related Disorders 

Unipolar depression (also called major depression) 

Consists of unremitting depression or periods of depression 

• Without mania 

What percentage of the population does major depression affect? 

• Its effects 8% of the U.S. population, with a median onset of age 32 

• Affects women 2-3x more than men 

• Transgender people have 2-4x rate of depression that cisgender people because of the societal stigmas 

• Dysthymia is a milder, more chronic version 

• Individuals with unipolar depression are 29x more likely to attempt suicide than a person in the general population 

symptoms of depression

• Depression is associated with a number of psychological and physical symptoms, including: 

• 1. Depressed mood 

• 2. Loss of ability to experience pleasure 

• 3. Restlessness, irritability, anger and/or anxiety 

• 4. Lack of energy and concentration 

• 5. Difficulty falling asleep or staying asleep 

• 6. Constipation, aches and pains 

• 7. Thoughts of death or suicide 

• A diagnosis requires that several of these symptoms be experienced over time and significantly impact functioning 

Gender difference in suicide

• Men are at very high risk of suicide when depression is severe because they tend to employ methods that are more violent 

• More men die by suicide  

• More women tend to attempt suicide 

What is bipolar disorder?

Characterized by cyclical periods of unipolar depression and mania 

What typically lasts longer: manic episodes or depressive episodes? 

Depressive episodes typically last much longer than manic episodes as manic episodes last a few days to a several months 

What percentage of the population is affected by bipolar disorder?

• 2.6% of the U.S. population, with a median onset of age 25 

• Affects men and women in equal numbers 

Symptoms of mania

• Can range from mild (“hypomania”) to sever and may be characterized by: 

• High energy 

• Overly good mood 

• Cognitive clarity 

• Little need for sleep 

• Feelings of power 

• Fast, erratic talking 

• Racing thoughts 

• Impatience 

• Irritability 

What are the two most heritable psychiatric disorders?

• Affective disorders, especially bipolar disorder, exhibit the largest heritability among all the psychiatric disorders 

• Schizophrenia 

• The concordance rate for monozygotic twins is approximately 70% for bipolar disorder; it is only 20% for dizygotic twins 

According to the diathesis stress model, what two factors contribute to mental illness/depression? 

• A vulnerability to depression 

• A stressful life event (or series of events, chronic stressor) that the individual is il-prepared to cope with 

What is the relationship between depression and hippocampal volume

A negative correlation exists between lifetime depression and hippocampal volume

anxiety

a state of tension over threats that may occur in the future 

fear

evoked by threats that are actually occurring 

anxiety disorder

A Psychological disorder characterized by persistent expression of several symptoms

Symptoms of anxiety disorders 

• Tension and worry 

• Over-activity of the sympathetic nervous system 

• Expectation of an impending disaster 

• Hyper-vigilance &arousal 

• Irritability 

• Avoidance of social activities 

5 types of anxiety disorders

• 1. Phobias 

• 2. Panic Disorder 

• 3. Social Anxiety Disorder 

• 4. Generalized Anxiety Disorder 

• 5. Separation Anxiety Disorder 

What is OCD characterized by

• Persistent, intrusive, anxiety-provoking thoughts (‘obsessions’) combined with strong urges (‘compulsions’) to perform repetitive, ritualistic behaviors (ex. Cleaning, checking behaviors, repetitive thoughts) 

• Compulsions function to relieve the anxiety provoked by the obsessive thoughts 

What is PTSD characterized by

Results from exposure to a situation of extreme danger and stress

What are the main symptoms that characterize PTSD

• Recurrent memories/recollections of traumatic event 

• Flashbacks of event (feelings that the traumatic event is reoccurring) 

• Intense psychological distress (hyper-vigilance and arousal) 

Causes of PTSD

• PTSD is associated with the number of traumatic events an individual has been exposed to as well as other types of pre-existing anxiety disorders 

• A history of early life stressful or adverse experiences is a major predictor of who will develop PTSD 

hippocampal volume

Individuals with posttraumatic stress disorder (PTSD) tend to have smaller hippocampal volumes compared to healthy individuals 

amygdala activation

Active when encountering fear and exposed to threats or threatening faces in our reality 

schizophrenia disorders

A class of disorders marked by delusions, hallucinations, disorganized speech, and abnormal motor behavior 

general symptoms

• Irrational thought 

• Deterioration of adaptive behavior 

• Distorted perceptions 

• Disturbed emotions 

• Delusions- false beliefs 

• Hallucinations – sensory perceptions (hearing/seeing)

Types of Symptoms - schizophrenia

• negative symptoms

• positive symptoms

• disorganized symptoms

• heritability

negative symptoms

• behavioral deficits 

• Ex. Lack of motivation 

positive symptoms

• behavioral excesses 

• Hallucinations and delusions 

disorganized symptoms

• disorganized thoughts and behaviors 

• Disorganized speech 

heritability- schizophrenia

Second largest heritability among all the psychiatric disorders 

eating disorder and objectification theory prevalence

• 9% of the U.S. population will have an eating disorder in their lifetime 

• Less than 6% of people with eating disorders are medically diagnosed as “underweight” 

• Have historically been associated with heterosexual, young, white females, but in reality, they affect people from all demographics of all races and ethnicities at similar rates 

common examples of eating disorders

Anorexia nervosa, bulimia nervosa, binge eating disorder 

sexual objectification

Viewing people and/or valuing a person as an object whose worth is based primarily on physical appearances, sexual attractiveness, and/or image maintenance, and not valued for: personality, abilities, and/or individuality 

objectification theory

• Founded by Barbra Frederickson & Tomi-Ann Roberts 

• Emphasizes self-objectification, wherein the objectifying gaze is turned to oneself in order to evaluate the extent to which one conforms to societal standards of beauty 

How does internalization contribute to dieting and eating disorder behaviors? 

It contributes to body surveillance, body shame, causing body image dysphoria, and ultimately leading to dieting behaviors 

What are examples of monoamine neurotransmitters regulated in antidepressants? 

• Depression has been loosely linked to the monoamine transmitters: 

• Dopamine (DA) 

• Norepinephrine (NE) 

• Serotonin (5-HT) 

What is the Monoamine Hypothesis (what is the relationship between depression and monoamines according to this hypothesis)? 

depression is linked to deficiencies or imbalances in specific neurotransmitters called monoamines, specifically serotonin, dopamine, and norepinephrine 

Is depression simply a chemical imbalance of monoamines? 

• It is true that monoamine enhancing drugs (basically all modern antidepressants) can in some, but not all, cases alleviate depression 

• But that doesn’t mean that depression is a chemical imbalance of monoamines, there isn’t enough evidence/research 

Antidepressants fail to work in up to what % of the individuals who take them?

50 %

psychoanalysis approaches

some underlying root conflict, some root cause gives rise to all of the symptoms of a psychological disorder 

role of the therapist in psychoanalysis

treat disorder by uncovering and dealing with these conflicts during therapy, analyzing content of patient free associations and dreams 

• Find the cause(s) and you treat the disorder 

• According to Freud: 

• Symptoms of mental illness were indicative of an ego struggling to manage conflict between id and superego 

• Root cause of mental disorder hidden in subconscious mind (hidden away, repressed) 

• Uncover root cause could be revealed by talking

What is free association?

• A technique in which a relaxed patient (verbally) reports all passing thoughts without reservation 

• The analyst's job is to listen carefully for clues in the patient’s language (reveals fragments of long forgotten/repressed memories, fantasies, etc.) 

Dream analysis

The “Royal Road to the Unconscious”

What is the manifest content?

The information that the patient remembers from the dream

What is latent content?

‘True meaning’, is what the analyst strives to understand

Why did academic psychology leave Freud behind?

• Psychodynamic is overly complex 

• The concepts and practical outcomes are largely untestable and unmeasurable 

• Ex. Hard to study defense mechanisms like repression 

• Practice relies on patient self-report and the creative interpretation by the analyst, everyone's experience in analysis is unique 

• Time consuming and expensive 

• Ex. It may last 5-10 years 

• Freud endorsed negative views of women – inherently inferior, needed to be guided by men 

What is Cognitive-behavioral therapy? (CBT) 

• Uses the knowledge of cognitive psychology and learning theory to develop empirically verified, targeted therapies to treat the symptoms 

Psychological disorders caused and sustained by maladaptive thoughts and behavioral patterns 

Cycle of thinking (distorted thoughts), affect (negative emotions), and (maladaptive) behavior 

.

Role of therapist: guide patient in belief modification 

• Identifying maladaptive, negative thought patterns and behaviors 

• Train patient to think about their life differently 

• Requires consistent practice 

What is the difference between rumination and worry? 

Rumination is typically about dwelling on past experiences, especially negative ones, while worry is more focused on potential future threats and dangers 

mindfulness-based cognitive therapy

combined with CBT

Goals and practices of therapy

To train the patient to focus on the present (ex. What am I feeling right now? What am I thinking? What am I experiencing?) 

Dialectical behavior therapy

• Supporting emotional regulation and interpersonal skills to navigate painful feelings in safe, helpful ways 

• Developed for those who are chronically suicidal and those with borderline personality disorder 

• Differences from CBT 

family systems therapy

• Individuals work to resolve problems and alleviate distress in the context of their family units 

• Each family member works together with others to better understand family dynamics and how individual behaviors contribute to conflict or conflict resolution 

Who developed client centered therapy

Humanistic approach advocated by Carl Rogers 

Key components and perspectives

• Patient is seen as a ‘client’ who is not mentally ill 

• Therapist acts more like a ‘life coach’, allowing the client to reach his or her own solutions 

• Congruence/genuineness 

• Being honest and transparent to foster strong relationship with client 

• Empathy 

• Expressing understanding for client’s feelings 

• Unconditional positive regard 

• Valuing and accepting the client fully, without placing judgement