PSYC1030 - Clinical Psychology

What does clinical psychology involve?

Evidence based treatment

Diagnose and treat mental, emotional and behavioural disorders

Scientific research, psychological theory and clinical knowledge to understand and alleviate psychological distress

What do clinical psychologists do?

Assess and diagnose psychological conditions

Implement evidence based treatments

Promote mental health and wellbeing

Why see a clinical psychologist?

• Mental health conditions

• Behavioural and emotional issues

  • Anger management

  • Relationship difficulties

  • Adjustment to life changes

• Severe and enduring mental illnesses

• Health psychology

  • coping with chronic illness

• Support for specific populations

  • gender identify

  • older adults

How do we define disorders?

Diagnostic and Statistical Manual of Mental Disorders (DSM)

• 18 classes of disorders

• Set of decision rules for deciding if met

International classification of Disease

Problems with DSM

Heterogeneity

• same diagnosis but different symptoms (e.g., suicidal MDD vs non-suicidal MDD)

Comorbidity

• Often people fit criteria for more than one disease simultaneously

Subjectivity

psychodynamic therapy

• bringing unconscious processes out

• linked to childhood experiences?

• internal conflicts and defense mechanisms

  • what are they and are they constructive or destructive?

• transference and countertransference

• therapeutic relationship

transference and countertransference

transference

• projecting feelings from past relationships onto therapist

countertransference

• therapist’s emotional response

allows for insight into client’s relational patterns, emotional blind spots, interpersonal difficulties

psychodynamic techniques

free association

• verbalising what comes to mind without filter

interpretation

dream analysis

transference process

biological therapy

treating biological and lifestyle causes

medication

lifestyle changes

biopsychosocial

• considering how biology, psychology and social domains interact

behavioural therapy

focus on observable behaviours and ways in which they are learned

• systematic desensitisation for phobias

• token economies

CBT

Dealing with thought processes that arise from an activating event

Process

• Identify unhelpful thoughts

• Challenge unhelpful thoughts

• Cognitive restructuring

  • replace unhelpful thoughts w more realistic

ABC

• Activating event

• Belief or thoughts during event

• Consequence of belief

Randomised control trials

Compare active treatment against placebos and current alternatives with random assignment

• 2+ independent RCTs needed

• assessment before and after + follow up

• large sample

MDD diagnostic criteria

5/9 symptoms present most of the day most days in 2 wk period

• must include depressive mood OR anhedonia (loss of pleasure)

Other symptoms

• change in appetite or weight

• change in sleep

• psychomotor agitation or retardation

• fatigue

• thoughts of worthlessness or guilt

• difficulty concentrating or indecisiveness

• recurrent thoughts of death or suicide

Significant change from normal functioning

Exclusion criteria (not meds or other illness)

Onset of MDD

Increases significantly around puberty

peaks in 20s

Remission of MDD

2+ months w/o symptoms or no more than 2 symptoms at a mild level

can go years without experiencing depressive episode

Prevalence of MDD

6-7% in adults

more prevalent in younger and females

Spontaneous recovery from depression

recovery w/o intervention

more likely for MDD than PDD

Risk factors for depressive episode relapse

younger at onset

severity of preceding ep

quantity of prior eps

PDD (Dysthymia) diagnostic criteria

Depressed mood for most of the day, most days for 2+ years (1yr for children and adolescents) and 2 other symptoms

Prevalence of PDD

0.5%

What is it called when you have both MDD and PDD

double depression

Onset of PDD

early and chronic

Biological and genetic factors causing depression

disrupted neurotransmitter functioning

genetic predisposition

Environmental factors influencing DDs

prejudicial childhood experiences

stressful life events

Aetiology

Development of disease

Diathesis stress model

Diathesis

• underlying predisposition (genetic, physiological or psychological vulnerability)

Stress

• triggering events expose vulnerability and cause DD

Cognitive-behavioural model of depression

Cognitive

• negative thoughts relating to self, world, future

• pessimistic explanatory style

Behavioural

• lack of positive reinforcement (having fun doing things u like)

• feeds into sense of learned helplessness (theres nothing i can do to make me feel better)

Treatment for depressive disorders

meds

electroconvulsive therapy (ECT)

CBT

• C

  • identify unhelpful thoughts and re-evaluate

• B

  • Targets anhedonia

  • Set hw to do stuff u like

• T

  • hay

3 systems of anxiety

cognitive (thoughts)

behavioural (actions)

physiological (body)

Specific phobia diagnostic criteria

extreme fear or anxiety almost always when confronted with stimuli

stimulus avoided or endured with intense anxiety

fear out of proportion to any actual danger

distress or impairment

Social anxiety disorder

fear or anxiety about or avoidance of social situations where you can be judged

Generalised anxiety disorder (GAD)

excessive worrying

GAD diagnostic criteria

uncontrollable worry 6+ months

3/6 physiological symptoms (e.g., muscle tension, restlessness)

distress or impairment

hypervigilance

What is hypervigilance?

Thoughts that the world is a dangerous place and you need to be on the lookout for danger

Panic disorder

recurrent, unexpected panic attacks

• intense abrupt surge of fear

• anticipatory anxiety of panic attack

people often insistent that their symptoms are a form of a more serious condition like heart attack

Panic disorder symptoms

physiological (e.g., palpitations, sweating, shaking, choking, chest pain, nausea, dizziness, chills, numbness/tingling)

derealisation (unreality or depersonalisation)

fear of losing control or going crazy

fear of dying

Panic disorder diagnostic criteria

at least one panic attack followed by:

• persistent anticipatory anxiety

• significant behavioural change

Prevalence of panic disorder

2-3%

not common in children

more likely in females

Temperament

Innate, rather than learned aspect of personality

Shyness, fear of unfamiliar situations and withdrawals are risk factor for anxiety

Causal models of anxiety

Heritability

Temperament

Environment

• traumatic events

• accumulation of stressful events

• parenting

  • modelling and overprotecting

Diathesis-stress

Cognitive behavioural model of anxiety

Rachman’s 3 pathways to fear

• experiences

  • past experiences generalised to new experiences

• instructional learning

  • transmission of info related to danger

• vicarious learning

  • seeing others w fear

CBT for anxiety disorders

works pretty well

some ppl not responsive and may experience recurrence of symptoms

Psychoeducation for anxiety disorders

educating clients about anxiety and that it is normal, adaptive and can be helpful

Cognitive restructuring for anxiety disorders

client understanding importance of thoughts

identify unhelpful thoughts

keep thought diary

evaluate thoughts (thoughts are theories to be tested)

can use ABC model to psychoeducate

Exposure therapy

develop hierarchy of feared situations and expose to each level of hierarchy

imaginatively or in vivo

now thought that no relaxation is good - must experience anxiety and learn its not gonna harm them

Behaviourist theory of personality

Explain personality in terms of behaviour rather than thoughts

Behaviours are deterministic - we don’t consciously choose how we behave

Skinner vs Freud

Both proponents of behaviourism

thought behaviours were deterministic

Skinner

• thought behaviours were influenced by unconscious factors in the environment that reinforce or punish us

Freud

• behaviours influenced by unconscious processes deep in our psyche

• unconscious contains

  • inaccessible memories

  • desires

  • thoughts

Albert Bandura

Social learning

• personality is the interaction btwn traits, thoughts and the environment

• reciprocal determinism

  • behavioural, cognitive (expectancies) and environment interact to produce personality

  • these categories influence each other

Criticisms of social learning

relies on cognition as central part

(animals may not have)

Humanistic model

proponents - carl rogers and abraham maslow

how positive motivations can be related to expression of personality

Carl Rogers

personality function of organism, self-concept and conditions of worth

• organism

  • person

• self/self-concept

  • what they see themselves as

• conditions of worth

  • expectations society puts on behaviour

  • leads to inconsistencies btwn self-concept and real self

personality dev would be fully realised in a world without expectations

Abraham Maslow

personality is expression of tendency to strive towards self-actualisation (fulfilling potential)

must meet hierarchy of needs first

criticisms of maslow’s hierarchy of needs

concepts defined subjectively

hard to test

traits vs types

types = rigid categories

traits = continuum

humoral theory

characterise personality based on what humor (fluid) in excess in body

yellow bile = choleric (bad tempered)

black bile = melancholic (gloomy)

too much phlegm = phlegmatic (sluggish)

too much blood = sanguine (cheerful)

Dimensions of personality

adjectives describing temporary states relating to personality

using factor analysis btwn 3-16 dimensions

Raymond Cattell

16 pf

Neil McCrae and Paul Costa

Big 5 (OCEAN)

Openness - intellectually curious and unconventional

Conscientiousness - careful and responsible

Extraversion - social and lively

Agreeableness - easy going friendly

Neuroticism - tense and moody

measured by NEO-PI (pi = personality inventory), a self report measure (can’t tap into unconscious aspects of personality)

Big 5 across cultures

CPAI in china

considerable overlap w big 5 but not completely

• some dimensions are dependent on culture while some are universal

Hans Eysenck

3 bipolar dimensions

Introversion to extraversion

neuroticism to emotional stability (relaxed, at peace)

psychoticism (aggressive, egocentric, antisocial) to self-control (kind and considerate, obedient of rules)

temperament determined by combination of the 3

Jeffery Gray

Biopsychosocial theory of personality

• BIS behavioural inhibition system

  • sensitivity to punishment and motivation for avoidance

  • looks like introversion

• BAS behavioural approach system

  • sensitivity to reward and motivation for approach

  • looks like extraversion

These affect arousal system

What is BAS

behavioural approach system

3 bipolar dimensions - Neuroticism to what?

Emotional stability

3 bipolar dimensions - Psychoticism to what?

self-control

phrenology

looking at bumps on head (early personality assessment)

physiognomy

looking at facial features (early personality assessment)

Objective tests

questionnaires like 16pf, NEO-PI, MMPI with objective results

• designed to detect deception and social desirability bias but not perfect

Projective tests

involve subjective judgment - low reliability and validity

Thematic Apperception Test

present ambiguous stimuli and ask ppl to describe

unconscious personality desires are supposedly projected

used to establish rapport btwn therapist and patient who doesn’t want to open up directly

What is personality?

Character traits that identify what makes a person who they are

consistent pattern of behaviours, thoughts, emotions that define individuals

What are the two approaches to studying personality?

Nomothetic - generalising (quantitative)

Idiographic - individual centred (qualitative)

Causes of personality

Genetic (e.g., neurotransmitter activity)

Shared environmental (e.g., culture, parenting)

Non-shared environmental (e.g., life events, friend groups)

Do shared or non-shared environmental factors play a bigger part in determining personality?

non-shared

nature and nurture

nature (genetics) and nurture (environment) combine to create personality.

genetics provide stable foundation for personality, non-shared environmental influences allow for flexibility and change

psychodynamic approach to personality

interaction btwn id, ego and superego (two subsystems, conscience and ego ideal)

ego regulates pleasure principle (id) and perfection principle (superego), often leading to internal conflict

psychosexual stages

how the interaction btwn id, superego and ego was thought to develop. Conflict btwn biological drive centred around erogenous zones and societal expectations

• lack of empirical evidence

• focus on sexuality

• culture and gender bias

• subjectivity

Types of measurement

aptitude - potential

achievement - proficiency at a learned skill

intelligence - general cognitive function or specific cognitive abilities

personality - enduring personality characteristics

Evaluating tests

standardisation

• consistent administration

• clear rubric

• appropriate level for audience

reliability

• test-retest consistency

• internal consistency (across the questions)

• clear, unambiguous questions

validity

• content (do questions represent content)

• criterion (does it align with other measures)

• construct (does it measure what it intends to measure?)

Bias

• cultural/language bias

• accessibility to learning disabilities, visual/auditory

• avoid trick questions

Binet and Simon

gave children tasks that children of certain ages should be able to complete to measure intelligence - see if anyone struggling

Stanford-Binet

Re-standardised and translates binet and simon’s questions to english

Initial definition of IQ

Old definition of IQ

(mental age/chronological age) * 100

Modern IQ scaling

performance relative to age normed standardised data

mean of 100

sd 15

Wechsler Adult Intelligence Scale groups of intelligence

Verbal comprehension

Perceptual reasoning

Working memory

Processing speed

General intelligence

Single thing that underlies all abilities, overarching cognitive factor

IQ tests reflect G

Spearman

Two-factor theory

G and S - specific factors that are unique to individual tasks

Multiple intelligences

Domain specific talents or attributes

Horn and Cattell

generally accepted model of multiple intelligence

gf and gc

gf - fluid intelligence

• ability to solve new problems

• inbuilt intelligence

gc - crystallised intelligence

• accumulated knowledge and skills

CHC model

Carroll combined with Horn and Cattell

Top stratum

• G

Stratum II

• Broad abilities - Gf, Gc

Stratum I

• Each broad ability divided into specific narrow abilities

Prevalence of schizophrenia

0.5-1%

Onset of schizophrenia

Younger in males (21) vs females (27)

Suicide risk % for schizophrenia

5%

suicide risk factors for schizo

• male

• younger

• higher education

• family history of suicide

• comorbid substance use

• depressive symptoms

• prior suicide attempts

• low SES

Direct vs indirect costs

direct = resources used, GP hospital visits

indirect = DALYs, value of production ppl w disease and those caring for them lost

Positive symptom

behaviour that occurs too much

negative symptom

behaviour in deficit

Diagnostic criteria for Schizophrenia

2 or more symptoms present for 6+ months, 1+ months of active symptoms

Symptoms of schizo

delusions

hallucinations

disorganised speech

grossly disorganised or catatonic behaviour

flat affect

alogia

avolition

lack of self care/personal hygiene

Types of delusions

grandeur - believe you have something that makes u superior

persecution - someone is out to get you

hallucinations

false sensory experiences

neologism

person makes up word (can be combo of two real words)

word salad

throwing words together in a way that doesn’t make sense