PSYCH 303 Exam 3

What kind of parenting/family life is associated with the development of CD?

• Insecure attachment between parents and children

• characterized by rejection, harsh and inconsistent discipline, lack of monitoring, and parental neglect

• Also low SES, poor neighborhoods, parental stress and depression are associated

What is “the cohesive family model” of CD?

• The disorder is conceptualized as being reinforced/maintained by parenting

• Places treatment on the interaction between children and parents

What types of interventions seem helpful for the treatment of CD?

• Psychological approaches that target risk factors, like the cohesive family model

• Parent management training (learning to manage children’s behaviors more effectively)

• Teaching the child social problem-solving skills

• Prevention programs for kids at risk of developing CD

What is a neurodevelopmental disorder according to your book?

• a group of conditions that has early onset and a persistent course that results from disruptions to normal brain development

• MUST onset during childhood (different than conditions like anxiety and depression in this way)

Dopamine Dysfunction

What differences did scientists find between how Ritalin affected patients with ADHD vs. controls? 

• Ritalin administered to people with ADHD and without led to similar increases of dopamine in their brains.

• Both groups had equal improvements on concentration with the drug, too

Dopamine Dysfunction

How did these findings challenge the assumption that ADHD is a result of dopamine dysfunction?

• Dopamine receptor levels were similar in patients with and without ADHD, which suggests that people with ADHD don’t have dopamine deficiencies any more often than poor concentrators without ADHD 

Treating adults with ADHD

In general, what are the clinical guidelines for treating children with ADHD (as described in this article)?

• Rigorous psychiatric testing that rules out other disorders

• Get reports about the patient from teachers and parents

• Treatment: behavior management and sometimes medication

Treating adults with ADHD

How do ADHD symptoms tend to differ in adults vs. children?

• Less physical hyperactivity seen in adults with ADHD

• More emotional or organizational problems in adults

• Might affect work or romantic relationships instead of school

Treating adults with ADHD

Why would assessing ADHD in adults be different than assessing ADHD in children?

• Might affect work or romantic relationships instead of school

• Relies on self-reports instead of parent/teacher reports

• Symptoms tend to be masked by other cognitive issues that arise in adulthood like depression or hormonal shifts

• Since it is a relatively new diagnosis, many psychiatrists are not trained in diagnosing or treating it, leading to inadequate treatment

Psychiatrists Reach Out to Teens of Color

Describe the general pattern of race-related biases in diagnosis presented in this article. Why are these types of misdiagnoses concerning in terms of outcomes for children?

• Children of color are more likely to be diagnosed with a disorder involving hostility or disruptive behaviors than white children because of stereotypes, even though symptoms may be more reflective of PTSD, depression, or anxiety

• This can lead to the wrong type of care/treatment and stereotypes about “hostile” kids among the justice system and at school

What are the characteristics of a neurodevelopmental disorder?

• Affecting the growth or development of the brain

• Typically manifests early in development (before school), has a persistent course

• Range from global to very specific

• Frequently co-occur within the category

What are the major categories of ADHD symptoms? Give examples of behaviors that fall under each category

• Inattention symptoms (ex. trouble following directions, bad attention to detail, trouble staying on task, distractable, etc)

• Hyperactivity/impulsivity symptoms (ex. Fidgeting, don’t enjoy quiet leisure, very talkative

In addition to having six of the inattentive and/or hyperactive/impulsive symptoms for ADHD, what additional criteria must be met for this diagnosis?

• Symptoms must present in 2 or more settings (not just in school)

• Symptoms must be disruptive and developmentally inappropriate for their age

• Symptoms must present before age 12 (used to be 7)

What are the three subtypes of ADHD? Which is most common?

• Combined type:

  • Most commonly diagnosed even though it requires the most symptoms (6+ inattentive and 6+ hyper/impulsive)

• Predominant inattentive

• predominant hyperactive-impulsive

Describe the pattern of differences in rates of ADHD diagnoses between boys and girls and possible reasons for this gap.

• More boys than girls are diagnosed

• Boys more likely to have hyperactive, girls more likely to have inattentive

• Possible reasons:

  • Maybe boys have more disruptive symptoms and are more likely to be sent in for assessment, while girls have more inattentive symptoms

  • Boys more likely to have learning disabilities and behavior disorders, so often they are diagnosed with ADHD while being treated for something else

What is the DSM’s perspective on the role of childhood symptoms in diagnosing ADHD in an adult? How does this perspective clash with the longitudinal data presented in class (both about ADHD diagnosed in childhood vs. adulthood and about fluctuating ADHD)?

• What the DSM says: 

  • ADHD must begin in childhood, even if it is not identified until adulthood - it cannot be diagnosed if you did not have symptoms before age 12

    • If symptoms show up after age 12, it is something else (like depression, substance use, etc)

• Clashes: in the longitudinal study…

  • Participants were made up of some had childhood ADHD, some didn’t

  • Assessed kids to see if they had ADHD, then blindly assessed them again as adults, and almost all with ADHD as kids did not get an adult ADHD diagnosis

  • Then assessed adults with ADHD and tried to see if they had ADHD as kids - most did not

What concerns are associated with stimulant medications used to treat ADHD?

• Concerns on stimulants:

  • 300% increased usage of stimulants over the past few decades - maybe bc more diagnoses, maybe because more access to meds

  •  People also worried about the increase in prescriptions for preschoolers and toddlers - it’s basically untested on them - not so common but it definitely happens 

  • 1 in 10 US boys taking stimulants - as high as 23% in some areas

  • Up to 30% of stimulants end up in other people’s hands

Are stimulants effective? Is there evidence for a “paradoxical effect” of these medications?

• Effectiveness:

  • Stimulants have a high quitting rate, very few continue taking them past one year

  • They help kids behavior in the classroom visibly

  • But it's not that clear that it actually helps learning - short term boost in learning outcomes, but not forever - doesn’t mean we shouldn’t use them though

  • Subgroup of kids which stimulants don’t work at all 

  • Great outcome immediately, but it tends to fade

• Paradoxical effect:

  • The paradoxical effect is that stimulants usually hype kids up, but in kids with ADHD, it calms them down

  • In reality, stimulants have the same effect on all kids (it makes it easier to pay attention to boring things), but kids with and without are starting from a different baseline so effects look different

When experiencing hallucinations, where do people with schizophrenia show elevated brain activity? What does this suggest about the nature of hallucinations?

• Shows increased activity in Broca’s area - an area of the frontal lobe that is involved in speech production rather than the area involved with speech comprehension

• Suggests that hallucinations occur when patients misinterpret their own thoughts as coming from another source

How do schizoaffective disorder, schizophreniform disorder and brief psychotic disorder differ from schizophrenia (in terms of diagnostic criteria)?

• schizoaffective disorder: psychotic symptoms that meet criteria for schizophrenia + marked changes in mood for a long time (like symptoms of severe mood disorder)

• schizophreniform disorder: schizophrenia-like psychoses that last at least one month but not for longer than 6 months and therefore do not get a diagnosis

• brief psychotic disorder: sudden onset of schizophrenic symptoms for only a few days, therefore does not get the full diagnosis

Explain the schizophrenia research findings with respect to the offspring of non-diagnosed discordant MZ twins.

• Researchers looked at MZ twins who were discordant (one with schizo, one without)

• Question at hand: if schizo is genetic, both twins should carry the gene for it, even though only one got sick

• They looked at the kids of the healthy twin to see if they developed schizophrenia at higher-than-normal rates

• Yes - 17.4% of those kids developed schizophrenia, which is much higher than the general population

• This provides evidence for genetic predisposition to schizo, more so than environmental factors

What is the evidence for the “virus” theory of schizophrenia? Explain how the difference between monochorionic and dichorionic twins is relevant to this theory

• In Helsinki after a big flu outbreak, more schizo was found in children whose mothers had their second trimester during the outbreak - but we don’t know if the mothers had the flu or not

• A later replication found that children of mothers who had the flu during pregnancy showed huge increased risk of schizo

• The higher rate of schizo in MZ than in DZ twins might be because some MZ twins are monochorionic (share a placenta and blood supply) and therefore can share infections

When researchers reviewed home videos of individuals who later developed schizophrenia, what factors seemed to predict the disorder?

• Facial and emotional expressions (less positive facial emotion and more negative facial emotion 

• Motor abnormalities (unusual hand movements)

Describe the schizophrenia research findings with respect to P50 suppression.

• People with schizo have poor P50 suppression/sensory gating (meaning their brain doesn’t dampen responses to repeated sensory stimuli - they react just as much to a second click than the first one, which normal people don’t do)

• Have trouble with both basic and higher-level cognitive processing

What do findings of enlarged brain ventricles among those with schizophrenia indicate?

• People with schizo have enlarged brain ventricles, indicating less total brain tissue/volume

• The decrease in brain volume is present very early in the illness, indicating that some brain abnormalities might predate the illness rather than develop as a side effect - perhaps even play a causal role

Describe the “immaturity hypothesis” of ADHD.

• delay in cortical thickening - their brains are a little younger than other kids their age, but they will catch up eventually

• Possible causal factor of having ADHD

What causal factors seem linked to the development of ADHD?

• It has moderately high heritability

• Possibly immaturity hypothesis - delay in brain development

• Prenatal factors - there are many that increase risk for ADHD, but it’s not necessarily specific to ADHD, can be other disorders too (preeclampsia, drug/alcohol use, etc, etc)

Describe the difference between conduct disorder and oppositional defiant disorder in terms of diagnostic criteria

• CD:

  • More severe and violent than ODD

  • Persistent pattern of behavior in which basic rights of others or age-appropriate societal norms are violated (hurting people, stealing)

• ODD: 

  • more emotional than CD, less severe

  • Pattern of angry/irritable mood, argumentative/defiant, vindictiveness

What kinds of outcomes are common later in life for children with a CD diagnosis?

• Many will go into the criminal justice system, have issues with jobs, have issues with domestic violence

• The earlier the serious behavior happens, the more worrisome bc it will be persistent

What have scientists found in terms of how children with CD/ODD respond to punishment?

• They have difficulty learning from punishment and tend not to care about being punished

What are two possible explanations for why ODD and CD are seen more in low SES areas? How did the “casino study” discussed in class shed light on these theories?

• Downward drift theory: if you have difficulty with impulse control/behavior, your SES will go down (bc job loss, jail, etc) - argument that it’s the behaviors that cause the poverty

• Social influence theory: social factors linked with poverty make it hard to parent and hard to be a kid

  • Casino study: longitudinal study on ODD/CD native american kids, some kids got a casino on their tribal land

    • Kids whose families got the casino (i.e. had more money now from jobs, community resources, etc), behaviors decreased

What types of parenting are associated with ODD and CD in offspring?

• abusive/rigid/extreme/absent parenting make CD more likely

What types of treatments are used for children with CD/ODD?

• moving is successful if kids have misbehaviors, but to some it’s not accessible

• parent training

Link between Pandemics and Psychosis

What types of findings/methods have linked the flu virus (or other viral infections) to schizophrenia?

• Patients with the flu developed a type of psychosis, but when they got over the flu it went away

• Babies born in winter/early spring (when mothers may have been exposed to flu) are more likely to develop schizophrenia

• Higher rates of schizophrenia in people born during the pandemic

• How does it work? Flu could interfere with fetal development through mothers immune system? Or flu could bring on an autoimmune disorder that interacts with brain?

Link between Pandemics and Psychosis

What is the possible explanation for why viral exposure might increase the risk of developing schizophrenia?

• Infections during pregnancy can cross the placenta, so the infection can get into the fetus’s brain and alter growth of brain cells

• Or with the flu, since it doesn’t infect fetus’s brain, makes lots of inflammatory molecules that can still alter the baby’s brian even if the baby doesn't get the virus

New way to treat people after first schizophrenia episode

What are the components of this “new” type of treatment?

• Psychotherapy, medication, supported employment and education, help for families, and case management

• It is critical that it begins right after the first episode

Doctors gave her antipsychotics

This article describes how antipsychotics (both first and second generation) have been a disappointment to practitioners and patients. Why? What are their downfalls?

• Maintenance on them can cause worse symptoms and brain atrophy

• Many patients quit usage because the side effects are so unbearable - diabetes, weight gain, stupor, tics, 

• They thought second generation would be better with less side effects, but they weren’t really

What is a delusion? What are delusions of reference?

• Delusions are fixed beliefs that are held with certainty

• Delusion of reference: thinking something broad is specific to you, like a radio broadcast

Describe the negative, disorganized, and cognitive symptoms of schizophrenia discussed in class.

• Negative symptoms: social, motivational, speech and emotional blunting

• Disorganized symptoms: disorganized behavior, disorganized speech

• Cognitive symptoms: impaired memory, attention and executive function

What are the key DSM diagnostic criteria for schizophrenia?

• You must have either delusions, hallucinations or disorganized speech

• You must have significant impairment in social/occupational functioning

• Other common ones are disorganized/catatonic behavior & negative symptoms

What are “prodromal” symptoms of schizophrenia?

• early, subtle changes in thinking, emotions, and behavior that occur before the onset of full-blown psychosis

• Unusual beliefs, perceptual changes, functional decline (withdrawal/difficulties at work, school, relationships)

What environmental or pre-natal factors seem to increase the risk for schizophrenia?

• Infection/maternal illness, nutritional deficiency, season of birth, maternal stress, oxygen deprivation, etc, etc

How might adolescent brain development play a role in schizophrenia?

• When the brain is changing, there is more room for things to go wrong

• Regressive changes to the brain happen during adolescence -> synaptic pruning (gets rid of unused synapses) -> it can go to far which is linked to schizophrenia

What are the differences between first generation and second generation antipsychotics?

• 1st gen antipsychotics

  • Will sedate you at really high doses

  • They block D receptors 

  • Pretty good at treating hallucinations fast -> not as fast for delusions

  • Pretty severe side effects: 

    • can cause movement disorders (tardive dyskinesia -> doesn’t go away after you have it)

• 2nd generation (“atypical”) antipsychotics:

  • Acts on serotonin (antagonists) and dopamine

  • Better for movement disorders, but big weight gain side effects (can develop into diabetes) 

For what types of symptoms are anti-psychotics most effective?

• Pretty good at helping positive symptoms, doesn’t affect negative symptoms at all, sometimes even makes them worse

What is tardive dyskinesia?

• A movement disorder that comes from use of anti psychotics

• It doesn’t go away after you get it

describe the proposed hybrid dimensional-categorical assessment model for PDs. Why was it abandoned by the DSM task force?

• They wanted to abandon the cluster approach because there are too many overlapping features across clusters

• The proposed dimensional method assumes that PDs have both categorical and dimensional components for each disorder

• The proposed changes were rejected, probably because it's a very complicated diagnostic system

Describe the research evidence for the link between schizotypal PD and schizophrenia.

• Many symptoms are similar to schizophrenia symptoms, like oddities in thinking, paranoia, ideas of reference, etc

• Many researchers characterize schizotypal PD as a lesser form of schizophrenia

• Teens with schizotypal PD are at increased risk for developing schizophrenia

Describe the research findings on ASPD and MAO-A.

• MAOA gene is involved in breakdown of NTs

• People with low MAOA activity were more likely to develop ASPD if they had experienced early maltreatment than people with high MAOA and maltreatment

Is there strong evidence linking BPD to childhood adversity/abuse? Explain.

• Childhood maltreatment and adversity increases risk for developing BDP in adulthood

• Also, people with the disorder usually report large numbers of negative/traumatic events in childhood

• Being exposed to stressors this early in life may compromise key brain circuits that are involved in emotional regulation

How is avoidant PD different from schizoid PD in terms of limited social relationships?

• Like schizoid, they have limited social relationships

• Unlike schizoid, they actually do want contact with others and desire affection - they are often lonely

Explain the findings regarding cardiac reactivity in successful vs. unsuccessful psychopaths.

• In a study, successful and unsuccessful psychopaths were asked to give a speech about their faults

• Successful psychopaths showed greater heart rate reactivity under stress than unsuccessful psychopaths

• Increased heart rate/reactivity may be beneficial in making decisions to ensure they don’t get caught

• Successful may have more intact information processing than unsuccessful

Describe the findings regarding psychopaths and fear conditioning/fear-potentiated startle.

• Unsuccessful psychopaths have more pronounced defects in amygdala

• Deficits in this may be linked to problems with fear conditioning

• They are slow at learning to stop behaviors to avoid punishment in experiments 

• They are not conditioned on the basis of punishment avoidance like most people

• Psychopaths also do not show a larger startle response when in an anxious state (like most people do)

Nine-year-old psychopath?

What are some risks associated with labeling a young child as a psychopath?

• Almost impossible to diagnose accurately in kids/teens because their brains are still developing and normal behavior can be misinterpreted at these ages

• Cost of stigma at such a young age is really high and will stick with them for the rest of their life since it is untreatable

Nine-year-old psychopath?

How do callous-unemotional children seem different from those with ADHD or CD?

• Kids with ADHD have poor impulse control, like CU kids, but feel bad when punished, while psychopaths do not

• CU kids caused more mayhem than ADHD who were more just disruptive

• ADHD kids are impulsive, and CD kids just hate rules, while CU kids use rules and expectations to their advantage to manipulate people

Nine-year-old psychopath?

Describe the findings regarding cold-blooded behaviors and the brain

• Cold blooded behavior has been linked to low levels of cortisol and below normal function in the amygdala - those parts of the brian are usually associated with processing feelings of shame and fear, which motivates people to behave - this causes their lack of aversion to punishment

Nine-year-old psychopath?

Why might treating these children with Ritalin be less than ideal?

• Since ritalin suppresses impulsive behavior, it might give CU kids the ability to plan more cruel and manipulative activities

When your child is a psychopath

What two possible “neural abnormalities” associated with psychopathy are described in this article?

• Limbic area contains less grey matter - its like the muscle is weaker - they may understand what they’re doing is wrong, but they don’t feel it

  • Esp smaller amygdala - may not be able to feel empathy or refrain from violence

• Overactive reward system (esp primed for drugs, sex, etc) with underactive breaks - engage in highly risky behavior because they seek reward but have no fear of punishment

When your child is a psychopath

Describe the treatment approach at Mendota

• They try to keep them out of the juvenile system and create reform through breaking the scale of pathology 

• The goal is to “wage an unrelenting war of presence” - they call this decompression - goal is to have them acclimate to a new normal without big changes to show that they don’t need to resort to violence

• They downplay punishment and play up rewards

The Bliss of a Quieter Ego

What is the “self-reflection paradox?”

• Self focus is an evolved trait because of competitive advantages in mating and survival, but being so focused on the self can also be a big source of unhappiness and maladjustment

• Our society supercharges self reflection to such an extent that it is running our lives

The Bliss of a Quieter Ego

Describe what it means to have a “quiet ego.”

• It is a balance between self focus and other focus - an identity that incorporates others without loss of self

• Includes traits like perspective taking, growth mindset and detached awareness/metacognition 

The Bliss of a Quieter Ego

What practical advice does the author offer for cultivating a quieter ego?

• Question the system that tells you to prioritize yourself before others 

• Ask yourself “what can i do for others? What can i better around me?” tell yourself “i might be wrong” “i am not my emotions”

What are the overall criteria for personality disorders (i.e., the criteria that are not disorder-specific)?

• Enduring pattern of experience/behavior that deviates from expectations in at least two areas

  • Areas: cognition, affectivity, impulsive control, interpersonal functioning

• enduring/inflexible across wide range of situations

• Clinically significant distress/impairment

• Must have shown signs back to adolescence/early adulthood

What are the guidelines with respect to diagnosing personality disorders in children?

• Only applied in unusual circumstances, must have seen features present for at least a year

  • No ASPD before 18 bc CD diagnosis exists

Describe the disorders in the odd-eccentric cluster.

• Paranoid PD:

  • Unwarranted suspicions, hypervigilance of loyalty/trust, reads hidden meaning into neutral things, associated with drug use, associated with head trauma, not rlly related to schizophrenia

• Schizoid:

  • Interpersonal relationships as unrewarding, messy, intrusive

  •  bit of overlap with autism

  • Some overlap with schizophrenia

  • Sometimes have transient periods of psychosis

• Schizotypal:

  • Socially isolated

  • Odd cognitions/eccentricities/speech

  • Shows similar cognitive deficits that are also seen in schizophrenia, like smooth eye tracking

  • Deficits with working memory/attention

Describe the disorders in the dramatic emotional cluster.

• Antisocial:

  • Diff from other PDs bc you need to have shown CD before age 15

  • Trouble conforming to social norms

  • deceitfulness/irritability/aggression

  • Lack of remorse

• Borderline:

  • “Borders” on other conditions, like psychosis and neurosis

  • Lots of combos of symptoms, so like depression, can look very different for diff people

  • Comorbid with depression, anxiety

  • Mild transient psychosis

  • unstable/intense relationships

  • Self damaging impulsivity

  • Suicidal idetaion/bheavior

  • Difficulty controlling anger

• Histrionic:

  • Needs to be center of attention

  • Sexually seductive/inappropriate behavior

  • Rapidly shifting emotions

  • dramatization

• Narcissistic:

  • Grandiosity, entitlement, needs admiration

  • Interpersonally exploitative

  • Want approval from others, like social media posts

Describe the disorders in the anxious fearful cluster.

• Avoidant:

  • Avoid others (similar to schizoids) but for diff reasons: want to be connected, but too fearful of criticism

  • Highly comorbid with social anxiety disorder - maybe just a chronic version of social anxiety disorder

• Dependent:

  • Difficulty making decisions without advice and reassurance from others

  • Excessive lengths to obtain nurturing

  • Not backed up by science as a diagnosis

• Obsessive compulsive PD:

  • Diff from OCD bc not true obsession or compulsions, its just your personality of interacting with the world - most don’t qualify for OCD diagnosis

  • High comorbidity with anorexia

  • perfectionism/rigidity/rules/schedules

Describe/explain the common criticisms of the concept of personality disorders and their diagnosis.

• Vague/subjective criteria (even compared to other disorders in the DSM)

• Way too much overlap/ very high comorbidity within PDs - PD NOS is most commonly diagnosed

• Too much diagnostic heterogeneity, like with borderline esp - suggest a problem with the diagnosis capturing the correct construct

• Reliability near zero

• Used in a pejorative way & it is stable/chronic - a PD is an enduring part of who you are, not what you have

• Lots of bias in diagnosing based on gender/racial/ses/cultural

What are the four main dimensions of psychopathy? How does psychopathy differ from a diagnosis of antisocial PD?

• Interpersonal factors, affective factors, lifestyle factors, and antisocial factors

• ASPD just focuses on the lifestyle and antisocial factors, while psychopathy encompasses both

How is psychopathy typically assessed?

• Hare psychopathy checklist of the four factors - score of 30+ means you have psychopathy

What are common characteristics of those with antisocial PD or psychopathy?

• high comorbidity with ADHD and CD

• Low levels of arousability - low resting heart rate, etc - need more stimulation to get aroused

• Low fear in threatening situations

• Constant stimulation seeking

• High reward sensitivity without fear

What are the key features of borderline PD?

• Immense amount of distress

• Several areas of instability: sense of self, in relationships

• High neuroticism, incredibly high hypersensitivity to criticism

• Inability to self soothe

• clinging/reassurance seeking

• Self harm

Describe dialectical behavior therapy.

• Uses goal hierarchy 

  • Stop behaviors associated with self harm and behaviors that mess up therapy first, then focus on behaviors impacting other areas of life

  • Techniques include: CBT, mindfulness, rogerian acceptance/unconditional positive regard, increase distress tolerance in patients

    • Can do through individual therapy, phone coaching/check-ins/texting, skills training group, team approach

  • Emphasizes building mentalization abilities 

    • Differentiating between your emotional state and that of others

    • Understanding how your mental state affects your behavior

What are the characteristics of a therapeutic alliance?

• (1) a sense of working collaboratively on the problem

• (2) agreement between patient and therapist about the goals and tasks of therapy

• (3) an affective bond between patient and therapist

Describe the 5 different ways of measuring success in therapy, and the weaknesses or strengths of each of these methods.

• (1) client evaluation

  • W: client not reliable because they may want to be better than they feel, may want to please the therapist, may want to feel like therapy is effective

• (2) clinician’s evaluation

  • S: more objective than client report

  • W: may be biased to see them succeed, has a limited observational sample

• (3) third party evaluation

  • S: more objective than client or clinician evaluation, third party evaluators with no connection are best

  • W: relatives may still be biased to improvement

• (4) objective measures (comparison of pretreatment and posttreatment scores on measures)

  • S: more objective than all human-facing evaluation

  • W: regression to the mean is prevalent here, sometimes lacking clinical significance

• (5) measures of change in overt behaviors

  • S: most objective, difficult to fake improvement

  • W: less appropriate for problems that aren’t easily observable, like bug phobia vs depression

What is manualized therapy? Why was it developed?

• It means creating a treatment manual to show how the therapy should be delivered and being trained/monitored to ensure clinicians are sticking to it

• It is as an attempt to minimize variability in patient outcomes that may result from inconsistencies in therapists and treatment

• Was created originally to standardize psychosocial treatments to fit the RCT (randomized control trial) paradigm

Describe the major approaches to behavior therapy (exposure, aversion, modeling, systematic reinforcement, token economies).

• Exposure therapy:

  • If anxiety is learned, it can unlearned through guided exposure to stimuli to facilitate desensitization

• Aversion therapy:

  • Modifies behavior through punishment, like snapping an elastic wrist band

• Modeling:

  • Client learns new skills by imitating another person who performs the desired behavior

• Systematic reinforcement:

  • Use reinforcement or elimination of reinforcement to increase desired behaviors or decrease undesirable behaviors

• Token economies: 

  • Earning tokens for good behavior that can be used for rewards

In what types of situations is neurosurgery still used today to treat psychological disorders?

• They are sometimes still used today as a last resort for patients who haven’t responded to anything else for 5 years and who are experiencing extremely disabling symptoms

• Ex: debilitating OCD, treatment resistant self injury, or severe anorexia

Overselling of Therapy

One of Jacobson’s arguments is that therapists should be more like physicians in terms of how they present treatment options. Explain this.

• They should provide patients with all viable treatment options with cost-benefit analyses, like physicians do

• Be familiar with recent literature

• Outcome evidence should be provided

• Progress should be assessed, and treatment should be stopped if its not working

Overselling of Therapy

Explain the difference between clinical and statistical significance. Why is this difference relevant to research evaluating whether psychotherapy is effective?

• Statistical significance does not equate to clinical significance because it doesn’t take into account contextual factors 

• Clinical significance is more about meaningful, real-world improvement

• Many treatments for disorders are statistically significant but not clinically significant (ex: antidepressants)

Overselling of Therapy

Does experience/training have an impact on the effectiveness of therapists? Explain.

• Outcomes are not improved by years of experience or years of professional training

• In a study on depressed and anxious students, professors did just as well as experienced clinicians in treating patients