Psychopathology Test two MILLER

generalize the "real world" for internal validity

we include only individuals with depression, no other comorbid disorders

generalize the "real world" , hurts external validity

uncommon to see depression without anxiety

researchers work hard to balance the competing needs of internal and external validity

one way to do so, design multiple studies

statistical methods

branch of mathematics

helps to protect against biases in evaluating data.

statistical significance

are the results due to chance

size of effect (difference in means)

level of significance (p value)

sample size

clinical significance

-are results clinically meaningful?

subjective, not just objective

statistical significance does not imply

sample of 200, find that exercise reduces depression by 2 points of a rating scale of 1-25

clinical meaningfulness

balancing statistical vs clinical significance

evaluate effect size (statistical measures that tell the magnitude of effect but focuses less on sample size)

a true experiment requires

a randomly assigned group

an independent variable (manipulated)

Nature of the Case Study

- Extensive observation and detailed description of a client (study this person intensively)

- Foundation for early developments in psychopathology

limitations of the case study

- poor internal and external validity

-lacks scientific rigor and suitable controls

-often entails numerous confounds (findings unique to the individual, more interference from "researcher")

The nature of correlation (research by correlation)

statistical relation between two or more variables (does not tell causation)

no independent variable is manipulated

Correlation and Causation (research by correlation)

- Problem of directionality (i.e. self esteem and

exercise) and third variable problems

- Correlation does not mean causation

Nature of Correlation and Strength of Association

- Range from -1.0 to +1.0

- Negative vs. positive correlation

Why use correlational studies?

can't randomly assign individuals to groups and can't manipulate the IV

epidemiological research

study incidence, prevalence, and course of disorders-looking for clues about the disorder

incidence

number of new cases during a specified time

prevalence

number of people with a disorder at any given time

distribution

more or less common in certain populations

epidemiological research can determine

what factors are associated with frequency of disorders

nature of experimental research

Manipulation of independent variables

Random assignment

Attempt to establish causal relations

really solid on internal validity

nature and purpose of control groups

necessary to show that IV is responsible for observed changes

should be nearly identical to treatment group

what could you not rule out if you didn't have a control group?

need to show that independent variable is responsible for observed changes

Placebo group

group ensures that treatment effect isn't due to expectation that one will improve

How does placebo work in psychotherapy?

easy to do with medications; less so with psychological treatment

comparative treatment designs

Type of group design: often next step after showing that treatment is better than placebo

Compare different forms of treatment in similar people ( e.g., psychotherapy vs medication vs combination)

Addresses treatment outcome (did change occur)

dismantling studies

break study into parts and remove or focus on certain aspects. Necessary to figure out the "active" components of the treatment

external validity and internal validity for single case experimental designs

internal: pretty good (more important than external anyways)

external: not great cuz it's still one person

single-case experimental design

"systematic study of individuals under a variety of conditions"

rigorous study of single cases; manipulations of experimental conditions and time

repeated measurement (rater than just once before and after treatment- like larger studies)

great for internal validity

regression to the mean

If the first measurement is extreme, second measurement will be closer to the mean

Types of single subject designs

Withdrawal designs

Multiple baseline designs

withdrawal designs

baseline (depression)

treatment (e.g., Zoloft); Assess depression

withdrawal (stop medication): Assess depression

Assets: better sense if treatment caused changes

Liabilities: remove a treatment that might be helpful; risk relapse; impossible to "withdraw" most psychological treatments (once learned, can't force patient to unlearn them)

multiple baseline design

don't stop and start treatment

instead, start intervention at different times across settings (home vs school) or behaviors (hitting; talking back; doing homework)

assets: don't have to withdrawal treatment

liabilities: still making conclusions on the basis of a small number of people

behavioral genetics

interaction among genes, experience, and behavior

phenotype vs genotype

Down Syndrome

phenotype (mental retardation, slanted eyes, thick tongue); genotype (extra 21st chromosome)

Strategies used in genetic research

family studies

adoptee studies

twin studies

genetic linkage and association studies

family studies

examine behavioral pattern/emotional traits in family members (e.g., schizophrenia; alcohol use)

just tells us correlation, not environmental effects

adoptee studies

Allow separation of environmental from genetic contributions

are children more like adoptive parents or biological parents?

number of studies looking at crime via adoption studies

(in general, research suggests some heritable component)

twin studies

evaluate psychopathology in fraternal vs identical twins

risk of developing schizophrenia in twins

monozygotic twins: 48%

dizygotic twins (fraternal): 78%

equal environments assumption

The assumption that the environments experienced by identical twins are no more similar to each other than are the environments experienced by fraternal twins. If they are more similar, then the greater similarity of the identical twins could plausibly be due to the fact that they experience more similar environments rather than the fact that they have more genes in common.

Genetic wide association studies

locate site of related genes

how does the problem or behavior change over time?

If not stable (e.g., normal response to environment and likely to "go away" soon), may choose not to intervene

Alternatively, if viewed as "too stable", might choose not to intervene or what we try to change

Studying behavior over time helps us understand precipitating factors for the manifestation of a disorder

studying behavior over time is important in prevention research

studying of risk factors for development of disorder (biological, psychological, environmental)

studying behavior over time is important in treatment research

What helps individuals recover (e.g., psychoeducation, emotional support, medication, behavioral activation)

cross sectional designs

Take a cross section of the population across different age groups and compare on a certain characteristic

tell us little about how problems develop BUT can tell us that two variables are related

not causal

example of cross-sectional design

substance use

cohorts

participants in each age group of a study with a cross-sectional design

member of cohort

same age, same historical time - exposed to similar experiences

cohort effect

confounding effect of age and experience

major limitation of cross-sectional designs

longitudinal designs

follow one group over time and assess changes in individuals

gets us closer to understanding causality (order of relationship; depression leads to fewer friends vs fewer friends leads to depression)

does a longitudinal design have a cohort effect?

no

why are longitudinal designs low in external validity?

following the same group of people, not very generalizable

attrition

a natural loss of individuals to follow up for a study

big issue with longitudinal studies

lose some of your statistical power in order to reject the null hypothesis

what factors could affect attrition

drug use

lower education people (just doing it for money)

problems with longitudinal designs

-long time

-$$$

-must worry about

participant attrition

-cross-generational effect

- study topic may no longer be relevant by the time study is complete

cross-generational effect

may not be possible to generalize study effects to other groups whose experiences are quite different

issue with external validity

W.E.I.R.D

Western, Educated, Industrialized, Rich, Democratic

Value of Cross-Cultural Research

studying abnormal behavior from various cultures can be informative: tells us about origins and treatment of disorders from different perspectives

overcome ethnocentric research

cultural bound syndromes

disorders found only in particular cultures

ex. eating disorders found in westernized cultures (bulimia specifically)

overcoming ethnocentric research

predictors of substance use in white adolescents, not necessarily the same for black adolescents

Issues in Cross-Cultural Research

must clarify how psychopathology manifests in different ethnic groups (same terminology may "look" or "feel" very different across cultures)

nonwestern cultures tend to emphasize aspects of depression (changes in appetites, sleep, or energy)

different thresholds for abnormal behavior

treatment exists within cultural context

components of a research program

-no one study will definitively answer the question

-studies proceed asking slightly different questions, using slightly different procedures

-conducted in stages, often involving replication

-scientific knowledge typically builds incrementally

-replication is vital!!

anxiety

-future oriented mood state

-characterized by marked negative affect

-somatic symptoms of tension

-apprehension about future danger or misfortune

Fear

- Present- oriented mood state

-Immediate fight or flight response to danger or threat

-Strong avoidance/escapist tendencies

-abrupt activation of the sympathetic nervous system

Anxiety vs. Fear

Anxiety - Apprehension about future threat

Fear - response to an immediate threat

Anxiety and Fear are ________ emotional states

normal

characteristics of anxiety disorders

-psychological disorders: pervasive and persistent symptoms of anxiety and fear

-involve excessive avoidance and escapist tendencies

-causes clinically significant distress and impairment

specifier (DSM)

extension to the diagnosis that further clarifies the course, severity, or special features of the disorder or illness

what is a panic attack?

abrupt experience of intense fear or discomfort

accompanied by several physical symptoms

DSM-5 types of panic attacks

expected and unexpected

expected panic attack

happens in context of obvious cue or trigger

may be seen more in phobias

unexpected panic attack

un-cued. may occur without any obvious external trigger

panic attack specifier can be used for

any diagnosis in DSM-5 anxiety or other

diathesis-stress

-inherit vulnerabilities for anxiety and panic, not disorders

-stress and life circumstances activate vulnerability

biological causes and inherent vulnerabilities

-anxiety and brain circuits- GABA, noradrenergic, and serotonergic systems. lower levels (GABA, serotonin)- more anxiety; higher levels (noradrenaline)-more anxiety

behavioral inhibition system (BIS)

activated by signals from the brain stem of unexpected events, such as major changes in body functioning that might signal danger

when BIS is activated

we tend to "freeze", experience anxiety, and anxiously evaluate environment for signs of danger

BIS thought to be distinct from circuit involved with panic

different than fight or flight system

Fight or Flight system

when system aroused, it produces an immediate "alarm and escape" response

environmental factors may change the sensitivity of the brain circuits, causing one to be

more or less apt to develop an anxiety disorder

Freud (psychological contributions to anxiety and panic)

anxiety is a psychological reaction to danger (but tied to early infant/childhood fears)

behaviorist views

anxiety and fear result from classical and operant conditioning and modeling (vicarious learning)

Psychological views (pertaining to psychological contributions to anxiety and panic)

- early experiences with uncontrollability and/or unpredictability

-parents, can, through their behavior, pass on lesson that the child has some impact on their environment AND that the child can cope with a world that is unpredictable

neurotic parents

helicopter parents

social contributions

-stressful life events trigger vulnerabilities

-many stressors are familial or interpersonal

comorbidity of anxiety disorders

common across anxiety disorders

approximately 50% of patients with an anxiety disorder have another secondary diagnosis

- major depression is most common secondary diagnosis

Comorbidity suggests

common factors exist across anxiety disorders ( and possibly between anxiety and mood disorders)

evidence suggests a strong link between anxiety and

depression

DSM-5 Anxiety disorders

Generalized anxiety disorder (GAD)

Specific phobias

Agoraphobia

Social anxiety disorder

Panic disorder

separation anxiety disorder

selective mutism

obsessive-compulsive and related disorders

Obsessive compulsive disorder

body dysmorphic disorder

hoarding disorder

trichotillomania

excoriation disorder (dermatillomania)

Trauma and stress related disorders

PTSD

acute stress disorder

adjustment disorder

reactive attachment disorder

disinhibited social engagement disorder

Generalized anxiety disorder (GAD): overview and defining features

excessive uncontrollable anxious apprehension and worry about a number of events or activities; worry and anxiety interfere with ability to function and or/cause distress

persists for 6 months or more (most days than not)

3+ symptoms of GAD (1 for children)

also have to have the definition

restlessness

easily fatigues

difficulty concentrating/ mind going blank

irritability

muscle tension

sleep disturbance

how is GAD different from "normal" worry?

more pervasive and distressing

lasts longer

occurs without triggers

worries come with physical symptoms

also associated with somatic symptoms such as GI distress and exaggerated startle response

GAD Facts & Statistics

affects 3% of the general population

females outnumber males about 2:1

onset is often insidious

median age of onset is 30 (when it is usually diagnosed)

prevalence peaks in middle age, declines later in life

symptoms tend to wax and wane across life

full remission is rare

earlier onset is associated with greater comorbidity and impairment

Causes of GAD - genetic factors

accounts for 30% of the variability

Causes of GAD - temperamental factors

high behavioral inhibition; neuroticism

Causes of GAD - environmental factors

Not clear in DSM; overprotection (G-E correlation?), childhood adversities

Causes of GAD - cognitive factors

highly sensitive to threat- especially threat that has personal relevance

appear to allocate more of their time attention to these cues but in automatic manner