PSYCH 2A03 - Abnormal Psychology Test #1

Abnormal psychology (psychopathology)

• The scientific study of psychological disorders 

• Focuses on behaviours that are atypical or unexpected 

• Devoted to understanding, treating, and preventing psychological dysfunction 

scientist practitioner model

• adoption of scientific methods

• consumer of science

• evaluator of practice

• creator of science

Defining abnormality (wrong way)

• Words like crazy or nuts

  • dismiss an dehumanize people who we consider different

  • Reinforce stigma among those with mental health issues 

Abnormality exists… (Continuum model of abnormality)

• on a continuum/line of human experiences

• On one side - Infrequent behaviours, on the other side - high behaviours 

  • Ex. Shyness exist somewhere on the line 

The 4 Ds of abnormality

1) dysfunction

2) distress

3) deviance

4) Dangerousness

Dysfunction

• Behaviours, thoughts and feelings are dysfunctional when they interfere with the person’s ability to function in daily life, hold a job, or to form close relationships 

• The more dysfunctional behaviours + feelings are, the more likely they are to be considered abnormal by mental health professionals 

  • Ex. believing you are Satan and should be punished makes it difficult to function in everyday life 

Distress

• Behaviours + feelings that cause distress to the ind or others around them are considered abnormal 

  • Ex. a man shows up in your lecture wearing only bikini bottoms 

• The person displaying abnormal behaviour is not in distress but are causing others distress 

  • I.e. stealing, chronic lying, violence 

Deviance

• Behaviour that deviates from the social norm 

  • Vary in terms of culture 

  • Are easy to spot 

Dangerousness

• Behaviours + feelings such as suicidal gestures have potential to bring harm to an ind 

• Excessive aggression could potentially harm others 

  • These are seen as abnormal 

Dangerousness

• Behaviours + feelings such as suicidal gestures have potential to bring harm to an ind 

• Excessive aggression could potentially harm others 

  • These are seen as abnormal 

The disease model of mental illness

• One way of looking at mental health disorders 

• Implies there's a biological origin*** 

  • However, in modern conceptualizations, mental disorders are not viewed as single diseases with a biological origin 

• MH experts view MDs as collections of problems in thinking or cognition, emotional responding or regulation, and in social behaviour 

Cultural norms 

• Context, or circumstances surrounding a behaviour influences whether the behavior is viewed as abnormal 

• Cultures have norms for what is considered acceptable behavior for men vs. women 

  • These gender role expectations influence the labeling of behaviours as normal and abnormal 

    • Ex. in many cultures men who display sadness or anxiety, etc. are at risk of being labeled as abnormal 

Cultural relativism

• The view that there are no universal standard or rules for labelling a behaviour abnormal; instead, behaviors can be labeled abnormal only relative to cultural norms 

  • Honours the norms and traditions of different cultures rather than imposing standards of one culture on judgements of abnormality  

3 types of theories used to explain AB (abnormal behavior) 

1) biological theories 

2) supernatural theories 

3) psychological theories 

biological theories 

• View AB as similar to physical diseases caused by the breakdown of systems in the body 

• Cure is restoration of bodily health 

supernatural theories 

• Viewed AB as a result of divine intervention, curses, demonic possessions + personal sin 

• Religious rituals, exorcisms, confessions + atonement 

• Atonement prescribed to rid the person of the perceived affliction 

psychological theories 

• Viewed AB as a result of psychological processes (i.e. beliefs, coping styles and life events like trauma, bereavement, or chronic stress) 

Ancient theories 

• Our understanding of prehistoric ppls conceptions of abnormality is based on inferences from archeological artifacts (fragments of bones, tools, artwork) + ancient writings abt AB.  

  • We’ve always viewed abnormality as smt needing special explanation 

The supernatural tradition 

• A person who acted oddly was suspected as being possessed by evil spirits

• AB caused by demons or witched 

  • Caused by stress or melancholy 

    • Weakened state 

    • Act in a way that’s unusual

• Belief that the moon and the stars were driving our behaviour 

  • Origin of the word lunatic 

• Treatment for abnormality was exorcism 

  • Driving evil spirits from the body of the suffering person

• Shamans + healers would  

  • recite prayers/incantations 

  • try to talk the spirits out of the body 

  • Make the body an uncomfy place for the spirits to reside 

Treatment during the stone age + middle ages 

• Drill holes in the skull of a person displaying AB to allow the spirits to depart 

• Archeologists found skulls with sections that had been drilled or cut away 

• Trephine 

  • Tool used for this trilling 

• Trephination 

  • What the operation was called  

• If the person survived the surgery, the evil spirits would have been released and the person’s AB would decline 

Medieval views

• Abnormality cause by things like shock, illness, or injury 

  • Could be attributed to biological (+ supernatural), traumatic events

• Ppl dealing with mental health problems were thought to be witches  

  • Witches were subjected to being burned at the stake 

  • Johann Weyer (1563) 

    • Argued that those accused of being witches were suffering from melancholy (depressions) + senility  

• Rise in psychic epidemics 

  • A phenomenon in which large numbers of ppl engage in unusual behaviors that appear to have a psychological origin 

    • During middle ages reports of dance frenzies/mania frequen

• Treatment 

  • Asylum  

    • Large building where ppl took care of ppl in the community with mental health problems  

Ancient China

• biological perspective 

  • AB due to imbalance of positive yin + negative yang

  •  Confronted + complimented each other 

  • 2 forces in balance - individual healthy 

  • 2 forces not in balance - would result in illness + insanity  

• Chinese medical philosophy - human emotions were controlled by internal organs 

Ancient Egypt, Greece + Rome 

• Greek physicians rejected supernatural explanations 

  • Hippocrates 

    • Argued that AB was like any disease of the body 

    • The body was composed of 4 basic humors 

      • 1) blood 

      • 2) phlegm 

      • 3) yellow bile 

      • 4) black bile 

  • Classified AB into 4 categories based on observation of patients + their dreams 

    • 1) epilepsy 

    • 2) mania 

    • 3) melancholia 

    • 4) brain fever 

  • Treatments intended to restore balance of the 4 humors 

    • Ranged from 

      • Psychological + intrusive 

        • Bleeding a patient 

      • Rest 

      • Relaxation 

      • Change of climate or scenery, etc 

• Hysteria

  • Wandering uterus 

    • Believed uterus wandered throughout female body 

    • Left them with unexplainable aches and pains 

    • Sadness or distress 

    • Apathy abt life 

  • Treatment 

    • Get married, get pregnant

19^th C - Syphillis 

• If not treated, leads to breakdown in mental stability 

  • Left untreated leaves ppl insane 

  • Doctors at the time noticed this pattern and watched the disease progress from being something located around the reproductive* organs to someone eventually losing their mental capacity 

  • Started to think about how mental health problems were related to very basic biological reasons 

1930s - Rise of biological treatment for mental health disorders

• Surgery used on ppl with mental health disorders 

  • Poke holes in brain  

  • Damaging frontal lobe – person loses their sense of self, personality, memories, word production ability 

  • Often calmed them down – bc. It turned them into a vegetable

• Saw our first psychiatric medications 

  • Big tranquilizers  

    • Targeting ppl with very disturbed behaviour (i.e. schizophrenia)  

    • Restrained in a medicated sense  

Asylums - 12^th C – until recent times 

• Mentally ill housed against their will in harsh conditions 

• Hospital of Saint Mary of Bethlehem (London) 

  • Nicknamed bedlanm 

  • Famous for deplorable conditions 

• Patients exhibited to the public for a fee 

• Lived in filth and confinement 

• Chained to the wall or locked inside small boxes 

• Asylums established by ppl who thought AB were medical illnesses 

Moral treatment in the 18th + 19th C (Asylums) 

• Growth of more humane treatment of ppl with mental health problems 

  • Known as mental hygiene movement 

• Treatment based on the psychological view that ppl developed problems bc they were separated form nature + succumbed to the stresses imposed by rapid social changes 

• Prescribed treatment 

  • Prayers + incantations 

  • Rest + relaxation in a serene + physically appealing place 

• Philippe Pinel  

  • Leader of the movement for moral treatment 

  • Believed forms of abnormality could be cured by restoring patients dignity + tranquility 

  • Ordered:  

    • patients be allowed to walk freely around the asylum 

    • Provided clean + sunny rooms 

    • Comfy sleeping quarters 

    • Good food 

The emergence of modern perspectives 

• 19^th C – knowledge of anatomy, physiology, neurology + chem of the body increased 

  • Advancement of knowledge focused on biological causes of abnormality 

• 1984 – Wilhelm Griesinger 

  • Argument – all psychological disorders can be explained in terms of brain pathology 

• 1883 – Emil Kraepelin 

  • Follower of Greisinger 

    • Developed a scheme for classifying symptoms into discrete disorders that is the basis of our modern classification systems 

The psychoanalytic perspective (Mesmer)

• Franz Anton Mesmer 

  • Believed ppl have a magnetic fluid in the body that must be distributed in a particular matter in order to maintain health 

  • The distribution of this fluid could be influenced by the magnetic forces of other ppl and the alignment of the planets 

• Mesmer's treatment focus 

  • Hysterical disorders 

    • Ppl lose functioning or feeling in some part of the body for no apparent physiological reason 

  • Mesmer touched patients realigning people's magnetic fluids through his own magnetic force 

• Methods known as mesmerism 

  • Induced his patients into a trancelike state later called hypnosis 

    • Under hypnosis his patients appeared suggestible and the suggestion that their ailments would disappear seemed enough to make them actually disappear 

Development of psychoanalytic theory (Freud)

• Conceptualized it as being in our minds unconscious (conflict in our mind that we are unaware of) 

• Psychoanalytic (psychodynamic) theory 

• Treat abnormal behaviour using hypnosis to try and pull out unconscious conflicts 

• Father of talk therapy  

  • First to say that if we talk abt our problems we'll feel better 

  • foundation for psychoanalysis   

    • Study of the unconscious  

The roots of behaviorism 

• Rely on behaviourism today as a cause of mental health problems 

• Unusual behaviour might be caused by patterns of reinforcement punishment

• Ivan Pavlov 

  • Classical condition

    • Developed methods and theories for understanding behavior in terms of stimuli an responses   

The cognitive revolution 

• Psych shifted its focus to the study of cognitions as a response to behaviourism (bc. it can be reductionist)  

  • Cognitions

    • Thought processes – like attention, interpretation of events and beliefs that influence behaviour and emotion 

      • Internal thought processes that mediate the relationship between stimulus and response  

    • Cognitions can be distorted 

      • The way that we think 

        • Ex. Eating disorder 

• Albert Bandura 

  • Contributed a great deal to the application of behaviours to psychopathology 

• Self-efficacy  

  • Referring to how we think about our own capabilities 

  • Have a lot of beliefs about our ability to control our behaviour and our actions 

    • Ex. Ppl with SUDs believe they have no control over what they're doing

Deinstitutionalization 

• Vocal movement called patients rights movement emerged 

  • These advocates argued that mental patients can recover more fully or live more satisfying lives if they are integrated into the community with the support of community based treatment facilities

• Community mental health movement 

  • Launched in 1963 by John Kennedy 

• The mental retardation facilities and community mental health center construction act (1963) 

  • Promoted the release of psychiatric patients from long term care facilities to short term and community mental health centers  

  • Result of this legislation 

    • Mass closures of psychiatric institutions and long term care facilities across the us 

  • Goal of the movement 

    • Offer less restrictive, more humane treatment options and provide coordinated mental health services to ppl in community mental health centers  

      • Had positive and negative consequences

Modern Mental Health Care 

• Breakthroughs made in drug treatments for some of the major forms of abnormality 

  • Discovery of a class of drugs that can reduce hallucinations and delusions (phenothiazines)

  • Made it possible for ppl who had been institutionalized for yrs to be released from asylums and hospitals 

    •  However, we saw ppl getting deinstitutionalized having to leave asylums and go to prison (incarcerated)  

      • Why?

        • bc. the right supports weren't in place, cost money

Managed care 

• Collection of methods for coordinating care that ranges from monitoring to total control over what care can be provided and paid for 

• Goals 

  • Coordinate services for an existing medical problem and to prevent future medical problems 

• Health care providers are given a set amount of money per member (patient) per month and then must determine how best to serve each patient  

Professions within abnormal psychology 

• Psychiatrists 

  • Have a MD degree and received specialized training in the treatment of psychological disorders 

  • Can prescribe medications for the treatment of these problems and are trained to conduct psychotherapies 

• Clinical psychologists 

  • Have a PhD in psych with a specialization in treating and researching psychopathology 

  • Or PsyD degree 

    • Doctoral degree from a grad program that emphasizes clinical training more than research training 

  • They conduct various forms of psychotherapy  

  • DO NOT prescribe medications 

    • They do have limited prescription privileges in some states, and psychologists are lobbying for prescription privileges in others 

• Marriage and family therapists (MFT 

  • Master level career 

  • Specialize in helping families, couples, and children overcome problems that are interfering with their well-being 

• Clinical social workers 

  • Master's degree in social work (MSW) 

    • Focus on helping people with psychological problems overcome social conditions that are contributing to their problems such as joblessness or homelessness 

biopsychosocial approach

• Overarching perspective that a clinical psychologist is gonna use when considering how disorder develops  

• Use this approach in looking at how behaviour is multiply determined 

  • Dif causes of behaviour 

• Anytime anyone has psychological symptoms, we have to think abt dif causes and how they interact with each other 

Biological factors that underline psychological disorders

• Genetic predisposition 

• Brain structure 

  • Abnormalities in the brain 

• Neurochemistry 

• Hormones 

• Autonomic nervous system function 

• Maternal viral infection 

  • When ppl who are pregnant, are exposed to viral infects at certain points, children are at higher risk of psychological disorders 

Psychological factors 

• Personality (ex. Being neurotic, sensation seeking, etc) 

• Predisposing factors that lead us into certain situations 

  • Ex. Say someone is drawn to interpersonal drama 

    • Put them at higher risk for experiencing stress and trauma which can lead to psychological disorders 

• Unconscious determinants 

  • Unconscious things going on in the mind that lead us to being vulnerable to psychological disorder 

  • The way you think abt the world 

    • Do you have a depressive cognitive set? Pessimistic? Optimistic? 

• Psychological stressors 

  • Increases the risk of developing a psychological disorder 

  • Coping strategies 

  • Social skills 

Social factors 

• Socio-environmental and socio-cultural 

  • May include race based systemic inequality 

  • Being a member of the non-dominant group in a culture 

    • Can cause you to have a higher risk for psychological disorder 

• Traumatic events 

• Marital conflict 

• Family dysfunction 

• Peer relationships 

• Cultural standards 

• Poverty 

  • Sets us up at more risk for mental health problems 

The diathesis-stress model of the development of disorders 

• Says there are 2 necessary components that have to be present in order to develop a psychological disorder 

  • 1) diathesis (same as saying a vulnerability) 

    • This vulnerability can come from psychological, social, or biological factors 

      • Ex. Biological vulnerability - genetic predisposition, maternal viral infection 

      • Ex. Social factors – growing up in very dysfunctional family environment 

      • Ex. Psychological - having some maladaptive cognitions 

        • Everything you see has a negative spin to it 

  • 2) Stress 

    • Biological trigger 

      • Ex. Exposure to toxins, ingesting cannabis can lead to schizophrenia and related disorders 

    • Social stress 

      • Ex. Traumatic event, loss of loved one, particularly if its unexpected 

    • Psychological trigger 

      • Perceived loss of control in your life, violation of trust  

• Says we need to have an underlying vulnerability and some kind of stress 

• Have both of these, at risk for developing a psychological disorder 

Diathesis-stress example

• Some ppl are more prone to psychological disorders than others 

  • Diathesis (dark brown)- Diathesis can be psychological, social, or biological 

    • Person A has a lot of diathesis (ex. genetic vulnerability) 

      • Has a genetic tendency to become an alcoholic  

    • Person B has less diathesis 

  • Stressor (lighter colour) - Stressor could be biological, social, psychological 

    • For both ppl, stressor is the same amount 

    • However, bc the first person has a higher level of diathesis that gets pushed over the red line, they're more at risk of developing a psychological disorder (alcohol use disorder 

      • Likely to be a combination of things (fact that your drinking + other stuff) 

        • Ex. Stress from school, being away from home, etc 

    • Other person doesn’t make it to that line because they don't have the strong vulnerability, even if they have the same stressor  

      • May have a little bit but not very much  

• Can assume both are drinking the same amount of alc, have same stressors but it’s the diathesis that changes the outcome 

Diathesis-stress example (extra notes)

• Diathesis + stress don't have to be the same (I.e. biological, social, psychological) 

  • Can be any combination of any factor  

• Say in this example, they have the same genetic tendency but for person B they have a small amount 

  • Which is why they don't make it to that threshold of disorder 

• Can assume both ppl are having the same amount of alc, same stressors but its because the diathesis is different, we see different outcomes 

• Could we swap it? 

  • Person A and B have the same amount of diathesis and the stressors be different 

    • Yes 

      • Ex. Both can have high degree of genetic vulnerability  

      • But say one of them lives in the Amish community where there's no alc. The stress becomes nothing so they won't get AU

Parts of the neuron (Neuroscience and biochemistry)

• Soma/Cell body 

• Dendrites

• Axon 

• Synaptic Gap 

• Receptor Sites 

Soma/Cell body 

• Also known as the soma 

• Powerhouse where the energy comes from

Dendrites

• Coming right off of cell body 

• They receive messages  

Axon

Has a long trunk that sends messages 

Synaptic Gap 

• Neurons in body don't touch each other, has a little bit of space 

• (In image) One end of an axon + dendrite 

  • Messages jump between synaptic gap 

  • Messages get sent form one end to the receiving dendrite  

  • Chemical messages being sent from one cell to another 

    • In order for them to be received they have to fit into the receptor sites 

    • Neurotransmitters and the receptor sites have to match shapes 

      • Like a key going into a lock, have to match perfectly 

Receptor Sites 

• On the dendrites of a receiving neuron, receptor sites have to match perfectly the shape of a neuron  

  • Ex. If its circular, it has to have a circular receptor site 

• Receptor neuron has only 5 sites where it can receive the neurotransmitter 

Function of the neuron

• If there are more neurotransmitter messages than 5 in the gap 2 things can happen:  

  • 1) Reuptake 

  • 2) Degradation 

• What happens to the neurotransmitters that bind to the receptor sites? 

  • If the receptor successfully receives the message, we start all over again from the first neuron 

    • Keeps going over and over 

Reuptake 

• Best case scenario is that the leftovers get taken in by the receptor sites 

  • Message has been received 

• Extras might get sucked back in to the sending neuron 

  • Side note: 

    • Selective serotonin reuptake inhibitors (depression + anxiety meds) 

    • What happening is its inhibiting the reuptake, meaning there's more serotonin in the synaptic gap  

Degradation

• If there's neurotransmitters in the synaptic gap that don't get received or taken up by the reuptake, they just sort of degrade in the synaptic gap 

  • Other cells (like garbage collectors) take that matter away eventually  

Neurotransmitters (new info)

Myth of chemical imbalance 

• More likely to be a problem of too many neurotransmitters in the synaptic gap OR the receiving neuron getting a double dose 

  • Problem with reuptake or degradation rather than a problem with too much or too little chemicals  

  • Problem with how chemicals are working inside the network 

Theory behind psychological disorders  

• Psychological disorders may be due to faulty receptor sites 

• Receiving neuron is getting too excited by the reception of those neurotransmitters and sending a message to the subsequent neurons that something big is happening when maybe it isnt 

• Delusions and hallucinations in schizophrenia may be due to too many dopamine receptors

4 types of neurotransmitters

1) Serotonin 

2) Dopamine 

3) Norepinephrine 

4) Glutamate and GABA 

Serotonin

• Or 5HT 

• Neurotransmitter/chemical message in the body that helps us to regulate mood 

  • Involved in depression, anxiety, aggression symptoms 

    • Not that there's too much or too little, but the receptor sites might not be working well 

Dopamine

• Neurotransmitter associated with pleasure + reward activity 

  • When you learn smt based on operant conditioning, dopamine levels are spiking in your brain 

  • Dopamine being flooded in your neurons 

• Highly affected by substances 

  • Putting in substances that make our brain feel good, there's no need to create dopamine inside us 

  • So if ppl are using ex. Cocaine, brain says it feels good and won't make dopamine anymore 

    • Leads to withdrawal symptoms 

Norepinephrine 

• Related to bodily functions + alarm responses 

  • Ex. Someone who gets startled easily 

    • Might mean there's something going on with norepinephrine or adrenaline in your body 

Glutamate and GABA 

• Inhibits some nerve impulses 

• Associated with anxiety disorders 

Endocrine system 

• Different glands in our body send hormonal messages throughout our body 

  • Hormones generally help us regulate emotions, mood, energy, and reactions to stress  

    • Those different messages have different jobs to help us deal with life  

The gene-environment correlation model 

• There's sometimes a genetic vulnerability that a person has that increases the likelihood of a particular stressor  

  • Goes hand in hand with biopsychosocial model 

    • Maybe there are some biological factors interacting with psychological or social stressors 

  • Ex. If a person is genetically more vulnerable to a blood phobia + has an impulsive personality, it can lead to more blood  

    • Impulsive personality means they're making decisions without thinking them through clearly  

      • Making irrational decisions leads to the presence of more blood which factors into blood phobia 

      • Will make it a stronger phobia and something that person will struggle with more 

Biological therapies  

• Drug therapies 

  • Meds that alter how that neurotransmitter system is working 

  • Often have adverse effects (side effects) 

    • Takes a few trials to find the med that works for you 

• Brain stimulation techniques 

  • Emerging field 

    • Noninvasive typically 

  • Ex. Electroconvulsive therapy 

    • Brain gets stimulated in one way 

    • Non evasive, see good results, for difficult cases 

    • Not first line treatment, for difficult cases 

• Psychosurgery 

  • Targeted small scale surgery done by lasers that can help really severe cases 

    • Ex. Severe OCD, depressive disorders 

The behaviourist perspective 

• How learning plays a part in the causes of disorders or therapy

• Can start to create behaviour therapy 

  • Here we see ppl getting reinforced for good behaviour, punished for bad sometimes 

  • Reinforcers + punishments might help to create new behaviours in somebody who has challenges with their own behaviour 

• Removal of reinforcements 

  • Heavy drug users, go to treatment therapy get told they need to find a new place to live, new friends, breakup with your person bc. Those things are associated with the drug 

    • If they try to do that sober it's really difficult to override your brain 

Behaviourism 

• Approach that focuses on observable behaviour, rather than on consciousness 

• Using these  

  • Classical conditioning 

  • Operant conditioning 

  • Modeling 

Aversion therapy (Behaviourism)

• Drug called Antabuse 

  • Person takes this, interacts with alc, take a drink, vomit uncontrollably 

  • Idea is that its aversive, positive punishment 

Systematic desensitization (Behaviourism)

• Say you have a phobia that’s bothersome and want to get treated for it (ex. Phobia of dogs)  

• Therapist systematically exposes you to the thing you're afraid of in every therapy session 

  • First session – look at a pic of a dog and try to sit with it and be exposed to that stimuli  

    • Exposing body to the thing that makes you feel afraid 

  • Second session – watch a vid 

  • Work your way up to having a dog sitting in your lap 

    • Systematically learning that you can be exposed to this feared stimuli and it's not dangerous 

Advantages of behavioural approaches 

• Set the standard for science 

  • Embraced the scientific method in psychology  

  • Taken that with us into modern day 

    • Rely on this type of perspective to help us explain certain symptoms in a lot of different disorders 

• Evidence comes from a lab as opposed to natural settings 

  • This can be a double edged sword 

    • Lab experiment gives us control over what we're studying but it's not always generalizable  

Disadvantages of behavioural approaches 

• Criticized for:

  • Bc it's not taking conscious thinking into play 

  • Not thinking abt how ppl have free will and make conscious decisions 

  • Looking at humans as animals merely reacting to their environment  

Cognitive theories 

• Looking at the conscious piece that behaviourists ignore  

  • Looking at free will, decisions we get to make because the frontal lobe allows us to do that 

• Emphasizing thoughts and beliefs here 

  • Means we focus on causal attributions and global assumptions 

    • Causal attributions 

      • The meaning given to an event and how that affects us 

        • Ex. Someone in our life dying 

          • We're going to attach meaning to that 

          • Might be "why did I lose that person?" 

      • Our interpretation of our life is really important in terms of how we think about it  

    • Broad assumptions of the world 

      • Play a part in how we think about ourselves in it 

Cognitive-behavioural therapy (CBT) 

• Beck thought we should take the cognitive perspective and bring it into a therapeutic context 

  • Maybe it's because of the way they think abt certain things  

  • Said that therapy should be driven by changing the way with think and behave 

• Therapist helps client understand + recognize that their thinking may not be serving them well 

  • Ex. Social anxiety 

    • Start every even thinking ppl will think they're weird, etc but the truth may not be that  

• Problem solving strategies 

• Designed to be short term 

  • 6-8 weeks sometimes 12 

Advantages of cognitive approaches

• Gold standard (best practice) for many types of disorders 

  • High level support that this therapy works for  

    • Sexual disorders 

    • Depressive disorders 

    • Substance use disorders 

Disadvantage of cognitive approaches

• Hard to show that the thoughts are what's driving the behaviour and not the other way around 

Psychodynamic approaches 

• Freud 

  • Didn’t want to be seen by client, didn’t want to impact what the client was saying 

• Goal 

  • Help clients recognize maladaptive coping strategies 

    • Similar to cognitive thinking 

      • Thought it had to do with unconscious concepts 

• Main idea 

  • By uncovering those conflicts and talking about how we felt would make us feel better  

    • Core of modern day therapy  

• Techniques 

  • Free association 

    • Would say a word, client says first thing that comes to mind 

  • Transference 

    • Concerned about this, still a concern in modern day 

    • Idea that the client somehow reacts the therapist in a certain way bc the therapist reminds them of someone in their life  

      • Ex. Reminded of grandparent 

        • Will transfer feelings  

  • Working through 

    • Main goal is to talk abt feelings, going over painful memories in order to emotionally resolve them  

Advantages of psychodynamic approaches

• The most comprehensive theory of human behaviour 

  • Freud spent a lot of time writing his ideas down 

    • Had a lot to say and gave us a lot to take into modern day 

  • Gave us a holistic view 

Disadvantages of psychodynamic approaches

• Because its theory, it's hard to test 

  • How do you measure unconscious conflicts if they're unconscious 

  • Can't impose/bring scientific method and use it to look at Freudian theory 

  • Using it as guiding principles + ideas 

• Long term nature makes it unaffordable for many people 

The humanistic paradigm 

• Idea is coming from a reaction to behaviourism  

  • Behaviourism said we're animals reacting to our environment 

• Carl Rogers –  

  • One of the early creators of the humanistic approach 

  • Carl said we're humans with really unique experiences 

  • Said that humans are innately good 

    • Most of us are inherently good people  

    • Let's help people live their best life 

  • Believed individuals were goal orientated to personal growth, self-actualization  

    • Created a therapy that tries to emphasize those things 

    • Let's try to maximize ourselves and be the best person they can be  

    • To be the best version of yourself is to be self-actualized 

Humanistic therapy

• Goal  

  • Help ppl see their potential and move towards it 

  • Important that its client centered 

    • Client gets asked who they are, have input 

  • Therapist has to be genuine and authentic 

    • Showing unconditional positive regard  

    • Has to show their client respect, be positive towards them, has to be unconditional 

      • Central to this therapy 

    • Being empathetic 

• Reflecting 

  • Tool used in this therapy 

  • Method of response that the therapist uses to try to show that they understand what the client is saying 

    • Idea that you echo what the client has said, without using the exact same words 

    • Client then feels heard, helps them to move forward 

Advantages of humanistic approaches

• We see a refreshing change from the pathological view 

  • I.e. what's wrong with you, what are you failing at? 

  • Flip it around to say what are you good at? 

Disadvantages of humanistic approaches

• Criticized 

  • How we measure/quantify certain concepts is fuzzy 

    • How do we measure self-actualization, quantify reflection? 

  • Can't be scientifically tested 

  • Humanistic therapy is good for people who are moderately distressed 

    • I.e. stress, anxiety 

    • Not for someone dealing with suicidal thoughts, self-harming, harming other ppl, etc 

Third wave approaches 

• Based in cognitive behavioural therapy with eastern flavor 

• Borrowed from Buddhist practices + principles 

  • Talk about needing people to understand and regulate their emotions 

• Matter of becoming okay with our thoughts 

  • Ex. Feeling anxious about something 

    • Engage in meta cognition 

    • Identify thoughts, don’t try to change them, let it go 

• 1) Dialectical behaviour therapy 

• 2) Acceptance and commitment therapy 

  • Both incorporate this new way of accepting how we're feeling, our thoughts, and not changing them 

  • Both also have huge robust research behind them 

Assessing third wave 

• Advantage:

  • Helpful for a wide range of mental health problems 

• Disadvantages:

  • Need more research looking at how they work rather than do they work 

  • Need to think about how and why they're helpful  

    • + How they compare to other therapies (ex. CBT) 

Using new tech to deliver treatment 

• Internet 

  • Can search up how to feel better, find a therapist, etc 

• Smartphone apps designed to help people feel better 

  • Self-help app which gives you exercises to do 

• AI being pioneered now 

  • Download an app and you have an AI therapist  

• These interventions can now be accessible to these types of communities 

  • Ppl living in rural areas 

  • Developing countries  

  • People with modest incomes  

    • May now have access to mental health resources that they would not have had before the internet  

Sociocultural approaches 

• Looking beyond the one person to the larger society to start thinking about where these problems may have come from  

• It's larger scale research looking at societal issues 

  • Looking at how things like socioeconomic disadvantage can contribute to the development of mental health problems 

    • Upheaval and disintegration inside of society 

    • Stigma and marginalized social groups 

    • Societal rules about abnormal behaviour  

• Gather info to determine who's at risk and why + how we can start to address that in different types of therapy 

Cross-cultural issues in treatment 

• Starting to see a slow revolution to start incorporating cross cultural issues 

• Starting to pay more attention to  

  • Know that most psychotherapies focused on the individual 

    • Most of the pop come from a collectivist society though  

  • Values emotions 

    • Some cultures place value on inhibiting emotion 

  • Some cultures defer to authority figures 

    • May have difficulties talking or taking an active role in therapy 

      • How do we help these clients 

  • Economic class + race 

    • Inhibit access to mental health services  

    • Have to figure out how to break that barrier down 

  • Sometimes we see issues between the client + therapist related to  

    • Age, gender, social, ethnicity differences, queer status, indigenous status 

    • All of these things can lead to a mismatch 

      • Ex. Someone who's 14, queer, marginalized group 

      • Therapist an old white man 

      • May not feel comfy talking to this therapist  

Assessing sociocultural approaches 

• Advantage:

  • Allows us to avoid blaming the victim cause we're blaming society now

• Disadvantages:

  • Criticized:

    • Sometimes it’s a bit fuzzy around how social and cultural forces are leading to psychological disturbance 

      • Don’t know how its working 

      • Research is being done to look at that how, the mechanism 

        • How does belonging to a certain cultural group relate to a high risk for a certain psychological disorder 

Common elements in effective treatments 

• Want to have a positive relationship 

  • Think positively of one another 

• Providing clients with explanation or interpretation  

• Encouraging client to think about painful memories or parts of their experience in life + having techniques to manage symptoms 

Validity 

The accuracy of a test in assessing what it is supposed to measure 

Face validity 

On face value, the items seem to measure what the test is intended to measure  

Content validity 

How well an instrument (I.e. test or questionnaire) appropriately measures the content, theory, or phenomenon being studied  

Predictive validity 

Addresses how well an instrument that is used for assessment like a survey can predict future behaviour 

Construct validity 

Is the extent to which a test measures what it is supposed to measure and not something else altogether

Reliability 

Indicates its consistency in measuring what it is supposed to measure 

Test-retest reliability 

Describes how consistent the results of a test are over time 

Alternative form reliability  

When people's answers to different forms of a test are similar 

Internal reliability 

When there's similarity in people's answers among dif parts of the same test 

Interrater/interjudge/reliability 

Different raters or judges who administer and score the interview or test should come to similar conclusions when they are evaluating the same people  

Standardization 

• Important way to improve validity and reliability is to standardize the administration and interpretation of tests 

  • A standard method of administering a test prevents extraneous factors from affecting a person's response  

Clinical interview 

• An interview or discussion  

  • Face convo between a mental health professional and a client where info is gathered about the client's behaviour, attitudes, emotions, life history and personality 

• Can be structured

  • Questions set out in a particular order, no deviation form script 

• Or unstructured

  • Script but therapist is allowed to ask follow up questions + clarification questions  

  • goes off script a bit 

Mental status exam 

• Process helps to determine the client's current mental status  

• Looking at 5 dif domains:

  • 1) Appearance and behaviour  

    • Ex. Does this person seem to have any kind of a twitch, appearance appropriate to the weather? 

  • 2) Thought processes 

    • Look at speech 

      • Is it coherent? Flow too fast or too slow? Continuous, make sense? 

  • 3) Mood + affect 

    • Want to know emotional state 

    • Is this person's mood and state appropriate to the situation  

  • 4) Intellectual functioning 

    • May look at the type of vocabulary to their age, education level 

  • 5) Sensorium 

    • Whether someone is oriented times 3 

    • Does this person know who they are, know the date, know where they are? 

Physical examination 

• Rule out medial conditions associated with psychological conditions 

  • Brain tumors 

    • Cause us to act unusually 

  • Thyroid 

  • Being on certain types of meds 

  • Bad food 

    • Serious food poisoning can cause psychological symptoms 

• If they think something else is going on  

  • Not typical for anxiety, depression, etc