Psychopathology & Mental Health Exam #1

abnormal

outdated term meaning atypical, however this is not an accurate term, reinforces an "us vs. them" mindset of mental health disorders

abnormal psychology

the application of psychological science to the study of mental disorders. Includes investigation of the causes and treatment of psychopathological conditions.

symptoms

thoughts, feelings, and behaviors that indicate a mental disorder. Ex: sleep changes, difficulty concentrating, being indecisive. When symptoms appear together, they can indicate a syndrome or disorder

syndrome

a group of symptoms that appear together and are assumed to represent a specific type of disorder. Used interchangeably with disorder

important features of disorders

 duration and frequency (how often they appear, how long they stay); functional impairment (impacting job, relationship, caring for oneself).

how do we define abnormal behavior?

personal distress and statistical norms.

personal distress

 would the client say they are distressed? You can also be distressed without having a mental disorder, or have a mental disorder without feeling distress

statistical norms

relative frequency of specific condition in general population. Some behaviors are rare, but not necessarily harmful/problematic; rare can also seem desirable if talent leads to success. Some behaviors are common, but harmful (binge drinking as a college student). Doesn't specify how unusual a behavior needs to be in order for it to be harmful

definitions of mental disorders

harmful dysfunction, changes based on cultural beliefs as well as updates from continued research. Disorders are only based on symptoms, not context (divorce, incarceration, unemployment).

harmful dysfunction

a condition is a mental disorder only if 1) results from the failure of some internal mechanism to perform its natural function (i.e., dysfunction) 2) causes harm to the person as judge by the standards of that person's culture (i.e., harmful). This controversial because we don't know what is supposed to be working and what isn't; too dichotomous (harmful or not)

mental disorder vs. abnormal behavior

there is overlap. abnormal behaviors may be symptoms of mental disorders, or not. the absence of mental health disorders does not mean that one is thriving.

culture

values and beliefs shared by a specific group of people

etic perspective

outsider's perspective. Relies on preexisting theories and perspectives. Outsiders are the one's who are composing the questions and gathering the data. Frequently the aim is to find generalizable trends (universal). Observers study from the outside, they are not direct participants or members of that culture. Problems: otherizes culture, people act differently if they know they are being observed, hard to gain access to observation

emic perspective

insider's perspective. People are embedded in the culture. Considers the members of the culture to be the best source of information about the culture

Who gets to decide what is normal?

Historically, white men in the western world.

zeitgeist

spirit of the time. For example: Drapetomania (running away from slavery used to be considered a mental disorder), homosexuality used to be considered a mental disorder, more recently gambling disorder has been added as a mental disorder.

problem suppression-facilitation model

 idea that cultural forces directly influence behavior. Some things suppress behavior (punishment), while other facilitate or increase behaviors (modeling, reward). These forces impact the individual and people's views of the behaviors (how you evaluate others)

Lambert et al. problem suppression-facilitation model study

American vs. Jamaican children. Looked at externalizing vs. internalizing behaviors. Results: regardless of American or Jamaican, boys had similar symptoms, but the types were different. Externalizing symptoms were more common in the American sample whereas internalizing symptoms were more common in the Jamaican sample. Reasoning: Americans rationalize boys behavior (boys will be boys).

epidemiology

-Study of the frequency and distribution of disorders within a population

comorbidity

manifestation of more than one disorder. For example: 60% of people with a depressive disorder also have an anxiety disorder.

incidence

the numbers of new cases of a disorder that occur in a population within a specific period

prevalence

the total number of active cases (old and new) present in the population at a given time

lifetime prevalence

total proportion of people in a population who have been affected at one point in their entire life

economic costs of depression

higher levels of unemployment, fewer hours at work, less productive when working, earn less money, complete less education

paradigm

set of assumptions about 1) the substance of a theory 2) how scientists should collect data and test theoretical propositions

major paradigms

psychoanalytic/psychodynamic, cognitive behavioral, humanistic, biological

psychoanalytic/psychodynamic paradigm

abnormal behavior caused by unconscious mental conflicts, emphasizing early childhood experiences in the family. Difficult to examine empirically. Contributions: innovative ideas about unconscious processes, early childhood experience shaping emotional health

cognitive behavioral paradigm

 abnormal behavior is the result of learning. Uses classical and operant conditioning

biological paradigm

Genes are not sufficient to account for the development of almost all disorders. Some disorders have strong genetic contributions, ex: ADHD. There is specific cause for a minority of disorders, ex: causes for Dementia and Autism. If there is a genetic influence, a disorder is not inevitable. Genes can predispose disorders or be risk factor, but it is not black and white. If a behavior or characteristic is genetically influenced, it can be changed. If there is a biological influence, a gene is not always responsible. There is not a "depression" or "schizophrenia" gene

behavior genetics

the study of genetic contributions to the development of normal and abnormal behaviors. It does not ignore environmental factors. Focuses on brain (structures and neurochemistry) and genes. Genes are either inherited or they are not

family incidence studies

do disorders run in families? Researchers identify a "proband" or the index person in a family. Examine the proportion of family members that suffer from different disorders. Can signal both genetic and environmental factors. Ex: If proband has depression, relatives are at increased risk for depression but not schizophrenia

twin studies

genetic contributions can be assessed by comparing concordance rates between monozygotic and dizygotic twins (concordant means if they match, either both have or both don’t). Are the monozygotic twins more alike? If so, genetics plays more of a role; dizygotic twins are more alike? Environment may play more of a role

adoption studies

look at concordance rates between biological parents and/or adoptive parents. If concordance is higher with biological parents, more of a genetic component. If concordance is higher with adoptive parents, more of an environmental component

genome wide associations (GWA)

examines how genetic variations across entire genomes are related to diseases. There are massive amounts of data. It is unbiased but not theory driven. Limited by current technology. Gotten cheaper over time

candidate gene studies

complimentary to GWA studies. Examines genetic variation in a priori genes of interest for a trait of disorder, genes are selected based on relevance to disorder

systems theory (biopsychosocial model)

The nature-nurture debate is over, they are not separate influences on behavior, they work together. social/psychological factors can cause changes in brain structures, hormones, and neurotransmitter function. Interaction between biology and social/psychological factors. Attempts to integrate evidence from biological, psychological, and social domains of behavior (causality), different paradigms operating at different levels of analysis when explaining human behavior

reciprocal gene-environment model

Genes might influence the environment that people seek out (shy people may not want to go to parties). Environmental factors may bring out a genetic predisposition (sensation seekers are more likely to get PTSD because they are more likely to seek out combat/risky activities)

epigenetics

above the genome. area of research that studies the trait variation that are caused by modification of gene expression by external factors. One mechanism through which experience gets under the skin and shapes biology.

equifinality

different causes for the same disorder. Ex: death of a parent --> depression; loss of job --> depression

multifinality

same causal factor but different outcomes. Ex: earthquake --> phobia, earthquake --> PTSD, earthquake --> no disorder

reciprocal causality

causality is bidirectional. Many researchers have suggested that causality occurs in only one direction

diathesis-stress model

existing vulnerability that precedes stressor, stress: any event that trigger s the onset of disturbance

orientations

use of psychological techniques to produce change

psychodynamic

revisions of Freud

psychoanalytic

Freud

psychodynamic/psychoanalytic orientation

Behavior is controlled by unconscious processes. Early development has a profound impact on adult functioning. Universal principles explain abnormality. Insight into unconscious will improve functioning

Freud’s psychoanalysis

goal is to reduce or eliminate pathological symptoms by bringing the unconscious into the conscious awareness and integrating repressed material into personality. insight is sufficient for curing psychological disorders. main components: analysis (interpretation) or free associations, and dreams, resistances, and transferences. It is much more collaborative and emphasizes a working alliance between client and therapist. It has declined over time partly because there is little research on it.

structural (drive) theory

underlying personality theory in freud’s psychoanalysis. personality is made up of the id, ego, and superego. Anxiety alerts the ego of threat. when ego is unable to avoid danger through rational means, it resorts to defensive mechanisms, or unconscious self-deceptions that reduce conscious anxiety by distorting anxiety-producing memories, emotion, and impulses

developmental theory in freud’s psychoanalysis

personality formed during childhood as result of experiences during psychosexual states of development. Healthy development is formed through interruption during the stages

maladaptive behavior in freud’s psychoanalysis

 psychopathology stems from unconscious, unresolved conflict that occurred during childhood

humanistic orientation

Focused on free will and the importance of self actualization. Importance of understanding another's experience. Believe in inherent potential for self-actualization. See therapeutic relationship as authentic, collaborative, and egalitarian. Underlying belief that people can reach their full potential (self-actualization). Focuses on current behaviors

Carl Roger’s client-centered therapy

goal is to be self-actualized. major components include genuineness, accurate empathy, unconditional positive regard

underlying personality theory in carl roger’s client-centered therapy

Focuses on notion of self. Doesn't want to distort the client's experience

maladaptive behavior in carl roger’s client-centered therapy

An incongruence between the self and the experience, leading to anxiety

cognitive behavioral orientation

not based on personality theory. Rooted in behavioral and cognitive psychology. Some thoughts and behaviors get reinforced in one's environment (increasing or decreasing the frequency of behavior). Goal is to help clients learn new ways of thinking, acting, and feeling

components of cognitive behavioral orientation

Establishing rapport and trust, Psychoeducation, goal setting, Collecting background info, Teaching skills, Collaborative empiricism

cognitive behavioral orientation procedures

Monitor maladaptive (irrational) self-statements, Their antecedents and consequences. Evaluate support. Substitute rational cognitions. Rehearsal (for example: keeping a daily log)

third wave therapies of cognitive behavioral orientation

extension of CBT, focuses on how people relate to internal experiences, incorporate mindfulness, acceptance, etc.

outcomes of cognitive behavioral orientation

treatment is short term, goal-directed, progress is monitored, used with many disorders (successful with anxiety and depression, as helpful as psychotropic medications)

psychopharmacology

the scientific study of the effects of drugs on the mind and behavior.

antipsychotic medication

used primarily with people with schizophrenia to reduce the intensity of delusions and hallucinations. Reduce dopamine by blocking dopamine receptors. Side effects include weight gain. Common ones: Haloperidol, Thorazine, Risperdal, Abilify. Problems: compliance, some people don't respond at all, right dosage (can vary across people), relapse rates are sometimes high following discontinuation

empirically supported treatments

specific psychological treatments for a specific population/disorder that have evidence supporting their success

efficacy

does it work under ideal circumstances? A lower bar. Can't assume it will work in the real world

effectiveness

does it work in the real world?

meta-analysis

combine results across studies to examine an overall effect. Average client is better off than 80% of their peers. Psychotherapy often provides more long-lasting benefits than medication alone. Many similar treatments used across disorders.

classification

Systems that are used to subdivide or organize a set of related objects. Benefits: facilitates description and communication, aids treatment decisions and prognosis, facilitates research on etiology, treatment outcome, facilitates 3rd party reimbursements.

Concerns: lead to stigmatization, unrelated problems may be misattributed to the disorder, expectations for behavior may change

categorical approach to classification

reflects a difference in kind or quality. Yes or no. People with abnormal behaviors are qualitatively different than other people (discrete groups). Largely used by DSM-5

dimensional approach to classification

focuses on the amount of a particular characteristic an object possesses. How much. People with abnormal behaviors are quantitatively different (continuum)

DSM

Diagnostic and Statistical Manual of Mental Disorders (DSM). Published by the American Psychiatric Association

DSM-I

published post-WWII, the first official manual of mental disorder, relied heavily on psychodynamic principles

DSM-II

psychodynamic perspective, included behavioral disorder of childhood and adolescence, new section for sexual deviation, removed homosexuality diagnosis in the 7th printing

DSM-III

symptom based system, introduced multi-axial system, added new diagnostic categories

DSM-IV

strict revisions based on empirical research

DSM-V

elimination of the multi-axial system, greater emphasis on comorbidity, increase in dimensional focus, greater emphasis on cultural differences

limitations of the DSM

Sometimes boundaries between normal and abnormal behavior seem arbitrary: cutoff points are not always empirically justified, reliance on clinicians'' subjective judgement, time periods in definitions of diagnoses

Problems with comorbidity: 56% of those who meet criteria for one disorder meet criteria for at least one other disorder, affects validity of the system and the reliability of diagnosis

ICD

International Statistical Classification of Diseases and Related Health Problems (ICD). Written by the WHO. Physical and mental disorders. Used by those both in and outside of the US

reliability

the degree to which an assessment measure produces the same result each time it is used to assess the same thing

test-retest reliability

refers to consistency between two repeated assessments of tests

inter-rater reliability

the agreement of raters about observations

validity

extent to which measuring instrument actually measures what it is supposed to measure. Conceptualized as a continuum of more to less useful

etiological validity

concerned with what specific factors that are regularly and perhaps

concurrent validity

concerned with the association between disorders and other symptoms, life circumstances/life events, and test performance

predictive validity

concerned with the accuracy of predicting future outcomes

psychological assessment examples

projective tests, interviews, observational procedures, physiological assessments, personality tests and self report.

projective tests

based on psychodynamic theory, indirect method using ambiguous stimuli (ex: rorschach inkblot test)

Advantages: provide a way to talk to people who are reluctant or unable to discuss, unique source of info about person's pov, access to unconscious thoughts and feelings

Limitations: interpretation is subjective --> low interrater reliability, questionable validity, often over-pathologizes

interviews

 to aid in making diagnosis, structured clinical interview for DSM-5, collect history, social context, etc.

Advantages: control interactions, observe non-verbal behavior, efficient, conducted in a variety of settings

Limitations: some people may be unable or unwilling to report problems, tendency to report socially desirable behavior, rely on subjective report

observational procedures

watching behavior in natural environments, multiple settings for children, quantifies behavior through rating scales, behavioral coding scales

Advantages: useful index of symptom severity and functional impairment, detail info about the person's behavior

Limitations: time consuming and expensive, observer bias, reactivity, limits in generalization, some things are impossible to observe

physiological assessments

Peripheral physiology: heart rate, skin conductance, respiration