E1 Psychopathology and Mental Health

What is a Paradigm?

It is a way of thinking about something. Affects the evidence that you look at, and therefore the conclusions that you come to. “If all you have is a hammer everything looks like a nail. “

What is Animism?

Animism: Spirit inside. Caused by abnormal spirits, and therefore the treatments was to action these spirits .One treatment was bloodletting 

What are the traditional/historical paradigms ?

• Biological  

• Psychodynamic  

• Behavioral/cognitive 

• Humanistic 

What is Reductionism?

To break things into a series of competent parts.

What is the purpose of the biological paradigm?

• Purpose is to engage in reductionism, i.e. to break things into a series of component parts 

• Therefore, you could manipulate and break apart specific parts to see which may have the largest results: Genetics, Behavior genetics, synaptic transmission, and heritability of major mental disorders.

What are different examples of behavioral genetics and what do they mean?

Genetic factors: Biology

Shared Environment Factors: Experiences that make individuals within a family alike

Non-shared environment factors: Experiences that make individuals within a family alike, such as being treated differently or raised apart.

Numerous personality traits are influenced by genetics.

Shared environment plays little role, especially in terms of adult personality.

What did a genetic study on the heritability of schizophrenia indicate?

The closer related a person is to someone who is diagnosed/affected by schizophrenia, the more likely they are to have it. If you have an identical twin that is affected, there is a 50% chance that you will be affected as well.

Do Psychotic like experiences in childhood imply future mental health issues?

Although some may experience certain experiences that children might have due to rearing or predisposition will not develop into full schizophrenia when they grow up  

What was the Adolescent brain cognitive development study and what did it demonstrate?

• The brain is a system at various levels 

• Areas in the brain are not independently firing, they are interacting with each other and some may fire together depending on the function  

• Activity in one network activates in another related area leading to sustained physiological processes.  

Who pioneered and what was the main focus of the psychoanalytic paradigm?

• FREUD  

• Focused on the internal conflicts of his patients  

• Main focus of therapy was insight as to why they were having these problems.  

What where the main components of the psychoanalytic paradigm?

ID: Unconscious biological drive that is present since birth.

Superego: Conscious, societal standards that try to govern the ID

Ego: Conscious, evolved through childhood to try and mediate the superego and the ID.

What where the main assessment and treatment carried out by the psychodynamic approach and what where issues with those?

• Rorschach test: give subjective tests where you just ask them what they see. People would eventually begin to leak out their inner thoughts.  

• Criticized for lacking reliability 

• Defensive mechanisms:  

• People actually do engage in some of these  

• These aren't really testable hypotheses.  

What is the humanistic paradigm, and what is it’s main goals? Who helped pioneer the paradigm?

• Personal growth 

• Free will 

• Responsibility 

• Major theorist:  

• Maslow: Self actualization 

• Rogers: Client centered therapy, unconditional positive therapy 

• May: Authenticity, existential psych 

What is the cognitive behavioral model paradigm? What are core Principles used in this paradigm?

• Behavioral perspective- focuses on environmental stimuli and the responses to those stimuli 

• Learning principles- classical and operant conditioning.  

What is Classical conditioning? What is operant conditioning?

Classical conditioning: Over time, an unconditioned stimulus will become a conditioned stimulus, leading to a conditioned response at the sight of the stimuli.

Operant Conditioning: focused on behavioral reward and punishment systems (positive and negative reinforcement)

What is the cognitive model of learning?

• People may behave in ways that don’t make sense with conditions, but rather because of your interpretation, this is called cognitive perspective  

• Cognitive principles: Schemas: Beliefs or expectations that affect behaviors 

What is cognitive Conditioning?

Our interpretation of the situation affects our conditioning. Expectations play a role in learning.

What are some examples of Cognitive distortions?

• All or nothing thinking

• Mental filter

• Jumping to conclusions

• Emotional Reasoning

• Personalization

• Over generalization

• Disqualifying the positive

• Catastrophizing

  Using critical words like should or must to make us feel like we already failed

What are examples of Freudian defense mechanisms?

• Denial

• Displacement

• Projection

• Rationalization

• Reaction Formation

• Repression

• Sublimation

What treatments do different paradigms provide?

Psychoanalytic- Insight, goal oriented therapy

Humanistic- Unconditional positive regard and support.

Biological- Medicine and physical changes to the brain biochemistry

CBT- Exposure therapy

What are the different paradigms view on inborn human nature?

Biological - Competitive, but some altruism

Psychodynamic- Aggressive, sexual

CBT - Neutral, Blank slate

Humanistic- Basic goodness

What are the different paradigms view on the cause of abnormality?

Biological- Genes, neurochemistry, physical damage

Psychodynamic- Early Childhood experiences

CBT- Social Learning

Humanistic- Frustrations of society

What are the different paradigm approach to treatment?

Biological- Medication, other somatic therapies

Psychodynamic- Psychodynamic therapy, focused on insight and finding a way to expose the unconscious

CBT- CBT therapy, challenging cognitive distortion, may also include exposure therapy, typically assigns hw.

Humanistic Therapy- Nondirective therapy

What is the main focus of every paradigm?

Biological- Bodily functions and structures

Psychodynamic- Unconscious mind

CBT- observable behavior

Humanistic- free will

What is reciprocal causation?

Two factors mutually effect each other. Isolation causes depression, and being depressed leading to isolation

What is Equifinality?

Multiple stressors/factors mutually contribute to a given psychopathology.

What is resilience?

The ability to recover and maintain a constant mild level of functioning afterward.

What provides more long lasting benefits for disorders?

Psychotherapy. Additionally, may

What is rebirthing?

Non supported treatment in which child is buried in blankets to be “reborn”, used for almost anything.

How do you best describe psychotherapy?

Interactive, more commonly practiced with psychologists. The main goal is to build a working relationship with client address distress/ needs.

What are common factors in therapy?

Quality of the therapeutic relationship (empathy, support, feedback), as well as the client’s level of self knowledge.

Who gets treatment?

1 in10 people receive treatment. 66% of individuals with psychopathology do not receive treatment. Women more likely to get treatment.

How do you standardize psychotherapy?

Manualized treatments provide session by session guidelines.

What are the basic principles for treatment?

The main goal is to help the person change, by using treatments that have been shown to work. Some of these may help deal with multiple problems, whilst others have been shown to just be harmful.

What are the main forms of psychoanalytic/psychodynamic therapies?

See human behavior as motivated by the unconscious. Early development has a profound affect on adult functioning. They use universal principles to explain personality and abnormal behavior. Insight into unconscious key to improvement.

What is maladaptive behavior according to Freud?

Psychopathology stems from an unconscious, unresolved conflict that occurred during childhood.

What are the 5 stages of psychosexual development?

Oral (0-1): Dependency

Anal (1-2) Orderliness, stinginess

Phallic (3-5) Oedipus, Electra complex

Latent (5-12) Calmness, other sex=yucky

Genital(12-death) Sexual maturity

What are some psychoanalytic interpretations of disorders?

Depression- Due to object loss coupled with anger toward the object turned inward.

Mania- Represents a defense against libidinal or aggressive urges that threaten to overwhelm the ego,

Phobias- Result of displacement of anxiety onto an object or event that is symbolic of the object or event involved in an unresolved conflict.

What are the main psychoanalytic procedures?

Goal- Reduce or eliminate pathological symptoms by bringing the unconscious into conscious awareness and integrating repressed material into personality. This was done through free association, dream interpretation, and analysis of resistance.

What is the current state of psychoanalysis?

Psychoanalysis has declined greatly, often no specified end and little research to support it.

Psychodynamic is more common. Focused on collaborative, egalitarian, view of therapeutic relationship.

Brief psychodynamic therapies: Time limited, and target specific problem.

Interpersonal therapy - Built on foundation of transference, focuses on changing emotional styles and interaction of those you are in close relationships with.

What is client centered therapy?

Popularized by Carl rogers and other. It rejects assessment and diagnoses. Focuses on Current behavior and the belief of inherit potential. It is collaborative and rational.

What are the 3 major components of client centered therapy?

Genuineness, accurate empathy, and unconditional positive regard.

What was Carl Roger’s explanation for Maladaptive behavior and underlying personality theory?

Underlying personality theory- Focuses on the notion of self, and integrating the ideas of self into unified whole.

Maladaptive behavior- An incongruence between self and experience

What is behavior therapy?

Behavior is determined by antecedents and consequences. Challenging behavior can lead to emotion changes, insight is not enough. The causes for their dilemma is their behavior. Some example of treatments would be exposure therapy.

What are some examples of treatments that occur in Behavior therapy?

Exposure ( and response prevention) - This treatment can be either in vivo or imaginal. This can be in the form of progressive muscle relacation and systematic desensitization, as well as flooding.

Therapy also focuses on skills training or behavioral rehearsal, such as assertiveness or parent skills training.

What are the outcomes of exposure therapy?

For specific phobias, after a single treatment, 65% of patients had no symptoms 4 years after treatment. For OCD, 50% show large improvement, and 25% moderately improve. 76% maintain the gains after several years.

What is contingency management?

Reward desired behavior and punish negative behaviors, Consistency is very important, and can sometimes be used with token economy in institutions.

What is the foundation of cognitive therapy?

Emotions are determined by self statements and not external events. people are aware of these and can discuss them. These negative emotions can be treated by teaching rational cognitions. It is rooted in behavioral and cognitive psychology.

what is the goal of cognitive behavioral therapies, and what are it’s components?

The goal is to help client learn new ways of thinking, acting, and feeling. Components often include: Establishing rapport and trust, goal setting, psychoeducation, teaching skills, collecting background info, and collaborative empiricism.

What is the CBT procedures?

Recognize maladaptive self statements, including their antecedents and consequences then evaluate and support them. Substitute rational cognitions and evaluate support. Rehearsal, through the use of things like daily diaries. It is similar to a science experiment, collaborative empiricism. Recognize maladaptive self-statements, including their antecedents and consequences, then evaluate and support them.

What are the CBT outcomes?

Treatment is short term, but goal directed. The progress is monitored and can be used for many disorders, such as depression and can be as affective as medication.

What is DBT?

It is added mindfulness and focuses on interpersonal skills, emotional regulation, and distress tolerance. Created and promoted by Marsha Linehan. It is extremely popular and has been demonstrated to be effective for several disorders.

What are the main types of biological treatments?

• Psychopharmacology

• ECT

• Neurosurgery

What are the main types of Psychotherapy treatments?

• Psychoanalytic therapy

• Behavior therapy

• CBT

• Client centered

How does Psychopharmacology directly manipulate neurochemical signaling?

• Agonist: Increase signaling.

• Antagonist: Blunt signaling

How common are antidepressants?

Most prescribed medication in the US, primarily by primary care physicians. More women than men.

What are some different types of psychopharmacology medicine?

• Antipsychotic

• Antidepressant

• Antianxiety

• Mood stabilizing

How does antipsychotic medication work?

Reduce the intensity of hallucinations and delusions by blocking dopamine receptors. 60% of schizophrenia patients have resolutions of hallucinations and delusions.

Common ones include Haldol, chlorpromazine, Risperdal, and Abilify.

What are some problems with antipsychotic medication?

• Tardive dyskinesia (movement abnormalities)

• Weight gain

• Medication adherence, long acting injectable forms to combat

What are the four main classes of antidepressant medication?

• SSRI - Selective serotonin reuptake inhibitors: Current preferred medication for depression.

• SNRI - Serotonin and norepinephrine reuptake inhibitors

• MAO - Inhibitors: Inhibit enzymes that break down serotonin and norepinephrine.

• TCA - Inhibit norepinephrine reuptake ( but also serotonin through lesser)

What are the outcomes of SSRIS

Positive response- 50% or larger reduction of symptoms, as well as remission. Additionally, 50% of patients show a positive response following 3-5 weeks of treatment. Examples: Prozac, Paxil, Zoloft. Also used for anxiety, bulimia, and borderline personality disorder. Some problems however are nausea, insomnia, and sexual problems.

Is medication or psychotherapy better?

• May depend on the condition or the circumstances. Although medication has side effects, its use is increasing while psychotherapy’s is declining. Only 3% of general population has one or more psychotherapy sessions.

What is ECT

Involves passing current through brain through a series of treatments over several days. Works for some people, but is mainly used for those who have not responded to other treatments. It’s main side effect is just retrograde amnesia which can remedied by minimizing unilateral electrode placement.

What are some new developments in anti depressant medication?

Ketamine and psilocybin.

What is the different paradigms goal of treatment?

Biological- Alter biology to relieve treatment

Psychodynamic- Gain insight into defenses/unconscious motivations

Cognitive behavioral- Learn more adaptive behaviors/cognitions

Humanistic- Increase emotions awareness

What is the different paradigms primary method of treatment?

Biological - Diagnosis, medication

Psychodynamic- interpretation of defenses

Cognitive behavioral- Instruction, guided learning, homework

Humanistic- Empathy, support, exploring emotions

What is the different paradigms role of therapists in treatment?

Biological- Active, directive, diagnostician.

Psychodynamic- Passive, nondirective, interpreter

Cognitive behavioral- active directive, nonjudgmental, teacher

Humanistic- passive, nondirective, warm and supporter

What is the different paradigms length of treatment for treatment?

Biological- Brief, with occasional follow up visits

Usually long term- some new short term treatments

Cognitive behavioral therapy- short term, with later “booster” sessions

Humanistic- varies, length not typically structured

What is outcome research?

It is one of the only situations in psychopathology hat allows experiments to be done. Investigators has control of the independent variable, which increase internal validity. Can allows for strong causal interferences.

How to research treatments?

Placebo effect: Inert treatments that work (perhaps due to expectation)

Nocebo effect: Inert treatments that cause adverse response.

Double blind study- Keep researchers in the dark, as their expectations can influence the study too.

What is the difference between efficacy and effectiveness?

• Efficacy: does it work in a pure laboratory environment?

• Effectiveness: does it work in the real world?

What are the guidelines to evaluating psychotherapy in research?

• We have to ask specific questions

• How was change measured?

• Who gets counted?

• Control groups included?

• How was treatment defined?

• Who were the therapists?

• Who were the clients?

• When was the outcome measured?

What are classification systems?

Different models that use different methods to categorize/ psychopathology. There isn’t one that is more or less right, they are all just more useful for a given purpose.

What is descriptive classification?

• Its from an early stage of science, where it looks at progress toward etiological classifications as science becomes more sophisticated.

What is the categorical classification?

Based on yes or no decisions. Qualitative distinctions such as AIDS or not .

What is the DSM?

Used for many purposes, insurance payments for treatment, selecting treatments by clinicians, guiding research effort. Some people favor broad coverage, others great precision.

What is the dimensional classification?

Emphasis is on “how much” quantitative distinctions, such as intelligence in a psychological setting, or hypertension in a medical example.

Which edition of the DSM was a huge turning point for psychiatric classification?

The DSM III

Added more complete descriptions, with inclusions and exclusion criteria. It also added personality disorders on Axis II and dropped terms such as “neurosis”

What are some recent changes that where added to the DSM 5 (2015)

• OCD and PTSD split off from Anxiety Disorders to form their own chapters

• Bipolar Disorder gets its own chapter, separate from Depressive Disorders

• Gambling Disorder moves to Substance Related and Addictive Disorders

• Sexual disorders split up into Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders

What are some recent changes made to the DSM 5 (2023)

Prolonged Grief Disorder: continued presence, for at least 12 months after the death of a loved one of impairing symptoms associated with grief

• Unspecified Mood Disorder: a residual category for presentations of mood symptoms which do not meet the full criteria for any of the disorders in either the bipolar or the depressive disorders diagnostic classes

• Stimulant-Induced Mild Neurocognitive Disorder: presence of neurocognitive symptoms, such as difficulties with learning and memory and executive function, associated with stimulant use

• Codes to flag and monitor suicidal behavior and nonsuicidal self-injury that can be used without the requirement of another diagnosis

What is the DSM’s criteria for having major depressive disorder?

Five ( or more) of the following symptoms have been present during the same two week period and represent a change from previous functioning; at least one symptoms is either 1) depressed mood or 2) loss of interest or pleasure

What is the definition of validity in this context?

• Systematic meaning or importance

• No single measure of validity

• The validity of a test or “construct” is a reflection of the total sum of information that has been accumulated about it – does it tell us something useful?

What are the common types of validity?

Content validity

Predictive validity

Concurrent validity

Construct validity

What is content validity?

How well test or interview items adequately measure various aspects of a variable, construct, or diagnosis.

What is predictive validity?

How well test scores or diagnoses predict and correlate with behavior or test scores that are observed or obtained at some future point.

What is concurrent validity?

How well test scores or diagnoses correlate with a related but independent set of test scores or behaviors

What is construct validity?

How well test scores or diagnoses correlate with other measures or behaviors in a logical and theoretically consistent way

What is reliability?

Concerned with consistency, inter judge agreement in diagnosis, measure with kappa, which corrects for agreement that occurs by chance.

What are the different types of Reliability?

Test- retest validity

Interrater reliability

Internal reliability

Internal consistency reliability

What is test-retest reliability

Consistency of test scores or diagnoses across some period of time.

What is interrater reliability?

Agreement between two or more raters or judges about level of a trait or presence/ absence of a feature or diagnosis

What is internal consistency reliability

Relationships among test items that measure the same variable

What is labeling theory?

• Concerned with the social context in which behavior occurs

• More popular in sociology

• Assumes that mental illness is a social role, or a self-fulfilling prophesy that is influenced by a label

• Emphasizes SECONDARY (identity) DEVIANCE rather than primary deviance (initial act)

How does labeling theory draw attention to stigma?

• Negative stereotypes and beliefs regarding the nature of mental disorders

• Harmful to those who are in treatment, including discrimination and social rejection

• Might be a good explanation for criminal behaviors

What was the point of the David Rosenhan study?

• Rosenhan argued that psychiatrists cannot tell the difference between psychotic patients and students without symptoms

What are different types of assessments?

• Interview and self-report

• Intelligence test

• Personality assessment

• Objective tests

• Projective tests

• Behavioral assessment

• Biological assessment

• Psychophysiological assessment

• Neuropsychological assessment

Why can’t we just ask people to judge themselves?

PT Barnum effect: the tendency to accept high base rate descriptors as accurate

What are the pros and cons of self reports?

• Pros - Quick, Cheap, Self-disclose

• Cons - Lower validity , Lower quality, More room for error

How are diagnostic interviews more beneficial than self reports?

• Structured interviews improved reliability of diagnosis

• Semi-structured interviews vs. fully structured interviews

• Have limits, especially when self-knowledge is limited

How are questionnaires and personality tests useful?

• Examples: MMPI-2, Beck Depression Inventory

• Useful for covering lots of ground efficiently

• Grounded in empirical research