Psychological Disorders and Treatments Notes

Psychological Disorders & Treatments

Reminders

• ZAPS lab on Test Anxiety due Sunday 4/27
• Diverse Voices reading on body image due Sunday 4/27

Outline (for 4/22 – 4/29)

• What is a Psychological Disorder? (13.1)
• The DSM (13.3-13.4)
• What is therapy? (14.2, brief overview of 14.5-14.9)
• Case studies:
  • Anxiety (13.6-13.8)
  • Treatment discussion: Exposure therapy (14.8)
  • Depression (13.12)
  • Treatment discussion: Cognitive Behavioral Therapy (14.9-14.10)
  • Schizophrenia (13.16-13.18)
• Body image & Body disorders
• Guest lecture from our GTA Shahrzad Ahmadkaraji

What is a Psychological Disorder?

• Clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.
• These are dysfunctions and are maladaptive, i.e., they interfere with day-to-day life.
• Notion of clinical distress: it is not fun to suffer from a psychological disorder.
• A psychological disorder is NOT:
  • An expected response to common stressors or loss.
  • A culturally approved response to a particular event.
  • Simple deviance from societal norms.

Example: Transition to college

Normal

• Thoughts
  • "My first two exams didn't go as I'd hoped, but I know that if I study harder and learn from my mistakes, I'll get the hang of this."
• Emotions
  • "I'm missing my high-school friends, but I'm starting to make new friends whom I really like."
  • Temporary feelings of anxiety and distress (often lasting minutes to hours) that do not interfere with academic and social functioning
  • Overall positive mood
• Behaviors
  • Attending all classes
  • Talking with instructors and teaching assistants
  • Meeting and getting to know new friends

Prevalence of Psychological Disorders

• Comorbidity: The occurrence of two or more disorders in an individual at a specific point in time.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013)

• The DSM-5 provides 20 categories of psychological disorders and an appendix listing disorders that occur in only some cultures.
• Specific criteria for disorders:
  • Essential features
  • Associated features
  • Functional significance
  • Exclusions

How Do Disorders Get Into the DSM?

• For DSM-5, they started meeting in 2007 (published in 2013).
• 15–20 APA-appointed committees for specific categories (mood, anxiety disorders, etc.), reviewed current research within each category
• Disorders must meet the criteria of:
  • Symptoms being severe enough to cause impairment or distress
  • Sufficiently different from categories of illness already recognized by manual
• Some changes from DSM-IV to DSM-5
  • Removed/consolidated several developmental disorders (e.g., “Asperberger’s Syndrome”, “pervasive developmental disorder not otherwise specified”) under the single umbrella “Autism Spectrum Disorder”
  • Removed “Gender Identity Disorder” and replaced with “Gender Dysphoria”

Pros and cons of diagnostic labels

Benefits of diagnostic labels:

• Access to treatment
• Improves research by allowing a “common language” for researchers to evaluate a phenomenon
• Can give a sense of well-being for folks who feel “understood”

Problems with diagnostic labels:

• Stigma – labels “stick”
• Encourages us to think as psychological disorders as fixed and enduring
• Creates a framework that reduces research and understanding of the real overlap between disorders
• Implies abnormal and normal are qualitatively different

Who provides therapy?

Therapy Providers

Therapeutic Approaches

• Psychodynamic approaches
  • Therapeutic approaches that derive from psychoanalytic theory, asserting that clinical symptoms arise from unconscious conflicts rooted in childhood.
  • E.g., “Interpersonal therapy”.
• Humanistic approaches
  • An approach to therapy centered around the idea that people must take responsibility for their lives and actions, focused on the search for meaning, self-actualization, and the present and future.
  • E.g., “person-centered therapy” C. Rogers
• Behavioral approaches
  • Assume that problematic behaviors and emotional responses are the result of learning experiences that have led to undesirable behaviors.
  • E.g., “Exposure therapy” (discussed in more depth later!)
• Cognitive approaches
  • Focus on thought patterns, with the goal of changing a person’s thinking to produce more adaptive behaviors and emotional responses.
  • E.g. “Cognitive-Behavioral Therapy” (discussed in more depth later!) A. Beck

Anxiety/stress has multiple components

• Physiological Arousal
  • Tension, increased heart rate, etc.
• Cognitive
  • Subjective appraisal of distress
• Behavioral
  • Avoidance, escape

Anxiety Disorders

• Anxiety disorders: the maladaptive experience of anxiety in terms of intensity, duration, and pervasiveness
• Diagnosed when fears and worries are painful and disabling
• Characterized by:
  • Responding to fears and worries with inhibition, withdrawal, avoidance, or over-control
  • Detection and/or avoidance of danger
• Several sub-categories of disorder, with high comorbidity

Types of Anxiety Disorders: Generalized Anxiety Disorder

• An anxiety disorder characterized by continuous, pervasive, and difficult-to-control anxiety
  • Cognitive symptoms: Feelings of inadequacy, difficulty concentrating and decision-making, sleep disturbances
  • Bodily symptoms: Muscle tension, elevated heart rate, diarrhea, breathing difficulty.
  • Lifetime prevalence: 6 percent
  • Twice as common in cis women as cis men

Types of Anxiety Disorders: Specific phobia

• A marked fear of or anxiety about a particular object or situation
• May have a significant impact on the life of a person when they develop elaborate strategies to avoid the phobic object
• The lifetime prevalence of any kind of phobia is 13 percent
• Cis women are twice as likely as cis men to have a specific phobia

Types of Anxiety Disorders: Social Anxiety Disorder

• An anxiety disorder characterized by extreme fear of being watched, evaluated, and judged by others
• Typically emerges in childhood or adolescence and places a person at increased risk for depression and substance abuse
• A lifetime prevalence of 13 percent
• Cis women and cis men are equally affected

Types of Anxiety Disorders: Panic Disorder

• Panic disorder: An anxiety disorder characterized by the occurrence of unexpected panic attacks
• Panic attack: A sudden episode of uncontrollable anxiety, accompanied by terrifying bodily symptoms that include one or more of the following: labored breathing, choking, dizziness, tingling hands and feet, sweating, trembling, heart palpitations, chest pain.

Types of Anxiety Disorders: Panic Disorder with Agoraphobia

• People with panic disorder sometimes develop a profound fear of having an attack, especially in public places
• Agoraphobia: A fear of being in situations in which help might not be available or escape might be difficult or embarrassing
• Often develops a powerful tendency to not venture outside of their designated “safe” places

Case study: Exposure therapy for anxiety disorders

• Counterconditioning: Using classical conditioning techniques, pair stimulus that causes fear or anxiety with a relaxing response.
• Exposure therapies expose people to the things that they are afraid of, desensitizing them to the fear and replacing the fear with relaxation responses.
• Mary Cover Jones

Major Depressive Disorder

• Depressed mood

• Diminished interest/pleasure in activities

• Significant weight loss/gain or increase/decrease in appetite

• Insomnia/hypersomnia

• Psychomotor agitation/retardation

• Fatigue/loss of energy

• Feeling worthless/excessive or inappropriate guilt

• Diminished ability to concentrate/ indecisiveness

• Recurrent thoughts of death, suicidal ideation, or a suicide attempt

  At least one of these + At least four of these

Major depressive disorder (or “depression”)

• One of the most common psychological disorder
• Lifetime prevalence: 7–15 percent for cis men and 20–25 percent for cis women.
• Depression can occur at any age, is frequently recurrent, and is most common in adolescence and young adulthood.
• Gender differences don’t appear until the teenage years, possibly due to cis women’s greater use of rumination and concern about body image.
• Rumination: The process of repetitively turning emotional difficulties over and over in the mind

Predictors of Depressive Disorders

Biological:

• Concordance rate for depression in identical twins is twice as high as for fraternal twins
• Although depression and bipolar disorder overlap in symptoms, they probably arise from different genetic sources

Cognitive processes:

• Negative cognitive schema: A mental framework in which a person consistently interprets events negatively
• Explanatory style: How a person explains why bad things happen

Interpersonal stress:

• Depressed primary caregiver or early parental loss increase the risk for depression
• Low socioeconomic status and national crises

Case study: Cognitive Behavioral Therapy for Depression

Basic tenets of CBT

• Cognitive activity affects behavior and vice-versa.
• Cognitions can be monitored and altered.
• Desired behavior change may be affected through cognitive change and vice-versa.

Cognitive-Behavioral Therapy

• Cognitive-behavioral therapists help patients identify and challenge negative thought patterns (internal beliefs or “automatic thoughts”) and replace them with more positive ways of thinking.
• Aaron Beck

Automatic thoughts stem from “cognitive distortions”

• Black & White Thinking: “I didn’t do a perfect job, which makes me a failure”
• Overgeneralization: “This date went so poorly. I’ll never find someone who loves me”
• Jumping to conclusions: “My friend isn’t responding to my text. I must have done something to make her angry”
• Catastrophizing: “I’m struggling to find time to study. I’m going to fail all of my classes and be forced to drop out”

Cognitive Restructuring

• Identify, challenge, and reframe negative automatic thoughts and negative core beliefs

Challenging automatic thoughts

Review the evidence:

• What is the evidence?
• What is the evidence supporting this idea?
• What is the evidence against this idea?
• Is there an alternative explanation?

Review possible outcomes:

• What is the worst thing that could happen? Could you live through it? What is the best thing that could happen?
• What is the most realistic outcome?

Problem-Solving

• What should I do about it?
• What would I tell _(a friend) if he or she were in the same situation?

Cognitive Restructuring

• Identify, challenge, and reframe negative automatic thoughts and negative core beliefs

Schizophrenia

• A psychological disorder characterized by a loss of contact with reality and a breakdown of the normal functions of the mind, leading to strange and unexpected perceptions
• Lifetime prevalence of 1 percent, typically diagnosed in late adolescence or early adulthood, and often begins earlier and has a more severe disease course in cis men than cis women

Schizophrenia: Positive vs. negative symptoms

• Positive symptoms: Hallucinations, delusions, disorganized speech and behavior, inappropriate emotional responses (e.g. laughter, tears, rage).
• Negative Symptoms: Toneless voices, expressionless faces, lack of speech, rigid movements, no movements (catatonia)

Hallucinations vs. Delusions

Hallucinations: False Perceptions

• Auditory
• Visual
• Olfactory (smell)
• Gustatory (taste)
• Somatic (touch)

Delusions: False Beliefs

• Persecutory
• Grandiose
• Reference
• Thought insertion

Brain & Biology of Schizophrenia

• Enlarged ventricles due to reduced brain volume
• Reduced volume especially in frontal and temporal lobes
• Loss of gray matter in prefrontal regions that support working memory

Brain & Biology of Schizophrenia

• Dopamine hypothesis: The hypothesis that schizophrenia arises from an abnormally high level of activity in brain circuits that are sensitive to the neurotransmitter dopamine
• More recent research has shown that general dopamine excess is not the sole cause of schizophrenia, but that dopamine imbalance is involved

Predictors of schizophrenia: Genetics and risk

• Odds of being diagnosed with schizophrenia are nearly 1 in 100; 1 in 10 for those with a diagnosed family member
• Adopted children's risk is related to biological parent
• Determining which genes are involved has been difficult and nonconclusive

Predictors of schizophrenia

Prenatal environment and risk

• Low birth weight
• Lack of oxygen during delivery
• Midpregnancy viral infection (e.g., flu, dense population, season of birth)
• Maternal prenatal nutrition

Schizophrenia

• What positive symptoms do you notice?
• What negative symptoms do you notice?

Concepts to review

Terms to know:

1. DSM-5
2. Therapeutic approaches
   1. Psychodynamic approaches
   2. Humanistic approaches
   3. Behavior approaches (e.g. exposure therapy)
   4. Cognitive-Behavioral therapy
3. Anxiety disorders
   1. GAD
   2. Specific phobias
   3. Social Anxiety Disorder
   4. Panic Disorders & Agoraphobia
4. Major depressive disorder
   1. Symptoms
   2. Predictors of depression
5. Cognitive Behavioral Therapy
   1. Automatic thoughts
   2. Cognitive distortions
6. Schizophrenia
   1. Positive vs. negative symptoms
   2. Hallucinations vs. delusions
   3. Brain and biology of schizophrenia
   4. Predictors of schizophrenia

Big-Picture Questions:

1. What are the conditions that make something a clinical disorder? Why is e.g. feeling grief in response to a loved one’s death not considered a psychological disorder, but persistent sadness due to depression is?
2. What are some pros and cons of diagnostic labels?
3. How does exposure therapy for phobias and anxiety work? How do theories of classical conditioning relate to this practice?
4. How can Cognitive-Behavioral Therapy be applied to a patient with a depressive disorder? Give an example of cognitive restructuring.