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Clinical
All PSYC1030 Clinical topic notes
Psychological Therapies
Clinical Psychology
Diagnose and treat mental, emotional, and behavioural disorders
Integrates scientific research, psychological theory, and clinical knowledge to understand and alleviate psychological distress
Sits within a broad group of mental health professionals including psychiatrists, therapists, counsellors, social workers, etc
Clinical psychologists often specialise in different areas, such as child and adolescent psychology, forensic psychology, neuropsychology, or health psychology.
Work settings include private practice, hospitals, community mental health centers, rehabilitation facilities, and academic institutions.
Role of Psychologists
It focuses on psychological therapy, assessment, and behavioural interventions
Assess and diagnose psychological conditions using clinical interviews, psychometric assessments, and observation.
Develop and implement evidence-based treatments tailored to individual needs.
Promote mental health and well-being through therapy, psychoeducation, and preventative interventions.
Conduct research to improve psychological treatments and understand mental health disorders.
Provide consultation and supervision to other professionals in clinical and academic settings.
Use standardized psychological tools, such as MMPI (Minnesota Multiphasic Personality Inventory), WAIS (Wechsler Adult Intelligence Scale), and Beck Depression Inventory.
Collaborate with other healthcare professionals to provide holistic care.
Why see a Clinical Psychologist?
Clinical psychologists support individuals across various psychological and life challenges. Common reasons for seeking therapy include:
Mental Health Conditions
Mood disorders: Major Depressive Disorder (MDD), Bipolar Disorder, Dysthymia
Anxiety disorders: Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Phobias
Obsessive-Compulsive & Related Disorders: OCD, Body Dysmorphic Disorder, Hoarding Disorder
Trauma & Stress-Related Disorders: PTSD, Acute Stress Disorder, Adjustment Disorder
Developmental and Neurological Disorders
Autism Spectrum Disorder (ASD): Social communication difficulties, repetitive behaviors
Attention-Deficit/Hyperactivity Disorder (ADHD): Impulsivity, inattention, hyperactivity
Learning Disabilities: Dyslexia, dyscalculia, executive functioning deficits
Health Psychology & Psychosomatic Issues
Chronic illness coping: Cancer, diabetes, autoimmune disorders
Pain management: Fibromyalgia, migraines, chronic pain conditions
Stress-related physical conditions: Hypertension, irritable bowel syndrome
Behavioural and Emotional Issues
Anger management: Difficulty regulating emotions
Interpersonal and relationship difficulties: Family, romantic, or workplace conflicts
Adjustment to life changes: Divorce, job loss, relocation, grief
Severe and Enduring Mental Illness
Schizophrenia and psychotic disorders: Hallucinations, delusions, disorganized thinking
Personality disorders: Borderline, Antisocial, Narcissistic, Avoidant Personality Disorders
Support for Specific Populations
Children and adolescents: Emotional regulation, bullying, school stress
Older adults: Dementia, late-life depression, grief counseling
DSM
Diagnostic and Statistical Manual of Mental Disorders
The DSM-5 (latest version) provides a biopsychosocial approach to diagnosing mental disorders.
Divides disorders into 18 different classes (e.g., neurodevelopmental disorders, schizophrenia spectrum, mood disorders, anxiety disorders, etc.).
Contains over 300 diagnoses with clearly defined criteria for diagnosis.
Sets thresholds and rules for meeting diagnostic criteria (e.g., symptom duration, impact on daily functioning).
Used by psychologists, psychiatrists, and mental health professionals worldwide.
Key Concepts in Diagnosis
Heterogeneity
Two people with the same diagnosis can experience very different symptoms.
Example: Two individuals with depression—one might have insomnia and anxiety, while another experiences lethargy and social withdrawal.
Comorbidity
If a person has one disorder, they are more likely to have another.
Example: Major Depressive Disorder (MDD) frequently co-occurs with Anxiety Disorders.
Psychological Therapies
Four Foundational Models of Psychological Therapy
Psychodynamic (Unconscious processes, early experiences)
Biological (Brain structure, genetics, neurotransmitters)
Behavioural (Learned behaviours, conditioning)
Cognitive-Behavioural (CBT) (Thought patterns influencing behaviour)
Psychodynamic
Rooted in Freudian theory but evolved significantly.
“Two things you need to know about Feud. One is he was wrong, and the second is that he’s dead.:
Explores unconscious processes, early childhood experiences, and internal conflicts.
Core Concepts
Unconscious Processes
Behavior, thoughts, and emotions are shaped by unconscious drives & motivations.
Therapy seeks to bring these hidden elements to awareness.
Early Childhood Experiences
Personality & relationship patterns are shaped by early experiences.
Unresolved past conflicts can manifest in current behaviors and emotional difficulties.
Internal Conflicts and Defense Mechanisms
Psychological distress stems from inner conflicts between unconscious desires & societal expectations.
Defense mechanisms (e.g., repression, denial, projection) help manage distress but may become maladaptive.
Therapy examines whether these defenses are helpful or hindering.
Transference and Countertransference
Transference: Client projects feelings from past relationships onto the therapist.
Countertransference: Therapist's emotional reaction to the client.
Exploring these dynamics reveals relational patterns and emotional blind spots.
Therapeutic Relationship
The therapist-client relationship serves as a microcosm for understanding a client’s emotional world.
Techniques
Free association (express thoughts without censorship)
Interpretation (analyzing themes in speech and behavior)
Dream analysis (examining unconscious symbolism)
Biological
Mental disorders have biological causes (e.g., brain structure, neurotransmitters, genetics).
Key Factors
Neurological & neurochemical: Imbalances in dopamine, serotonin, etc.
Genetic & epigenetic: Inherited vulnerabilities, environmental triggers.
Endocrine system: Thyroid, stress hormones affecting mood.
Medication: Antidepressants, anxiolytics, antipsychotics, mood stabilizers.
Other interventions: ECT (electroconvulsive therapy), TMS (transcranial magnetic stimulation), VNS (vagus nerve stimulation), DBS (deep brain stimulation), neurofeedback
ect and tms helps with severe depression that nothing else seems to work for
Lifestyle factors: Diet, sleep, and exercise significantly impact mental health.
Biopsychosocial
biological — physical health and genetics → medical interventions
psychological and social factors interpret more broadly and inform complementary strategies
Behavioural
Focuses on observable behaviors and how they are learned through conditioning.
Key Concepts
Classical Conditioning (Pavlov): Learning through association.
Operant Conditioning (Skinner): Behavior shaped by rewards and punishments.
Social Learning (Bandura): Observing and imitating others.
Therapeutic Techniques
Systematic Desensitization: Gradual exposure for phobias.
Token Economies: Reward-based systems for behavior change.
Cognitive
cognitions (thoughts) are also important — dysfunctional thinking leads to dysfunctional emotions or behaviours
identify and challenge distorted or irrational thoughts and beliefs, and replace them with more realistic, positive ones
Focuses on how thoughts influence emotions and behaviors.
Developed into Cognitive-Behavioral Therapy (CBT), which combines cognitive and behavioral strategies.
techniques include cognitive restructuring, problem-solving, and skills training
explain the rationale for the importance of thoughts — their relationship with feelings and behaviours
Techniques
Cognitive Restructuring:
Identifying and challenging distorted thoughts.
Example: Changing “I’m a failure” to “I made a mistake, but I can improve.”
ABC model
“A”ctivating event
“B”eliefs or thoughts about that event
“C”onsequences — that is, your emotional, physiological and behavioural consequences
Example
**Activating event—**Partner not home from work an hour later than usual – they are rarely late and there has been no call or text
**Belief—**Stuck in a meeting → **Consequences—**Maybe a bit annoyed;Maybe a bit empathetic; Maybe a bit happy; Delay dinner
**Belief—**In a serious accident → **Consequences—**Worried; Increased heart rate; Call the hospital/police
**Belief—**Cheating on you → **Consequences—**Angry/upset; Heart races; Short of breath; Panic/anxiety; Destroy their stuff
Evaluating Therapies
How do we know which therapies work?
Must be evidences based
Must use APA guidelines
Treatments must be evidence-based to be considered effective.
3 criteria:
at least two independent randomised controlled trials (RCTs) that indicate that the intervention is useful in treating a particular presenting problem
the active treatment must be better than either a placebo condition or an alternative active reaction
the rct must be competently carried out
Randomised Controlled Trials
should be registered on a clinical trials register
full protocol for the trial should be outlined
recruitment procedures plus inclusion/exclusion criteria specified
random assignment to conditions (conditions clearly described - active intervention, a placebo or a wait list control)
assessment before and after the intervention (plus follow-ups)
enough participants to be able to detect a difference between conditions if such a difference exists – adequately powered
Gold standard for research.
Includes pre/post-assessment, randomization, control groups.
Example: Comparing CBT for anxiety vs. medication.
Depression and Anxiety
Introduction to Anxiety and Mood Disorders
Unlike physical disorders, which are diagnosed through physical tests (blood tests, scans, biopsies, etc), mental illnesses are diagnosed through the assessment of signs and symptoms.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD) are the ‘bibles’ of diagnoses
Depressive Disorders
Within the DSM-5, there are from depressive disorders
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Disruptive Mood
Dysregulation Disorder
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder
Other Specified Depressive Disorder
Unspecified Depressive Disorder
Major Depressive Disorder
The diagnostic criteria states that:
a person needs to have demonstrated 5 or more symptoms during the same 2-week period for most of the day, nearly everyday;
the person’s presentation needs to represent a significant change compared to their previous functioning;
and that one of 5 symptoms needs to be either persistent sad mood most of the days and on most days—or loss of interest or pleasure
‘sad mood’ may manifest as irritable in children and adolescents
loss of interest/pleasure in previously enjoyed activities is referred to anhedonia
Some other symptoms are:
loss of weight or appetite in either direction — an increase or decrease
weight loss may be deliberate
weight gain needs to be a change of 5% within a month
change in sleep patterns — increase or decrease, insomnia or hypersomnia
people are more than likely to sleep more when they are depressed, as they become tired and physically exhausted when constantly sad
the desire to sleep can also be an escape mechanism of sorts, a desire to escape the symptoms of depresion
psychomotor behaviour — agitation or ‘retardation’
psychomotor = someone who is very fidgety and can’t sit still when they’re depression
psychomotor retardation = reduced and slow movement; very common
fatigue, loss or energy
thoughts of worthlessness or excessive/inappropriate guilt nearly every day, which may be delusional
diminished ability to think or concentrate, or indecisiveness, nearly everyday
suicidal thinking or ideation, reoccurring thoughts of death, but not just a fear of dying
suicidal thoughts/ideation without a plan, an attempt, or a specific plan for suicide.
The DSM notes that the symptoms must represent a significant change from a person’s previous level of functioning, and the symptoms of MDD must cause clinically significant distress or impairment in a person’s functioning
the idea of distress and impairment is critical — this is because many symptoms of diff mental illness are things that everyone can experience from time to time
When considering the symptoms, note that other disorders could present with these too. This requires the consideration of other potential explanations for the symptoms that the person is displaying.
One exclusion criterion specifics that psychologists need to be sure that the symptoms are not able to be explained by physiological effects of a substance, another medical condition, or grief/loss
if there is reason to believe it is a substance, appropriate investigations (tox screen, blood test) should be concluded to rule out these causes.
grief/loss can take many forms — death, financial ruin, end of a relationship.
psychologists must be mindful of this as they do not want to slap a diagnostic label on a very normal process and pathologise it
in some cases, however, if the symptoms persist for a long time, the grief may have become a depressive disorder
People may show symptoms of MDD as a result of a medical condition or substance use. For example, weight loss with untreated diabetes or fatigue, as a consequence of cancer, not necessarily MDD.
Psychologists need to be mindful in thinking about, “Is the diagnosis we are considering the must accurate way of explaining or thinking about this presentation?”
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Persistent Depressive Disorder (Dysthymia)
Eeyore has Dysthymia :(
Dysthymia is a chronic, but lower grade intensity version of MDD. In saying this, however, it is important to emphasise that the impact of this disorder can be as or more significant than the impact of MDD
The symptoms are very similar. In order to meet the criteria, a person needs to demonstrate depressed mood for most of the day, more days than not, for at least two years. For children and adolescents the criterion is one. In addition, people need to display two symptoms from this list:
poor appetite or over eating
insomnia or hypersomnia
low energy or fatigue
low self-esteem
poor concentration or problems making decisions
a sense of hopelessness
This disorder is an amalgamation of two DSM-4 disorders = dysthymic disorder and chronic major depressive episode
Someone can have both MDD and Dysthymia at the same time = double depression
Prevalence of Depression Disorders
AUS & US data indicate that the 12-month prevalence of MDD in adults is between 6 & 7%. In 18-29 year olds, the prevalence is 3 times more than people aged 60 or older. Many adults with depression say it started within adolescence or early adulthood
Females are more than likely to develop MDD than males, the difference 1.5 to 3 times.
The Course of Depressive Disorders
MDD can begin at any age but onset does increase with puberty. In Western nations, incidence seems to peak in the 20s although it isn’t uncommon for onset to be later in life
Dysthymia tends to have an early and chronic onset. MDD has remission (2 or more months with no symptoms or no more than 2 symptoms at a mild level) and some can go for a number of years without experiencing a major depressive episode.
Most people, given enough time, will recover without intervention. This is called spontaneous recovery. For 2 in 5 people with MDD, spontaneous recovery will occur within 3 months of onset; and for 4 in 5 people this will happen within 12 months of onset
Features associated with lower rates of recovery from a major depressive disorder include
symptom severity
personality disorders
psychotic features
Factors associated with increased risk of experiencing another episode of MDD include:
the severity of preceding episode
being younger at onset
having experienced more prior episodes.
If a person with dysthymia develops symptoms that meet criteria for a major depressive episode, what will typically happen is that the symptoms will return to a lower level — such that the criteria for dysthymia but not major depressive disorder continue to met
In terms of symptom resolution, this is more likely to occur spontaneously with MDD than dysthymia.
The Causal Models of Depressive Disorders
There is good evidence that biological and genetic factors play an important role in development of depressive disorders.
Disrupted neurotransmitter functioning has been implicated - in particular, the neurotransmitters, serotonin, dopamine, and noradrenaline
First degree relatives of individuals with MDD are at risk for developing this disorder compared to the general population. The increased odds are 2-4 times
Research suggests dysthymia has an even heavier genetic loading.
Prejudicial childhood experiences — trauma, abuse, and/or neglect — are risk factors for developing depression. Stressful life events have also been found to be associated with the onset of major depressive episodes.
It is very unlikely for depression to occur without stressful life events—it’s just that not everyone will develop a depressive disorder in response to stressful life events
So, the best and more accurate way of thinking about aetiology or development of a depressive illness is in terms of a diathesis-stress model.
A person may have an underlying predisposition, this may be a genetic, physiological or a psychological vulnerability to develop depression, which is then triggered by exposure to stressful life events for example — causing the predisposition to convert into a disorder.
Cognitive Behavioural Model of Depression
From the cognitive behavioural perspective, thinking about the development/aetiology of depressive disorders, the behavioural component suggests that depression is maintained by the lack of positive reinforcement that results from a person’s failure to engage in previously enjoyed activities
This in turn feeds into a sense of learned helplessness; a sense of utter powerlessness in relation to the external environment
Learned helplessness might be expressed in thoughts such as “There is nothing I can do to make myself feel better. I may as well just stop trying.” Depression is very much about negative thoughts relating to the self, the world and the future.
People who are clinically depressed often demonstrate what is referred to as a pessimistic explanatory style, where bad things are attributed to internal, stable, and global factors; while positive things are attributed to external, random factors.
Treatment for Depressive Disorders
Antidepressant medication is very commonly used in the management of depression. The most commonly prescribed class of antidepressants is the Selective Serotonin Reuptake Inhibitors or SSRIs
Another biological treatment for depressive disorders that tends to be used as a last resort, for treatment-resistant depression, is Electroconvulsive therapy or ECT
In terms of psychological interventions, cognitive behavioural therapy or CBT has the strongest evidence base, with Interpersonal therapy or IPT also showing good outcomes.
Two of the key strategies within CBT for the treatment of depression are behavioural activation and cognitive restructuring.
Behavioural activation, also known as Pleasant Events Scheduling, targets the depressive symptom of loss of pleasure or interest in previously enjoyed activities.
With this strategy, psychologist work with their client to figure out what activities they used to enjoy before they became depressed. Then, they set homework tasks in which the client has to engage in activities they previously enjoyed.
The rationale for behavioural activation is that, with some time, the client will begin to experience positive reinforcement for engaging in these activities, which will lead to an improvement in their mood.
The second strategy of cognition restructuring involves working with a client to help them identify or catch the thoughts that are contributing to their sadness and hopelessness; and evaluating the evidence for and against the likelihood of these thoughts being accurate.
Anxiety
Anxiety, as an emotion, is a normal part of being human—everyone gets anxious. The problem is how one distinguishes between anxiety that falls within the broad parameters of normal, and anxiety that as become clinically significant.
Clinically significant is if a person’s anxiety is causing them a great deal of distress and/or it’s really interfering with their functioning. It comes down to two key constructs — distress caused and associated impairment or interference in functioning
There are a number of DSM-5 anxiety disorders:
Separation Anxiety Disorder
Selective Mutism
Specific Phobia
Social Anxiety Disorder (social phobia)
Panic Disorder
Agoraphobia
Generalised Anxiety Disorder
Substance/Medication Induced Anxiety Disorder
Anxiety Disorder Due to Another Medical Condition
Other Specified Anxiety Disorder
Unspecified Anxiety Disorder
There is an idea of 3 systems of anxiety
the cognitive system — what people think either before, during, or after a situation where they feel anxious
the behavioural system — what people do when they are anxious
the physiological system — what happens in people’s bodies when they are anxious
Specific Phobia
People with a Specific Phobia demonstrate a really high level of fear, anxiety, or avoidance in relation to very specific, circumscribed situations or objects
Essentially, very specific fears that are out of all proportion to any actual danger. The fear may be manifested in children and adolescents as behaviours such as crying. tantrums, and clinging.
The most common types, and diagnostic specifiers, of phobic stimuli are
animals — snakes, spiders, etc
natural environment — storms
blood-injection-injury — injections
situational — enclosed spaces
other situations — a situation that a person associates with choking or vomiting
In order to meet the criteria for a Specific Phobia, a person must demonstrate:
extreme fear or anxiety about a specific situation/object almost always when confronted with it
avoided or endured the phobic stimulus, which is out of proportion to any actual danger posed by it
the fear/anxiety/avoidance must have been experienced for 6 months or longer, and must cause clinically significant distress or interference
must not be better explained by symptoms of another mental illness
These phobias usually develop in early childhood, with most cases beginning before the age of 10. The prevalence rate for Specific Phobia is around 5% going up to 16% in adolescents, and 3-5% to beyond adolescence. It affects twice as many females compared to males
Social Anxiety Disorder
Social Anxiety Disorder is different to generally feeling anxious in social situations, as it is a fear/anxiety about or avoidance of social situations and interactions in which there is the possibility of being scrutinised or judged by others
Common social interactions that may provoke anxiety include:
eating in front of others
performing in front of others
having to meet someone new
These situations almost always provoke anxiety and are either avoided or endured with extreme anxiety. Anxiety must have been present for at least 6 months, and must be out of proportion for what it is, resulting in either intense distress and/or significant impairment in functioning
In Western Countries, the 12-month prevalence rate for Social Anxiety Disorder is around 7% across all ages, ,ore common in females, with 75% of onset between ages of 8 and 15. Social anxiety forming in adulthood is reasonably rare.
Panic Disorder
Characterised by recurrent, unexpected panic attacks. Panic attacks are defined as ‘an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes’
A panic attack involves four or more of the symptoms:
palpitations, pounding heart, accelerated heart rate
sweating
trembling or shaking
sensations of shortness of breath or smothering
feelings of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or faint
chills or heat sensations
paresthesias —numbness or tingling sensations
derealisation — feelings of unreality, or depersonalisation, being detached from oneself
fear of losing control or going crazy
fear of dying
To meet the criteria for Panic Disorder, at least one panic attack must have been followed by at least a month of either or both of:
persistent anticipatory anxiety or concern about having another attack or the consequences of having an attack
a significant and problematic behavioural change related to the attack, for example avoiding exercise as one might induce a panic attack
While many of the listed symptoms are common in general anxiety and a panic attack, there are differences in the usual thinking. For example, someone having anxiety may think ‘the reason my heart is racing is that i’m anxious’, whereas someone having a panic attack will think ‘my heart is beating so fast, i must be having a heart attack.’
Typically, by the time somebody with panic disorder ends up seeing a mental health professional, they have done the rounds in terms of various medical specialists. Often, people with panic disorder are pretty unhappy to be seeing a mental health professional.
12 month prevalence is around a 2-3 rate across adolescents and adults. Not commonly seen in children. Diagnosed about twice as often in females as males.
Comorbidity—Focus on Panic Disorder
Comorbidity = where a person meets criteria simultaneously for more than one diagnosis.
Somewhere between 10 and 65% of people with a primary diagnosis of Panic disorder will also meet criteria for MDD. In most cases, MDD develops either around the same time or subsequent to the panic disorder
The co-occurrence of panic disorders and substance use problems is due to people using substances to self-medicate or to try to reduce the distress and interference caused by their anxiety symptoms. This is very common.
Generalised Anxiety Disorder
Essentially defined by excessive worrying. Differences between GAD and non-clinical worrying would be that people with GAD may tell you that they experience their worry as totally uncontrollable.
People with GAD may worry about all manner of things: work, school, health, health of others, the impression they make on others, things that are happening elsewhere-natural disasters, civil wars, etc
A person must find it difficult to control worry or anxiety for more than 6 months and 3 out of 6 symptoms:
muscle tension & restlessness
distress or impairment
hypervigilance
being easily fatigued
difficulty concentrating or mind going blank
sleep disturbance.
GAD has a 12 month prevalence rate of 0.9% in adolescents and 2.9% in adults, females twice as likely as males to be diagnosed
Causal Models of Anxiety Disorders
Anxiety runs in families — if one your relatives with an anxiety disorder, your odds of developing an anxiety disorder increases.
Common features across anxiety disorders are
heritability, which accounts for upwards of 30-40% of the variance in the development of anxiety disorders
temperament — an innate rather than learned aspect of personality — has been found to be important in the development. In particular, the temperamental quality of behavioural inhibition—characterised by shyness, fear of unfamiliar situations and withdrawal—has been identified as an important risk factor.
environmental factors including exposure to potentially traumatic events, an accumulation of stressful life events, and parenting behaviours, such as modelling and overprotection
The best way of understanding how anxiety develops is by considering the ways in which biological risks may interact with environmental triggers
Cognitive Behavioural Models of Anxiety
From a cognitive behavioural perspective, the behavioural component in the aetiology of anxiety disorders is informed by Stanley Rachman’s work published in 1977
Rachman proposed three pathways through which people might develop fear.
The first is through their own direction experience, which may become generalised through conditioning (eg, if you’re bit by a dog, you’re gonna fear dogs)
The second pathway is instructional learning, which involves the transmission of information relating to danger (eg when a parents warns a child to stay away from a pool as people drown, the child may be fearful of pools)
The third is vicarious learning, which is when you repeatedly see someone else, usually an important person in your life like a parent, behave fearfully the confronted by a particular stimulus, then you develop that fear.
Cognitive Behavioural Therapy for Treating Anxiety Disorders
The frontline intervention for treating anxiety disorders is cognitive behavioural therapy (CBT)
CBT is an efficacious treatment across diagnoses, resulting in superior outcomes compared to waitlist control conditions and expectancy control treatments.
CBT seems to work better for GAD than Social Anxiety Disorder.
A review of treatment in anxiety disorders in children and adolescents reported an average remission rate of 56.5%. It isn’t a perfect treatment though, as some didn’t feel it worked whatsoever and others reported reoccurring symptoms, albeit not as strong
Other Treatments for Anxiety Disorders
Medication is an option but no the frontline intervention
Some other treatments include
psychoeducation about anxiety — educating clients about anxiety, including telling them that it is normal, often adaptive or helpful, and that we understand it to consist of threep separate but interrelated systems (cognitive, behavioural, physiological systems)
cognitive restructuring and exposure — requires the client to understand the important of thoughts. Would ask the client to start identifying the unhelpful thoughts that are making them anxious in ways like a thought diary. These thoughts are then worked through to evaluate the evidence for and against the likelihood of the thoughts being accurate.
Children go through the ‘Scientific Approach’ where kids are encouraged to think of themselves as scientists who have to evaluate the evidence for and against their ‘hypotheses’ (anxious thoughts)
Adults go through ‘Socratic Questioning’
These strategies tend to be used together.
Systematic desensitisation or exposure aims to address the avoidance of feared stimuli that tends to go with the anxiety. This strategy is based on the psychological principle of habituation and involves deliberately and repeatedly placing yourself in anxiety-provoking situations that would normally be avoided.
Treatment begins with creating a list of anxiety provoking situations in a hierarchy. Relaxation was used before to reduce the anxiety in these situations, however research as showed this to be a subtle form of avoidance. Thus, the aim is to be exposed to the situation and fully experience the anxiety to realise that you can handle handle the situation through relaxing within it. The experiences in the hierarchy needs to be experienced (imaginally or in real life) repeatedly until the fear response has been extinguished.
The most common behavioural response to anxiety is avoidance. Avoidance means that the individual misses out on the opportunity to discover that he or she actually can cope with that feared situation. Instead, it strengthens and reinforces anxiety
Personality 1
What is Personality?
personality refers to the character traits that identify what makes a person who they are
the unique way of each of us responds to the world around us — our consistent pattern of behaviours, thoughts, and emotions
these patterns define an individual and differentiate them from others
represents a dynamic combination of biological, psychological, environmental influences
consistency = personality traits tend to be relatively stable across time and situations
uniqueness = personality highlights what makes an individual distinct from others
individuality = encompasses both innate tendencies and learned behaviours
patterns = refer to the repeated ways in which individuals interact with the world
individual differences = variability in personality traits and behaviours across people. differences are what make each person unique
Why study personality?
clinical = diagnosing and treating mental health conditions
social = predicting social interactions and relationships
developmental = understanding how traits emerge and evolve throughout life
Approaches to studying personality
Nomothetic = searching for general laws that govern all human behaviour
focuses on identifying general laws or principles that apply to all individuals
emphasises universality and generalisation
personality models
studies of genetic contributions to personality
idiographic = focusing on unique aspects of individuals
focuses on understanding the unique characteristics of an individual
emphasises individuality over generalisation
tracking the personality development of a single person over decades to understand how traits evolve with age and life event
designing a therapy plan for a person with PTSD
Why Study Personality?: Clinical
Diagnosis and treatment
certain issues may be linked to stable patterns in personality
tailor interventions, predict treatment challenges, and guide therapeutic approaches
Risk factors and prognosis
traits can predispose individuals to anxiety or depression onset and outcomes
Therapeutic Relationships
traits can affect engagement and response to therapy
Causes of Personality
Nature and Nurture
Shaped by a combination of biological inheritance and environmental influences
genetic factors
influence brain structure and function, such as neurotransmitter activity, which impacts personality traits
eg dopamine systems are linked to traits like extraversion and reward sensitivity
shared environmental factors
parenting style: authoriative, permissive, or authoritarian parenting may influence personality development
socioeconomic status: access to resources, education, and social norms can shape personality
cultural value: a shared emphasis on collectivism or individualism within a family
non-shared environmental factors
explains majority of environmental variances in personality traits
different peer groups: friends can shape attitudes, behaviours, and preferences
unique life events: personal traumas, achievements, or opportunities that differ between siblings
birth order: firstborns may receive more parental attention, while later-borns may have different expectations place upon them
Psychodynamic Approach
Interaction between id, ego, superego
Developed through psychosexual stages
Criticised for its lack of empirical evidence and its focus on sexuality
Dynamic interplay
the id wants instant gratification
the superego imposes strict moral guidelines
the ego mediates to achieve balance, often leading to internal tension
Id
pleasure principles, seek pleasure and avoid pain
primitive and instinctual part of the mind, operating entirely on the unconscious level
contains biological drives and instincts
Ego
reality principle, delay gratification when necessary
rational and realistic part of the mind that mediates. between the id and the eternal world
executive decision maker — balances the impulsive desires of the id and the moral constraints of the superego
Superego
perfection principle, pushing the individual to strive for moral perfection
moral and ethical component of personality, representing societal and parental standards
develops around age 5-6 through internalisation of rules and values
two subsystems
conscience = guilt for violating moral standards
ego ideal = aspirations for achieving moral and ideal behaviours
Psychosexual Stages of Development
personality develops through a series of stages, each centred on a specific erogenous zone
at each stage, children experience conflicts between their biological drives and societal expectations
successful resolution of these conflicts is essential for healthy personality development
fixation at a stage can lead to personality and behavioural issues later and life
Criticisms of Freud’s Theories
lack of empirical evidence
freud’s theories are difficult to test scientifically and lack of falsifiability
Overemphasis on sexuality
his psychosexual stages have been criticised for being overly focused on sexual development
Cultural and Gender bias
concepts like “penis envy” are considered sexist and reflective of Victorian-era values
Subjectivity
ideas were based on case studies and subjective interpretations rather than controlled research
Freud’s Contributions
importance of early childhood experiences in shaping personality
Concepts like fixation and unconscious conflict laid groundwork for modern psychodynamic therapies
Freud’s ideas have permeated literature, art, and discussion of human behaviour, even beyond psychology
Freud’s theories actually gave people a socially acceptable way to talk about sexuality by giving sexual interpretations to everyday behaviours
Sexual development and sexuality is an important part of psychology
Behavioural Theories of Personality
Early psychology focused on unconscious processes, but moved onto focusing on things people can measure
Behaviourists thought that people should explain personality in terms of people’s behaviour rather than just their thoughts — because that could be measured
B.F. Skinner proposed behaviourism mainly
The behavioural approach to personality is the idea that personality is under the control of genetic factors and environmental reinforces and punishers
Skinner, like Freud, thought that our behaviour is strictly deterministic, that one doesn’t consciously chose how we behave, as well that is is determined by unconscious processes
Freud however says unconscious processes are things that happen deep inside our psyche, outside of our level of awareness, whereas Skinner thought the unconscious things that affect us are things that are in the environment that reinforce or punish us
Skinner thought that the unconscious variables are outside of oneself.
Social Learning Theories of Personality
Albert Bandura took Skinner’s idea of environmental influences on people’s behaviour, but also that cognition was still important in terms of behaviour and how we express personality
Bandura argued that personality is the interaction between a person’s traits, their thoughts, and the environment that their behaviour is expressed in
Reciprocal determinism refers to the idea that behavioural, cognitive, and environmental variable interact to produce personality
Although, Bandura’s social learning approach relies on expectancies — you need to have the cognitive machinery to be able to form these expectancies which is a higher level of cognitive function, but we still see social learning in animals that don’t have cognitive machinery
Humanistic Theory of Personality
More positive = how positive motivations can be related to the expression of personality
Two main proponents of these perspectives, Carl Rogers and Abraham Maslow
Rogers thought that personality was a function of the person, the self which is the self-concept, and what he called the Conditions of Worth
Conditions of Worth are the expectations or rules that society puts on our behaviour, which can lead to an inconsistency between people’s self-concept and what they are actually like
Personality development will be fully realised in a world where there were no expectancies about what people are meant to be like = Roger’s idealised this world
Maslow thought that positive motivation was important for personality
Maslow defined personality as the expression of the tendency to strive for what he calls self-actualisation, which is the idea that people want to fulfil their potential.
Hierarchy of needs = the idea that if our phsyiological needs are met (food, water, oxygen, rest), we would be motivated by the next tier up, which are safety needs
The idea is we can’t be motivation by self-actualisation unless all of these lower order needs are satisfied first — however, the needs are defined subjectively, thus hard to test
Types versus trait models of personality
Humoral theory = first theories of personality was a type model
Humoral theory characterised a person’s personality based on what sort of humour/fluid they had in excess in their body
choleric type people—too much yellow biles, they would be bad tempered and irritable
melancholic people = too much black bile, gloomy & pessimistic
No biological evidence for humoral theory, but people still think about personality in terms of types
Personality traits
Traits are the building blocks of personality and refer to enduring characteristics that influence behaviour
stable tendencies to think, feel, or behave in certain ways across different situations
they exist on dimensions or spectrums, rather than as categorical types
they help predict behaviours
traits contribute to individual differences in how people respond to similar situations
Trait theorists think that traits are the factors that are responsible for causing patterns of behaviour, that traits are things that reside in our brains
brain injuries, drugs, etc, may affect your personality when changing the brain
To determine personality traits, you can give someone a questionnaire and ask them how many personality specific words apply to them. Then, perform a statistical test — factor analysis — on the responses, which tells us what the minimum number of things we need to summarise the data and the minimum number of things are the dimensions of personality. You can then plot the responses and see if you need a certain amount of dimensions
From research, people seem to agree that there are between 3 and 16 dimensions of personality that are necessary for describing it.
Raymond Cattell came up with ‘16PF’ = 16 personality factors
Neil Mccrae and Paul Costa came up with Big Five = 5 factors to personality
neuroticism = tense and moody
extraversion = social and lively
openness = intellectually curious and unconventional
agreeableness = friendly and easy to get along with
conscientiousness = careful and responsible
Hans Eysenck came up with three bipolar dimensions
extraversion to introversion = going from outgoing nature, high level of activity, to shuns crowds, prefers solitary activity
neuroticism to emotional stability = going from full of anxiety, worries and guilt to relaxed and at peace
psychoticism to self-control = aggressive, egocentric and antisocial
The Big 5 Across Cultures
China has 26 different personality constructs = Chinese Personality Assessment Inventory (CPAI)
dependability = responsibility, optimism, trustworthiness
interpersonal relatedness = harmony, thrift, relational orientation, tradition
social potency = leadership, adventurousness, extraversion
individualism = logical orientation, defensiveness, self-orientation
Overlaps with B5 — neuroticism was correlated with dependability, extraversion with social potency, agreeableness with individualism
Biopsychological Theory of Personality
Jeffery Gray developed the idea that personality is explained by physical differences in the brain
Gray proposed the behavioural inhibition system (BIS) and behavioural approach system (BAS)
BIS
related to the individuals sensitivity to punishment and motivation for avoidance
BAS
related to the individuals sensitivity to reward as well as their motivation for approach
Personality Assessment: Objective Tests
Minnesota Multiphasic Personality Inventory (MMPI)
questionnaire measure of personality with a large number of items
designed for a clinical setting
MMPI is useful for diagnosing psychological disorders
yet comes with the risk of being deceived even if made to detect deception and social desirability bias
Thematic Apperception Test
present people with an ambiguous stimuli and ask people to describe whats in the image
Personality Assessment: Projective Tests
Rorschach inkblot
shows someone an ambiguous inkblot and ask them to describe what they see, then score according to different coding schemes.
Involves subjective judgements = low reliability and low validity
Schizophrenia
Prevalence of Mental Illness
Western nations = 1 in 5 people will have a mental illness across their lifespan, the type depending on ages, gender, culture, etc
Schizophrenia
Key Facts
Prevalence = 0.5 - 1 %
Similar prevalence between males and females, but difference in the age range for onset — common between ages 15 and 35. Late onset is considering 40+
The Lifetime risk for suicide in people living with schizophrenia is 5%. Risk factors associated with suicide including being male, being younger, and having a high level of education, as does a history of suicide and substance abuse
People with schizophrenia die much earlier than expected with up to 40% of premature mortality attributed to suicide and unnatural death
Referred to as the prototypical psychotic disorder as it one of the most common and covers the main 5 symptoms
One of the highest impact disorders, having the most impact on the individual and the people around them, as well as the economic cost
The Costs Associated with Schizophrenia
Diagnostic Criteria
DSM-5
Within the Schizophrenia Spectrum and Other Psychotic Disorders category
Not all symptoms have to be demonstrated, only two or more
Criterion A
symptoms must be present for a six-month period or longer, with at least one month of active symptoms
Delusions
Hallucinations
Disorganised speech
Grossly disorganised or catatonic behaviour
Negative symptoms
Positive symptoms = the fact that the behaviours or experiences that make up these symptoms are happening too much
Negative symptoms = behaviours that are in a deficit
Delusions
Positive symptom
A false belief, so the content of their thought is inaccurate or false. Are not explained by religious or cultural beliefs.
Are believed despite all the evidence to the contrary; it is pointless to try and persuade someone that they are inncorrect
Delusions of Persecution = paranoid flavour with a theme of others being out to get you. May think that they are being followed everywhere
Delusions of Grandeur = someone believes that they possess qualities or attributes that make them superior to other people — money, fame, talent, intelligence, special relationship with someone in power. May think they’re Taylor Swift’s best friend
Disorganised Speech
Positive symptom
Reflects a disturbance in the form of thought as opposed to the content of though
When somebody’s thoughts, the form and the process of them, are disorganised, their speech will also be affected
Speech disturbance involves prolonged patterns of disorganised speech that are much more extreme
Neologism = when a person makes up a word. The word has no meaning and is often a combination of two words
Word Salad = words tossed together that makes no sense, has no meaning
Tangential speech = changes topic from a specific trigger, and never returns to the original topic of conversation and lacks insight into this behaviour
Hallucinations
Disturbances of perception, a false sensory experience
Any hallucinations could be a product of organic brain disease and this must be ruled out very early on (MRIs, etc)
Believe they are experiencing something through one of the five senses when they are not
Very distressing as it feels real and they fully believe it so
Most common are auditory hallucinations = hearing voices, ones that are usually derogatory and negative. May be more than one voice.
Visual hallucinations = the experience of seeing something that is not actually there.
Olfactory hallucinations = smelling something that isn’t there
Gustatory hallucinations = tasting something that theyre not actually tasting
Tactile Hallucination = false sensory experience in relation to sense of touc
Disorganised or Abnormal Motor Behaviour
Can manifest in many different ways, such as:
Psychomotor agitation, such as restlessness and inability to stay still
Behaviour may be characterised by childish silliness or a complete lack of focus
Excessive purposeless activity that is unrelated to anything going on in the environment going on in the environment
Self-initiated bizarre postures, such as standing bent at the waist with one arm in the air
Complete lack of response to all stimuli, like not responding when someone talks to you, prods you, and os on
Catatonia = neurogenic motor immobility, or behavioural abnormality manifested as stupor; where some can become rigid and immobile. Not very common
Negative Symptoms
Reflects normal behaviours that are in deficit
Expression of affect or emotion, speech, and motivation
Affect or expression of emotion
‘flat affect’, where the expression of emotion through tone of voice and facial expression is significantly reduce
Speech
alogia = poverty of speech, involves a lack of spontaneous speech, reflects impoverish thought processes
Motivation
avolition = inability to initiate or engage in goal-directed behaviours
depression
lack of self-care around personal hygiene
Course of Schizophrenia
Is an episodic illness, with majority of people experiencing more than one psychotic episode
Three phases
Prodromal phase = decline in functioning. Negative symptoms such as motivation, social withdrawal, and a decline in self-care appear
Active phase = positive symptoms appear.
Residual phase = positive symptoms have remitted, usually with help of medication, but some negative symptoms remain.
Aetiology of Schizophrenia
Genetics and biology are extremely important — the prevalence wherein you have a biological relative goes up to 10% from 1%. For monozygotic twins, this goes up to 50%
People with schizophrenia have been found to have structural brain abnormalities and biochemical abnormalities (neurotransmitter dopamine)
Being exposed to pregnancy and birth complications that may have caused structural damage to the brain is another factor
Social factors, particularly low socioeconomic status (SES), is associated with schizophrenia.
More common but not restricted to
Some potential harmful characteristics associated with lower SES include stress, social isolation, poor nutrition, lack of access to medical services
Social dislocation is another social factor linked to schizophrenia
higher rates are found in people who have migrated to a new country
Expression emotion is a psychological factor
refers to the level of criticism, hostility, and emotional over-involvement that exists within a family
people who live in a family with a high level of negative emotion expressed are significantly more likely to relapse into schizophrenia than those not
With family though — no do not fall into the trap of blaming family members. Have empathy for those who have to live with someone with this disorder
Diathesis-stress model of Schizophrenia
Proposes that, with schizophrenia, there is an underlying vulnerability that is most likely related to a genetic predisposition
However, this vulnerability may only convert into an illness in the context of the environmental stressors
Hypothesised diatheses for schizophrenia include
genetic factors
physical trauma prenatally or during birth
structural abnormalities of the brain
abnormalities in the neurotransmitter
Environmental stressors may include
chronic psychological and social stressors, such as poverty
living in a family environment with a high level of negative expressed emotion
drug use, especially marijuana
Treatment of Schizophrenia
Medication = anti-psychotics (good responses in positive symptoms)
Anti-psychotics don’t work with one quarter of people however, and have many negative side effects such as weight gain and tardive dyskinesia (involuntary neurological movement disorder affecting lower face)
Psych-education = done with the schizophrenic person and their family members to educate them about the signs of relapse and what to do if it happens
Behavioural strategies = help people with schizophrenia to develop their social skills, with a view to promote the development and maintenance of social relationships and friendships
CBT = recommended to those with well-managed or stable schizophrenia, but treats symptoms in the small range
Support to families is imperative
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