Clinical Psychology Notes
Stress and Illness & Health and Happiness
Stress
Stress is the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging.
Eustress: positive and motivating stress
Distress: negative and debilitating
Stressors and stress reactions
Measuring Stress
Thomas Holmes and Richard Rache (1967)
Social Readjustment Rating Scale (SRRS), Life Change Units (LCUs)
Self-report using the LCUs about changes in her or his life.
Selling a home, changing jobs
Getting married or having a child
General Adaptation Syndrome (GAS)
Selye’s concept of the body’s adaptive response to stress in three phases - alarm, resistance, exhaustion. (Hans Selye, 1936, 1976)
Phase 1: Alarm Reaction, sympathetic nervous system is activated.
Phase 2: Resistance, you’re fully engaged, summoning all your resources to meet the challenge.
Phase 3: Exhaustion, become vulnerable to illness and further..
Hypertension / immune suppression
Managing Stress
Tend-and-befriend theory: a stress response where individuals, particularly women, tend to their offspring and seek social support and connection with others.
Emotion-focused coping: strategies that address the emotional reactions to a stressful situation, rather than directly addressing the problem itself.
Stress and Vulnerability
Health psychology: a subfield of psychology that provides psychology’s contribution to behavioral medicine.
Psychoneuroimmunology: the study of how psychological, neural, and endocrine processes together affect the immune system and resulting health.
B lymphocytes
T lymphocytes
Macrophage cells
Natural killer cells
Stress and Heart Disease
Coronary heart disease: the clogging of the vessels that nourish the heart muscle; the leading cause of death in many developed countries.
Stress and personality play big role in heart disease.
Type A personality: Friedman and Rosenman’s term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people.
Anger associated with an aggressively reactive temperament.
Type B personality: easygoing, relaxed people.
POSITIVE PSYCHOLOGY
Shares the optimistic focus of humanistic psychology but is committed to supporting its theories with empirical evidence from research studies.
Positive psychology researchers investigate how humans can flourish, maximize their potential, achieve happiness, and improve the quality of our lives.
POSITIVE PSYCHOLOGY 6 core VIRTUEs
Wisdom
Courage
Humanity
Justice
Temperance
Transcendence
POSITIVE PSYCHOLOGY
6 core VIRTUEs
Wisdom
Courage
Humanity
Justice
Temperance
Transcendence
Additionally…
Well-being
Gratitude
Resilience
Post-traumatic growth
Introduction to Psychological Disorders
Psychological Disorders
How should we define psychological disorders?
How should we understand disorders? How do underlying biological factors contribute to disorder? How to troubling environments influence our well-being? And how to these effects of nature and nurture interact?
How should we classify psychological disorders? And can we do so in a way that allows us to help people without stigmatizing or labeling them?
What do we know about rates of psychological disorders? How many people have them? How is vulnerable, and when?
Defining Psychological Disorders
Psychological disorder: a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.
Such thoughts, emotions, or behaviors are dysfunctional or maladaptive – they interfere with normal day-to-day life.
Distress often accompanies dysfunctional behaviors.
Atypical (feelings): deviate from the norm
Diathesis-stress model: suggests that people with a predisposition for a disorder are more likely to develop the disorder when faced with stress
Understanding Psychological Disorders
In earlier times, people often thought that strange behaviors were evidence that strange forces – the movements of the stars, godlike powers, or evil spirits – were at work.
Philippe Pinal (1745-1826) in France:
Madness is … a sickness of the mind caused by several stress and inhumane conditions.
“Moral treatment” – talking with patients
Replaced brutality with gentleness, isolation with activity, and filth with clean air and sunshine.
The Medical Model
Medical model: the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and , in most cases, cured, often through treatment in a hospital.
Found in 1800s, syphilis (a sexually transmitted infection) invades the brain and distorts the mind.
Genetically influenced abnormalities in brain structure
Biochemistry contribution to disorders
The Biopsychosocial Approach
Biological, psychological, and social-cultural influences together weave the fabric of our thoughts, feelings, and behaviors.
The Biopsychosocial Approach
We are physically embodied and socially embedded.
The environment’s influence on disorders can be seen in culture-related symptoms (Beardsley, 1994; Castillo, 1997).
Latin America
Anxiety - susto
Severe anxiety, restlessness, and a fear of black magic
Japan
Social anxiety – taijin-kyofusho
Anxiety about their appearance, combined with readiness to blush and a fear of eye contact
North America
Anorexia / Bulimia nervosa
Eating disorders – can’t eat at all vs. binge eating
Malaysia
Disordered aggression - amok
A sudden outburst of violent behavior was traditionally attributed to an evil spirit.
Classifying Disorders - and Labeling People
In psychiatry and psychology, classification attempts to
predict a disorder’s future course.
suggest appropriate treatment.
prompt research into a disorder’s cause.
DSM-5-TR: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Test Revision (published in 2022); a widely used system for classifying psychological disorders.
Classifying Disorders - and Labeling People
Critics:
The DSM-5’s wider net will extend the pathologizing of every life.
Classifying Disorders - and Labeling People
Despite the risks, diagnostic labels have benefits:
They help mental health professionals communicate about their cases and study the causes and treatments of disorder.
Clients are often relieved to learn that the nature of their suffering has a name, and that they are not alone in experiencing their symptoms.
Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder
Anxiety Disorders
Anxiety disorders: psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.
Generalized anxiety disorder
Panic disorder
Phobias
Social anxiety disorder: intense fear and avoidance of social situations. (Formerly called social phobia)
Generalized Anxiety Disorders
Generalized anxiety disorder: an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
Panic Disorders
Panic disorder: an anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.
Phobia
Phobia: an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD): a disorder characterized by unwanted repetitive thoughts (obsessions), actions (compulsive), or both.
Posttraumatic Stress Disorder (PTSD)
a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience.
Understanding Anxiety Disorders, OCD, and PTSD
Conditioning:
Stimulus generalization occurs when a person experiences a fearful event and later develops a fear of similar events.
Once fears and anxieties are learned, reinforcement helps maintain them.
Understanding Anxiety Disorders, OCD, and PTSD
Cognition:
Conditioning influences our feelings of anxiety, but so does cognition – our thoughts, memories, interpretations, and expectations.
We learn some fears by observing others.
Our interpretations and expectations also shape our reactions.
People with anxiety disorders tend to be hypervigilant.
They attend more to threatening stimuli.
They more often interpret ambiguous stimuli as threatening.
They more readily remember threatening events.
Understanding Anxiety Disorders, OCD, and PTSD
Biology:
Genes: Some genes influence anxiety disorders by regulating brain levels of neurotransmitters. But experience affect gene expression.
The brain: Our experiences change our brain, paving new pathways. The anterior cingulate cortex, a brain region that monitors our actions and checks for errors, seems especially likely to be hyperactive.
Natural selection: Some of our modern fears may also have an evolutionary explanation.
Depressive Disorders, Bipolar Disorder, Suicide, and Self-Injury
Major Depressive Disorder and Bipolar Disorder
Major depressive disorder is a prolonged state of hopeless depression.
Bipolar disorder (formerly called manic-depressive disorder) alternates between depression and overexcited hyperactivity.
Anxiety is a response to the threat of future loss; depression is often a response to past and current loss.
Depression protects us, sending us into a sort of psychic hibernation – slows us down, defuses aggression, helps us let go of unattainable goals, and restrains risk taking.
Major Depressive Disorder
Major depressive disorder: a disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure.
Depression is the number-one reason people seek mental health services.
Bipolar Disorder
Bipolar disorder: a disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
Mania: a hyperactive, wildly optimistic state in which dangerously poor judgment is common.
Understanding Major Depressive & Bipolar Disorder
Behaviors and thoughts change with depression.
Depression is widespread.
Women’s risk of major depressive disorder is nearly double men’s.
Most major depressive episodes end on their own.
Stressful events often precede depression.
With each new generation, depression strikes earlier (late teens) and affects more people, with the highest rates among young adults in developed countries.
The Biological Perspective
Genes and depression: Major depressive disorder and bipolar disorder run in families.
The depressed brain: During depression, brain activity slows; during mania, it increase.
Norepinephrine & Serotonin : increase arousal and boosts mood; scarce or inactive during depression
Nutritional effects: excessive alcohol use correlates with depression, partly because depression can increase alcohol use mostly because alcohol misuse leads to depression (Fergusson et al., 2009).
The Social-Cognitive Perspective
Our actions and thinking matter. The social-cognitive explores how people’s assumptions and expectations influence what they perceive.
Their self-defeating beliefs and negative explanatory style feed depression’s vicious cycle.
Negative thoughts and negative moods interact:
Self-defeating beliefs may arise from learned helplessness.
Rumination: compulsive fretting; overthinking about our problems and their causes.
Explanatory style: they explain bad events in terms that are stable, global, and internal. Pessimistic, overgeneralized, self-focused, and self-blaming.
The Social-Cognitive Perspective
Depression’s vicious cycle:
Depression is both a cause and an effect of stressful experiences that disrupt our sense of who we are and why we are worthy.
Stressful events interpreted through
a brooding, negative explanatory style create
a hopeless, depressed state that
hampers the way the person thinks and acts; these thoughts and actions, in turn, fuel
Stressful experiences such as rejection.
Suicide and Self-Injury
Nonsuicidal self-injury (NSSI):
Depressed-prone people, especially adolescents and young adults, may cut or burn their skin, hit themselves, insert objects under their nails or skin, or tattoo themselves (Fikke et al., 2011).
Schizophrenia
Schizophrenia
Schizophrenia: a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression.
“Split” – schizo ; “Mind” – phrenia
NOT a multiple-personality split but rather the mind’s split from reality
Psychotic disorder: a group of psychological disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality.
Only 1 in 7 experience a full and enduring recovery
Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate behaviors – may experience hallucinations, talk in disorganized and deluded ways, and exhibit inappropriate laughter, tears, or rage.
Negative symptoms: the absence of appropriate behavior – may have toneless voices, expressionless faces, or mute and rigid bodies.
Disturbed perceptions:
Hallucinations – seeing, feeling, tasting, or smelling things that exist only in one’s mind.
Symptoms of Schizophrenia
Disorganized thinking and speech:
Delusion: a false belief, often of persecution or grandeur, that may accompany psychotic disorders.
Jumbled ideas may make no sense even within sentences, forming what is known as word salad.
One cause of disorganized thinking may be a breakdown in selective attention.
Diminished and inappropriate emotions:
People with schizophrenia lapse into an emotionless flat affect state of no apparent feeling.
Most also have an impaired theory of mind – they have difficulty reading others’ facial emotions and state of mind.
Motor behavior may also be inappropriate and disruptive.
Onset and Development of Schizophrenia
Chronic schizophrenia: (aka, process schizophrenia) a form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood. As people age, psychotic episodes last longer and recovery periods shorten.
Acute schizophrenia: (aka, reactive schizophrenia) a form of schizophrenia that can begin at any age, frequently occurs in response to an emotionally traumatic event, and has extended recovery periods.
Understanding Schizophrenia
Brain abnormalities
Dopamine overactivity: hyper-responsive dopamine system could intensify brain signals, creating positive symptoms such as hallucinations and paranoia (Maia & Frank, 2017).
Abnormal brain activity and anatomy: Schizophrenia involves not one isolated brain abnormalities but problems with several brain regions and their interconnections (Andreasen, 1997, 2001; Arnedo et al., 2015).
The cortex, the hippocampus, and the corpus callosum, smaller-than-normal
Thalamus: difficulty filtering sensory input and focusing attention
Prenatal environment and risk: Risk factors for schizophrenia include low birth weight, maternal diabetes, older paternal age, and oxygen deprivation during delivery (King et al., 2010). Famine may also increase risks.
Genetic influences: For those who have a sibling or parent with the disorder, the odds increase to about 1 in 10. and if the affected sibling is an identical twin, the odds increase to nearly 1 in 2.
Other Disorders
Somatic Symptom and Related Disorders
Somatic symptom disorder: a psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause. (formerly called somatoform disorder)
Conversion disorder: a disorder related to somatic symptom disorder in which a person experiences very specific, physical symptoms that are not compatible with recognized medical or neurological conditions.
Illness anxiety disorder: a disorder related to somatic symptom disorder in which a person interprets normal physical sensations as symptoms of disease.
Dissociative Disorders
Dissociative disorders: controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.
Dissociative identity disorder (DID): a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities (former called, multiple personality disorder).
Understanding DID
Skeptics have raised serious concerns about DID:
They find it suspicious that the disorder has such a short and localized history.
DID varies by culture.
Could DID be an extension of our normal capacity for personality shifts?
Have you ever felt like another part of your does things you can’t control? Does this part of you have a name? can I talk to the angry part of you?
Understanding DID
Other researchers and clinicians believe DID is a real disorder:
People with DID exhibit heightened activity in brain areas linked with the control and inhibition of traumatic memories.
Both the psychodynamic and learning perspectives have interpreted DID symptoms as ways of coping with anxiety.
DID is a natural, protective response to traumatic experiences during childhood.
Personality Disorders
Personality disorders: inflexible and enduring behavior patterns that impair social functioning
Anxiety, such as a fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder.
Eccentric or odd behaviors, such as the emotionless disengagement of schizotypal personality disorder.
Dramatic or impulsive behaviors, such as the attention-getting borderline personality disorder, the self-focused and self-inflating narcissistic personality disorder, and the callous, and sometimes dangerous, antisocial personality disorder.
Personality Disorders
Antisocial personality disorders: a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members; may be aggressive and ruthless or a clever con artist.
Understanding Antisocial Personality Disorders
Antisocial personality disorder is woven of both biological and psychological strands.
Genetic influences, often in combination with negative environmental factors such as childhood abuse, family instability, or poverty, help wire the brain (Dodge, 2009).
…violent repeat offenders had 11 percent less frontal lobe tissue than normal.
People with antisocial personality disorder fall far below normal in aspects of thinking such as planning, organization, and inhibition, which are all frontal lobe functions (Morgan & Lilienfeld, 2000).
Eating Disorders
Anorexia nervosa: an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly underweight; sometimes accompanied by excessive exercise.
Bulimia nervosa: an eating disorder in which a person alternates binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use) or fasting.
Binge-eating disorder: significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa.
Understanding Eating Disorders
Eating disorders often have low self-evaluations, set perfectionist standards, fret about falling short of expectations, and are intensely concerned with how others perceive them. (Brauhardt et al., 2014; Pieter et al., 2007; Yiend et al., 2014).
Heredity also matters – twin studies.
Media effects and peer teasing