psychology final exam pt 2

CLINICAL PSYCHOLOGY PT 3 

Depressive Disorders 

Mood disorders 

• most well known psychological disorders that have mood disturbance as their prominent feature  

DSM-5 types of mood disorders: 

• Depressive Disorders: Major depressive disorder, persistent depressive disorder (dysthymia) 

• Bipolar I disorder 

Depressive Disorders

• Depressive disorders affect a large proportion of the population 

• Gender differences ( more women are diagnosed with depression than men) 

Most well known depressive disorder 

• major depressive disorder 

Major Depressive Disorder: Diagnostic criteria:

• Depressed mood

• Loss iPod interest or pleasure 

• Significant weight loss / gain 

• Insomnia or hypersomnia 

Major Depressive Disorder: Diagnostic criteria 

• symptoms cause clinically significant distress / impairment 

• not attributable to physiological effects of another medical condition or substance 

Major depressive disorder MDD: 

• onset: may appear at any age, but is more likely in the 18-29 age group 

• Prognosis: some individuals rarely, experience remission without treatment

• Chronicity is associated with underlying personality dimensions and presence of other disorders 

Risk Factors for MDD:

• temperamental (particularly neuroticism, or negative effect) and other psychological factors 

• environmental (adverse childhood experiences, stressful life) 

Comorbidity for major depressive disorder: 

• substance- related disorders, pain-disorders, obsessive-compulsive disorder, anorexia nervosa, and bulimia nervosa

Attribution theory: 

• holds that the way a person thinks about failure makes her more or less likely to be depressed 

• attribution of failures to internal characteristics 

• believe that failures are permanent, belief that failures are global 

Persistent Depressive Disorder 

• moderate depressive symptoms that last for more then two years 

Double depression: 

• when persistent depressive disorder and major depressive disorders co-occur

TREATMENT OF PSYCHOLOGICAL DISORDERS PT 1

Types of Clinician

• Psychiatrist: medical doctor, can diagnose, prescribe, and practice psychotherapy 

• Psychologist: can diagnose and practice psychotherapy 

• Clinical counsellor: can practice psychotherapy 

• Social worker: can practice psychotherapy 

Diagnosis Involves:

• Psychological treatment and biological treatment

Why get treatment? 

•  Inability to carry out daily activities, inability to manage relationships

• financial costs, billions of dollars per year in lost work 

• these impairments are just as severe as those associated with physical illness 

Access to treatment 

• getting access to treatment is one of the biggest challenges in mental health

• 20% canadians suffer from serious mental health disorders, and only 40% seek treatment

Why do people fail to get treatment? 

1. they don’t realize they have a disorder

2. psychological beliefs prevent people from seeking treatment:

• belief that they can treat themselves (72%) 

• belief that mental health problems is not severe (16.4%)

• belief that they will be stigmatized by others for seeking mental health support (9.1%) 

3. there are structural barriers to seeking care 

• don’t know where to look

TREATMENT OF PSYCHOLOGICAL DISORDERS PT 2

Techniques in Psychotherapy or psychological treatment:

• orientations 

Psychodynamic therapy:

• has its roots in freud's methods of psychoanalysis, centred in the belief that psychological problems come from ineffectively repressing urges and fixations starting in childhood 

• Psychoanalysis attempts to give the patient insight into these conflicts 

Topics discussed in psychoanalytic session?

• Childhood events 

• Dream analysis  

• Subconscious thoughts and urges 

• Projective techniques 

Psychodynamic Approach - Interpersonal psychotherapy (IPT):

• attachment (beginning in infancy) 

• Grief (loss of a relationship) 

• Rose disputes (conflicts within a relationship)

• Role transitions (changes in life status) 

Humanistic existential therapies 

• humanistic psychologists emphasize…the importance of striving for personal improvement, and free will

Person centered therapy 

• assumes that individuals have a tendency toward growth; centres in acceptance and genuine reactions from therapist 

• Congruence (words, body language)

• Empathy

• Unconditional positive regard

Types of Cognitive and Behavioural therapy 

• behavioural and cognitive therapies are the most common type of psychotherapy in Canada 

• behavioural/ cognitive therapy relies on behaviourism

Behaviourism 

• study of observable, measurable variables and focuses on changing behaviour (actions or cognition (thoughts) to combat mental illness 

Behavioural therapy: Operant conditioning, Classical conditioning 

• behavioural therapy centres around conditioning 

• works to change actions 

Operant conditioning:

• rewards for positive behaviour and punishments for negative behaviour 

Token economy

• rewarding positive behaviour with vouchers 

Classical conditioning:

• exposure therapy, her less repeated exposure to stimulus believed to be threatening -> reduction in threat response

 Cognitive therapy 

• cognitive therapy works to change unhealthy thought patterns leading to mental illness

• focuses on restructuring of irrational thought processes 

Cognitive-behavioural therapy 

• therapists combine behavioural and cognitive orientations into one technique

• most common psychological treatment for depression and anxiety is: problem focused, action oriented, transparent (unlike psychoanalysis) 

TREATMENT OF PSYCHOLOGICAL DISORDERS PT 3

Biological Treatment consisted of:

• Medications 

• Electroconvulsive therapy (ECT) 

• Transcranial magnetic stimulation (TMS) 

• Psychosurgery 

• Pharmacological treatment = medications 

Pharmacological treatment 

• drug classes and specific drugs to specific psychological disorders 

Antipsychotic medication:

• use of medication for psychological illness began with an accident 

• Chlorpromazine is a phenothiazine and was first developed in France as an anti-histamine (allergy medication)

• Chlorpromazine blocks dopamine receptors, results in euphoric calm patients instead of agisted ones 

• Intro to antipsychotic medication changed the way schizophrenia is treated

• has significant side effects 

Anti-anxiety medication 

• Anti-anxiety medications (benzodiazepines)

• facilitate GABA neurotransmitter activity then inhibit anxiety 

• Drug tolerance, withdrawal symptoms, addiction profile

• Side effects: drowsiness, poor coordination

Anti-depressant medication

• Discovered accidentally

• Prevented breakdown of serotonin and dopamine

Monoamine oxidase inhibitors 

• Type of antidepressant and was used to treat tuberculosis in the 1950s

• Coincidentally evaluated patient mood and prevented breakdown of serotonin dopamine

Reuptake inhibitors 

• Most antidepressants are reuptake inhibitors and prevents neurotransmitters from being taken back up

• Can work on many transmitters or just one

• Serotonin only or serotonin and norepinephrine

Side effects of antidepressants

• Difficulty concentrating, sexual side effects, weight gain, emotional numbness, withdrawal symptoms (brain zaps)

Physiological interventions:

Electroconvulsive therapy (ECT)

• Induces controlled seizures

• Highly effective and safe (in modern times) 

• Not permanent (may need to be repeated)

Transcranial magnetic stimulation (TMS)

• Produces longer lasting changes to brain chemistry 

Deep brain stimulation (DBS)

• Embedded electrodes produce repetitive brain stimulation

Natural and alternative solutions

• There are natural and alternative solutions for specifically depression and anxiety

STRESS AND HEALTH PT 1

Stress: the physical and psychological response to internal or external stressors 

Stressors: specific events or chronic pressuresthat place demands on a person or threaten their subjective well-being

Health psychology: the subfield of psychology that examines the relationship between physical health and psychological health

Stress adaptation 

• Stress is an evolved response to threat, when we’re stressed out adrenal glands are activated

• Increase in cortisol equals more glucose in the bloodstream

• Increase heart and respiration rate equals to more oxygen in the bloodstream

General adaptation syndrome 

• Canadian physician hans selye proposed general adaptation syndrome

Stages to general adaptation syndrome:

1. Alarm phase - initial, healthy reaction to stress (fight or flight)

2. Resistance phase - body adapts to high stress; non-stress-related processes are shutdown

3. Exhaustion phase - body cannot cope with other processes being shut down; illness, injury, or death can occur 

Psychological stress and physical illness

• There is a high correlation between psychological stress and physical illness

• For many of us we were experiencing stress shortly before we became ill

Stress scales

• Operate by summing points for various stressful life events

• Most well known stress scale: holmes-rahe stress scale 

Holmes-Rahe Stress Scale 

• Most well known stress scale developed by Thomas Holmes and Richard Rahe 

• Asked patients to self-report stressful events, compared their scores on stress scale to their actual medical records, high correlation between stress score and physical illness

Acute stressors

• One time stressful events 

• Most stressors listed on a stress scale are one time stressful events 

Chronic stress 

• Sources of stress that occur continuously or repeatedly 

• Chronic stress can affect physical health as much or more than acute stressors

Repeated Chronic stress

• Causes a constant stress response which can result in exhaustion

Control

• Biggest factor of stress, we are more stressed by events we cannot control 

Glass and Singer (1972)

• Placed ppl into a room and asked them to complete different puzzles, one group did so with loud noise they couldn't control, the other group did so with loud noise the could control, the group with loud noise they couldn't control suffered more 

• Our perceived control of a stressor affects our stress response

Appraisal 

• Primary appraisal- determining whether an event is dangerous/ threatening

• Secondary appraisal- determining whether you can handle the stressor 

Coping with stressors: Repressive coping, rational coping, refraining, mediation, relaxation, exercise 

1.Repressive coping 

• When we avoid situations or thoughts that remind us of a stressor, often includes artificially positive viewpoints

2.Rational coping

• Facing stress and working to overcome it

Rational coping stages 

1. Acceptance - coming to realise that the stressor cannot be wished away 

2. Exposure - attending to the stressor, seeking it out

3. Understanding - working to find the meaning of the stressor in your life 

3. Reframing

• Changing a way one thinks about a stressor

• one type of reframing is stress inoculation training - developing repetitive, positive ways to think about a stressor

4. Meditation

• this coping strategy involves the absence of thought, or focusing on one un+stressful thought, increases the way our brains are structured, increased myelination, and connectivity

Mindfulness meditation 

• One type of meditation focused on immediate experience, rather than faraway thoughts 

5. Relaxation 

• A way to reduce stress is to consciously reduce muscle tension, when we are stressed our muscles are in a constant state of tension

Biofeedback

• Technology that alerts us when certain muscles are tense 

6. Exercise 

• Physical way to decrease stress, exercise reduces perceived stress and depressive symptoms 

HEALTH AND STRESS PT 2

Bioecological models 

• Psychological and physical health are affected by myriad internal and external factors 

• Most well known is bronfenbrenner's model

Biofrenbenners biological model 

• Microsystem - daily interactions (family that you live with)

• Mesosystem - interconnections between parts of of the microsystem 

• Exosystem - environments that affect the individual but with which they don't directly interact 

• Macrosystem - the broader cultural context (canadian culture, social media) 

• Chronosystem - the influence of history (cohort effects)

Person-environment transactions

• Our personalities affect our environment, which affects our personalities

Diathesis stress model 

• Individuals have a have a propensity (potential) for illness (nature) 

• This potential is increased or decreased by experience (nature)