Exam Charts

Disorder

Symptoms 

Major Depressive Disorder

• Feeling sad, empty, hopeless, worthless,inappropriate guilt

• Diminished interest or pleasure in most daily activities

• Significant weight loss or weight gain

• Decrease in appetite

• Insomnia or hypersomnia

• Restlessness

• Fatigue

• Diminished ability to concentrate

• Recurrent thoughts of death of suicide

• Psychotic delusions or hallucinations ( see more paranoia, may start hunting for evidence about their paranoia)  (in extreme cases) 

Seasonal Affective Disorder

• Mood disorder characterized by feelings of depression around the same time annually (usually winter months)

• Most common in Canada, due to the large immigration population, individuals acclimating to our population climate 

• Looking similar to MDD, but is due to lack of sunshine 

• Does have a significant biological explanation, so will want medical intervention 

• Same symptoms of MDD

Postpartum Disorder

• Disturbances in appetite and sleep

• Low self-esteem

• Difficulties with concentration

• Feeling overwhelmed, guilty or hopeless

• Not bonding with baby

• Feeling irritated, angry, empty, numb or afraid

• Recurrent thoughts of death or suicide

• Usually lasts for 3 months following childbirth, but can persist for a year or more

  • Also depends on the amount of children they have

  • The more children they have, the hormones take longer to regulate 

• Persistent and severe mood changes that occur following childbirth, still-birth or miscarriage

  • Natural hormonal dip that often leads to mimicked symptoms of depression when in reality it is that hormones are reregulating 

  • Physicians usually will only prescribe exercise and good exercise because it is temporary

  • Physical interventions rather than medication 

• Also referred to as “baby blues”

• Recognized as a subtype of MDD

• Very few women (approx. 15%) will get help

• Fathers may also experience PPD

Causes

• Changes in hormone levels (drop in estrogen and progesterone)

• Psychosocial factors: financial problems, troubled relationship, lack of social or emotional support, history of depression, unwanted or sick baby

• Breastfeeding problems, preterm delivery

• Experienced depression or anxiety previously

• Genetic factors unclear

• Increases risk for future depressive episodes

• Some women have intrusive thoughts that they will harm their child (OCD) 

Bipolar Disorder

Characterized by chronic mood swings between states of extreme elation and severe depression

Two types:

• Bipolar I (occurrence of manic and depressive episodes, or 1 or more manic episodes without depressive episodes, or the two types of episodes occurring simultaneously)

• Bipolar II (depressive episodes occur with milder forms of mania)

Manic Episodes

• periods of unrealistically heightened euphoria, extreme restlessness, and excessive activity characterized by disorganized behaviour and impaired judgment

Rapid Cycling

• two or more full cycles of mania and depression within a year without any intervening normal periods

Manic Symptoms

•  Abnormally upbeat, jumpy or wired

• Increased activity, energy or agitation

• Exaggerated sense of well-being and self-confidence(euphoria)

•  Decreased need for sleep

•  Unusual talkativeness

•  Racing thoughts

•  Distractibility

• Poor decision-making

  • Don’t need to have all of these symptoms in order to meet criteria for a manic episode 

Major Depressive Episodes

•  Depressed mood, such as feeling sad, empty, hopeless or tearful

• Marked loss of interest or feeling no pleasure in all — or almost all — activities

• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite

• Either insomnia or sleeping too much

• Restlessness or slowed behavior

• Fatigue or loss of energy

• Feelings of worthlessness or excessive or inappropriate guilt

•  Decreased ability to think or concentrate, or indecisiveness

•  Thinking about, planning or attempting suicide

  • May be mislabelled as depression first prior to bipolar, age of onset (16-24 year olds) may have not had a manic episode yet)

  • You want to monitor clients for mania as it would be a different intervention than what we would use for depression 

Panic Disorder

A. Recurrent unexpected panic attacks – intense fear or discomfort that reaches a peak within minutes – 4 or more of the following occur

• Palpitations, accelerated heart rate, sweating, shaking, sensation of shortness of breath, feelings of choking, chest pain, nausea, dizzy, chills or heat, numbness or tingling, derealization (unreality) or depersonalization (detached), fear of losing control, fear of dying

B. At least 1 of the attacks has been followed by 1 month or more of 1 & 2

1. persistent concern or worry about more panic attacks or their

consequences (losing control, heart attack)

2. significant maladaptive change in behavior (avoidance –

situations, places)

Generalized Anxiety Disorder

A Excessive anxiety & worry about a number of events or activities, more

days than not for 6 months or more

B. The worry is difficult to control

C. The worry is associated with 3 or more of these 6 physical symptoms

1. Restlessness, feeling keyed up, or on edge

2. Being easily fatigued

3. Difficulty concentrating or mind goes blank

4. Irritability

5. Muscle tension

6. Sleep disturbance (difficulty falling or staying asleep)

D. Symptoms cause significant distress and/or impairment in functioning

• A lot of people who have anxiety disorders end up with GAD diagnosis

• When you are working with anxiety disorders, the system may say it is GAD when it can be other anxiety disorders 

• Have a list, if they don’t meet everything it can be more specific so need to be wary of that

• Look out for performance based worries (OCD) 

Social Anxiety 

A Fear/anxiety about social situations where the individual is exposed to possible scrutiny by others

B Fear they will act in a way or show anxiety symptoms that will be

negatively evaluated

C These social situations almost always provoke fear/anxiety

D Situations are avoided or endured with distress

E Fear is out of proportion

F Fear, anxiety, avoidance lasts longer than 6 months

G Causes significant distress or impairment - functional impact (declines functionally) 

Not attributable to substances, medical condition, another mental disorder

Symptoms

• Blushing 

• Heart palpitations 

• Increased bodily arousal 

• Sweating 

• Nausea 

• Vomiting 

• Breathlessness 

• Dizziness 

• Feeling that your mind has gone blank 

• Gone blank 

Specific Phobia

A. Marked Fear or Anxiety

Fear or anxiety is triggered by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, or seeing blood).

B. Immediate Fear Response

Exposure to the phobic stimulus almost always provokes an immediate fear or anxiety response, which can take the form of a panic attack or severe distress.

C. Avoidance or Endurance

The individual actively avoids the phobic stimulus or endures it with intense fear or anxiety.

D. Out of Proportion

The fear or anxiety is out of proportion to the actual danger posed by the phobic stimulus and the sociocultural context.

E. Persistent Duration

The fear, anxiety, or avoidance lasts for 6 months or more.

OCD

Anxiety disorder in which people suffer from recurrent obsession or compulsions, or both (for more than 1 hour a day).

A. Obsessions, compulsions or both

Obsessions 

– recurrent, persistent thoughts, urges, images – that are intrusive,

unwanted, cause anxiety or distress

- attempts to ignore, suppress thoughts, urges, images or to neutralize

them with another thought or action (performing a compulsion)

Compulsions

- repetitive behaviours (handwashing, checking etc..) or mental

acts (counting, praying etc...) – feels driven to perform in response to an obsession

- behaviours or mental acts are aimed at preventing or reducing a

dreaded event or situation – not realistic, clearly excessive

B. Obsessions and compulsions are time consuming (more than 1 hour per day) or

cause significant distress or impairment in social, occupational areas

• If they only have obsessive thoughts, we call the obsessive thoughts the compulsion 

Obsessive Thoughts Examples

• Fear of being contaminated by germs or dirt or contaminating others

  • I gave my mom brownies that had expired milk, now my mom is going to die (Contamination) 

  • I didn’t clean the pan well enough, they are going to get sick (contamination)

  • Excessive cleaning 

• Fear of losing control and harming yourself or others

  • Performance category

  • If you are a teacher in charge of young kids, a child hits another child in the head, you are solely blaming yourself for the fact that this occurs

  • You do have some responsibility, you don’t have ALL the responsibility 

  • Responsibility pie 

    • Teach people to go through different scenarios and teach them the amount of responsibility they would have for something 

  • People think everything is their fault 

  • Stop signs - did I stop long enough? 

  • If they zoned out while driving, they will talk about it for hours and be anxious about it 

• Intrusive sexually explicit or violent thoughts and images

  • The area of the brain that has impact with OCD and hormone that is impacted is dopamine, closely related to psychosis - similar to people who have schizophrenia 

  • Accidental harm for others, so worried that they won’t get consent while engaging sexually

  • May flat out refuse to engage in sexual acts, may build their own story on how they raped someone - facts don’t fit the thoughts 

  • Assess for fear of accidental harm before we address an issue 

• Excessive focus on religious or moral ideas

  • Fear of accidental harm 

  • Develop their own strategy of how they are going to be morally exceptional 

• Fear of losing or not having things you might need

  • Excessive organization, rituals around organization

  • This thought is most associated with ADHD

  • Comorbidity between ADHD and OCD - 80%

• Order and symmetry: the idea that everything must line up “just right”

• Superstitions; excessive attention to something considered lucky or unlucky

  • Religiously this may be some people, could be cultural factors 

Intrusive Thoughts

• Hoarding 

• Intrusive thoughts and rumination

• Symmetry and rearranging

• Checking

• Contamination and cleaning 

• Since intrusive thoughts are so overwhelming, thought reappraisals are NOT going to work, we need to use behavioural interventions first 

• Worry-timer is used <- cognitive and behavioural 

• What they are training their brain to do is be in control of their worry time, set a time that is appropriate to store their thoughts, won’t be able to change their thoughts, teaching them thought challenging strategies cannot set the expectation that this will work outside of session

Compulsive Behaviour Symptoms

• Excessive double-checking of things, such as locks, appliances, and

• switches

• Repeatedly checking in on loved ones to make sure they’re safe

• Counting, tapping, repeating certain words, or doing other senseless

• things to reduce anxiety

• Spending a lot of time washing or cleaning

• Ordering or arranging things “just so”

• Praying excessively or engaging in rituals triggered by religious fear

• Accumulating “junk” such as old newspapers or empty food containers

Causes

• Twin studies indicate moderate heritability

• Family history

• Autoimmune origins (exposure to bacteria found in group a strep, lyme’s disease and h1n1 linked to onset of OCD in children)

• Traumatic brain injury

PTSD

Criteria A 

• Has dramatically changed over the years to attempt to provide a more valid and reliable definition of what a traumatic event is

• “The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone”

  • This is not a good enough definition that will “ruin our research”, if it is too broad, how do we study it? 

• “The person has been exposed to a traumatic event in which both of the following were present:

  • (1) the person experienced, witnessed, or was confronted with an event or events that involved

  • actual or threatened death or serious injury, or a threat to the

  • physical integrity of self or others.

  • (2) the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior”

• Ended up with the following for DSM: 

• “Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more ways (directly, witnessing, learning about, repeated exposure to details)”

• If client shows all other symptoms except criterion A, still treat them 

Criterion A Examples

Exposure to a traumatic event: 

• Rape survivors

• Soldier exposed to combat

• Victims of sexual or physical assault

• Victims of motor vehicle accidents/ other accidents

• First responders

• Victims of natural disasters

• Survivor of war, residential schooling or torture

• Death of family members

The Criterion A Problem

• A legacy of accessible research on veteran populations in comparison to other populations that experience trauma has impacted the criteria and symptoms obtained within DSM language – research bias

• Given the widespread differences of experiences across criterion A events (e.g., sexual trauma versus war combat) it is difficult to maintain a reliable and valid definition of trauma (e.g., that is easily measurable and does not rely on subjective opinion).

• Many clinicians have resorted to assessing Criterion A with their clinical judgement.

• Researchers have also suggested that those with ambiguous criterion A experiences (or partial/little ‘t’ trauma) often have similar symptom distress to those who have defined and clear Criterion A traumas – leading researchers to argue if Criterion A is helpful to ensuring all clients receive the adequate care that is needed.

What these symptoms might look like

• Avoiding cues or stimuli associated with traumatic event (Defensive Avoidance)

  • Tension reduction behaviours, if I drink before I see my family I will be blackout and I won’t remember what happened anyways

• Re-experiencing trauma(Intrusive Experiences)

  • Brain does this to help us plan on what to do for next time

• Intrusive images, flashbacks, nightmares

• Weakened emotional responsiveness or heightened

  • We are desensitized or we are overly sensitized 

• Impairment of functioning

  • Concentration challenges, sleep difficulties, not opening mail, afraid of what will come in the mail

• Heightened bodily arousal (racing heart beat, catching breath)

• Irritability, angry outbursts

• Difficulty sleeping and concentrating

• Tension Reduction Behaviour

• Substance misuse

Symptom: Dissociation 

Fight or Flight or Freeze 

• Also going to explain freeze whereas in anxiety we explained fight or flight, going to also explain submit and attach 

• Our body will first resort to fight or flight, if that doesn’t work what is there to do?

• Freeze

  • If I just stay like this, while I survive this if I don’t fight back?

  • A lot of survivors of sexual trauma feel guilty of this, in reality they probably froze

  • Clients should understand how this works

  • Once freeze is opened up once, it can keep opening up (easier to open up) 

Dissociation 

Dissociation: Freezing in a moment where a traumatic event is occurring to “soften the blow”

Feeling out of your body or disconnected from yourself.

Feeling like you’re looking in on your life, not living it

Specify if PTSD with Dissociative Symptoms 

1. Depersonalization: Persistent or recurrent experiences of being detached from, and as if one were an outside observer of one’s mental processes or body (as in a dream, sense of unreality of self/body or of time moving slowly)

2. Derealization: Persistent or recurrent experiences of unreality of surroundings (the world around the individual is experienced as unreal, dreamlike, distant or distorted)

* 1 & 2 may also occur with anxiety, borderline personality disorder, Psychosis

Borderline Personality Disorder

• A pervasive pattern of instability in relationships, self-image, and mood and lack of control over impulses 

Signs

• Moods shift frequently and abruptly

• Uncertain about their values, goals, loyalties, careers, choices of friends, and perhaps even sexual orientations

• There is an inherent unknown to who they are 

  • “They are an energy vampire”

  • You will use yourself as a tool for intervention probably more than other interventions, because they are learning how to have healthy relationships. You are learning the model for that 

  • Everything that relationally happens becomes therapeutic 

  • Transference information - reinforcing why they are lonely 

  • Ideally, make a vent corner - you can vent for 10 minutes then we move on 

• Feelings of emptiness or boredom

• Fear of abandonment renders them clingy and demanding

• Signs of rejection can enrage

  • Can find rejection in the smallest of things

  • Minimal encourager: mhm <- one time you change your encourager, they will notice and question it 

  • They will think it is a sign of rejection 

• Manipulate to feel loved

• Self-harm for attention

  • Escalation 

  • I asked for help and nobody heard me, I am asking for help really loud and now I am going to self-harm

  • The answer is to give them attention when they are asking at a lower level or more appropriate level 

  • Healthcare professionals start to push this person away

  • Reinforce minor complaints before they become major 

• Dichotomous thinking

  • Cognitive style

  • Black and white thinking 

  • It is fair or unfair, good or bad

  • They will split people into categories of good or bad, and will not necessarily see that people make good and bad choices 

• Be cautious about ANY self-disclosure with individuals with BPD, as they often like to map onto your own goals and can reinforce negative behaviours 

• Functioning is likely to be low (loss jobs, substance use, maladaptive coping mechanisms) 

Symptoms

• May demonstrate transient psychotic behaviour during times of stress

  • Might hear voices in their head

  • Might see things that are not there - does not mean they have psychosis 

  • Can be extremity to which they are experiencing stress

• Instability of moods (anger, irritability, depression, anxiety)

• Loneliness

• Deep sense of emptiness

• Impulsivity (may lead to suicidal behaviour) 

  • General risk assessment would not work. If they take steps to take their own life it would be an impulsive decision 

  • Put plans in place before they get to suicidal ideation 

  • Someone with BPD is going to kill themselves impulsively so you need to be aware of this 

Obsessive-Compulsive Personality Disorder

Obsessive Compulsive Personality Disorder

• Characterized by rigid ways of relating to others, perfectionistic tendencies, lack of spontaneity, and excessive attention to details

• Do not necessarily experience compulsions or obsessions 

Symptoms

• Difficulty completing things in a timely manner

• Ruminate about the past or things they could have changed

• Control issues

• Frugal

  • Will develop a rigid strict routine around frugality and won’t know that they are doing it 

• Difficulty making decisions

• Dichotomous thinking

  • Good or bad, fair or unfair 

• Rigid and stubborn

  • Do not want others to influence their worldview 

• Exhibit perfectionism

  • Professional athletes 

  • Specifically, ones where two rigid controls around their weight is important

  • Wrestling, dancing, cheerleading 

Population

• Twice as common in men

• 2-7% of the overall population is affected

• Extreme symptoms decrease with age

• Onset is usually in early adulthood

Causes

• Genetics and family environment 

• Family history

• Strnog moralistic and rigid family environment 

Schizophrenia 

• Schizophrenia Disorder

  • Acute episodes are characterized by delusions, hallucinations, illogical thinking, incoherent speech & bizarre behaviour.

  • Between episodes, people may still be unable to think clearly and may lack appropriate emotional responses to people & events in their lives.

• Categories of schizophrenia 

• 1. Catatonic: disturbances in movement and reduction in activity 

  • Requires a neuropsychologist to do the assessments for 

    • Need to physiologically rule out a lot 

  • Therefore, can take a lot for someone to be diagnosed with catatonic schizophrenia 

• 2. Paranoid: auditory hallucination or prominent delusions of conspiracy/persecution

  • Seen most frequently in media 

• 3. Disorganized: disorganized thought processes, difficulty with daily tasks, emotionally unstable

  • Sometimes gets confused with Autism Spectrum disorders 

• 4. Childhood: degeneration of thinking, motor skills and emotional management (onset prior to 15 years of age)

• 5. Residual: symptoms are no longer prominent 

  • When individuals have not had an episode in a long time (due to medications), they put this label on it 

  • For medication management 

Signs and symptoms of schizophrenia

• Type 1: Positive symptoms 

  • Hallucinations: false perception of objects or events involving your senses: sight, sound, smell, touch and taste

  • Delusions: an unshakable belief in something that's untrue 

• Type 2: Negative symptoms 

  • Flat affect 

  • Low motivation

  • Social withdrawal 

  • Reduction in speech 

  • Hygiene issues 

• Disturbances of thought and speech 

• Delusions of persecution

  • People are out to get me

  • Conspiring against you 

• Delusions of being controlled

  • Aliens, others, government are controlling your actions through surveyance 

  • Government installed microchips in my brain

• Delusions of grandeur 

  • I am jesus 

• Other common forms of delusions 

• Thought broadcasting: believing others can hear or interpret their thoughts  

• Thought insertion: someone planted a thought in my head, it is not my own thought

• Thought withdrawal: someone took my thoughts away 

• Disturbances in the form of thought

• Thought disorder

  • Disorganized schizophrenia type → thoughts jump all over the place, different topics, cannot put them together to determine what to think or do 

    • "I need to do laundry, but the sky is purple. Did you know airplanes have thoughts? Anyway, I forgot the keys to my spaceship."

• Neologisms: Come up with their own unique sayings or phrases 

  • Flibberflop 

• Perseveration: unintentional repetition of a response or behavior in a way that is not appropriate for the situation 

  • Continuing to talk about an event even when the conversation has ended 

• Clanging and blocking 

  • Clanging: Speech based on sound associations (e.g., rhyming or punning) rather than meaning.

    • Example: "The cat sat on the mat, flat and fat, where’s the bat?"

  • Blocking: Sudden interruption of thought or speech, often without explanation.

    • Example: "I was going to the store to buy... (pause for several seconds) ...what was I saying?"

Schizoaffective Disorder

Schizoaffective Disorder

• Can be misdiagnoses - major depressive disorder with psychotic features 

• Symptoms

• Criteria A: An uninterrupted period of illness during which, at some time, there is either a major depressive episode., a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia.

• Criteria B: During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

• Criteria C: Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

• Criteria D: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Substance-Induced Psychosis

• Criteria A: Presence of one or both of the following symptoms: Delusions or Hallucinations

• Criteria B: There is evidence from the history, physical examination, or laboratory findings that either (1) or (2): The symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal or medication used is etiologically related to the disturbance

• Criteria C: The disturbance is not better accounted for by a psychotic disorder that is not substance induced. Evidence that the symptoms are better accounted for by a psychotic disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent nonsubstance-induced psychotic disorder (e.g., a history of recurrent nonsubstance-related episodes).

• D. The disturbance does not occur exclusively during the course of delirium. ADHD and substance induced psychosis has A HIGH MORBIDITY. Those who had ADHD, when using psychoactive substances, are more likely to have substance induced psychosis 

Does substance use make us more likely to develop psychosis?

• Yes, due to dysregulation of dopamine

Disorder 

Psychological 

Drug

Main Model 

Depression 

CBT → BA or behavioural reinforcement 

Cognitive therapy

Very severe cases: electoconvulsive therapy (resets neurotransmitters)

• Memory loss

Social: 

Diet changes 

• Sugar and alcohol 

Alternative medicine 

• St. John’s Wort 

  • Cancels out BC

Essential oils 

Yoga / weight lifting 

• Weight lifting is best

Yoga 2x/week, 3months 

Antidepressant: 

1. Tricyclic (TCAs)

2. Monoamine oxidase (MAO) 

3. Selective serotonin reuptive (SSRIs)

4. Selective norepinephrine reuptake (SNRIs)

Biopsychosocial model 

• Stressors: death, unemployment, physical illness, rel problems

• Biological: metabolic activity in prefrontal cortex is lower and strucural abnormalities in limbic system (bigger amygdala)

Behavioural perspectives 

• Lack of reinforcement from social isolation, moving, loss of friends, illness or injury

Cognitive perspectives

• Negative views of self, world, and future

• Distorted thinking (i.e. all or nothing, overgeneralization, should statements)

Learned helplessness theory

• Perceptions of lack of control 

• Internal Attribution- blaming ourselves (affect self-esteem)

• External Attribution- blaming others or external circumstances

• Stable Attribution- typical or recurring events (chronic)

  • Gambling fallacy: because you won one time, I will win again

• Unstable Attribution- isolated events

• Global Attribution- event rooted in a systemic issue (increase helplessness)

• Specific Attribution- evidence of a specific shortcoming

  • Ex. COVID and some people blaming the government for it happening

Diathesis stress model

• Stressors that make us more susceptible to the onset of depression plus biology  

Seasonal Affective Disorder 

Phototherapy: intensive light therapy 

Sometimes Fluoxetine (Prozac)

Bipolar 1 + 2 

Lithium

• Stomach irritation, weight gain, thirst)

Personality Disorder

Dialectical Behaviour Therapy 

Behavioural - maladaptive behaviours to adaptive ones

• Behaviour changes are much healthier intervention strategies with this population 

  • “You participated in a behaviour, let's go backwards and talk about everything that happened and map it out and highlight what you think contributed” “What were your behavioural vulnerabilities that led you here? “I want you to use another strategy instead of XYZ”

Genogram (tool to understand)

Anti-Anxiety Drugs:

• Drug Therapy does not directly treat personality disorders as it doesn’t change behaviour directly however can manage some of the symptoms of the disorders.

• EX: Prozac used to reduce aggressive behaviour and irritability to increase availability of serotonin

• Diathesis-Stress Model

• Biopsychosocial model 

Anxiety Disorders

GAD - Cognitive processing, thought reappraisals, thought record, cognitive errors and healthy thought patterns 

Social Anxiety - same as GAD, however we can use systematic desentization  

• Benzo: Recommended on an as needed basis, situationally or infrequently recommended Ie. preparing someone to get on a flight who usually doesn’t need to go on a flight, they could be prescribed enough medication for upcoming flights 

• Mild tranquilizers, barbiturates and sedative-hypnotics

• Biological approach may use Benzodiazepines (ex. Valium and Ativan) that work to regulate GABA receptors, effectively enhancing their inhibitory potential

Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

• Work to regulate and increase both serotonin and norepinephrine

• Norepinephrine is related to increased alertness, reductions in ‘brain fog symptoms’ and can help with vigilance levels

• Technically still considered an anti-depressant, many of these medications are also used to treat anxiety disorders

• Biopsychosocial Model 

• Social Determinants of Health 

Panic Disorder

Interoceptive exposure

Benzos 

Specific Phobia 

Systemic desensitization

Benzos 

Psychotic

Learning-Based Approaches

• Social Skills Training

• Recognize difference between what is going on in my head and what is going on 

Psychosocial rehabilitation

• Social Skills Training

• Training for daily tasks

Antipsychotic drugs 

• Block dopamine receptors 

• Side effects like Tardive Dyskinesia: movement disorder (face, mouth, neck, trunk) → can be life threatening 

Diathesis stress model 

• D: genetic vulnerability, neurotransmitters

• S: prenatal trauma, birth complications, critical family environment, stressful event 

Family systems approach 

• Schizophrenogenic mother: cold and overprotective 

• Double-bind communication: contradictory messages 

• Communication deviance: poor parental communicaiton 

• Expressed emotion: hostility toward family member with schizophrenia - not a cause, triggers episodes 

• Family factors: stress 

Biological perspective 

• Genetic factors 

• Chromosomes 

• Over activity of dopamine 

• Viral prenatal infections 

• Marjuana 

• Brain abnormalities (enlarged brain ventricles) 

• Reduced activity in prefrontal cortex 

OCD

Exposure and response prevention

Responsibility pie 

Worry Timer 

Treatments are more behavioural oriented than cognitive 

• OCD is difficult to treat without medication

  • Best: psychological + meds 

• SSRI 

  • Sertraline (SSRI) 

  • Most physicians start with cipralex (SSRI) 

• Twintrellix (SMS) 

• Very few medications that are approved for adolescents - cipralex 

PTSD 

Cognitive Processing Therapy

• Manulized 12 sessions

• Adapt thoughts, challenging core beliefs present during and after trauma

E.g., safety and trust modules

• Identify negative belief

• Identify previous negative and positive experiences that shape these beliefs

• Identify symptoms associated with negative belief

• Identify stuck thoughts

• Come up with possible solutions and alternate thoughts.

EMDR

• Somatic and neurological pieces 

• Neurological pieces of EMDR are different and do help benefit .. 

Cognitive

• Treatment approach that focuses on cognitive errors and forming healthy thought patterns.

• Cognitive is MORE important than behavioural in trauma

• How do I develop healthier thoughts? 

Cognitive Therapy

• Cognitive restructuring- replacing irrational and self-defeating thoughts

• Decatastrophizing- avoiding tendencies to think the worst

Behavioural

• Build an exposure plan to build them back into this setting

Anti-Anxiety Drugs

• Drugs that depress anxiety in Central Nervous System (CNS) and reduce muscle tension

• Reduce respiration and heart rate

• Mild tranquilizers, barbiturates and sedative-hypnotics

• Biological approach may use Benzodiazepines (ex. Valium and

• Ativan) that work to regulate GABA receptors, effectively

• enhancing their inhibitory potential

  • May give for first 30 days to help relief, regulation 

Antidepressants

• Drugs that are prescribed to treat depression and some anxiety disorders.

• 3 types: tricyclics, monoamine oxidase (MAO) inhibitors,

• selective serotonin-reuptake inhibitors (SSRI’s)

• Control availability of neurotransmitters norepinephrine and serotonin

• Biopsychosocial Model 

Theory

Important Notes/Definitions

Etiological Roots/Maintenance of Mental Illness

Examples/Treatment

Cognitive Theory

Sensorimotor = Infancy 

• We develop a working memory and object permanence

Preoperational = Early Childhood 

• Symbolic functions and imaginations 

• Primitive reasoning - we become curious and ask questions

Concrete Operational = Middle Childhood 

• Inductive reasoning 

• Understand thoughts and feelings are unique

Formal Operational = Adolescence

• We think abstractly, understand success and failure, identity, morality 

Cognitive development 

•  Way of perceiving and mentally representing the world

 Schema 

• A mental structure that categorizes information based on similarity

Assimilation 

• Absorbing new events into existing schemes

• Can sometimes be broken

Accommodation

•  Modification of existing schemes when assimilation does not allow the child to make sense of novel events

Confirmation Bias

• A tendency to search for information that confirms one’s preconceptions

Representativeness Heuristic

• Tendency to presume that someone or something belongs to a particular group resembling a typical member (e.g.) racial profiling 

Availability Heuristic

• A cognitive rule that judges the likelihood of things in terms of their availability in memory 

• E.g. dreading terrorism but ignoring climate change 

Counterfactual thinking

• Imagining alternative scenarios and outcomes that might have happened - e.g. bronze vs silver medalists at Olympics - underlies our feelings of luck, more regret over things not done

Belief Perseverance

• Persistence of one’s initial conceptions, even in the face of disconfirming evidence, not willing to accommodate out of our old, engrained schemas 

Cognitive Flexibility 

• Ability to adapt one’s thinking and behaviour to changing circumstances 

View on Abnormal Behaviour: Symptoms of psychopathology result when pathological schemas are activated by stressful events

• Abnormal behaviour is the result of faulty cognitive (thinking) processes

• Pathological schema - not a healthy schema, may have been helpful in the past but is no longer helpful 

ABCD - Beck Model 

• Explores the relationship between events, beliefs and feelings.

• The way we interpret events is more important then what occurs in reality

• A= activating event

• B= one’s belief system

• C= one’s emotional consequence/response (includes behaviour,

• thoughts and emotions)

• SOLUTION is D= disputing (actively and forcefully disputing irrational beliefs

• Our thoughts impact our emotions that affect our behaviours, when we are treating someone from a cognitive perspective we want to isolate the schema, we want the event to be more directly related to how someone feels and chooses to act 

• We have old stuff that comes up in novel experiences - want to develop more adaptive ways of dealing with it 

Beck’s Cognitive Assessment

• Early upbringing (e.g., collect early experiences of cognitive schema’s)

• Current Schema Content (maladaptive thoughts and behaviours)

• Precipitating events to the current distress

• Current symptom content

• Use diagnostic information (Beck has a series of theoretically drive cognitive

• processes that occur for carrying illnesses like the ‘Cognitive Triad of Depression)

• Use paper and pencil measures (BDI, BAI) - psychometric measures 

• Assess the self-schema and relational schema of the client based on the behaviour with the therapist

Schema Identification 

Downward Arrow Method

• Create a problem list

• Have the client complete a thought record based on an event on the ‘Problem List’

• “If this automatic thought were true, why would this be upsetting”

  • You will get a sense of the clients underlying thought patterns with these questions and be able to identify core beliefs that are driving present maladaptive thoughts and behaviours

Judy, a 25-year-old paramedic, experienced a distressing call involving a deceased individual whose situation mirrored her estranged father's death. Following the incident, she developed symptoms including nightmares, intrusive thoughts, self-blame, emotional sensitivity, and withdrawal from her family.

Cognitive Appraisal: Judy interprets the event through a lens of self-blame, questioning her actions and responsibility for the individual's death, which parallels unresolved guilt and emotions about her father’s death.

Core Beliefs: Her sense of failure and worthlessness may stem from deeper, pre-existing beliefs reinforced by the trauma

Automatic Thoughts: Persistent, negative automatic thoughts (e.g., "I am a failure," "I should have done more") exacerbate distress and maintain symptoms.

Cognitive Avoidance: Withdrawal from family and sensitivity to others’ interactions may reflect avoidance of emotions or reminders of the event and her father's death.

Maladaptive Coping: Intrusive thoughts and hyperarousal may persist due to ineffective strategies for processing trauma, reinforcing the cycle of distress.

Learning Theory

• Learning Theory: behaviors, including maladaptive behaviors, are acquired and maintained through learning processes such as conditioning and reinforcement. It plays a significant role in conceptualizing the etiology (cause) and maintenance of mental illness.

• Components:

  • Classical Conditioning (Pavlovian or Respondent Conditioning): Learning through association. A neutral stimulus becomes associated with a meaningful stimulus, producing a conditioned response.

    • Example: A person with social anxiety may have learned to associate social situations with anxiety because of previous negative or embarrassing experiences.

  • Operant Conditioning: Learning through reinforcement and punishment. Behavior is shaped by consequences—reinforcements increase behavior, while punishments decrease it.

    • Example: A person with depression may engage in avoidance behaviors (e.g., not going to work) and experience temporary relief (negative reinforcement), which maintains the avoidance.

  • Observational Learning (Social Learning): Learning by observing others' behaviors and the consequences that follow.

    • Example: A child who observes a parent dealing with stress by using avoidance may adopt similar coping strategies, maintaining anxiety or stress-related problems.

Etiology: Maladaptive behaviors are thought to be learned in response to environmental factors, such as traumatic experiences, modeling, or reinforcement of dysfunctional behaviors.

Maintenance: Maladaptive behaviors are reinforced and perpetuated through conditioning processes. For instance, avoidance behaviors in anxiety disorders can prevent exposure to feared stimuli, reinforcing the anxiety over time.

A person with social anxiety may have had negative or embarrassing social experiences in the past (classical conditioning). Over time, avoiding social situations provides short-term relief from anxiety (operant conditioning), which reinforces the avoidance behavior and maintains the anxiety in the long run.

Emotion Theory

Development of emotion 

• Infants are born with some capacity to assess emotional experiences (starts off as survival and contentment or pleasant experiences).

  • They know what is negative and positive - attached to caregiver and food 

• Can recognize some facial expressions attached to emotional experiences by the time they are 1 years old

  • Generally fear, anger, and happiness → Continues to develop with age 

• Early experiences help shape how they will learn and respond to environmental stimuli (e.g., how a trusted adult reacts or problem solves through an emotional experience)

• It is normal for children and teenagers to have dysregulated emotions and we do not want to over-normalize them 

  • Example: Tessa gets angry at John when he throws out food. As a result, her son Austin gets angry at John for throwing out food. His reaction/anger is a reflection of Tessa’s anger. 

  • When it is a child/teen, the parents are responsible for their emotions 

• Emotions communicate 

  • Helps us communicate our needs to others 

  • Expressing our emotion can help others understand reasoning 

    • I.e. I had a tragic loss this week, I am in a bad emotional space, I cannot come into work this week 

• Emotions help organize thoughts

  • Emotions are similar to cognitive schemas; an emotional experience helps us store memories based on our experiences 

    • I.e. sad memory is stored as a memory that was sad 

      • Helps us learn what makes us sad 

  • Quick pieces of information that tells us we experienced these feelings before 

    • Allows us to act quickly 

  • Grief is an example 

    • Do a bad job of educating what a normal grief response looks like 

• Emotions motivate action

Does half smiling really work?

• Your emotional experiences are tied to automatic physiological responses that are hardwired for us biologically → we have them from birth 

  • These are generally structured to motivate you into action

    • E.g., fear = flight, fight or freeze and the body physiologically prepares

• You have some power over how your respond when those automatic physical sensations arise

  • Do not have control over automatic responses, but are going to work towards the pieces that are in our control 

Models of emotions

• Discrete view 

• Dimensional view 

Discrete view

Universal Emotions: 

• Fear

• Sadness

• Anger

• Disgust 

• Happiness

• Contempt

• Surprise 

Primary and secondary emotions

• You have primary emotional experiences, but based on their intensity or situational trigger, there can be different labels for it 

  • I.e. sadness can be hurt, depressed, guilt, remoreseful, powerless, ashamed

Discrete view 

• Core system - amygdala - evolutionary + Control system - learning - emotion regulation 

• Sometimes difficult to determine if someone’s emotion is learned and no longer serves them or is it how their emotional command centre works (and they need to learn how to integrate it into their response system)

Conceptualization of discrete emotions

• Excess or too intensely 

• Dearth 

• Alternation

• Two states simultaneously – bounce back and forth between what they should be 

• Deficient or maladaptive strategies 

• *Difficult to determine if it is activation of or defects in core system or control system or both – impacts our conceptualization of symptoms and so treatment strategies

Dimensional View of Emotion

• The Approach and Withdrawal Model 

• Peter Lang’s Bioinformational Theory 

1. Approach Withdrawal Model 

• Based on the idea that people have an urge to move toward or away from an object 

• Approach and withdrawal are core systems of emotional behaviour and personality that can be observed in infants and develop over time 

• Focuses on neural activity associated with goal-related emotion and thus on overt actions (approach or withdrawal from a situation)

• BIS vs. BAS systems 

  • Behavioural inhibition vs. behavioural activation systems 

• Behavioural activation system 

  • Approach towards goals and rewards 

  • Sensation seeking, outgoing 

• Behavioural inhibition system 

  • Drives us to avoid the negative outcomes in life 

  • Preoccupation with negative outcomes 

  • Fear and panic circuits 

  • Anxiety 

Clinical Implications of Approach and Withdrawal System Model 

1. High rate of comorbidity of anxiety and depression 

2. Extensive overlap of symptoms of anxiety and depression

3. Conceptualizing a range of disparate symptoms as negative effect

4. Decreasing negative affect is not the same as increasing positive affect 

2. Peter Lang’s Bioinformational Theory

• Emotions are represented in memory as linked propositions (cognitions) of 3 types - if enough elements are matched then emotion triggered (maybe without meaning)

• 1. stimulus elements – spider

• 2. response elements – running, increased heart rate

• 3. meaning elements – I’ll get bitten and die (this is not emotion, this is cognition) 

• Tied to 2 motivational systems in lower brain

  • Appetitive system

  • Defensive system

Lang’s Theory 

• Hybrid of discrete and dimensional – discrete emotion of fear but links it to dimensional motivation systems in lower brain

• Cognitions play a central role

• Most emotional responses are a product of learning and conditioning (some can be innate)

Clinical Implications of Lang’s Theory

•  Pathological fears conceptualized as arising when person learns problematic connections in propositional network

  • E.g. tachycardia (response) means I am having a heart attack (meaning)

• Treatment = emotion network activated and disconfirming information presented so individual creates a new response and meaning e.g. exposure treatments inagoraphobia, panic, phobias

  • I.e. tachycardia can be an emotional response, not always indicative of a heart attack

• Emotion state dependence – emotions act like magnets for memories

  • E.g. Sad – negative memories, self, future (coping cards, DBT phone calls)

Emotional Suppression

• We ‘gas light’ our emotional experiences as a society – ‘they didn’t mean to be mean so I shouldn’t be upset’, ‘you’re tougher than this’, ‘I hate being sad’

• There isn’t always time or space for emotional experiences in our busy world

  • Keep in mind this is an area where we as society are not healthy → tools will be difficult for them to apply because other people do not use them 

    • Talk about safe people to practice these skills with → i.e. starting with the therapeutic relationship 

• Sometimes we over rely on the logical parts of our mind, instead of using ‘Wise Mind’

  • Want to use the prefrontal cortex (reasonable mind) plus the emotional mind (amygdala) = wise mind 

• Emotional suppression has been linked to honor-based suicides 

  • “People are better off without me because I am a burden” 

• Emotional validation (including self-validation) are important strategies to learn to reduce emotional suppression and learn to use emotional signals for their purpose

  • Want clients to learn how to understand their emotions themselves 

  • “Would you say that to your best friend?” 

    • Use when they say something really self-depricating 

Emotional Suppression: Consequences

• Research on college students indicated that emotional suppression was related to the following in their transition year: 

  • 1. Lower social support

  • 2. Less closeness to others

  • 3. Social satisfaction

• Problematically suppression is impacting social support and social support is linked to positive college transitions and less depressive symptoms.

Emotional Manipulation

• Research has suggested that high emotional intensity in an individual can lead others to feel an immediate need to meet the emotional need of another person (even if it violates their own needs) 

  • Countertransference is information about how other people feel about the client → use this information to make the client’s lives better 

• Problematically most people will encourage the individual to suppress their emotional experience (e.g., stop crying) or offer a distraction

  • Feel like people will not hear them unless they do that 

• Sometimes, individuals will attempt to meet the need of the person, regardless of their boundaries – this can be problematic and not an ultimate solution to management of emotional experiences

  • Best thing you can do is not give in

    • I.E. a client emails you on a Friday night stating that they are going to end their life, you have already set boundary, safety plan, and went over consent form - best not to respond right away 

• Healthier emotional experiences are managed through thinking through our options and require some self-reliance

Emotional Monitoring - Dr. Nicole LaPera

• Constantly asking people if they’re ok and trying to make sure they're not upset is a form of emotional monitoring, it can damage relationships

• Emotional monitoring is a constant focus on scanning the moods of those around you in order to feel safe. Most people aren’t aware they do this because it’s a subconscious survival adaptation 

• We run the risk of emotionally suppressing ourselves and the people around us

• Research about men raised in violent households

  • They either become the victim or emotionally suppress others as the strategy or they become the perpetrator 

DBT Emotional Myths - Linehan

• One of the most common emotional myths are that there are ‘good’ and ‘bad’ emotional experiences

• Emotions are just information we use to process experiences – they are not ‘good’ or ‘bad’ –they are information

10 implications for intervention of discrete emotion models (core and control) 

1. Emotions can be changed by inducing other emotions

Opposite action

Half smiling 

These things help with emotional experiences that do not fit the facts 

2. Interventions to prevent activation of intense emotions are helpful 

We do not want to experience the emotion in excess or too intensely because it becomes hard to utilize our higher order thinking 

3. Cognitive interventions do not change some emotions 

Core                           

Evolutionary, visceral/emotional/logical/intellectual 

Emotional vulnerability DBT 

Control 

Learning 

Emotional regulation DBT 

4. Promote tolerance of intense emotions 

Want to let clients know they are normal, we just want to bring them down to use for their purpose 

I.e. acceptance, mindfulness, distress tolerance, TIPP, self soothing – senses, harm reduction

5. Strategies to reduce suppression are helpful 

CBT exposures

I.e. If someone has issues with anger such as intense road rage, start planning gradual exposures. Start with walking outside, then biking, then gradually driving - purpose is to learn how to regulate emotions

ACT mindfulness, acceptance 

Sometimes emotions do fit the facts so we need to help validate them and how to accept these emotions

Suppression is unhealthy

6. Pretreatment contracting can help regulate intense emotions 

OCD, CPT for PTSD, DBT 

CPT - 12 general thoughts people have after trauma, general rather than specific because everyone with PTSD has them, work through how to deal with them 

7. Emotion regulation skills are helpful – increasing positive emotions/experiences/decreasing vulnerability

E.g. ABC (Accumulating positive experiences, Build mastery, Cope ahead of time with emotional situations)

To cope ahead: PLEASE (treat PhysicaL illness, balance Eating, Avoid mood altering drugs, balance Sleep, get Exercise)

8. A focus on particular discrete emotions helpful

E.g. DBT shame, contempt (an aspect of disgust)

Often people feel shame when they feel unhelpful guilt and it does not motivate them to change a situation

Talk to clients about helpful guilt vs. unhelpful guilt 

E.g. OCD fear and disgust

9. Treatment in phases is needed for some individuals

DBT – emotional regulation skills prior to treating PTSD

CBT Anxiety – cognitive challenging skills prior to exposures

CBT Depression – behavioural activation skills prior to cognitive skills

10. Telephone coaching can be helpful

Core system activated & control system unable to kick in without assistance

***True DBT (versus using DBT strategies) – Linehan style - a team approach – individual and group sessions for the client and client can call therapists as needed. The therapist has weekly meetings with the team.

Example of emotion theory (Peter Lang) 

• A person assaulted in a dark alley might develop intrusive thoughts about the event, heightened physical reactions (e.g., shaking) when near similar alleys, and avoidance of going out at night, maintaining their fear and distress.

Social Determinants of Health

The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the

conditions of daily life. These forces and systems include economic policies and systems, development agendas, social

norms, social policies and political systems.

Social determinants of health refer to a specific group of social and

economic factors within the broader determinants of health. These

relate to an individual's place in society, such as income, education or

employment. Experiences of discrimination, racism and historical

trauma are important social determinants of health for certain groups

such as Indigenous Peoples, LGBTQ and Black Canadians.

The Main Social Determinants of Health include:

• Income and social status

• Childhood experiences

• Healthy behaviours

• Gender

• Access to health services

• Culture

• Employment and working conditions

• Physical environment 

• Education and literacy

• Social supports and coping skills

• Biology and genetic endowment 

• Race / racism

• The risk of developing mental disorders and poorer mental health are greater for members of groups with less access to power, material resources, and policy making as a result of broader social, political, and economic factors that sustain inequalities 

• Safe environments, adequate food, housing, high-quality health care, appropriate employment

• The social determinants of health also include interpersonal variables

  • Social exclusion, discrimination, low social status

• Many refugees and asylum seekers are at risk for poor mental health not only because of prior traumatic exposures, but also because of post-migration social determinants of health, and the impact of those determinants may increase over time 

Social Determinants of Health - Indigenous Peoples

• Impact of colonialism structural determinants on health 

  • Persistent disparities between ABoriginal peoples’ non-Aboriginal peoples’ in Canada

    • Diminished life expectancy

    • Chronic disease

    • Addictions

    • Social violence 

Proximal Determinants

• Direct and immediate influences on an individual’s health or behavior.

• Examples: Personal behaviors (diet, exercise), mental health, exposure to hazards, or access to healthcare.

Intermediate Determinants

• Factors that mediate or indirectly influence health by shaping proximal determinants.

• Examples: Living conditions, employment, education, healthcare infrastructure, and social support networks.

Distal Determinants

• Broad, structural, or systemic factors that shape intermediate and proximal determinants over time.

• Examples: Socioeconomic policies, cultural norms, political stability, discrimination, and historical or systemic inequalities.

Refugees

Income

• Low socio-economic status correlates with PTSD, distress, and depression.

Employment

• Refugees struggle to find jobs due to language barriers and unrecognized credentials.

Housing

• Financial constraints lead to overcrowding and post-migration stress.

Language Skill and Interpretation

• Language difficulties have widespread effects, limiting advocacy for rights.

Asylum-Seeking Process

• Stability and security are crucial for reducing anxiety and depression.

Social Support and Isolation

• Refugees face loneliness due to language barriers, discrimination, poverty, and family separation.

Discrimination

• Feeling accepted reduces mood disorders among refugees.

• Refugee youth experience more internalizing disorders, linked to post-migration trauma and discrimination.

Biopsychosocial Model

The biopsychosocial model is an integrated approach to understanding mental illness, emphasizing the interaction of biological, psychological, and social factors. It suggests that mental health is influenced by:

1. Biological factors: Genetics, neurochemistry, and brain function.

2. Psychological factors: Cognitive patterns, emotional regulation, coping mechanisms, and personality traits.

3. Social factors: Life experiences, social support, cultural influences, and environmental stressors.

This model views mental illness as the result of complex interactions among these domains, rather than as a consequence of a single factor.

Example: Tony, a 40-year-old married father of two, is the head of his late father's illegal gambling business and has a history of panic attacks. As a first-generation Italian immigrant, he faced stigma and hardship growing up, including witnessing his father's violent acts and his mother's abuse, and now struggles with panic attacks while also feeling responsible for his sister, who has long struggled with mental health issues.

• Biological: Genetic vulnerability to anxiety.

• Psychological: Negative thinking style and poor coping skills.

• Social: Media scrutiny, discrimination, and his status as a famous individual contribute to social stressors, but he also benefits from financial resources, social support, and a supportive wife.

Diathesis-Stress Model

The diathesis-stress model assumes that mental illnesses occur due

to stressful conditions in the environment interacting with the

biological and psychological characteristics of the individual. The

model assumes that mental disorders can require a predisposition

towards the disease, and it provides a general explanation for why

individuals with a predisposition for a disorder, but who live in a

healthy environment, may not develop the disorder, and why people

who live in a stressful environment without a predisposition may not

develop certain disorders

• Diathesis: a predisposition or a vulnerability for the development of a pathological state- biology, genetics, psychological

• Stress  - environmental factors, internal and external

• Neither the diathesis nor stress alone is sufficient to produce the disorder

• Stress activates the diathesis, which then leads to the disorder

• Diathesis-stress models are similar to the idea of risk-factors for stress-related diseases

  • Example: schizophrenia - usually due to cold mothers

1. Depression

Why: A genetic predisposition to depression or a negative attributional style (diathesis) may interact with stressors like significant loss, chronic stress, or trauma to trigger depressive symptoms.

Example: A person with a family history of depression may develop the disorder after a job loss or breakup.

2. Schizophrenia

Example: A person with a family history of schizophrenia might experience their first psychotic episode during a period of extreme stress or substance misuse.

3. Post-Traumatic Stress Disorder (PTSD)

Example: A combat veteran with high emotional sensitivity may develop PTSD after witnessing violence.

Classical Conditioning

Classical Conditioning involves learning through the association of a neutral stimulus (NS) with an unconditioned stimulus (UCS) that elicits an unconditioned response (UCR), leading to the neutral stimulus becoming a conditioned stimulus (CS) that triggers a conditioned response (CR).

Classical conditioning can contribute to the development of phobias, PTSD, or anxiety disorders, as neutral stimuli (e.g., locations or people) can become associated with distressing experiences (e.g., trauma, panic attacks), leading to automatic fear responses. This unconscious learning can create complex emotional reactions, sometimes without clear triggers.

Sarah was bitten by a dog in a park, associating the park and dogs (neutral stimuli) with fear and pain.

She now experiences automatic fear responses to dogs and avoids similar settings, developing a phobia.

Maslow Hierarchy of Needs 

• Explanation and levels

  • 1. Physiological Needs: Basic needs (food, water, shelter, sleep).

  • 2. Safety Needs: Security, stability, protection.

  • 3. Love and Belonging: Relationships, friendships, family, intimacy.

  • 4. Esteem Needs: Self-esteem, recognition, respect, achievements.

  • 5. Self-Actualization: Reaching one’s full potential, personal growth, creativity

How it explains mental illness:

• Unmet needs at lower levels (e.g., lack of safety or love) can lead to mental distress.

• Inadequate fulfillment of esteem needs (feeling worthless, unrecognized) can result in low self-esteem and anxiety.

• Unmet self-actualization needs may contribute to feelings of frustration or lack of purpose, possibly triggering depression or identity issues.

• Mental illness can emerge when individuals are stuck in an earlier level, unable to move forward in fulfilling higher psychological needs

Example (Physiological) A person who is homeless may struggle with inadequate food, water, and sleep, leading to high stress, anxiety, and potential depression due to unmet basic needs.

Example (Safety) An individual living in an abusive environment may constantly fear for their physical safety.

Example (Love) A person who experiences social isolation, such as a recent immigrant without a support network, may struggle to connect with others.

Example (Esteem) A person facing constant job rejection may begin to question their abilities and value.

Example (Actualization) An individual in a high-pressure job that stifles their creativity and personal growth may feel unfulfilled.