Clinical Psychology
13.1: Defining Psychological Disorders
Psychological (Mental) Disorders: Syndromes, or clusters of symptoms that tend to occur simultaneously
Symptom – Physical or mental feature that may be regarded as an indication of particular condition or psychological disorder
Psychopathology: Scientific study of psychological disorders or to the disorders themselves
Clinical Psychology: Assessment and treatment of psychological disorders
Psychological Disorders
To qualify as a psychological disorder, a syndrome must not be...
A) expectable response to common stressors and losses (such as the loss of a loved one)
B) a culturally approved response to a particular event (trance states in religious rituals)
C) simple deviance from social norms
Point Prevalence: Percentage of people in a given population who have a given psychological disorder at a particular point in time
Lifetime Prevalence: Percentage of people in a certain population who will have a given psychological disorder at any point in their lives
Specific moment vs entire lifespan
Examples of Anxiety Disorder
Generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD),panic disorder, and social anxiety disorder
MDD = Major Depressive Disorder
Psychological disorders are behavioral or psychological syndromes or patterns that lead to clinically significant distress or disability
Nearly half of the people in the United States will experience a psychological disorder in their lifetimes. More than a quarter will have 2 or more disorders
Psychological Disorders represent 5 of the 10 leading causes of disability and premature death worldwide
13.2: Assessing Psychological Disorders
Clinical assessment – procedure for gathering info needed to evaluate an individual's psychological functioning + determine whether a diagnosis is warranted
Clinical interview: 1:1 interview where clinician asks client to describe their problems/concerns (structured - q's already determined, unstructured – patient just talks and gets an idea + gets q's)
Self-report measures: Reports/surveys (fixed set of questions the client answers) measures severity of client symptoms - results must be interpreted keeping in mind the client's history
Projective (Personality) tests: Client is asked to respond to unstructured or ambiguous stimuli (usually pictures) and asked to interpret them -- Responding to these stimuli, reveals unconscious/hidden wishes/conflicts (very popular method)
A clinical assessment is used to evaluate a client's psychological functioning and to determine whether a psychological disorder is present
Clinical interviews are designed to systematically explore a client's current mental state, life circumstances, and history
Self-report measures and projective tests are frequently used to supplement a clinical interview
13.4: Benefits and Costs of Diagnostic Labels
Benefits of Labels
Improved treatment for psychological disorders --- Provide care (understanding self-awareness)
Specific labels for different disorders help ensure clients get the appropriate treatment (therapy, medication, or both) -- without diagnostic labels, it'd be difficult to know which treatment to provide
'Reason' for their hardship making it a bit easier to process
Allows accommodations to ensure someone with disabilities is not systematically challenges
Facilitates research on psychological disorders
Cons of Labels
Limiting (in terms of beliefs about themselves)
Hopeless (daunting label that is their reality)
Stigmatizing (encourages researchers and clinicians to think of each psychological disorder as a fixed and enduring diagnosis)
In the US, psychological disorders are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Benefits of diagnostic labeling include better treatment and more precise research
Costs of diagnostic labeling include stigmatization of clients and an overemphasis on the separation between each of the psychological disorders
Treatment providers make a strong effort to distinguish between the person and the illness – for example, by referring to "people with schizophrenia" rather than "schizophrenics"
14.1: Early "Therapies" for Psychological Disorders
Trephination: Early therapy for mental disorders that involved cutting a hole in the skull (so demons could be driven out through this "exit")
Calm the demons with music or chase them away with prayer
Patients were starved, flogged, or immersed in boiling water, force vomit
"Hospitals for the Insane" -- to isolate the "undesirables" from the rest of humanity
England put patients on display for members to pay and wander among patients with psychological disorders
Activists:
Phillipe Pinel: pressured the French government to stop barbaric practices in Paris hospitals and developed a more humane method (moral treatment) of providing therapy to psychiatric patients
Provide exercise and fresh air
Dorothea Dix: Championed the cause of mistreated people with mental illness
Led to dramatic growth of state-supported institutions for psychological care in US and Canada
Sigmund Freud: Founder of the talking cure, observed that verbalizing a traumatic event and related emotions seemed to help his clients
Early treatments for psychological disorders were harsh and ineffective; they were based on the idea that these disorders were caused by demons or evil spirits
Conditions in the first hospitals for the psychologically ill were barbaric. These institutions functioned principally to confine social "undesirables"
Reformers gradually succeeded in eliminating the worst treatment practices, and in the past century, many new biological and psychological treatments for psychological disorders have been developed
14.2: Contemporary Therapy Providers
Psychological Therapies
These are provided by accredited psychologists, psychotherapists, etc.
Biological Therapies
A family doctor or a psychiatrist can prescribe medications as part of a treatment plan
In Canada, a psychologist cannot prescribe medications
Providers licensed to offer psychological therapies
Clinical Psychologists
Psychiatrists
Psychiatric nurses
Marriage, family, and child counselors
School and vocational counselors
Mental health counselors
Clinical social workers
What Predicts a therapist's success?
The therapist's interpersonal skills + how well the treatment fits the clients' needs (rather than years of experience practicing or education
Psychologists adhere to a set of ethical principles
1) Striving to benefit the people they work with; Do not harm
2) Establishing relationships that are based on trust;
3) showing integrity by being accurate, honest, and truthful;
4) being vigilant and potential biases; and
5) showing respect for the dignity and worth of all people
Ongoing debate about who should be allowed to prescribe medications to treat psychological disorders
Who therapists are and what they do seem to be more important predictors of therapy outcomes than professional credentials or years of experience
In the US, professionals such as psychiatrists can prescribe biological therapies. Some states allow clinical psychologists to prescribe biological therapies, but this move is controversial
14.3: Contemporary Therapy Recipients
North and South America = Higher rates of anxiety disorders than depressive disorders
Africa = Lower prevalence for both depressive and anxiety disorders
Subsyndromal Disorders – Versions of psychological disorders that don't meet the DSM-5 criteria for diagnosis but that may nonetheless cause significant problems
In the US, more than 50% of people managing psychological disorders do not receive any therapy … why?
Men less likely than women to seek therapy
Non-white less likely than white
Accessibility access (high volume of people + low income cuz therapy is expensive)
Remaining stigma can prevent some people from seeking therapy
People in certain ethnic groups may experience more stigma (ex, brown/Asians)
Gender expectations can contribute to stigma experienced by men
Reasons why/Barriers?
Access – Some parts of the world don't have relevant health care providers available
Financial – low incomes are less likely to have insurance coverage leading to lower rates of psychological treatment
Recognition – Individuals must recognize they have a treatable condition: but also believe seeking treatment is a good idea (however high level of stigma is still associated with psychological disorders in many places)
5-10% have been proven to get worse after therapy
Psychological disorders have significant financial as well as emotional costs
Many people are treated for psychological disorders every year, but many more people who would benefit from treatment do not receive the care they need
Barriers to receiving appropriate care for psychological disorders include limited access, lack of financial means, and the stigma associated with psychological illness
Therapy can benefit people from a wide range of backgrounds, particularly those who have a sense of rapport with their therapist, a strong motivation to become well, and a disorder that is amenable to the type of treatment that is being provided
14.10: Cognitive-Behavioural Approaches
Cognitive-Behavioural Therapy (CBT) = Hybrid form of psychotherapy focused on changing the patient's habitual interpretations of the world and ways of behaving; it combines cognitive and behavioural approaches to therapy
Cognitive Behavioural Therapists – present-focused
Concerned with identifying and solving problems that their clients wish to address
Clients expected to do homework between sessions (practicing new skills or new ways of thinking, thought records etc.)
Cognitive Restarting - Replacing maladaptive thought patterns with more realistic/positive ones that reduce anxiety and problematic behaviour
Potential Short Answer, given a situation, how could you challenge ___ belief's?
Behavioural & Cognitive Approaches (to therapy)
Behavioral Approaches
We learn behaviors that are maladaptive
Example treatment: exposure therapies to treat a phobia response (exposure therapy)
Cognitive Approaches
We make errors in thinking that cause maladaptive behaviors
Example treatment: adjusting the belief that "Everything I do must be perfect"
Third Wave Therapies: Retain the behavioural and cognitive therapists' goal of addressing unhelpful patterns of thinking, feeling, and behaviour
Seek to modify the hold that our thoughts have on us, allowing us to achieve valued goals
Encourage clients to accept thoughts and feelings without judging them
1st Wave = behavioural therapies
2nd Wave = Cognitive therapies
3rd Wave Therapies:
Acceptance and Commitment Therapy – Helping the client achieve a greater awareness and acceptance of thoughts and feels (despite having to manage their negative thoughts/feelings)
Clients can pursue valued goals despite having unwanted thoughts and feelings
Mindfulness-based Stress Reduction – Initially used to help people manage chronic pain, its use now expanded to wide range of conditions, including anxiety, and mood disorders
Teaches people to be fully present in the moment, to observe their thoughts, feelings, and sensations, nonjudgmentally and as fleeting mental byproducts
View their negative and painful feelings as clouds passing in the sky or bubbles floating by on a stream
Evidence Based Practices (related to 14.1)
Both these theories are evidence-based, meaning psychological research has been conducted and peer-reviewed studies have been published
Cognitive-behavioral approaches employ both behavioral and cognitive techniques
Third wave therapies are cognitive-behavioral therapies that place less emphasis on direct cognitive change, and more emphasis on pursuing valued goals despite the client's unwanted thoughts and feelings
14.19: Physical Activity and Natural Environments
Levels of physical activity are lower in individuals with severe psychological illnesses
Increase PA may decrease severity of negative symptoms and increase levels of overall psychological health
Reduces symptoms of depression and schizophrenia in individuals with mental illness
Exposure to Natural Environments;
Can lead to increased levels of well-being
Individuals managing mental disorders who exercised a lot reported a greater decrease of symptoms (though they must overcome symptoms such as fatigue, pain, low motivation)
Time spent in natural environments may improve mental health by reducing activation of the amygdala in response to stress
Ready access to green space associated with higher levels of well-being and lower levels of distress
Urban living magnifies responses to stressful situations
Green Exercise = Outdoor Exercise
No compelling evidence
that exposure to nature can help treat psychological disorders
Experiment Example from Video
Brain Imaging of brains after a test (neurological evidence)
People in rural areas handles stress well
Dramatic effect as compared to those who lived in cities
Physical activity levels are negatively related to psychological disorders, and there is some indication that increasing activity levels may help improve mental health
Exposure to natural environments is also thought to have beneficial stress-reducing effects
14.21: Do Psychological Therapies Really Work? If So, Which Is Best?
Small percentage of individuals who get worse after psychological therapy
An average person who receives therapy is better off at the end of it than 80% of people who don't
Hans Eysenck concluded that therapy actually seemed to decrease the spontaneous improvement evident in people who did not receive therapy
Meta-Analysis: Combines the results of many different studies
Empirically Supported Treatments (EST): Testable Material
Treatments that research has shown to be effective for treating a given disorder
Continue to test which are the most empirically supported treatments
Dodo Bird Verdict: An expression used to summarize the comparative effectiveness of different forms of psychotherapy
According to the dodo bird in Alice in Wonderland, "Everybody has won and all must have prizes"
Meaning that all the major forms of psychotherapy are equally effective
Behavioral Therapy – effective for treating anxiety disorders, particularly the phobias (rarely used for personality disorders)
Cognitive Therapy – Effective in treating mood disorders and may be just as effective as drug treatment (but with longer-lasting impact and without the side effects)
Also useful for other diagnoses like panic disorder, bulimia nervosa
Less effective with problems including phobias
Experimental Therapies – Alleviate depression and anxiety disorders, though they have their limits and are less effective for schizophrenia
Meta-analyses suggest that therapy is often helpful
Empirically supported treatments are those that have been empirically demonstrated to work
Some researchers believe theat the dodo bird verdict is correct, and that even widely different interventions can have comparable effects
Other researchers disagree, pointing to evidence that some therapies are more effective that other therapies for specific disorder