Psych Exam 4

Chapter 15: Psychopathology

• Where is the line between “normal” and “abnormal?”

• Examples of “abnormal” behavior

  • Professor who sings his lectures

  • Walking on your hands instead of feet

  • Person arguing with themself

  • Counting each step you take each day 

  • Eating only foods with 2 or fewer vowels 

  • Putting 46 bumper stickers on your car

• What is “abnormal?”

  • Statistical Infrequency (Deviant)

    • Is it rare?

    • Unusual (outlier)

      • Schizophrenia =1% (lifetime prevalence)

  • Personal Discomfort (Distressful)

    • Does it cause personal suffering? 

    • Abnormality hurts

  • Impairment (Dysfunctional) **

    • Does it interfere with functioning?

• What are some conceptions of psychopathology?

  • Contemporary approaches to psychopathology

  • Medical model

    • DSM-5-TR (March 2022)

      • Diagnostic and Statistical Manual of Mental Disorders

    • Etiology (causes), diagnosis, treatment, prognosis (future)

  • Categorical vs. Dimensional approaches to diagnosis

    • Categorical: black or white decision, dichotomous 

      • Light switch that you can switch on and off 

      • 5+ out of 9 to qualify for this as a diagnosis

    • Dimensional: idea that mental disorders have a continuum 

      • Gradual light switch/dimmer

• Diathesis-Stress Model of Mental Disorders

  • NATURE

    • Diathesis/tendency/predisposition: vulnerability to psychological disorders

      • Distal causes

      • Genetic inheritance

      • Biological processes, such as brain abnormalities or neurotransmitter problems

  • Nurture

    • Environmental stressors

      • Proximate causes

      • “triggers”

      • Noxious physical stressors

      • Relationship/job problems 

      • Trauma, abuse, neglect

  • Both have the ability to lead to mental disorders

• How are mental disorders classified?

  • Diagnostic and statistical manual of Mental Disorders (DSM-5-TR)

  • Classifies numerous disorder into categories

  • Comorbidity: co-occurrence of more than one disorder in the same individual

    • +2 disorders

  • Types of disorders

    • Anxiety Disorders

    • Substance-related disorders

    • Mood disorders

    • Schizophrenia

    • Personality disorders 

    • ASPD

      • Never that person's fault

      • No responsibility

• Anxiety Disorders

• Etiology of Anxiety Disorders 

  • Etiological is causes

  • Biological Factors

    • Twin studies suggest a genetic predisposition (diathesis)

    • Anxiety sensitivity (feedback loop; panic disorder)

      • Physiological symptoms (sxs. Increased heart rate)

        • If you have catastrophic thoughts and you think about how bad these thoughts are it causes your heart rate to increase more leading to a spiral. 

    • Neurotransmitters (GABA, serotonin)

      • Give medication to increase GABA levels like valium or xanax

  • Learning/Conditioning

    • Can be acquired through classical conditioning 

    • Can be maintained through operant conditioning 

    • Observational learning may also play a role

  • Cognitive Factors

    • Certain ways of thinking may make someone more vulnerable to anxiety disorders

• Mood Disorders

  • Major Depressive Disorder (Unipolar depression) 

    • Lifetime prevalence 

      • Men = 5-12%

      • Women = 10-25%

  • Bipolar Disorder (Manic-Depression)

    • Lifetime prevalence

      • 0.4-1.6%

    • “Normal” - - - - - - - - - - - - - - - - - - - 

      • Bipolar is a negative sin graph with the lower bubbles being depression and the higher bubbles being MANIA

• DSM-5 Symptoms of Depression

1. Depressed mood most of the day, nearly everyday

2. Diminished interest in or pleasure in activities

3. Significant weight loss/gain or decrease/increase in appetite

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Feelings of worthlessness or guilt

8. Diminished ability to think or concentrate

9. Suicidal thoughts, plans, or actions

• Etiology of Mood Disorders

  • Genetic Vulnerability

    • Twin studies suggest a strong genetic predisposition (diathesis)

  • Neurochemical Factors

    • Norepinephrine

    • Serotonin levels lower than normal (SSRIs: Prozac, Paxil, Zoloft)

  • Cognitive Factors

    • Depressogenic thinking

      • Beck: cognitive distortions

        • All-or-nothing, Always or never, Dichotomous thinking 

        • Labeling

        • Magnification and minimization

      • Seligman: negative attributional style

        • Attribution: explanation for why something happened

        • Negative events drive you towards depression

          • 1.) Internal attributions for the negative events

          • 2.) Global, I suck at everything

          • 3.) Stable, I am gonna do bad at the next thing too

  • Situational Factors

    • Life Stressors

      • Linear relationship between number of stressors and risk of depression

      • More stressors more depression

• Attributional Style and Depression

• Symptoms of Schizophrenia 

  • Can be divided into two categories

    • 1) Positive Symptoms - “normal” + pos sxs. = “schizophrenia”

      • Reflect an excess or distortion of normal functions

      • Include delusions, hallucinations, disorganized thought and speech, disorganized motor disturbances

        • Delusions = false beliefs, makes schizophrenia be described as a psychotic disorder

        • Hallucinations = False sensory experiences (starting to lose touch with reality)

        • Disorganized thought and speech = Thought disorder 

        • Disorganized motor disturbances = range between catatonic and frenetic

    • 2) Negative Symptoms - “normal” - neg sxs. = “schizophrenia”

      • Consist of behavior deficits 

      • Include flat affect, alogia, and avolition

  • Lifetime prevalence = 0.5 - 1% 

    • 1% is the figure usually used for schizophrenia

• Etiology of Schizophrenia

  • Genetic Vulnerability (Diathesis)

    • Twin studies 

    • The more similar you are biologically to someone the more likely you are to develop schizophrenia too. 

  • Neurochemical Factors

    • Dopamine (levels are too high)

    • Serotonin 

    • Glutamate

  • Structural Abnormalities in the Brain

    • Enlarged ventricles (increased fluid filled cavities which leaves less space for remaining brain volume.)

    • Smaller than thalamus with less metabolic activity

      • Thalamus relays sensory information aside from scent

  • Neurodevelopmental Hypothesis

    • Disruptions in normal maturational processes of the brain before or at birth 

• Substance Abuse vs. Dependence 

  • Substance Abuse: significant negative consequences related to substance use

    • Work, school, home

    • Use in physically hazardous situations

    • Legal problems

    • Continued use despite social/interpersonal problems caused or exacerbated by use

  • Substance Dependence:

    • Tolerance

    • Withdrawal

    • Larger amounts/longer period than intended

    • Unsuccessful efforts to cut down 

    • Great deal of time obtaining, using, or recovering from substance

    • Giving up or reducing important activities

    • Continued use despite knowledge of physical or psychological problems caused or exacerbated by use

• DSM-5-TR Diagnostic Changes

  • DSM-5-TR basically combines the symptoms lists for substance abuse and substance dependence all into one list

  • Only two changes have been made

    • 1) recurrent legal problems criterion deleted

    • 2) added “craving or a strong desire or urge to use a substance”

  • Threshold for substance use disorder diagnosis is now two or more criteria

• Childhood Disorders

  • Attention-Deficit/Hyperactivity Disorder (ADHD)

    • Prevalence in school-age children = 3-7%

    • Male:female ratio of 4:1 to 9:1

    • 3 essential features

      • Inattention: easily distracted 

      • Hyperactivity: Can’t sit still, excessive activity

      • Impulsivity: Acting without thinking, symptom can cause problems with peer relationships, manifest itself in terms of increased injury

  • Autism Spectrum Disorder

    • New category in DSM-5

    • Prevalence = 1.9%

    • Onset prior to age 3

    • Impairments in two domains

      • 1) social communication (verbal and nonverbal) and social interaction (unaware of others)

      • 2) Restricted and repetitive behaviors, interests, and activities

Chapter 16: Treatment of Psychopathology

• Biomedical Therapies

  • Psychosurgery

    • Brain surgery

      • Lobotomy (Back in the day)

    • “Treatment of last resort” for three possible conditions…

      • 1.) Depression

      • 2.) OCD

      • 3.) Chronic Pain

  • Electroconvulsive Therapy (ECT)

    • “Shock therapy”

      • Not so great depictions in TV shows and movies

    • Refined overtime

    • Deliver a jolt of electricity to the person’s brain while monitoring their BP, ECG after receiving a muscle sedative

      • Causes seizures (10-30 sec) which is why the muscle relaxer is needed. 

    • Multiple treatments over a couple weeks

    • Causes minor retrograde amnesia as a result

    • It is a successful treatment, don’t know why it works, it’s like a hard reboot for someone with depression (again treatment of last resort)

  • Repetitive Transcranial Magnetic Stimulation (rTMS)

    • Less invasive, placing wire coil on top of head and from that wire coil pulses of magnetic energy are applied 

      • Just like the eeg records at the overlining layer the magnetic waves only penetrate the top layer of the brain

    • 2-4 weeks of coming back for treatment

    • Not knocked out, no retrograde amnesia

    • Works because it stimulates the left frontal lobe which tends to be inactive in folks with depression 

  • Drug Therapies

    • Depression

      • Three major classes of antidepressant medications

        • 1.) Monoamine oxidase inhibitors (MAOIs)

          • Side effects and some dietary restrictions

            • Chocolate and red wine

          • Strange interactions with over the counter medications

        • 2.) Tricyclics

        • 3.) Selective serotonin reuptake inhibitors (SSRIs)

          • Most common because it affects everyday life the least therefore people will actually take it

          • Medications stop the removal or reuptake of the neurotransmitter serotonin which leaves more serotonin in the synaptic gap. 

          • May take some time for symptom relief

      • Marked improvement in up to 60-70% of patients

• Types of Psychotherapy

  • Psychoanalysis (Freud)

(Insight) |--X—------------------------| (Action)

• Sigmund Freud

• Onsight-oriented treatment

• Emphasizes the recovery of unconscious conflicts, motives, and defenses

  • Goal: “make the unconscious conscious” 

    • Think back to the iceberg, dredge up the unconscious and bring insight to it to help you in the long run

• Technique include 

  • Free association: Just think out loud and say whatever comes to mind with no filter

  • Dream analysis: Manifest content (story), and latent content (interpretation about the story, symbol) no way to disprove theory, not falsifiable 

  • Analysis of Transference: drag and drop scenario, dragging interests, concerns, desires from other contexts 

    • You remind me of my father because of this this and this to be further analyzed

• Client-centered Therapy (Rogers)

                        (Insight) |--—---------X---------------| (Action)

• Carl Rogers

  • Humanistic approach (positive optimistic rather than negative like freud)

  • Aka “person-centered therapy”

  • Emphasizes a supportive emotional climate for clients

  • Clients play a major role in determining the pace and direction of therapy

  • Philosophy almost

  • Therapist provides 

    • Empathy: tries to communicate that you understand how they are feeling, and validating feelings

    • Unconditional positive regard: acceptance, I accept you and I think highly of you 

    • Genuineness: honesty within the moment, share your feelings on what the client just told you. 

  • ACTIVE LISTENING!! 

• Cognitive Therapy (Beck)

  • Aaron T. Beck

    • Emphasizes recognizing and changing negative thoughts and maladaptive beliefs

    • Utilized with a broad range of disorders 

    • Typically combined with behavioral interventions

      • Cognitive-Behavioral Therapy (CBT)

    • Thoughts → Behaviors → Feelings all connected

    • Treatment is about thinking and behaviors

      • 1.) Catch it

      • 2.) Check it 

      • 3.) Change it 

        • Substitute for an alternative thought

        • The “it” refers to the negative thoughts

• Behavior Therapy (Wolpe)

                        (Insight) |--—----------------------X--| (Action)

• Phobias

• One form of exposure therapy

• Systematic Desensitization

  • Reduces phobic clients’ anxiety through exposure and counterconditioning 

  • Breaks the connection between the conditioned stimulus (e.g., snakes) and the conditioned response (e.g., anxiety)

  • Anxiety Response: is replaced with a relaxation conditioned response.

    • Parasympathetic vs sympathetic

    • Reciprocal inhibition

  • 1.) Relaxation Training

  • 2.) Construct an anxiety hierarchy

    • Baby steps to reach no phobia

  • 3.) exposure with relaxation substituted in for anxiety

    • Relaxation treatment after seeing the trigger

  • Doesn’t care why you are afraid just wants to help

• Exposures counteract the negative reinforcement that results from avoidance

• Evaluating Psychotherapy Outcomes

  • 1.) Does psychotherapy work better than no therapy at all?

    • Is doing something better than doing nothing?

  • 2.) Do some kinds of therapy work better than others?

    • Is some form better?

•   Does Psychotherapy Work?

  • Meta-Analysis: combines the results of many different studies to arrive at an overall conclusion

  • Conclusion: The average person who receives therapy is better off at the end of it than 80% of persons who don’t receive therapy (control group vs experimental group). 

  • The 80% finding: 80% of untreated people are worse off than the average treated person

    • DOING SOMETHING IS GENERALLY BETTER THAN DOING NOTHING

• Do Some Kinds of Therapy Work better than Others?

  • Most studies suggest that the various psychotherapies are all about equally effective 

  • Common Factors:

    • Address emotional situations

    • Provide interpersonal learning (new perspective)

    • Offer an empathic, trustong, caring relationship

  • Specific therapies for specific patients (manualized empirically supported therapies)

• Specific Treatment for Specific Disorders

  • Anxiety Disorders:

    • Cognitive-behavioral treatments (CBT) are superior

    • Systematic Desensitization for phobias

    • CBT for panic disorder (barlow)

    • Exposure and response prevention for OCD

  • Depression:

    • No best way to treat depression

    • Antidepressants are effective for 60-70 percent of depressed patients

    • CBT is just as effective as medications

    • Combination of both bullets listed above is the best treatment. 

  • Schizophrenia

    • Medication treatments are superior (positive: hallucinations, delusions, thought disorder)

    • Social skills training is helpful to address social skills deficits associated with schizophrenia

Test #4 Breakdown:

• Psych disorders: 20 Questions

• Treatment: 10 questions

• Social Psych: 10 questions 

Chapter 13: Social Psychology

Social influence: social facilitation, conformity, and obedience

Social Cognition: Attributions (Why?)

• What is Social Psychology?

  • The scientific study of 

    • 1) how we think about (Attributions, why?)

    • 2) Influence

    • 3) Relate to one another

• Are We Influenced by Other People?

  • Norman Triplett (1897)

    • Why do bicycle racers have better times when they compete head-to-head than when they compete “against the clock?”

      • To answer his question, Triplett studied children reeling fishing line alone or against a partner

      • Triplett found that most children reeled the line more quickly with a partner, but some children did so more slowly

  • Robert Zajonc (1965) proposed a resolution to the mixed findings of social facilitation research

    • Zajonc suggested that the presence of other people increases arousal, which enhances dominant responses

    • Therefore, social facilitation will cause well-learned (experienced) behaviors to be performed better and novel (newbie) behaviors to be performed worse. 

  • Muzafer Sherif (1935)

    • Other people influence the autokinetic effect (method used)

    • People are influenced by others when they do not have a good reference point (ambiguous)

    • The moving red dot in a dark room, graph converging

• Are We Influenced by Other People? … If the Answer is Obvious?

  • Solomon Asch (1955)

    • Hypothesized that people would not be influenced when information is objective

    • Task: students match a line with a series of three other lines 

      • DECEPTION

        • Does not tell you he is doing this study to peer pressure and conformity  

        • Only one participant in a room of confederates (NPC)

          • NPC give the right answer the first couple of times and then start to give the wrong answer

  • How Often Were People Influenced to Make Errors?

    • People “misjudged” the length of the line 36.8% of the time (⅜)

    • As the number of confederates grew, the misjudgements became more frequent

• Are We Influenced by Other People? … To Perform Harmful Behaviors?

  • Stanley Milgram (1963)

    • Obedience

    • Why did people follow orders during the Holocaust?

    • Would people follow the orders of an authority figure if doing so might result in another person’s death?

    • Deceptions

      • 1) Tells participants the study is about about learning and memory

      • 2) Tells you that you are going to be randomly assigned to be the teacher

        • The learner is a confederate

      • 3) Confederate tells authority figure he has a heart condition

      • 4) authority figure tells him shocks hurt but are not deadly even though the shock box says each level of shock

      • 5) Confederate is not actually getting shocked 

    • Results

      • ⅔ went to the very end of the shock level after the man stopped responding just because an authority figure said to do so

      • Teachers were really shook up after the study which caused them to experience a lot of stress

  • Replication of study remade at Santa Clara in 2008 showing the same results regardless of gender

• What is an Attribution?

  • How do ordinary people explain another person’s behavior?

  • Is the behavior due to the situation or the person’s disposition?

    • External explanation: looks for external things that might be driving that outcome, situation

      • If you fail a math test was it because you had a family emergency, were you sick, did a pet pass away. 

      • sympathetic

    • Internal explanation: it is within that actor, disposition

      • If someone walks in late right now you might be like you are late all the time

      • No sympathy, assumes the worst or the best based on one action

•  How Do We Determine the Cause of Other People’s Behavior?

  • Harold Kelley (1967)

    • Attribution Theory: WHY?

    • To what do people attribute the cause of another person’s behavior?

    • Situation (external, factors people cannot control) or Disposition (internal, within the person)

  • Kelley suggested three sources of information used in making attributions:

1. Distinctiveness

   1. Unique?

   2. Outlier?

2. Consistency (over context and time)

   1. Are you seeing this again and again?

      1. If so it says something about what you are attributed to

3. Consensus

   1. Agreement?

      1. Is that other set of people you are talking too all on the same page?

      2. Can everyone see the behavior linked to the attribution?

• Example: why is your roommate being rude?

1. Distinctiveness: is the behavior (relatively) uniquely related to this person or object?

   1. Is your roommate ruder than anyone else you’ve ever met?

      1. YES

2. Consistency: Does this behavior recur over time and in different contexts?

   1. Is your roommate pretty much always rude?

      1. YES

3. Consensus: Do other people agree with the assessment of the person?

   1. Do your neighbors agree that your roommate is a rude person?

      1. YES

• This whole scenario with three yes’s leads to a dispositional attribution

  • If there are three no’s this leads to a situational attribution

• Do People Make Mistakes in Their Attributions?

  • Edward Jones and Victor Harris (1967) discovered what came to be known as the fundamental attribution error (FAE). 

    • FAE: 1.) overestimate, 2.) dispositional, 3.) others

      • People tend to overestimate the dispositional explanations for other people’s behavior. 

    • Ex: How smart are “quizmasters” versus “contestants” on game shows?

      • Made up Jeopardy from random assignment