Abnormal Psychology Chapters 3&4 Notes
Abnormal Psychology Chapters 3&4 Notes PSY 254
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Models of Abnormality Chapter 3 1. Models- a set of assumptions and concept that help scientists explain and interpret observations. Also called a paradigm. i. Molds the scientists’ investigations, questions, and interpretation of information I. The Biological Model 1. The Biological Model is used to explain a patient’s abnormal behavior as a result of a biological basis. A. How Do Biological Theorists Explain Abnormal Behavior? 1. Biological theorists see abnormal behavior as an illness brought by a malfunction in the individual or organism. 2. Transference- Client develops feelings for therapist 3. Countertransference- Therapist develops feelings for client a. i.e. brain anatomy, brain chemistry B. Brain Anatomy and Abnormal Behavior 1. Neurons – nerve cells in the brain. Approx. 100 bil. a. Large groups of neurons form brain regions, which each have their own function. Ex: hippocampus, amygdala b. Certain psychological disorders are linked to malfunction in specific regions in the brain i. Cortex – outer layer of brain ii. Corpus collosum- connects two cerebral hemispheres iii. Basal ganglia- movement iv. Hippocampus- emotions and memory (hippo at camp fire sharing his memories) v. Amygdala- emotional memory 2. Brain Chemistry and Abnormal Behavior a. Disorders can also be caused when there is a problem transmitting information between the neurons i. Information travels: dendrites (antenna-like extensions located at one end of the neuron) axon (long fiber extending from neuron’s body nerve ending (end of axon) dendrites of nearby neurons b. Synapse- the tiny space that separates neurons. c. Neurotransmitter- a chemical that is sent from one neuron to the dendrite of a neighboring neuron. d. Receptors- spot on dendrites of each neuron, which receives neurotransmitter. e. Hormones- chemicals release by endocrine system into bloodstream. Help regulate growth, reproduction, sexual activity, temp, stress, etc. 2. Sources of Biological Abnormalities 1. Genetics and Abnormal Behavior a. Genes- 23 chromosome segments that control the characteristics and traits we inherit b. Inherited genes / chromosomes can lead to psychological and behavioral problems i. Mood disorders, schizophrenia 2. Evolution and Abnormal Behavior a. Genes responsible of problems may be mutations or inherited after being accidentally added to a long family line as an old mutation b. Human reactions and genes are responsible for them to have survived over time i. Fear response 3. Viral Infections and Abnormal Behavior a. Viral infections can lead to disorders i. Schizophrenia and prenatal viral exposure II. Biological Treatments 1. Biological practitioners attempt to pinpoint the physical source of dysfunction to determine the course of treatment A. Three types of biological treatment: 2. 3. 4. B. Drug therapy 1. 1950s- advent of psychotropic medications a. Greatly changed the outlook for a number of mental disorders 2. Four major drug groups: a. Antianxiety drugs (anxiolytics; minor tranquilizers) b. Antidepressants drugs c. Anti-bipolar drugs (mood stabilizers) d. Antipsychotic drugs C. Electroconvulsive therapy (ECT): 1. Mostly used for depression, particularly when drugs and therapies failed D. Psychosurgery (neurosurgery) 1. Historical roots of trephination 2. 1930s- first lobotomy 3. Considered experimental and used only in extreme cases III. Assessing the Biological Model A. Strengths: 1. Enjoys considerable respect in the field 2. Constantly produces valuable new information 3. Treatments bring great relief B. Weaknesses: 1. Can limit, rather than enhance, our understanding a. Too simplistic 2. Treatments produce significant undesirable (negative) effects IV. The Psychodynamic Model A. Based on belief that a person’s behavior (normal/abnormal) is determined largely by underlying dynamic – interacting – psychological forces of which she or he is not consciously aware B. How did Freud Explain Normal and Abnormal Functioning? C. Aspects of Personality- The Unconscious Forces 1. The Id a. Guided by the Pleasure Principle i. Instinctual needs, drives, and impulses ii. Sexual; fueled by libido (sexual energy) 2. The Ego a. Guided by Reality Principle i. Seeks gratification, but guides us to know when we can and cannot express our wishes ii. Ego defense mechanisms protect us from anxiety 3. The Superego a. Guided my the Morality Principle i. Conscience; unconsciously adopted from our parents 4. These three parts of the personality are often in some degree of conflict a. A healthy personality is one in which an effective working relationship exists among the three forces b. If the Id, ego, and superego are in excessive conflict, the person’s behavior may show signs of dysfunction c. If development of these aspects of personality are unsuccessful, it is called fixation 5. Developmental Stages- Psychosexual Development a. Oral- breast feeding, everything goes in their mouth (0-18 months) b. Anal- bodily functioning (18 months to 3 years) c. Phallic- attention goes toward their genitalia, awareness of the different sexes (3 to 5 years) d. Latency- sexual impulses are repressed, and energy is directed towards social life and playing (5 to 12 years) e. Genital- puberty and sexual experimentation begins (12 years to adulthood) D. How Do Other Psychodynamic Explanations Differ From Freud’s? 1. Although the new theories depart from Freud’s ideas in important ways, each retains the belief that human functioning is shaped by dynamic (interacting) forces: a. Ego theorists 1. Emphasize the role of the ego and consider it more independent and powerful force than Freud did b. Self-theorists 1. Give greatest attention to the role of self- the unified personality. Basic human motive is to strengthen the wholeness of the self c. Object relations theorists 1. Propose that people are motivated mainly by a need to have relationships with others and that severe problems in relationships b/w children and their caregivers may lead to abnormal development E. Psychodynamic Therapies a. Attempts to uncover past traumas and the inner conflicts that have resulted from them; tries to help clients resolve or settle those conflicts and to resume personal development. 1. Free Association a. A psychodynamic technique in which the patient describes any thought, feeling, or image that comes to mind, even if it seems unimportant. b. Used to uncover unconscious events. 2. Therapist Interpretation 3. Catharsis 4. Working Through 5. Current Trends in Psychodynamic Therapy a. Short-term Psychodynamic Therapies b. Relational Psychoanalytic Therapy F. Assessing the Psychodynamic Model V. The Behavioral Model A. How Do Behaviorists Explain Abnormal Functioning? B. Behavioral Therapies C. Assessing the Behavioral VI. The Cognitive Model A. How Do Cognitive Theorists Explain Abnormal Functioning? B. Cognitive Therapies C. Assessing the Cognitive Model VII. The Humanistic- Existential Model A. Rogers’ Humanistic Theory and Therapy B. Gestalt Theory and Therapy C. Spiritual Views and Inventions D. Existential Theories and Therapy E. Assessing Humanistic-Existential Model VIII. The Sociocultural Model: Family-Social and Multicultural Perspectives A. How Do Family-Social Theorists Explain Abnormal Functioning? 1. Social Labels and Roles 2. Social Connections and Supports 3. Family Structure and Communication 4. Family-Social Treatments 5. Group Therapy 6. Family Therapy 7. Couple Therapy 8. Community Treatment B. How Do Multicultural Theorist Explain Abnormal Functioning? a. Multicultural Functioning b. Assessing the Sociocultural Model Clinical Assessment, Diagnosis, and Treatment Chapter 4 I. Clinical Assessment: How and Why Does the Client Behave Abnormally? A. Assessment is collecting relevant information in an effort to reach a conclusion 1. Clinical assessment is used to determine how and why a person is behaving abnormally and how that person may be helped a. Focus is idiographic (i.e., on an individual person) b. Also may be used to evaluate treatment progress 2. Characteristics of Assessment Tools a. The specific tools used in an assessment depend on the clinician's theoretical orientation b. Hundreds of clinical assessment tools have been developed and fall into three categories: i. Clinical interviews ii. Tests iii. Observations c. To be useful, assessment tools must be standardized and have clear reliability and validity d. To standardize a technique is to set up common steps to be followed whenever it is administered e. One must standardize administration, scoring, and interpretation 3. Reliability refers to the consistency of an assessment measure a. A good tool will always yield the same results in the same situation b. Two main types: i. Test–retest reliability – yields the same results every time it is given to the same people ii. Interacter reliability – different judges independently agree on how to score and interpret a particular tool 4. Validity refers to the accuracy of a tool's results a. A good assessment tool must accurately measure what it is supposed to measure b. Three specific types: i. Face validity – a tool appears to measure what it is supposed to measure; does not necessarily indicate true validity ii. Predictive validity – a tool accurately predicts future characteristics or behavior iii. Concurrent validity – a tool's results agree with independent measures assessing similar characteristics or behavior II. Clinical Interviews A. These face-to-face encounters often are the first contact between a client and a clinician/assessor 1. Used to collect detailed information, especially personal history, about a client B. Allow the interviewer to focus on whatever topics they consider most important 1. Focus depends on theoretical orientation C. Conducting the interview 1. Can be either unstructured or structured a. In an unstructured interview, clinicians ask open-ended questions b. In a structured interview, clinicians ask prepared questions, often from a published interview schedule i. May include a mental status exam 2. Limitations: a. May lack validity or accuracy i. Individuals may be intentionally misleading b. Interviewers may be biased or may make mistakes in judgment c. Interviews, particularly unstructured ones, may lack reliability III. Clinical Tests 1. Tests are devices for gathering information about a few aspects of a person's psychological functioning, from which broader information can be inferred 2. More than 500 clinical tests are currently in use A. Projective tests 1. Require that clients interpret vague and ambiguous stimuli or follow open-ended instruction 2. Mainly used by psychodynamic practitioners 3. Most popular: a. Rorschach Test b. Thematic Apperception Test c. Sentence completion tests d. Drawings 4. Psychology’s Wiki Leaks? a. In 2009 an emergency room physician posted all 10 Rorschach cards on the online encyclopedia, Wikipedia b. Many psychologists argue that test responses of patients who have previously seen the cards on Wikipedia cannot be trusted. c. Why do you think this Rorschach debate has led to an increase in the distribution of psychological tests? 5. Strengths and weaknesses: a. Helpful for providing “supplementary” information b. Have rarely demonstrated much reliability or validity c. May be biased against minority ethnic groups B. Clinical Test: Rorschach Inkblot 1. Asks patient to see first image they see in a randomly structured inkblot C. Clinical Test: Sentence-Completion Test 1. “I wish ___________________________” 2. “My father ________________________” D. Clinical Test: Drawings 1. Draw-a-Person (DAP) test: a. “Draw a person” b. “Draw another person of the opposite sex” E. Personality inventories 1. Designed to measure broad personality characteristics 2. Focus on behaviors, beliefs, and feelings 3. Usually based on self-reported responses 4. Most widely used: Minnesota Multiphasic Personality Inventory a. For adults: MMPI (original) or MMPI-2 (1989 revision) b. For adolescents: MMPI-A 5. Strengths and weaknesses: a. Easier, cheaper, and faster to administer than projective tests b. Objectively scored and standardized c. Appear to have greater validity than projective tests i. However, they cannot be considered highly valid – measured traits often cannot be directly examined – how can we really know the assessment is correct? ii. Tests fail to allow for cultural differences in responses F. Clinical Test: Minnesota Multiphasic Personality Inventory (MMPI) 1. Consists of more than 500 self-statements that can be answered “true,” “false,” or “cannot say” 2. Statements describe physical concerns, mood, morale, attitudes toward religion, sex, and social activities, and psychological symptoms 3. Assesses careless responding and lying 4. Comprised of ten clinical scales: a. Hypochondriasis (HS) b. Depression (D) c. Conversion hysteria (Hy) d. Psychopathic deviate (PD) e. Masculinity-femininity (Mf) i. ii. Graphed to create a “profile” f. Paranoia (P) g. Psychasthenia (Pt) h. Schizophrenia (Sc) i. Hypomania (Ma) j. Social introversion (Si) i. Scores range from 0 to 120 i. Above 70 = deviant G. Response inventories 1. Usually based on self-reported responses 2. Focus on one specific area of functioning a. Affective inventories (example: Beck Depression Inventory) b. Social skills inventories c. Cognitive inventories 3. Strengths and weaknesses: a. Have strong face validity b. Not all have been subjected to careful standardization, reliability, and/or validity procedures (Beck Depression Inventory and a few others are exceptions) H. Psychophysiological tests 1. Measure physiological response as an indication of psychological problems a. Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction 2. Most popular is the polygraph (lie detector) I. Psychophysiological tests 1. Strengths and weaknesses: a. Require expensive equipment that must be tuned and maintained b. Can be inaccurate and unreliable J. Neurological and neuropsychological tests 1. Neurological tests directly assess brain function by assessing brain structure and activity a. Examples: EEG, PET scans, CAT scans, MRI, fMRI 2. Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual, and motor functioning a. Most widely used is the Bender Visual-Motor Gestalt Test 3. Clinicians often use a battery of tests K. Neurological and neuropsychological tests 1. Strengths and weaknesses: a. Can be very accurate b. At best, though, these tests are general screening devices i. Best when used in a battery of tests, each targeting a specific skill area L. Intelligence tests 1. Designed to indirectly measure intellectual ability 2. Typically comprised of a series of tests assessing both verbal and nonverbal skills 3. General score is an intelligence quotient (IQ) a. Represents the ratio of a person's “mental” age to his or her “chronological” age 4. Strengths: a. Are among the most carefully produced of all clinical tests i. Highly standardized on large groups of subjects ii. Have very high reliability and validity 5. Weaknesses: a. Performance can be influenced by nonintelligence factors (e.g., motivation, anxiety, test-taking experience) b. Tests may contain cultural biases in language or tasks c. Members of minority groups may have less experience and be less comfortable with these types of tests, influencing their results 6. Intelligence Tests, Too? eBay and the Public Good a. Intelligence tests can be found for sale on eBay’s online auction site b. Test producer is concerned that they will be misused i. eBay denied the request to restrict the sales c. When free enterprise principles conflict with psychological well being, how should the matter be resolved? II. Clinical Observations A. Systematic observations of behavior 1. Several kinds: a. Naturalistic b. Analog c. Self-monitoring B. Naturalistic and analog observations 1. Naturalistic observations occur in everyday environments a. Can occur in homes, schools, institutions (hospitals and prisons), and community settings b. Most focus on parent–child, sibling–child, or teacher–child interactions c. Observations are generally made by “participant observers” and reported to a clinician 2. If naturalistic observation is impractical, analog observations are used and conducted in artificial settings 3. Strengths and weaknesses: a. Reliability is a concern i. Different observers may focus on different aspects of behavior b. Validity is a concern i. Risk of “overload,” “observer drift,” and observer bias ii. Client reactivity may also limit validity iii. Observations may lack cross- situational validity C. Self-monitoring 1. People observe themselves and carefully record the frequency of certain behaviors, feelings, or cognitions as they occur over time 2. Strengths and weaknesses: a. Useful in assessing infrequent behaviors b. Useful for observing overly frequent behaviors c. Provides a means of measuring private thoughts or perceptions d. Validity is often a problem i. Clients may not record information accurately ii. When people monitor themselves, they often change their behavior 3. Diagnosis: Does the Client's Syndrome Match a Known Disorder? a. Using all available information, clinicians attempt to paint a “clinical picture” i. Influenced by their theoretical orientation b. Using assessment data and the clinical picture, clinicians attempt to make a diagnosis i. A determination that a person's psychological problems constitute a particular disorder ii. Based on an existing classification system 4. Classification Systems a. Lists of categories, disorders, and symptom descriptions, with guidelines for assignment i. Focus on clusters of symptoms (syndromes) b. In current use in the U.S.: DSM-5 D. DSM-5 1. Lists approximately 500 disorders 2. Describes criteria for diagnoses, key clinical features, and related features that are often, but not always, present 3. Categorical Information a. DSM-5 requires clinicians to provide both categorical and dimensional information as part of a proper diagnosis. b. Categorical information refers to the name of the category (disorder) indicated by the client’s symptoms. c. Dimensional information is a rating of how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality. 4. Is DSM-5 an Effective Classification System? a. A classification system, like an assessment method, is judged by its reliability and validity b. Here, reliability means that different clinicians are likely to agree on a diagnosis using the system to diagnose the same client i. DSM-5 appears to have greater reliability than any previous edition i. Used field trials to increase reliability ii. Reliability is still a concern c. The validity of a classification system is the accuracy of the information that its diagnostic categories provide i. Predictive validity is of the most use clinically ii. DSM-5 has greater validity than any previous edition i. Conducted extensive literature reviews and ran field studies iii. Validity is still a concern d. The framers of DSM-5 followed certain procedures in their development of the new manual to help ensure that DSM-5 would have greater reliability than the previous DSMs e. A number of new diagnostic criteria were developed and categories, expecting that the new criteria and categories were in fact reliable. f. Some critics continue to have concerns about the procedures used in the development of DSM-5 5. DSM-5 Changes a. Adding a new category, “autism spectrum disorder,” that combines certain past categories such as “autistic disorder” and “Asperger’s syndrome” (see Chapter 17) b. Viewing “obsessive-compulsive disorder” as a problem that is different from the anxiety disorders and grouping it instead along with other compulsive-like disorders such as “hoarding disorder,” “body dysmorphic disorder,” “hair-pulling disorder,” and “excoriation (skin-picking) disorder” (see Chapter 5) c. Viewing “posttraumatic stress disorder” as a problem that is distinct from the anxiety disorders (see Chapter 6) d. Adding a new category, “somatic symptom disorder” (see Chapter 7) e. Replacing the term “hypochondriasis” with the new term “illness anxiety disorder” (see Chapter 7) f. Adding a new category, “premenstrual dysphoric disorder” (see Chapter 8) g. Adding a new category, “disruptive mood dysregulation disorder” (see Chapters 8 and 17) h. Adding a new category, “binge eating disorder” (see Chapter 11) i. Adding a new category, “substance use disorder,” that combines past categories “substance abuse” and “substance dependence” (see Chapter 12) j. Viewing “gambling disorder” as a problem that should be grouped as an addictive disorder alongside the “substance use disorders” (Chapters 12) k. Replacing the term “gender identity disorder” with the new term “gender dysphoria” (see Chapter 13) l. Replacing the term “mental retardation” with the new term “intellectual developmental disorder” (Chapter 17) m. Adding a new category, “specific learning disorder,” that combines past categories “reading disorder,” “mathematics disorder,” and “disorder of written expression” (see Chapter 17) n. Replacing the term “dementia” with the new term “neurocognitive disorder” (Chapter 18) o. Adding a new category, “mild neurocognitive disorder” (see Chapter 18) 6. Can Diagnosis and Labeling Cause Harm? a. Misdiagnosis is always a concern i. Major issue is the reliance on clinical judgment b. Also present is the issue of labeling and stigma i. Diagnosis may be a self-fulfilling prophecy c. Because of these problems, some clinicians would like to do away with the practice of diagnosis 7. Treatment: How Might the Client Be Helped? a. Treatment decisions i. Begin with assessment information and diagnostic decisions to determine a treatment plan i. Use a combination of idiographic and nomothetic information ii. Other factors: i. Therapist's theoretical orientation ii. Current research iii. General state of clinical knowledge – currently focusing on empirically supported, evidence-based treatment 8. The Effectiveness of Treatment a. More than 400 forms of therapy in practice, but is therapy effective? i. Difficult question to answer: i. How do you define success? ii. How do you measure improvement? iii. How do you compare treatments? 1. People differ in their problems, personal styles, and motivations for therapy 2. Therapists differ in skill, knowledge, orientation, and personality 3. Therapies differ in theory, format, and setting b. Therapy outcome studies typically assess one of the following questions: i. Is therapy in general effective? ii. Are particular therapies generally effective? iii. Are particular therapies effective for particular problems? c. Is therapy generally effective? i. Research suggests that therapy is generally more helpful than no treatment or than placebo ii. In one major study using meta- analysis, the average person who received treatment was better off than 75% of the untreated subjects d. Is therapy generally effective? i. Some clinicians are concerned with a related question: Can therapy can be harmful? i. It does have this potential ii. Studies suggest that 5-10% of patients get worse with treatment e. Are particular therapies generally effective? i. Generally, therapy-outcome studies lump all therapies together to consider their general effectiveness i. Some critics call this the “uniformity myth” ii. An alternative approach examines the effectiveness of particular therapies i. There is a movement (“rapprochement”) to look at commonalities among therapies, regardless of clinician orientation f. Are particular therapies effective for particular problems? i. Studies now being conducted to examine the effectiveness of specific treatments for specific disorders: i. “What specific treatment, by whom, is the most effective for this individual with that specific problem, and under which set of circumstances?” ii. Recent studies focus on the effectiveness of combined approaches – drug therapy combined with certain forms of psychotherapy – to treat certain disorders E. Assessment and Diagnosis at a Crossroads 1. Clinicians differ considerably in their approaches to assessment and diagnosis 2. Present state of assessment and diagnosis argues against relying exclusively on any one approach 3. Other factors a. Precise diagnostic criteria b. Insurance parity and treatment coverage
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