Midterm Notes Psych 130
Popular in Clinical Psychology
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Popular in Psychology
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This 14 page Study Guide was uploaded by Jennifer Fu on Sunday October 9, 2016. The Study Guide belongs to Psych 130 at University of California Berkeley taught by Sonia Bishop in Fall 2016. Since its upload, it has received 17 views. For similar materials see Clinical Psychology in Psychology at University of California Berkeley.
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Date Created: 10/09/16
Clinical Psychology: the branch of psychology concerned with understanding, assessing, and treating psychiatric problems Four Characteristics of Stigma - Distinguishing label is applied - Label refers to undesirable attributes - People with the label are seen as different - People with the label are discriminated against Diagnosis: the classification of disorders by symptoms and signs Advantages of Diagnosis - Facilitates communication among professionals - Advances the search for causes and treatments - Cornerstone of clinical care Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-5 includes - Psychiatric and medical diagnoses - Psychosocial and contextual factors - Disability DSM-5 is reorganized to reflect new knowledge of comorbidity and shared etiology Culture can influence - Risk factors - Types of symptoms experienced - Willingness to seek help - Availability of treatments Categorical Classification: presence/absence of a disorder Dimensional Classification: rank on a continuous quantitative dimension Assessment: to describe problem, determine causes, make diagnosis, determine treatment, assess ongoing success of treatment, and as basis for research Assessment Methods - Interview: can be unstructured or structured - Behavioral Observation: can be formal(structured) or unstructured - Psychological Tests - Neuropsychological tests - Self-report personality and cognitive style questionnaires Structured Interview - Pros o Matches DSM and directly assesses all relevant symptoms o Questions are presented in a prescribed fashion o Uses branching o Clear guidelines for scoring symptom severity and translating symptom ratings into diagnoses o Generally good inter-rater reliability - Cons o Can be leading o Arbitrary threshold for severity of symptoms Unstructured Interview - Pros o The person usually feels more at ease, better rapport o A good clinician can find out more information that might not be revealed in response to a structured interview - Cons o Key questions might be missed or incorrectly assessed – can be hard to relate to DSM criteria Formal Behavioral Observation - Often used to determine course and evaluate ongoing success of neuropsychological treatment (rehabilitation after brain injury) - Ex. Multiple errands task Behavioral Observation - Pros o May be more sensitive to problems in every-day life than interviews and cognitive tests o Can be used to assess severity of behavioral problems o Can be used to track progress in therapy and rehabilitation (e.g. OCD/phobia) - Cons o Certain degree of subjectivity in interpretation Self-Report Questionnaires - Used to screen for psychological problems using a personality profile with items chosen to distinguish between different patient groups and controls - Used to assess specific traits or characteristics - Used to assess current levels of symptomatology - All the measures are depended upon standardization - Pros o Quick and informative o Person usually has most insight into their own subjective thoughts and feelings - Cons o Subjects to biases in self-presentation and self-assessment o Often retrospective – rely on memory o May not be useful for people with limited cognitive abilities o Reliability and validity can vary widely Cognitive Style Questionnaires - Used to assess attitudes, interpretations, schema about the world - Can provide insight into cognitive mechanism disrupted in different disorders Self-Observation - Self-monitoring (not completed on-line) - Ecological momentary assessment (completed online) - Limitation: behavior can be altered by self-monitoring - However, for addiction, self-monitoring reduces the behavior Psychological Tests - Used to assess different aspects of psychological or cognitive function - Ex. IQ test, body image test Neuropsychological Tests - Focus upon aspects of cognitive function disrupted by damage to the brain following head trauma, stroke etc. - Based on the idea that different cognitive functions are localized to different brain regions - Used to create a profile of intact versus disrupted function - Two main purposes o Diagnosis/characterization of profile of deficits o Rehabilitation planning and evaluation - Two main approaches o Fixed-battery – large predetermined set of tests that assess a variety of abilities and have been shown to be sensitive to brain damage – good for profiling strengths and weaknesses – lots of normative data o Flexible, Process-Oriented Approach – selects test for in-depth evaluation of relevant cognitive abilities – allows more detailed analysis of language, attention skills, etc. – easier to incorporate new and improved measures derived from research advances - Limitations o Some cognitive functions can be hard to assess o Findings in the clinic may not predict real-world behavior or problems Neuroimaging - Look directly for altered brain structure (volume, connectivity) or function (activity, connectivity) - Structure can be assessed with o CT (X-ray) o MRI – better resolution, more expensive - Function can be assessed with o PET o fMRI – good for linking changes in task performance to changes in brain activity o EEG – can assess instantaneous changes in brain electrical properties in response to stimuli - Limitations o More valuable at the group level than at the individual level o People may trust it too much Appropriate assessment method must be chosen based on - Initial symptom presentation - Relevant circumstances - Person’s abilities and comprehension level With social anxiety disorder and social phobia, unstructured behavioral observation is often utilized With eating disorders, psychological tests are often utilized Two cornerstones of diagnosis are validity and reliability Content Validity: does the measure adequately cover the domain of interest? Criterion Validity: does the measure relate to a given criterion? - Concurrent: measured at same time - Predictive Construct Validity: does test measure what it claims, or purports, to be measured Interrater Reliability: the degree to which 2 independent observers/raters agree Test-Rest Reliability: consistency of scores on a given measure at 2 different time points – only makes sense for trait and not state variables Alternate-Form Reliability: 2 versions of test, look to see if scores are consistent – useful if performance/score may change with repetition of test items Internal Consistency Reliability: are test items related to each other? Paradigm - Goal: study causes and treatment of psychiatric illness scientifically - A conceptual framework or approach to research from within which a scientist operates - Provides a set of basic assumptions, a general perspective on how to study the question in hand, how to gather and analyze data Behavioral Paradigm - Draws on behaviorism (the study of learning by focusing on observable behavior) - Classical conditioning – relevant to PTSD, phobias, panic disorder - Operant conditioning – behavior (not stimulus) paired with outcome o Positive reinforcement o Negative reinforcement o Shaping: reward a series of responses that more and more closely resemble desired response (e.g. child rearing) o Modeling: observational learning - Behavioral Therapy: applies procedures based on classical and operant conditioning to treat clinical problems o Systematic desensitization – based on classical conditioning § Graded exposure to feared stimuli/situations whilst in relaxed state § Used to treat phobias / as a component of CBT o Behavioral modification – based upon operant conditioning § Idea: problem behavior is likely to be continued if reinforced Cognitive Science - Examines how cognitive processes and emotion interact / build and test theories or models - CBT o Maladaptive schema may lead to cognitive biases (attention/memory) o Goal: give individuals experiences that will alter the schemas - Emotional stroop test Within-Subject Design: experimental and control conditions are administered to the same person / order of conditions needs to be randomized Cognitive Neuroscience - fMRI – blood oxygenation level dependent signal (BOLD) - PET - meta-analysis: since functional neuroimaging studies often have small sample sizes, multiple studies by different researchers addressing similar questions will be conducted through meta-analysis to integrate the results of the studies o pros § enable integration of results from multiple studies § help to see if the effect is reliable and generalizable o cons § only as valid and reliable as studies included in the meta-analysis § often studies don’t report null results, biasing overall picture Basic Neuroscience - key neurotransmitter s implicated in psychopathology are o dopamine – influence prefrontal function and attention / reward processing o serotonin – influence amygdala function and emotional responsivity o norepinephrine – involves in arousal and stress response o GABA – inhibitory - Serotonin and dopamine implicated in depression, mania, schizophrenia - Norepinephrine and GABA implicated in anxiety disorder - Psychopharmacology can be combined with neuroimaging to examine the influence of agonists/antagonist on the function of different regions of the brain Genetics - Genes influence our environment, but equally environmental influences affect gene expression - 30,000 genes – carriers of the genetic information (DNA) passed from parent to child - Gene expression: the process of proteins turns on or off other genes - Polygenic contributions to vulnerability: multiple genes are thought to contribute to vulnerability to most psychiatric illnesses - Heritability: variability in a given behavior in a population is due to genetic factors - Shared environment factors: events and experiences that family members have in common - Non-shared environment factors: events and experiences that are unique to each family member - Genetic and non-shared environmental factors are highly important to risk of psychiatric illness - Genotype: individual’s genetic makeup – assessed by whole genome scan/sequencing - Phenotype: observable behavior and characteristics – changes over time depending on interaction of genotype and environment Behavioral Genetics - The study of the degree to which genes and environmental factors influence behavior - Family method: if the disorder is highly heritable, then relatives of the proband should show higher rates of the disorder - Twin method: extent to which concordance rates are higher in monozygotic/identical than in dizygotic pairs Molecular Genetics - Studies the effects of specific polymorphisms or variants in particular genes - Genetic polymorphism: a difference or variation in DNA sequence observed within the population o If impact DNA sequence of gene itself can change proteins altering gene function o Can also alter gene expression through impacting promoter function - Alleles: the different forms of a genes resulting from a given genetic polymorphism - Individuals possess one or two copies of the short or long 5HTT allele o Possession of one or more short alleles is associated with reduced 5HTT expression and increased anxiety symptoms - Knockout Studies: specific gene taken out of mouse DNA to examine behavior in knockout mouse – allows hypothesis as to influence of gene on behavior - Association Studies: examine the correlation between a specific allele of a given genetic polymorphism and a trait, behavior or diagnostic status in a given population o Association of 5HTT-LPR and depression/ APOE-4 and Alzheimer’s Gene-environment interaction: occurs if participants’ responses to a specific environmental event are influenced by genetic factors - Ex. 5HTT genotype interacted with childhood maltreatment to predict probability of occurrence of major depressive disorder o In short alleles carriers, maltreatment during childhood increased likelihood of major depressive disorder – not true for long alleles carriers Epigenetics: study of how the environment can alter gene expression of function Anxiety DSM-5 Anxiety Disorders (most common psychiatric disorders) - Specific phobias - Social anxiety disorder - Panic disorder - Agoraphobia - Generalized anxiety disorder DSM-5 Criteria for Anxiety Disorders - Symptoms interfere with important areas of functioning or cause marked distress - Symptoms are not caused by a drug or a medical condition - Symptoms persist for at least 6 months or at lease 1 month for panic disorder - The fears and anxieties are distinct from the symptoms of another anxiety disorder Many anxiety disorders onset in late childhood/adolescence Women are at greater risk for developing anxiety disorders AD has high comorbidity to other ADs– may be due to - Overlapping symptoms used to diagnose different Ads - Common genetic and environmental risk factors - Common neural and neurochemical substrate AD also has a high comorbidity with other disorders Common Risk Factors - Genetic - Non-shared environmental o Negative life events - Disruption to neurotransmitter (5HT, NA and GABA) - Neural substrate o Amygdala hyper-responsivity o Frontal hypo-responsivity - Cognitive biases o Attentional bias towards threat o Negative interpretative biases o Negative beliefs about the future Common Treatment - Behavioral: exposure to feared object/situation until arousal levels go down o Systematic desensitization o Relaxation + imaginal exposure o Should include as many features of the trigger in as many setting as possible - Cognitive: challenge dysfunctional beliefs about likelihood of occurrence of feared events/outcomes - Pharmacological o Benzodiazepine o SSRIs (treatment of choice – reduces anxiety symptoms without severe side effects) o SNRIs Cognitive Biases in processing of threat-related stimuli - Evolutionary basis o Threat-related attentional bias: it is adaptive to have rapid detection of cues signaling danger o Threat-related interpretative bias: in the case of ambiguous cues, priority needs to be given to potential threat-related meanings - Greater attention capture by threat effects are seen in patients with ADs – slowing tends to be greatest when meaning of word is related to patients’ concern - Ex. Emotional Stroop Test / Dot Probe Specific Phobia Criteria - Marked and persistent fear of specific situation/object for 6 months - Exposure to (or anticipation of exposure to) feared stimulus provokes immediate anxiety/fear - Avoidance of situation/object or endurance with intense anxiety - Fear/anxiety is disproportionate to actual danger posed - Clinically significant distress or impaired function Etiology - Conditioning – Mowrer’s two-factor model Mowrer’s two-factor model - Pairing of stimulus (CS) with aversive UCS leads to fear (CR) – classical conditioning - Avoidance of CS maintained through negative reinforcement – operant conditioning - Problems o Many people never experience aversive interaction with phobic object § Possible solutions • Direct experience • Modelling • Verbal instruction o Assume that with CC, any stimulus could become the object of a phobia § However, people with phobias tend to fear only certain types of objects Preparedness (Seligman 1971) - Conditioned response will develop more quickly/strongly to threatening stimuli relevant to mankind of the past Neurobiology of Phobic Anxiety - Amygdala is important to the acquisition of conditioned fear - Media prefrontal cortex is important to the extinction/ recall (maintenance) of extinction of conditioned fear - However, we cannot be sure if increased amygdala activity is cause or effect of stronger conditioned fear response - Trait anxiety also linked to reduced recruitment of ventromedial prefrontal cortex which is linked to maintained expression of conditioned fear responses Treatment - CBT Social Anxiety Disorder Criteria - Marked, persistent and disproportionate fear of social or performance situations where person is exposed to unfamiliar people and possible scrutiny by others for 6+ months - Individual fears acting a way or showing anxiety symptoms that will be negatively evaluated - The social situations almost always provoke fear/anxiety and are avoided or endured with intense anxiety/distress - Clinically significant distress or social/occupational impairment in functioning Lots of parallels with specific phobia, but the CS is social situations Mowrer’s two-factor model has also been applied Cognitive biases seem to play a bigger role in social anxiety disorder Treatment - CBT o Teach the patients to dispute the irrational belief in conjunction with exposure to the feared object - Behavioral – exposure o Systematic desensitization – can be both imaginal or in vivo o Flooding o Both rely on exposure during relaxation o The over-writing of the original negative association with a new one involving the non-occurrence of anything aversive is held to be the basis of extinction of the conditioned fear response - Social skill training - Pharmacotherapy o Benzodiazepine – increase GABA transmission § Tolerance and dependence § Aversive withdrawal syndrome o SSRIs o Medications may acutely relieve anxiety, but may not reduce the anxiety of subsequent (non-medicated) experiences - Combined exposure and pharmacotherapy o DCS given to augment effect of exposure by acting on NMDA receptors to increase learning – may speed extinction o However, if exposure so brief that it leads to reconsolidation of conditioned fear response rather than extinction, DCS can also act to increase this reconsolidation Ost el al. (1997) - Exposure treatment for specific phobia against spider Panic Disorder Panic attack: sudden experience of intense fear or discomfort that peaks within minutes People often experience intense desire to flee whatever situation they are in when a panic attack occurs Criteria - Recurrent unexpected panic attacks - 1+month concern/worry about having more attacks, worry about the consequences of an attack, or maladaptive behavior changes because of the attacks - not due to effects of substance, another medical condition or another mental disorder Not everyone who experiences a panic attack develops panic disorder Onset in adolescence Cause - neurobiological factors o panic attack reflects a misfire of the fear circuit, with a surge in activity in the sympathetic nervous system o one part of the fear circuit, the locus coeruleus is particularly important in panic disorder o LC – source of neurotransmitter norepinephrine (which triggers SNS activity) - From panic to panic disorder o Classical conditioning § CS (bodily sensation of panic attack), UCS (first experience of panic), CR (fear) o Subsequent experience of somatic sensations leads to fear response which increases them – spirals into a new panic attack, known as interceptive conditioning Cognitive model of panic attacks - Importance of misinterpretation of bodily sensations o Individuals with history of panic attacks & those scoring highly on measure of fear of bodily sensations are more likely to experience panic attack after breathing CO2 BUT ONLY if not told it would produce symptoms of increased arousal - Maintain the vicious circle o Catastrophic misinterpretation leads to § Hyper-vigilant scanning of body § Safety behaviors – global or subtle avoidance Treatment - CBT o Reverse the maintaining factors identified in the model o Panic control therapy (behavioral) - Pharmacotherapy o Drugs that decrease activity in the LC decreases the risk of panic attacks § Tricyclics (imipramine) - No advantage combined PCT and imipramine - Relapse is lower for PCT than imipramine Agoraphobia Situations feared due to thought that escape might be difficult or help unavailable if panic-like symptoms or other embarrassing symptoms experienced The situations provoke fear/anxiety and are avoided requiring a companion, or endured with distress It is diagnosed irrespective of the presence of panic disorder Symptoms are not confined to a single situation type Obsessive Compulsive Disorder Obsession - Persistent recurring, intrusive unwanted thoughts, images or urges - The person tries to ignore, suppress or neutralize Compulsion - Repetitive behaviors or mental acts that a person feels compelled to perform - To prevent or reduce anxiety or distress / to prevent a dreaded event (not connected in a realistic way or are clearly excessive) - Can be in response to an obsession Criteria - The obsessions or compulsion are time consuming (require at least 1 hour/day) - Cause clinically significant distress or impairment - Compulsions are recognized as irrational Less difference by gender than other Ads Etiology - Mowrer’s 2-factor theory o Fear of thought/impulse/image is acquired through classical condition o Compulsions maintained by operant conditioning as the individual learns to reduce anxiety/discomfort triggered by obsession by engaging in compulsive behaviors o Account better for the persistence of compulsions, than for the development of obsessions - Normal subjects could dismiss intrusive thoughts/images easily – people with OCD could not - People with OCD have over-developed sense of their own responsibility - Cognitive o Sense of responsibility for feared outcome if compulsion not conducted leads to distress and urge to carry out compulsion o Deliberate attempts to suppress a target thought will increase the likelihood of its occurrence o Believe that thinking about something can alter its likelihood and sense of responsibility may increase attempts at thought suppression - Disruption to neural function o Orbitofrontal cortex o Anterior cingulate o Caudate nucleus o Unclear whether these reflect cause of effect of OCD Treatment - Behavioral o ERP (exposure and response prevention) – hopes to lead to extinction of anxiety response § ERP is more successful than clomipramine § However, significant minority refuse ERP - Cognitive o Identification and modification of beliefs relating to responsibility and what will happen if not complete compulsive ritual o Help the client conclude that obsessional thoughts are irrelevant to further action o CBT is as good as ERP - Pharmacological o SSRIs o Symptoms often do not fully remit o Relapse rates after treatment stopped higher than for ERP o ERP + clomipramine is not more effective than ERP alone Post-Traumatic Stress Disorder Criteria - Sufferer must have been exposed to an event that involved actual or threatened death, serious injury or sexual violence by o Directly experiencing the event o Witnessing in person o Learning that the event occurred to a close other o Experiencing repeated or extreme exposure to aversive details of the events - Intrusion symptoms beginning after the event o Recurrent, involuntary and intrusive distressing memories of the trauma o Recurrent distressing dreams with content or affect related to event o Dissociative reactions in which individual feels/acts as if trauma recurring o Intense or prolonged psychological distress or physiological reactivity in response to internal/external cues that symbolize or resemble an aspect of the trauma - Persistent avoidance symptoms - Negative alterations in cognition and mood - Alternations in arousal and reactivity - The symptoms began or worsened after the trauma and have been experienced for at least one month - There is clinically significant distress or impairment in function - Not secondary to another medical condition Predictors of increased rates of PTSD - Type of trauma - Witnessing death - Proximity to epicenter of trauma - Vulnerability factors o Early environment o Genetics o Pre-trauma volume or function of different brain regions o They are not mutually exclusive Neurobiology - Amygdala hyper-reactivity – conditioned fear acquisition - Frontal hypo-activity – conditioned fear extinction - Small volume of hippocampus – conditioned fear generalization/ contextual modulation Mowrer’s 2 stage model - Cues linked to trauma become conditioned Treatment - Exposure (imaginal/ virtual reality) - Drugs that alter learning to either o Interfere with consolidation of the trauma memory o Enhance extinction learning in exposure Acute Stress Disorder Criteria - Suffer must have been exposed to an event that involved actual or threatened death, serious injury or sexual violence by o Directly experiencing the event o Witnessing in person o Learning that the event occurred to a close other o Experiencing repeated or extreme exposure to aversive details of the events - At least 9 symptoms began or worsened after the trauma lasting 3-31 days from any of the 5 categories of intrusion, negative mood, dissociation, avoidance and arousal - Cause clinically significant distress or impairment to function Vuilleumier (2001) Task: match faces or houses Factors: attention / expression Question: is the amygdala response to threat modulated by attention? Result: amygdala response stronger when faces are fearful regardless whether faces or houses are attended Conclusion: there is no main effect of attention and no interaction of attention x expression Pessoa (2002) Factors: attention / expression Result: interaction of expression by attention – amygdala only responded more strongly to fearful than neutral faces when faces were attended Conclusion: amygdala response to fearful faces is influenced by attentional competition Why is there discrepancy between the two studies - The load or task difficulty explanation - The individual differences explanation – effects of anxiety were ignored Bishop (2004) Goal: try to evaluate if the individual differences explanation is true Factors: attention / expression / anxiety level Result: there was an interaction of attention x expression x anxiety level - Low anxious subjects behaved like the volunteers in pessoa’s study - High anxious subjects behaved like the volunteers in Vuilleumier study Conclusion: amygdala activity to unattended fearful faces only notable in high anxious volunteers Possible problem: we cannot be sure that this is not the consequence of attentional capture by threat rather than the cause of attentional capture by threat Lopatka & Rachman (1995) Hypothesis: sense of responsibility for feared outcome if compulsion not conducted leads to distress and urge to carry out compulsion Measure: responsibility manipulation (1 factor, 3 levels) – low, high, control Result: low responsibility was followed by reductions in discomfort/urge to carry out compulsion McNally What the study set out to answer - Invest selective processing of threat cues in patients with panic disorder - What’s the time course of stroop interference for threat words - Does mere familiarity with threat words produce stroop interference - What threat cues product stroop interference in these patients IV: word types DV: stroop interference Main Findings: - Panic disorder patients showed greater slowing of color naming for all 3 categories of threat words than the controls - Catastrophe words produced more interference than did bodily sensation words, fear words, and neutral words - Both patients and controls exhibited a similar pattern of interference, as catastrophe words produce more interference than either bodily sensation words or fear words. However, the magnitude of interference for all threat cues is greater for patients than for controls General Conclusion - provides evidence for attentional capture by threat cues in PD patients - panic patients, like other anxiety-disordered subjects, are characterized by an attentional bias for personally-threatening information - although patients consistently exhibited greater interference than did control subjects, the magnitude of interference declined over trials for both groups. The practice effect suggesting that habituation to the semantic content of the stimuli may occur Macleod Question: whether sentence continuation reading times for the non-cue condition resembled with - The threat cue condition - The neutral cue condition General Conclusion - The pattern of results was fully consistent with the current hypothesis that highly trait anxious subjects are characterized by a disproportionate tendency to selectively impose threatening meanings on ambiguous information Improvement - Since many factors other than the interpretation of the initial ambiguous sentence might contribute to individual differences in the relative comprehension latencies shown on each type of continuation sentence, perhaps future research could include additional control conditions
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