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W&M / Psychology / PSY 202 / What are the sources of stress?

What are the sources of stress?

What are the sources of stress?

Description

School: The College of William & Mary
Department: Psychology
Course: Intro to Psychology as a Social Science
Professor: Constance pilkington
Term: Fall 2016
Tags:
Cost: 50
Name: Psych Notes: Exam III
Description: All notes taken in class that cover Exam III, the final exam.
Uploaded: 12/01/2016
21 Pages 8 Views 7 Unlocks
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Psychology 202 with Professor Pilkington


What are the sources of stress?



Notes for Exam III

Stress

Stress: Portrait of a Killer 

∙ Stress is measurable and can be dangerous

∙ Robert Sapolsky: looked at monkeys to understand human stress

o Biological indicators for stress: stress is about survival

o Humans turn on stress for psychological reasons as well as for physical reasons  and can’t seem to turn it off

o Lack of control ???? stress and worry

▪ In contrast, control reduces stress and increases productivity

o Baboons’ stress levels are related to their social status

▪ Lower status ???? higher stress ???? higher levels of blood pressure and heart  rates

▪ Compared to dominate monkeys, subordinate monkeys’ arteries had more  plaque in them, making them more susceptible to heart attacks

∙ Whitehall study: on a British government branch

o Lower status ???? higher risk of disease/lower resistance to other stressors ▪ Lower-ranking people are more likely to gain weight around their middle  (same with monkeys)


What are the factors that moderate the impact of stress?



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∙ Ulcers: earliest diagnosis connected with stress

o Stress causes the body to shut down its nonessential systems, including the  immune system, making the body more susceptible to sickness

∙ Research with rats: stressed rats had smaller brain cells in the hippocampus, which is  responsible for learning and memory

∙ Shively: found a relationship between pleasure, stress, and status

o Lower status ???? more stress and less pleasure in life ???? lower life expectancy ∙ Roseboom: found that babies conceived during the Dutch famine during WWII became  adults with lower health who were more susceptible to stress and mood disorders ∙ Stress increases the shrinking of telomeres, which hold chromosomes together o Length of telomeres is reduced by stress and is directly related to the strength and  extent of the stress  

o Blackburn: found an enzyme that stimulates the healing of telomeres


What is Psychological Disorders ?



∙ Compassion and caring for others ???? healing and longevity

o Aggressive, isolated male monkeys were more susceptible to sickness ▪ Higher levels of affiliation ???? lower stress and better health

Stress 

∙ Definition: physiological and psychological reaction to an event or circumstance that  threatens one’s wellbeing

o Stressor: cause of stress

▪ Perception is key in determining the stressor because there’s considerable  variability in what people view as stressfulDon't forget about the age old question of call protected bond

∙ Sources of stress

o Pressure: expectations or demands on a person to behave in a certain way  ▪ Carries the threat of negative consequences

▪ Example: conformity

o Frustration: blocking of goal-directed behavior

▪ The more important the goal ???? the greater the stress

o Life events/changes: significant changes in life, both positive and negative ▪ We like stability, and major changes are disruptive

▪ Positively correlate with illness

o Minor annoyances: everyday hassles

▪ Accumulate into a stressful experience

▪ May increase as a result of life events/changes

o Intrapsychic conflict: when multiple motives compete and only one can be  satisfied

▪ Approach-approach: when you must choose between 2 equally attractive  alternatives

∙ Stressful because we have to lose the attractive qualities of the  

rejected alternative and must live with the negative qualities of the  

chosen alternative

∙ Stronger when the goal is more important or when the qualities  

that distinguish the alternatives are very different

▪ Avoidance-avoidance: when you must choose between 2 equally  

unattractive alternatives

▪ Approach-avoidance: when the goal has both positive and negative  

consequences

∙ When the goal is far away in the future: the desire/excitement  

component is stronger

∙ At the vacillation point, the disadvantages/costs become stronger  

as the goal looms nearer ???? look to procrastinate your decision

Appraisal Processes 

∙ How we think of events We also discuss several other topics like phy 2048 fiu

∙ Primary appraisal: when we first notice an event and evaluate it as one of 3 types… o Irrelevant: no impact on us and therefore no stress

o Relevant but not threatening

o Relevant and threatening: leads to stress

∙ Secondary appraisal: when we look at our coping resources and options o Determines how stressful the event is  

∙ Influencing factors

o Familiarity: less familiar = more stressful

o Controllability: less control you think you have over the event = more stressful ▪ Exception: some people don’t want the added responsibility of control o Predictability: more unexpected events = more stressful

Physiology of Stress 

∙ First pathway

o Starts with the hypothalamus, which activates the sympathetic nervous system o Sympathetic nervous system regulates the body’s expenditure of energy and  activates the adrenal medulla Don't forget about the age old question of baylor psychology
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o Adrenal medulla releases catecholamines Don't forget about the age old question of math 122a

o Catecholamines produce physiological changes: increased rate of blood flow,  increased respiration, dilation of pupils, and slowing of digestion

o Fast-acting

∙ Second pathway

o Stars with the hypothalamus, which activates the pituitary gland

o Pituitary gland secretes ACTH

o ACTH stimulates the adrenal cortex

o Adrenal cortex secretes corticosteroids (stress hormones)

o Corticosteroids increase the amount of glucose in the blood stream, giving the  body more energy to use

o Slower-acting

Effects of Stress 

∙ Selye’s General Adaption Syndrome: states that reactions to stressors are nonspecific (in  other words, reactions aren’t tailored to each stressor)

o Stages

▪ Alarm reaction: recognition that a threat exists (leads to an increased  

arousal level)

▪ Resistance: physiological arousal level stabilizes at a higher level than  normal in order to cope

∙ Leads to an increased ability to resist that stressor, but also to a  

decreased ability to cope with new stressors

▪ Exhaustion: state that occurs when coping wasn’t effective and the body’s  resources are depleted

o Longer stress ???? increased susceptibility to illness

o Criticisms

▪ Alarm reactions might not be so nonspecific/general or as automatic

▪ Theory doesn’t take individuals’ considerable differences into account ∙ Illness

o More stressed = more prone to colds, ulcers, appendicitis, strokes, heart attacks,  etc.

o Why? Because stress suppresses the immune system’s functioning and ability to  fight off disease

∙ Burnout: physical, mental, and emotional exhaustion resulting from work-related stress o Builds gradually

o Person becomes irritable and depressed

o Person develops a negative attitude toward work and self

o Later extended to include any role-related stress

∙ Post-Traumatic Stress Disorder (PTSD): disturbed behavior resulting from a single very  stressful event that emerges once the event is over

o Examples: soldiers, rape victims

o Three categories of symptoms

▪ Re-experiencing symptoms: person experiences flashbacks, nightmares,  and sudden frightening thoughts and vividly relives the trauma

▪ Hyperarousal symptoms: person is easily startled, feels tense, has  

difficulty sleeping, and experiences angry outbursts

▪ Avoidance symptoms: person stays away from objects, places, and people  that are reminders of the trauma

∙ Doesn’t enjoy things that used to be pleasurable

∙ Is worried, depressed, guilty, or emotionally numb

∙ Sometimes has difficulty remembering the trauma

Coping 

∙ Definition: active efforts to master, reduce, or tolerate the demands created by stress o Maladaptive coping strategies are not helpful or can even be harmful

o Constructive coping strategies are…

▪ Relevant to the stressor

▪ Reality-based (use a realistic appraisal)

▪ Emotion-focused (alleviate negative emotions)

o Type of stressors

▪ Controllable: better handled/reduced through problem-solving strategies ▪ Uncontrollable: aren’t much reduced through problem-solving strategies  due to the lack of control

o Types of strategies

▪ Approach-based: directly approaches/handles the stressor (and thus better  reduces stress)

▪ Avoidance-based: reduces tension but not necessarily the stressor

∙ Other behavioral responses

o Over-eating

▪ Two possible explanations

∙ Stress and eating are incompatible bodily processes, meaning that  

eating takes blood flow away from the brain to the digestive tract,  

which causes a tranquilizing effect

∙ Since the hypothalamus deals with stress reaction and eating, a  

stimulation of the former could also affect the latter

o Learned helplessness: occurs when a person learns to expect that their efforts  won’t fix their problems, leading to depression

▪ Research with dogs

Factors That Moderate the Impact of Stress 

∙ Type A personality: competitive, motivated, ambitious, and impatient o Tend to be hostile and have a high need for control

o More likely to get heart disease (double the likelihood)

▪ More likely to impose stress on self and get into conflict with others

▪ Great physio-reactivity

▪ Hostility pushes others away, meaning they have fewer sources of comfort ∙ Hostility = moodiness ???? greater risk for heart disease

▪ Poor health habits

∙ Type B personality: easy-going, friendly, laid-back, and relaxed

∙ Hardiness

o Research: compared executives with more stress to those with less stress and  looked at who became sick

▪ Sense of commitment vs. alienation

∙ Those who were committed to their family and friends, their job,  

and their ideals had a sense of purpose

∙ Those who were alienated felt apathetic and that life was boring  

and/or meaningless yet also stressful

▪ Sense of control vs. powerlessness

∙ Those who had a sense of control believed that they had an impact  

on their life and could control situations

∙ Those who felt powerless were passive and felt that life is best  

when there’s no change

▪ View change as a challenge vs. as a threat

∙ Those who view it as a challenge are curious; they believe that  

change is a normal part of life and that it’s an opportunity to learn

∙ Those who view it as a threat are made unsettled

∙ Social support: aid and comfort from family and friends

o Four types

▪ Emotional support: affection for the stressed person and concern for their  problem

▪ Appraisal support: help in evaluating/clarifying the nature of the stressor  and in identifying potential coping resources

▪ Informational support: advice about possible solutions to the problem

▪ Instrumental support: material aid and services

o Buffering effect

▪ Direct: reduces stress by providing resources, aid, etc.

▪ Indirect: reduces stress by providing a sense of security and support

TED Talk: The Surprising Science of Happiness 

∙ Over time, the human brain has tripled in mass

o Why? Because it has gained new structures, including the frontal lobe and the  pre-frontal cortex

▪ Pre-frontal cortex: an experience simulator

∙ Impact bias: our experience simulator overestimates the impact of expected gains or  losses

∙ Psychological immune system: leads to our wellbeing by changing our views about the  world/synthesizing happiness

o Synthetic happiness: made when we don’t get the result we wanted, so we change  our attitude accordingly

▪ Just as valid/strong as natural happiness, which occurs when we get the  result we wanted

▪ Works better/more when we’re stuck or don’t have any freedom to  

choose (aka in irreversible situations)

Psychological Disorders

Historical Approaches 

∙ Supernatural approach: abnormal behavior is caused by possession by evil spirits o Goes back to the time of Plato but was especially prevalent during Medieval  Europe

▪ “Cures” included exorcisms and skull drillings to release the evil spirits ∙ Biological models

o Hippocrates: believed that the body has 4 humors (blood, phlegm, black bile, and  yellow bile)

▪ An imbalance in the humors lead to abnormal behavior

▪ Examples: too much blood ???? sanguine personality (aka manic episodes),  while too much phlegm ???? phlegmatic personality (aka depression)

o Ancient Greeks: believed that hysteria was caused by a wandering uterus (yes,  really) that wreaked havoc in the parts of the body that it passed through

o Kraft-Ebbing: argued that paresis (the degeneration of cerebral tissue caused by  untreated syphilis) led to psychological disorders

o Kraeplin: argued that psychological disorders have physical, organic causes ▪ By identifying those physical causes, one could effectively treat the  

disorders

▪ This lead to the inception of psychiatry as a field of medicine

∙ Psychological models

o Freud’s psychodynamic model: traumatic memories trapped in a person’s  unconscious can still trouble them, leading to psychological disorders (like Anna  O.)

o Behavioral model: psychological disorders are learned and thus can be untaught  through training in healthy behaviors

o Cognitive models: irrational or maladaptive thought patterns lead to psychological  disorders

∙ “Social” models: environmental factors are causes of psychological disorders o Systems perspective: an unhealthy social environment leads to dysfunctionality  and disorders

o Szasz: The Myth of Mental Illness

▪ Argues that mental illness doesn’t exist, and what people call mental  

illness is actually just a label used to dismiss people who threaten the  

social order

o Rosenhan: On Being Sane in Insane Places

▪ In his experiment, psychologically sane people reported hearing voices to  various health facilities

▪ After being admitted, they reported that they were no longer hearing  

voices and acted completely normally

▪ Yet it was hard for these people to be discharged because the doctors  

continued to treat them based on their original diagnosis of schizophrenia,  despite their consistently normal behavior

Identifying Psychological Disorders 

∙ “Abnormal” vs. “normal” behavior

o Continuity hypothesis: abnormal behavior = severe expressions of normal  behavior (quantitative differences in behavior that interfere with functioning) o Discontinuity hypothesis: abnormal behavior = a different type of behavior than  normal behavior (qualitative differences in behavior)

o Which is it? It depends on the disorder: some are one, some the other

∙ Statistical criterion

o Abnormal = departs from the norm (aka is statistically rare)

o Problems: some behaviors that depart from the norm don’t necessarily have a  psychological disorder causing them

∙ Psychosocial criterion

o Abnormal = differs from widely accepted social expectations

o Problems: expectations vary according to culture

∙ Harmfulness of behavior

o Abnormal = harms self and/or others

o Problems: not all harmful behavior is due to psychological disorders

∙ Absolute standards for mental health

o Goal: to describe what a healthy psychology is like, and then to use it as a  comparison to distinguish what constitutes an unhealthy psychology

∙ Practical approach

o Judgments on behavior based on…

▪ Content of behavior: What is it, and how does it affect others? (Is it  

maladaptive, strange, irrational, harmful, uncontrollable, or  

unpredictable?)

▪ Context of behavior: When and where does it occur?

▪ Subjective consequences: Does it distress the person?

▪ Diagnostic and Statistical Manual (DSM): a complex classification system  for the critical assessment of behavior

∙ Changes with the development of new perspectives and the  

progression of psychiatry as a discipline

Anxiety Disorders 

∙ Anxiety: uncomfortable feelings of nervousness or disruptive levels of worry o Present among 19% of the population

∙ Phobic disorders: focused anxieties characterized by an intense, irrational fear for specific  objects or situations

o Simple phobic disorders: most specific and least disruptive

▪ Examples: claustrophobia, arachnophobia, acrophobia, and xenophobia ▪ Etiology

∙ These disorders develop via classical conditioning, a form of  

learning that begins with an unconditioned stimulus (which  

prompts a natural response)

o Unconditioned stimulus ???? unconditioned response

o Unconditioned stimulus + conditioned stimulus ????

unconditioned response

o Conditioned stimulus ???? conditioned response

∙ “Little Albert”: research experiment in which a little boy saw a  

white rat and always heard a loud noise, and so he came to fear the  

sight of the rat because he expected the noise

∙ These disorders are maintained via operant conditioning, which  

means: the probability of a behavior/response increases when it’s  

rewarded and decreases when it’s punished

o People avoid the anxiety-provoking stimulus and thus  

never face it or come to understand it, which means their  

fear of it remains

∙ Observational learning can also lead to the development of phobias o Preparedness

▪ Some phobias are more easily/naturally acquired due to biological  preparedness for certain threats (such as dogs) as a result of evolution

o Agoraphobia: the fear of open and public places

▪ Person fears leaving familiar places because they worry about getting a  panic attack, which is humiliating in public

∙ Generalized Anxiety Disorder: free-floating anxiety (meaning there’s no specific  stimulus or source)

o Worry is relentless

o Person has problems concentration due to being preoccupied

o Person dreads decision-making

o Other symptoms

▪ Lack of sleep

▪ Self-consciousness

▪ Lack of appetite

▪ Irritability

∙ Panic Disorder: when a person goes for a while without anxiety and then experiences a  sudden, intense, and unprovoked attack of panic

o Symptoms: increased heart rate and respiration

o Panic attacks have to occur frequently for a person to be diagnosed ∙ Obsessive-Compulsive Disorder (OCD)

o Obsession: an anxiety-provoking thought that won’t go away

▪ Thought is recurring and uncontrollable

▪ Person can recognize that it’s irrational but can’t repress it

o Compulsion: an irresistible urge to engage in a specific behavior

▪ Anxiety results when the behavior can’t be done

o Onset

▪ Develops usually in adolescence or adulthood in response to a particular  source of anxiety

▪ Partly maintained due to reinforcement (acting according to the  

compulsion is satisfying, at least momentarily)

∙ Etiology for anxiety disorders as a group

o Genes: genetic influence

▪ Example: if one identical twin has an anxiety disorder, the other one has a  40% of developing one

o Neurotransmitters: carry neural messages between neurons

▪ GABA inhibits neuron activity in the areas in the brain that control arousal  (low GABA ???? high arousal)

o Cognitive factors

▪ People with anxiety disorders overreact to stressors

Affective Disorders 

∙ Consist of stronger feelings that last longer

∙ Depression

o Present among 15% of the population

o Often goes undiagnosed

o Diagnosis

▪ Depression must be the person’s primary problem and must have lasted  for at least 2 weeks for it to be diagnosed as clinical depression

▪ Symptoms

∙ Depressed mood that lasts most of the day (feelings of sadness and  

discouragement)

∙ Loss of interest in activities that were previously enjoyable

∙ Change in appetite (either eating more or less than usual)

∙ Sleeping problems (sleeping too much or too little)

∙ Loss of energy

∙ Motor retardation or agitation

∙ Cognitive difficulties (problems with concentrating or decision

making)

∙ Feelings of worthlessness and failure

∙ Suicidal thoughts

▪ To be diagnosed, a person must have severe feelings of depression and  have at least 5 of these symptoms (and 1 of them must either be a  

depressed mood or a lack of interest)

o Persistent Depressive Disorder (Dysthymia): a less severe form of depression with  less severe symptoms but that is persistent (meaning it must have lasted for at  least 2 years)

o Diagnosed in women twice as much as in men

∙ Etiology of depression

o Behavioral model: argues that depression is learned through a loss of an important  source of rewards

▪ This leads to the reduction of other pleasant activities, and so the process  begins again, leading to a downward spiral

o Cognitive models

▪ Beck: argues that depression is caused by negative thoughts about self,  others, and the world

∙ People with depression overgeneralize their failures and have an  

unrealistically negative/pessimistic way of thinking

▪ Learned helplessness: person learns to expect that their behavior won’t  produce the desired results, and so they learn to give up easily

▪ Attributional approach

∙ Depressed attributional style: depressed people tend to make  

internal, stable, and global attributions for negative events,  

whereas they tend to make external, unstable, and specific  

attributions for positive events

o Non-depressed people make the opposite attributions

▪ Depressed people are actually more accurate in their estimates on how  much control they have over events

∙ Non-depressed people tend to overestimate their control

o Genetic factors

▪ Mood disorders tend to run in families

▪ 5-HTTLPR: people with 1 or 2 short versions of this gene are more  vulnerable to developing depression than people with 2 long versions

▪ Diathesis-Stress Model: a person can inherit a predisposition to develop a  certain disorder, but the environment determines whether it develops or  not

o Brain regions involved in depression

▪ Amygdala: is important in understanding emotions

∙ When a person is stimulated by negative emotions, they have  

elevated neural activity in this area

▪ Prefrontal Cortex: regulates emotions

∙ Decreased activity in a depressed person

o Neurotransmitters: chemicals that carry neural impulses between neurons ▪ The ones that deal with mood: serotonin, norepinephrine, and dopamine ▪ Drugs that regulate these neurotransmitters help alleviate mood problems ∙ These drugs are slow-acting (they have to be taken for a while  

before their effects are felt)

∙ Some people respond well to drugs that regulate any of these  

neurotransmitters (which begs the question why, since they affect  

different brain mechanisms)

∙ On the other hand, some people respond well to drugs that only  

regulate one of these neurotransmitters (or to none of the drugs at  

all)

∙ Bipolar Disorder: used to be called manic depression because the person alternates 2  extreme moods, mania and depression

o Present among 1% of the population

o Mania: characterized by hyper energy and ceaseless busyness

▪ Person…  

∙ Demands other people’s attention

∙ Is constantly talkative and jumps from subject to subject

∙ Is easily distracted and irritable

∙ Sleeps less

∙ Has an inflated sense of self-esteem

∙ Appears reckless/shows a lack of restraint

▪ The elevated mood must last for at least 1 week to be diagnosed as manic ▪ Person unpredictably swings between manic and depressive episodes o Equally diagnosed among women as men

o Etiology

▪ A lot is unknown

▪ However, there is a definite genetic component

Dissociative Disorders 

∙ Characterized by sudden changes in cognition and memory

∙ Dissociative amnesia: loss of memory about important personal information o Too extensive to be ordinary forgetfulness

o The amount of time lost can be a few weeks or a few years

o No clear organic cause

o Memory loss focuses around a specific traumatic event or period of time ▪ No memory of the traumatic event or the time after it

∙ Dissociative fugue: loss of memory of one’s personal identity (so, loss of everything up  to that point in time)

o Symptom of wandering

o Because of such severe memory loss, the person often takes on a new personality  that is more sociable and fun-loving than their previous personality

∙ Dissociative Identity Disorder (also known as Multiple Personality Disorder) o Person shifts abruptly and repeatedly between different personalities

▪ The shifts are dramatic and related to stress

o The personalities are very different from each other

▪ Each personality has its own memories and impulses, which often conflict  with those of the other personalities

▪ Sometimes the personalities have physiological differences too (such as,  one consistently has higher blood pressure)

o Original personality is unaware of the other personalities

▪ However, the alternate personalities are aware of the original one and have  varying amounts of knowledge about each other

o Etiology

▪ A lot is unknown

▪ Often rooted in severe emotional trauma experienced during childhood ∙ Alternate personalities are thought to have emerged when the  

abuse was taking place in order to protect the original one

o Very rare

▪ The 1980s saw a dramatic increase in the number of diagnoses

∙ One explanation is that the conditions that promote it became more  

prevalent

∙ Another explanation is that clinical psychiatrists looked out for it  

more

o Perhaps the disorder was left undiagnosed in the past, and  

then once it was studied it was looked for

▪ Fewer and fewer diagnoses are being made since then

Somatoform Disorders 

∙ Person experiences symptoms of physical ailments, but the causes are psychological, not  physiological

∙ Hypochondriasis: excessive concern over one’s health

o Minor “symptoms” become signs of major illness

o Characterized by catastrophic thinking

∙ Somatization Disorder: characterized by a history of diverse physical complaints that are  psychological in origin

o Complaints are very diverse and eventually cover all of the body’s systems o More often diagnoses in women

∙ Conversion Disorder: characterized by a significant loss of physical functioning isolated  in a specific bodily system

o No organic cause or biological reason can be found

o Often the symptoms are inconsistent with medical knowledge

∙ Etiology

o People with histrionic and/or self-centered personalities are more likely to  develop these disorders than others

▪ These people are overly dramatic, excitable, and emotional

o Behavioral causes through reinforcement

▪ Being sick means getting a lot of attention, and people with the above  personalities find it appealing to be the center of attention

Schizophrenia 

∙ Symptoms

o Cognitive problems that render the person out of touch with reality

▪ Attention difficulties: they either cannot or do not filter incoming sensory  information and thus become bombarded with overstimulation

▪ Impairment of working/short-term memory

▪ General deterioration in thought processes: thinking becomes chaotic and  illogical

▪ Delusions: false and irrational beliefs

∙ Delusion of persecution: belief that you are being hunted, watched,  

betrayed, etc.

∙ Delusion of grandiosity/grandeur: belief that you have great  

powers, knowledge, or talents

∙ Delusion of identity: belief that you are someone else who is  

powerful (such as the president or even God)

∙ Delusion of control: belief that your thoughts and actions are being  

controlled by others, usually extraterrestrial aliens

o Thought-blocking: belief that someone is preventing or  

stealing your thoughts

o Thought insertion: belief that someone is putting thoughts  

into your mind

∙ Delusion of exposure (thought-broadcasting): belief that your  

thoughts are being broadcast to others so that they can hear them as  

you think them

o Hallucinations: false perceptions (perceiving things that don’t exist)

▪ Auditory: hearing voices

∙ Most common type of hallucination

▪ Tactile: false feelings

▪ Visual: seeing things

▪ Olfactory: false smells

▪ Gustatory: false tastes (familiar foods might taste strange ???? worry about  being poisoned)

o Affective disorders

▪ Flattened emotion: person shows no real emotional reaction to anything ▪ Inappropriate emotion: person displays emotions that are not right or  socially acceptable for the situation

▪ Emotional volatility: unpredictable bursts of emotion

o Social withdrawal

▪ Person seems to have little interest in social interaction, or…

▪ Person wants social interaction but fears rejection, negative reactions, etc. ▪ Person then withdraws into his or her own world

o Behavioral issues

▪ Person behaves strangely

∙ Exhibits childish silliness, talks to themselves or aloud, has poor  

personal hygiene, or has difficulty performing routine activities)

o Communication difficulties

▪ Echolalia: person repeats the last word or phrase that has been spoken to  them

▪ Verbigeration: person meaninglessly repeats words or phrases that they  themselves have generated  

▪ Verbal exhibitionism: person speaks in grandiose, pompous phrases ▪ Neologisms: person makes up new words (neologisms) that have meaning  only to that person

▪ Loose associations: person’s thoughts are loosely or superficially  

connected to other thoughts, or there is no connection at all

▪ Word salad: person’s words and phrases seem to be haphazardly tossed  together

∙ Reorganizing symptom sets

o Positive symptoms: involve behavioral excess

▪ Bizarre behaviors, delusions, hallucinations, disordered thoughts and  speech

o Negative symptoms: reflect deficits in functioning

▪ Reduced/flattened emotions, loss of motivation, slowed speech and  behavior

o Diagnosis

▪ Patient has to exhibit at least 2 symptoms

∙ One of them must be either delusions, hallucinations, or  

disorganized speech

∙ Patient must show continuous symptoms for at least 6 months

∙ Types of schizophrenia (based on types of characteristics)

o Disorganized schizophrenia: characterized by frequent or constant incoherent  speech, hallucinations and delusions are very disorganized

▪ Very rare: only 5% of people with schizophrenia are diagnoses with this  type

o Catatonic schizophrenia: characterized by either a very mute, unmoving state that  is trance-like (waxy catatonia), or by a state of hyperactivity

▪ In some cases, the person will alternate between these 2 states

o Paranoid schizophrenia: delusions of persecution and/or grandiosity ▪ Person is very untrusting and often anxious and/or angry

▪ Person may try to retaliate against the supposed tormentors

▪ Develops mostly in people between the ages of 25 and 30 (other forms of  schizophrenia usually develop in the late teens/early 20s)

o Undifferentiated schizophrenia: person fits into more than one of the categories or  doesn’t fit neatly into any of them

∙ Causes

o Neurotransmitters: dopamine is most clearly related to schizophrenia ▪ Excessive activity of dopamine is thought to be connected to  

schizophrenia, but the evidence is indirect

▪ Drugs that reduce dopamine activity often decrease symptomology, but  not in all people

▪ More recent evidence suggests that…

∙ High levels of dopamine activity occur in the subcortical regions of  the brain

∙ Low levels of activity occur in the prefrontal cortex

o Neural deterioration/destruction in certain regions of the brain

▪ Cerebral cortex: involved in cognitive processes

▪ Limbic system: involved in emotion and motivation

▪ Thalamus: responsible for routing incoming sensory information to the  appropriate areas of the brain for interpretation

∙ Also responsible for doing some preliminary integration of that  

sensory information

∙ Might be related to the attention difficulties

o Brain ventricles: hollow, fluid-filled cavities in the brain

▪ There is evidence that schizophrenia is related to enlarged ventricles,  which represent deterioration of nearby brain tissue

▪ Yet it is unknown whether the enlargement is a cause or a symptom of  schizophrenia

▪ In addition, not everyone diagnosed with schizophrenia shows this  

enlargement

▪ More strongly related to negative symptoms

o Events during pregnancy

▪ Certain events can increase the likelihood of schizophrenia

∙ Mother gets the flu or another virus, severe maternal stress, or  

malnutrition during the second trimester ???? increased risk

∙ This is because these events disrupt the prenatal neurological  

development that takes place during the second trimester

o Gene factors

▪ High concordance rate

∙ Identical twins: if one develops schizophrenia, the other has a 48%  

chance of doing so

∙ Fraternal twins: if one develops schizophrenia, the other has a 17%  

chance of doing so

∙ General population: 1% of the population has schizophrenia

▪ Diathesis: stress model that argues that what we inherit is a vulnerability  or a predisposition for a disorder

∙ Whether we develop the disorder or not depends on how much  

environmental stress we experience

o Systems approach: argues that the social environment of an individual contributes  to the development of the disorder

▪ Family dynamics

∙ Express emotion: characterized by emotional over-involvement in  

the person’s life and/or excessive criticism of them

o Person in a family that is high in express emotion is more  

likely to develop schizophrenia

∙ Double-bind communications: contradictory messages from one or  

more family members

o From 1 family member: person doesn’t understand what  

that family member wants

o From 2 family members: person has trouble figuring out  

who to listen to because trouble is created either way

∙ Other communication problems: vague or confusing  

communication

▪ Study: adopted children whose mothers were diagnosed with  

schizophrenia

∙ When raised in a healthy family ???? some of the children developed  

schizophrenia

∙ When raised in a dysfunctional family ???? 11% of the children  

developed schizophrenia while 41% developed some other  

psychological disorder

Therapy 

∙ Psychoanalysis (aka Psychodynamic Therapy) – Freud

o Psychodynamic Theory: argues that unconscious conflicts and anxieties cause  psychological problems even though the ego has pushed them out of the  

conscious mind

o Psychoanalysis: aims to relax the ego so that these unconscious thoughts can  come into the conscious mind, but this is not an easy process

o Job of the therapist

▪ To create conditions in which the ego’s censorship is relaxed

∙ Therapist is out of view, and patient is relaxed

▪ To interpret the symbolic revelations that the unconscious mind makes ∙ The actual events are so traumatic that the mind translates them  

into symbols

▪ To work with the patient to deal with the underlying issues once they are  identified

∙ Methods

o Free association: patient talks in a loose, undirected way (stream of  consciousness) to unburden self

▪ Reveals what the person’s thoughts are and how they are connected o Dream interpretation: patient recalls their dreams in as much detail as possible,  and the therapist interprets their meanings

▪ Manifest content: the actual events and people that appear in the dream ▪ Latent content: the symbolic meanings of the events that occur in the  dream

▪ Reveals the underlying issues

o Interpretation of resistance (any form of opposition by the patient to the therapy) ▪ Vague form: accidentally missing appointments or questioning the value  of the therapy

▪ Specific form: actual resistance to a given interpretation made by the  therapist

▪ Any form of resistance shows that some unconscious issue has been  discovered, an issue so uncomfortable that the patient wants to avoid  talking about it

o Interpretation of transference

▪ Transference occurs when the patient transfers his emotions for someone in his life to the therapist

∙ Patient projects feelings toward another person onto the therapist,  becoming angry, resentful, etc.

o Freudian slips: slips of the tongue that aren’t accidental and instead reveal a  person’s thoughts

o Catharsis: occurs when pent-up emotions are released

▪ Sudden, big release that gives insight into some repressed memory or  feeling

▪ Provides temporary relief of the emotional turmoil but doesn’t solve the  underlying problem

▪ Further conscious effort is needed to fix the problem

∙ Modern Psychodynamic approaches

o Based more on Neo-Freudian theorists

o Greater focus on conscious processes

o Greater emphasis on the patient’s current social relationships and problems (and  less of an emphasis on repressed childhood memories)

o Less lofty interpretation

o Less emphasis on sex

o Involves more candid communication between the patient and the therapist ∙ Evaluation

o It is difficult to test Freud’s theories because most of them cannot be tested/are  not falsifiable

o Time-consuming and expensive

o Psychoanalysis places the patient in a passive role

Behavioral Therapy 

∙ Behavior is learned, including problematic and/or disordered behavior because it has  been reinforced

o Therefore, behavior can be unlearned and replaced with more desirable behavior ∙ The disordered behavior is the problem and not a sign of a deeper psychological problem o Therefore, fixing the behavior fixes the problem

∙ Job of the therapist

o As a teacher, the therapist works with the client to identify the problematic  behaviors and replace them with more adaptive behaviors

▪ The client is responsible in making change/has an active role

o To set goals and continuously evaluate the client’s progress toward those goals ∙ Positive reinforcement: rewarding desired behaviors while ignoring/not rewarding  undesirable behaviors

o Often used with children

o Can be used by oneself to modify one’s own behaviors

o Token economies: the client must view the reinforcement as a true reward for it to  be effective

▪ Clients receive chips for good behavior that can be exchanged for  

privileges, rewards, etc., allowing them to choose rewarding experiences

∙ Modeling: learning desired behavior through observation

o Client watches a model engage in the desired behavior and tries to imitate it o Role-playing is a necessary initial step, allowing the client to practice the  behaviors in a safe environment

∙ Extinction procedures: aim to extinguish certain sets of behaviors

o Punishment: obnoxious stimuli introduced when the undesired behavior occurs ▪ Has to be used very carefully

▪ Is risky: it could serve as an aggressive model or could eliminate  

undesirable behaviors along with related desirable behaviors

▪ By itself, punishment doesn’t teach desirable behaviors

o Flooding: used to treat phobias and other anxieties

▪ Client is exposed to high levels of the phobic stimulus, and the exposure is  continued until the fear response is extinguished

▪ Normally, people avoid the phobic stimulus, which maintains their fear of  it ???? flooding tries to solve this

o Systematic desensitization

▪ Progressive relaxation training: method of learning how to deeply relax  the muscles of the body

∙ Involves tensing and un-tensing the body’s 16 sets of muscles

▪ Anxiety hierarchy: list of feared stimuli that is ranked according to the  least anxiety-provoking stimulus to the most

▪ Combining the two: the client relaxes and imagines the first scenario; if  that’s possible, he moves up the hierarchy until he can’t keep his state of  

relaxation

∙ This process is continued until the client can imagine going to the  

top of the hierarchy without tensing

▪ “In vivo”: actually performing the behaviors/being in the situations  

imagined

Humanistic Therapies 

∙ Overview

o Psychological disturbance is a result of not accepting yourself for who you are ▪ Results from denying your own desires of who you want to be or trying to  be someone that other people want you to be

▪ Goal: to reveal what your actual goals are and help you to fulfill those  goals

o Carl Roger’s Client-Centered Therapy

▪ Emphasizes the client’s ability to help himself

▪ Job of the therapist

∙ To set up an atmosphere in which the client can explore their ideas  

without fearing negative reactions

o Therapists are a partner

∙ Reflection: paraphrasing or summarizing the ideas and emotions  

that the client has brought up, allowing the client to recall them  

and become more self-aware

∙ Client-therapist relationship

o Acceptance (aka unconditional positive regard)

▪ The client must be able to express their goals or insecurities without  

fearing the therapist’s rejection

o Empathic understanding: the therapist must be able to put himself in the client’s  shoes and empathize with his experiences

▪ Requires active, sensitive listening

o Congruence: the therapist’s actual self and desired self must be consistent ▪ Indicated by genuineness or realness

▪ In this case, the therapist acts as a model for the client by showing  

congruence

∙ Evaluation

o Very useful for personal growth and for minor depression

o Not helpful for disorders like schizophrenia

Cognitive Therapy 

∙ Argues that maladaptive ways of thinking are learned and are translated into problematic  behavior

∙ Beck’s cognitive therapy: treats depression

o Depression is caused by negative ways of thinking

o Automatic negative thoughts: depressed person comes up with negative thoughts  about self, the world, and the future without being aware of it

o Reality test: method of getting a depressed person to reflect on how they tend to  overgeneralize certain data and to see things as more of a problem than they  actually are

o Belief system: depressed person has unrealistic underlying assumptions and  beliefs that lead to these negative thoughts

∙ Ellis’s rational-emotive therapy: a cognitive-behavioral approach

o Assumes that people are born with the potential for rational thought

o But people fall prey to an uncritical acceptance of irrational beliefs, which are  learned in childhood before they can evaluate what they’re being told

o Process of re-education: getting the client to re-evaluate their beliefs, question  them, and re-decide what they want to believe

o A-B-C model

▪ A = actual, activating event

▪ B = belief system that guides the individual’s interpretation of the  

activating event

▪ C = consequence (emotional)

o Techniques to get the individual to critically examine his beliefs and behavior ▪ Persuasion, teaching, suggestions, confrontation

∙ Cognitive-behavioral therapy

o Extension of Beck’s Therapy

o Agrees with Ellis’s theory

o Also looks at behavior and how it influences thoughts

o Diagram

▪ Event ???? distorted thoughts ???? negative emotions

 ???? maladaptive behavior

▪ Negative emotions ???? distorted thoughts

 ???? maladaptive behavior

▪ Maladaptive behavior ???? distorted thoughts

???? negative emotions

Biomedical Therapy 

∙ Based on a modern medical model

o Psychopharmacology: drug approaches

o Surgery

o Electric shock

∙ Antipsychotic drugs

o Phenothiazines: reduce the responses of the automatic nervous system by  decreasing dopamine activity in certain areas of the brain

o Examples: Thorazine, Haldon, Mellaril

o Decrease the positive symptoms of schizophrenia

o Side effects

▪ “Minor” ones: drowsiness, constipation, dry mouth, tremors, muscle  

rigidity, and loss of coordination

▪ Tardive dyskinesia: neurological disorder similar to Parkinson’s Disease ∙ Involuntary muscle spasms, jerking of the tongue, mouth, and  

facial muscles, jerking of the hands and feet

∙ 25% of the people who received long-term treatment of Thorazine  

developed this

∙ No known cure

o Atypical or second-generation antipsychotics

▪ Example: Clozapine

▪ Reduces dopamine and serotonin activity in the brain

▪ Problem: destroys white blood cells, which fight infection

∙ Reversible though requires constant monitoring

▪ May increase patient’s risk of diabetes and cardiovascular problems o General problem: once people leave in-patient care, they tend to discontinue the  drugs

∙ Antidepressants

o Tricyclics

▪ Example: Elavil

▪ No effect on schizophrenia but elevates mood

▪ Increase the activity of serotonin and norepinephrine

▪ Side effects

∙ Dry mouth, constipation, dizziness, blurred vision, tremors

▪ Preferred over MAO inhibitors

o Monoamine oxidase (MAO) inhibitors

▪ Increase the activity of serotonin and norepinephrine

▪ Side effects

∙ Hypertension, liver damage, cerebral hemorrhage

o SSRIs (Selective Serotonin Reuptake Inhibitors)

▪ Increasing the activity of certain sub-classes of serotonin

▪ Examples: Prozac, Paxil

▪ Milder side effects

∙ Can impact sex drive, sleep

o SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

▪ Example: Effexor

▪ Treats depression, dysthymia, and generalized anxiety disorder

▪ Same side effects as SSRIs

o Different people respond differently to different drugs, so sometimes multiple are  tried before one is found that is the most effective

∙ Lithium: natural salt

o Has been used to treat bipolar disorder

▪ Prevents future episodes of mania and depression

▪ Doesn’t alleviate current episodes

▪ Dosage

∙ Effective dose is necessary to be useful, but it is close to the toxic  

dose

∙ Side effects

o Kidney, heart, and thyroid damage

▪ Alternatives: valproic acid

∙ Work almost as well as lithium and have fewer negative side  

effects (better tolerated)

∙ Anti-anxiety drugs

o Used to relieve tension, apprehension, and nervousness

o Benzodiazepines

▪ Examples: Valium, Librium, Miltown

▪ Tranquilizers: fast-acting but short-lived effects

▪ GABA facilitators

∙ GABA: inhibitory neurotransmitter

▪ Addictive if used consistently over a period of time at high doses ▪ Dangerous if used along with alcohol

o Buspar

▪ Slow-acting

▪ Fewer side effects

▪ Treats generalized anxiety disorder

What Works? 

∙ Evaluation studies

o People who seek out and undergo therapy are more likely to recover from a  psychological disorder, and are more likely to do so faster

∙ Eclectic approaches

o Most common approach

o Tailored to treat the individual’s issues

o Can involve multiple therapies

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