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study guide exam 2 127a
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This 73 page Study Guide was uploaded by Morgan Hawes on Monday February 29, 2016. The Study Guide belongs to 127a at University of California - Los Angeles taught by Dr. Repetti in Winter 2016. Since its upload, it has received 128 views. For similar materials see Abnormal Psychology in Psychlogy at University of California - Los Angeles.
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1 Study Guide: Psych 127a Winter 2016 Chapter 1: 1. Psychopathology a. The symptoms and signs of mental disorders, including such phenomena as depressed mood, panic attacks, and bizarre beliefs. 2. Abnormal psychology a. is the application of psychological science to the study of mental disorders. 3. Psychosis a. a general term that refers to several types of severe mental disorders in which the person is considered to be out of contract with reality 4. Syndrome a. A group of symptoms that appear together and are assumed to represent a specific type of disorder. Mental disorders are typically defined by a set of characteristic features; one symptom by itself is seldom sufficient to make diagnosis. 5. Characteristic Features of Mental Disorders: a. The duration of a person’s symptoms is also important. Mental disorders are defined in terms of persistent maladaptive behaviors. b. Impairment in the ability to perform social and occupational roles is another consideration in identifying the presence of a mental disorder. Delusional beliefs and disorganized speech typically lead to a profound disruption of relationships with other people. 6. Can people be tested in some way to confirm the presence or absence of a mental disorder? a. No, psychologists and other mental health professionals do not at present have laboratory tests that can be used to confirm definitively the presence of psychopathology because the processes that are responsible for mental disorders have not yet been discovered. 7. By what criteria do we decide whether a particular set of behaviors or emotional reactions should be viewed as a mental disorder? a. We might say that abnormal behavior is defined in terms of subjective discomfort that leads the person to seek help from a mental health professional. However, this definition is fraught with problems. S. Kevin’s case illustrates one of the major reasons that this approach does not work. Before his second hospitalization, Kevin was unable or unwilling to appreciate the extent of his problem or the impact his behavior had on other people. A psychologist would say that he did not have insight regarding his disorder. b. Another approach is to define abnormal behavior in terms of Statistical norms—how common or rare it is in the general population. By this definition, people with unusually high levels of anxiety or depression would be considered abnormal because their experience deviates from the expected norm. This approach, however, does not specify how unusual the behavior must be before it is considered abnormal. Another weakness of the statistical approach is that it does not distinguish between deviations that are harmful and those that are not. 8. Harmful Dysfunction (definition of a mental disorder) 2 a. The condition results from the inability of some internal mechanism (mental or physical) to perform its natural function. b. The condition causes some harm to the person as judged by the standards of the person’s culture. These negative consequences are measured in terms of the person’s own subjective distress or difficulty performing expected social or occupational roles. c. The DSM-5 definition places primary emphasis on the consequences of certain behavioral syndromes. 9. The DSM-5 definition excludes voluntary behaviors, as well as beliefs and actions that are shared by religious, political, or sexual minority groups (e.g., gays and lesbians).:. The DSM-5 thus provides another simplistic, although practical, answer to our question as to why Kevin’s behavior would be considered abnormal: He would be considered to be exhibiting abnormal behavior because his experiences fit the description of schizophrenia, which is one of the officially recognized forms of mental disorder (see Thinking Critically About DSM-5). 10. What is mental health? Is Optimal mental health more than the absence of mental disorder? a. The answer is clearly “yes.” In the realm of psychological functioning, people who function at the highest levels can be described flourishing They are people who typically experience many positive emotions, are interested in life, and tend to be calm and peaceful. Flourishing people also hold positive attitudes about themselves and other people. They find meaning and direction in their lives and develop trusting relationships with other people. 11. Culture is defined in terms of the values, beliefs. And practices that are shared by a specific community or group of people. These values and beliefs have a profound influence on opinions regarding the difference between normal and abnormal behavior (Bass et al., 2012). The impact of particular behaviors and experiences on a person’s adjustment depends on the culture in which the person lives. To use Jerome Wakefield’s (1992) terms, “only dysfunctions that are socially disvalued are disorders a. So if mental health is subjective to one’s culture, how do you define mental health in a cross cultural society like the united states? b. Which cultural values are you taking? Anglo-Saxon? c. Difference between dysfunctional behavior and abnormal behavior 12. Epidemiology a. is the scientific study of the frequency and distribution of disorders within a population (Cordis, 2008). 13. Incidence a. refers to the number of new cases of a disorder that appear in a population during a specific period of time. 14. Prevalence a. refers to the total number of active cases, both old and new, that are present in a population during a specific period of time 15. The lifetime prevalence a. is the total proportion of people in a given population who have been affected by the disorder at some point during their lives. 16. The( presence of more than one condition within the same period of time is known as comorbidity (or co-occurrence). 3 17. Epidemiologists measure disease burden by combining two factors: mortality and disability. a. The common measure is based on time: lost years of healthy life, which might be caused by premature death (compared to the persons standard life expectancy) or living with a disability (weighted for severity). 18. A hypothesis is any new prediction, the null hypothesis is the alternative to the experimental hypothesis. Chapter 4 1. Assessment a. Your job is to figure out how to help this woman. How serious is her problem? What else do you need to know? What questions should you ask and how should you collect the information? The process of gathering this information is b. You will want to use data from your assessment to compare her experiences with those ol: other patients c. Rather than reinventing the wheel each time a new patient walks into her office, the therapist can use a classification system to streamline the diagnostic process. 2. A classification system a. -a list of various types of problems and their associated symptoms. b. Is used to subdivide or organize a set of objects 3. Diagnosis a. Refers to the identification or recognition of a disorder on the refers to ) the identification or recognition of a disorder on the basis of its characteristic symptoms. 4. DSM’5 defines mental disorders in terms of the individual rather than relationships or family systems. 5. Categorical approach to classification a. Assumes that distinctions among members of different categories are qualitative. In other words, the differences reflect a difference in kind (quality) rather than a difference in amount (quantity). b. Either you have a pathology or you do not 6. Dimensional a. Degree or range of problems b. A Continuum 7. We need a classification system for abnormal behavior for two primary reasons. a. First, a classification system is useful to clinicians, who must match their clients’ problems with the form of intervention that is most likely to be effective. b. Second, a classification system must be used in the search for new knowledge. 8. Intense, public displays of anger Intense, public displays of anger or grief might be expected in one culture but considered signs of disturbance in another. Interpretations of emotional distress and Other symptoms of disorder are influenced by the explanations that a person’s culture assigns to such experiences. Religious beliefs, social roles, and sexual identities all play an important part in constructing meanings that are assigned to these phenomena ). The accuracy and utility of a clinical diagnosis depend on more than a simple count of the symptoms that appear to be present. They also hinge on the clinician’s ability to consider the cultural context in which the problem appeared 4 9. cultural concepts of distress (culture-bound syndromes or idioms of distress) a. These are patterns of erratic or unusual thinking and behavior that have been identified in diverse societies around the world and do not fit easily into the other diagnostic categories b. They are considered to be unique to particular societies, particularly in non-Western or developing countries. Their appearance is easily recognized and understood to be a form of abnormal behavior by members of certain cultures, but they do not conform to typical patterns of mental disorders seen in the United States or Europe. 10. What is the relation between cultural concepts of distress and the formal categories listed in DSM-5? a. ‘The answer is unclear and also varies from one syndrome to the next. i. Are they similar problems that are simply given different names in other cultures? 1. Probably not 11. Utility can be measured in terms of two principal criteria: reliability and validity. a. Reliability i. refers to the consistency of measurements, including diagnostic decisions. If a diagnosis is to be useful, it will have to be made consistently. One important form of reliability, known as “interrater reliability,” refers to agreement between clinicians who are provided with exactly the same information. b. The term validity refers i. To the meaning or imoortance of a measurement—in this case, a diagnostic decision ii. Importance is not an “all or-none” phenomenon; it is a quantitative issue. Diagnostic categories are more or less useful, and their validity (or utility) can be determined in several ways. iii. Validity is, in a sense, a reflection of the success that has been achieved in understanding the nature of a disorder. 12. It may be helpful to think of different forms of validity in terms of their relationship in time with the appearance of symptoms of the disorder. a. Etiological validity is concerned with factors that cause or contribute to the onset of the disorder. These are things that have happened in the past. , Was the disorder regularly triggered by a specific set of events or circumstances.’’ Did it run in families? whether there are any specific causal factors that are regularly, and perhaps uniquely. Associated with this disorder. b. Face Validity: atheortietical Face validity: To what extent do the items or content of the measure capture what is supposed to be measured? c. d. Concurrent validity is concerned with the present time and with correlations between the disorder and other symptoms, circumstances, and test procedures. Is the disorder currently associated with any other types of behaviors, such as performance on psychological tests? Do precise measures of biological variables, such as brain structure and function, distinguish reliably between people who have the disorder and those who do not? 5 e. Predictive validity is concerned with the future and with the stability of the problem over time. ^ Will it be persistent? If it is short-lived, how long will an episode last? Will the disorder have a predictable outcome? Do people with this problem typically improve if they are given a specific type of medication 13. Comorbidity, a. which is defined as the simultaneous appearance of two or more disorders in the same person. Comorbidity rates are very high for mental disorders as they are defined in the DSM system. For example, in the National Comorbidity Survey, among those people who qualified for at least one diagnosis at some point during their lifetime, 56 percent met the criteria for two or more disorders. Unfortunately, the very high rate of comorbidity suggests that these explanations account for a small proportion of overlap between categories. b. The real problem associated with comorbidity arises when a person with a mixed pattern of symptoms, usually of a severe nature, simultaneously meets the criteria for more than one disorder 14. Psychological assessment is the process of collecting and interpreting information that will be used to understand another person. 15. Assessment procedures can be used for several purposes. a. Perhaps most obvious is the need to describe the nature of the person’s principal problem. Making a diagnosis b. The same criteria that are used to evaluate diagnostic categories are used to evaluate the usefulness of assessment procedures: reliability and validity. In the case of assessment procedures, reliability can refer to various types of consistency. For example, the consistency of measurements over time is known as test-retest reliability, The internal consistency of items within a test is known as split-half reliability. If a test with many items measures a specific trait or ability, and halves agree with each other. c. The validity of an assessment procedure refers to its meaning or importance ^). Is the person’s score on this test or procedure actually a reflection of the trait or ability that the test was designed to measure? 16. Interviews a. ADVANTAGES The clinical interview is the primary tool employed by clinical psychologists in the assessment of psychopathology. Several features of interviews account for this popularity, including the following issues: i. The interviewer can control the interaction and can probe further when necessary. ii. By observing the patient’s nonverbal behavior, the interviewer can try to detect areas of resistance. In that sense, the validity of the information may be enhanced. iii. N interview can provide a lot of information in a short period of time. It can cover past events and many different settings. b. LIMITATIONS Several limitations in the use of clinical interviews as part of the assessment process must be kept in mind. These include the following considerations: i. Some patients may be unable or unwilling to provide a rational account of their problems. This may be particularly true of young children, who have not 6 developed verbal skills, as well as some psychotic and demented patients who are unable to speak coherently. ii. People may be reluctant to admit experiences that are embar rassing or frightening. They may feel that they should report to the interviewer only those feelings and behaviors that are socially desirable. iii. Information provided by the client is necessarily filtered through the client’s eyes. It is a subjective account and may be influenced or distorted by errors in memory and by selective perception. iv. Interviewers can influence their clients’ accounts by the ways in which they phrase their questions and respond to the clients responses. 17. Rating scale in which the observer is asked to make judgments that place the person somewhere along a dimension. F( Rating scales provide abstract descriptions of a person’s behavior rather than a specific record of exactly what the person has done. The value of these judgments depends on the experience of the person who makes the ratings. 1 ney are useful to the extent that the observer is able to synthesize accurately the information that has been collected and then rate the frequency or severity the problem relative to the behavior or otner people. 18. BEHAVIORAL CODING SYSTEMS a. Ir. Because they require extensive time and training, behavioral coding systems are used more frequently in research studies than in clinical settings. b. ADVANTAGES Observational measures, including rating scales and behavioral coding systems, can provide a useful supplement to information that is typically collected in an interview format Their advantage lies primarily in the fact that clinicians observed behavior directly rather than relying on patients’ self-reports. Specific types of observational measures have distinct advantages: i. Rating scales are primarily useful as an overall index of symptom severity or functional impairment. ii. Behavioral coding systems provide detailed information about the person’s behavior in a particular situation. c. LIMITATIONS Observations are sometimes considered to be similar to photographs: They provide a more direct or realistic view of behavior than do people’s recollections of their actions and feelings. But just as the quality of a photograph is influenced by the quality of the camera, the value of observational data depends on the procedures that are used to collect them. Thus, observations have a number of limitations: i. Observational procedures can be time-consuming and therefore expensive. Raters usually require extensive training before they can use a detailed behavioral coding system. ii. Observers can make errors. Their perception may be biased: just as the inferences of an interviewer may be biased. Th reliability of ratings as well as behavioral coding must be monitored iii. People may alter their behavior, either intentionally or unin tentionally, when they know that they are being observed a phenomenon known as reactivity. For example, a person who is asked to count the number of times that he washes his hands may wash less frequently than he does when he is not keeping track. 7 iv. Observational measures tell us only about the particular situation that was selected to be observed. We don’t know if the person will behave in a similar way elsewhere or at a different time, unless we extend the scope of our observations v. There are some aspects of psychopathology that cannot be observed by anyone other than the person who has the problem. This is especially true for subjective experiences, such as guilt or low selt-esteem. 19. Personality inventories consist of a series of straightforward statements; the person being tested is typically required to indicate whether each statement is true or false in relation to himself 20. Actuarial interpretation a. Rather than depending only on their own experience and clinical judgment, which may be subject to various sorts of bias and inconsistency, many clinicians analyze the results of a specific test on the basis of an explicit set ot rules that are derived from empirical research 21. ADVANTAGES The MMPI-2 has several advantages in comparison to interviews and observational procedures. In clinical practice, it is seldom used by itself, but, for the following reasons, it can serve as a useful supplement to other metnoas ot collectmg information. a. The MMPI-2 provides information about the persons testtaking ; attitude, which alerts the clinician to the possibility that clients are careless, defensive, or exaggerating their problems. b. The MMPI-2 covers a wide range ot problems s in a direct anc efficient manner. It would take a clinician several hours to go over all these topics using an interview format. c. Because the MMPI-2 is scored objectively, the test’s description of the person’s adjustment is not influenced by the clini cian’s subjective impression ol the client. d. The MMPI-2 can be interpreted in an actuarial actuarial fashion, using extensive banks of information regarding people who respond to items in a particular way. 22. LIMITATIONS The MMPI-2 also has some limitations. Some of its limitations derive from the fact that it has been used for many years, and the ways in which ditterent forms ot psycnopathology are viewed have changed over time. a. The utility of the traditional clinical scales (see Table 4.3) has been questioned, especially with regard to their ability to discriminate between different types of mental disorders. Restructured clinical scales have been developed in order to address these problems, but the new scales remain controversial b. The test depends on the person’s ability to read and respond to written statements. Some people cannot complete the rather extensive list of questions. These include many people who are acutely psychotic, intellectually impaired, or poorly educated. c. Specific data are not always available tor a particular profile. Many patients’ test results do not meet criteria for a particu lar code type with which extensive data are associate( Therefore, actuarial interpretation is not really possible for these profiles d. Some studies have found that profile types are not stable over time. It is not clear whether this instability should be interpreted as lack of reliability or as sensitivity to change in the person’s level ot adjustment. 8 23. In projective tests, the person is presented with a series of ambiguous stimuli. Projective techniques such as the Rorschach test were originally based on psychodynamic assumptions about the nature of personality and psychopathology. Considerable emphasis was placed on the importance of unconscious motivations— a. ADVANTAGES The advantages of projective tests center on the fact that the tests are interesting to give and interpret, and the sometimes provide a way to talk to people who are otherwise reluctant or unable to discuss their problems. Projective tests are more appealing to psychologists who adopt a psychodynamic view of personality and psychopathology because such tests are bel’elieved to reflect unconscious conflicts and motivations. Some specific advantages are listed as follows: i. Some people may feel more comfortable talking in an unstructured situation than they would if they were required to participate in a stmctured interview or to complete the lengthy MMPI. ii. Projective tests can provide an interesting source of information regarding the person’s unique view of the world, anc they can be a useful supplement to information obtained with other assessment tools (Weiner & Meyer, 2009). iii. To whatever extent a person’s relationships with other people are governed by unconscious cognitive and emotional events, projective tests may provide information that cannot be obtained through direct interviewing methods or observational procedures b. LIMITATIONS There are many serious problems with the use of projective tests. The popularity of projective tests has declined considerably since the 1970s, even in clinical settings, primarily because research studies have found relatively little evidence to support their reliability and validity i. 1. Lack of standardization in administration and scoring was a serious problem, but the Comprehensive System for scoring the Rorschach has made improvements in that regard. ii. Little information is available on which to base comparison to normal adults or children. iii. Some projective procedures, such as the Rorschach, can be very time consuming, particularly if the person’s responses are scored with a standardized procedure such as the Comprehensive System. iv. Information regarding the reliability and validity of projective tests is mixed, with many scales showing little systematic value. 24. Brain Imaging Techniques a. Studies of this type are typically concerned with the size of various parts of the brain. b. Other methods can be used to create dynamic images of brain functions—reflecting the rate of activity in various parts of the brain—while a person is performing different tasks. c. They may also alow us to learn whether specific areas or pathways in the brain are uniquely associated with specific types of mental disorders. d. While other functional imaging procedures such as PET are only able to measure activities that are sustained over a period of several minutes, fMRI is able to identify changes in brain activity that lasts less than a Second 9 i. VANTAGES Brain imaging techniques provide detailed information regarding the structure of brain areas and activity levels in the brain that are associated with the performance of particular tasks. They have important uses, primarily as research tools: 1. In clinical practice, imaging techniques can be used to rule out various neurological conditions that might explain behavioral or cognitive deficits. These include such conditions as brain tumors and vascular disease. 2. Procedures such as fMRI and PET can help research investigators explore the relation between brain functions and specific mental disorders. This type of information will be considered in several chapters later in this book. ii. LIMITATIONS Brain imaging procedures are used extensively in the study and assessment of neurological disorders. In the field of psychopathology, they are currently research tools and have little clinical importance outside the assessment and treatment of disorders such as Alzheimer’s disease (see Chapter 14). Some of the major limitations are listed here: 1. Norms have not been established for any of these measures. It is not possible to use brain imaging procedures for diagnostic purposes. 2. Lese procedures are relatively expensive—especially PET scans and fMRI—and some procedures must be used cautiously because the patient may be exposed to radioactive substances. 3. We should not assume that all cognitive processes, emotional experiences, or mental disorders are necessarily linked activity (or the absence of activity) in a specific area of the brain. Scientists are still debating the extent to which these experiences are localized within the brain Chapter 5 1. . Younger generations are experiencing higher rates of depression than their predecessors, and those who become depressed are doing so at an early age 2. Ir. Emotion refers to a state of arousal that is defined by subjective states of feeling, such as sadness, anger, and disgust. Emotions are often accompanied by physiological changes, such as changes in heart rate and respiration rate. 3. Affect refers to the pattern of observable behaviors, such as facial expression, that are associated with these subjective feelings. People also express affect through the pitch of their voices and with their hand and body movements. 4. Mood refers to a pervasive and sustained emotional response that, in its extreme form, can color the person’s perception of the world 5. Depression can refer either to a mood or to a clinical syndrome, a combination of emotional, cognitive, and behavioral symptoms. The feelings associated with a depressed mood often include disappointment and despair. Although sadness is a universal experience, profound depression is not. 10 6. . In the syndrome of depression, which is also called clinical depression, a depressed mood is accompanied by several other symptoms, such as fatigue, loss of energy, difficulty in sleeping, and changes in appetite. 7. Mania, the flip side of depression, also involves a disturbance in mood that is accompanied by additional symptoms. Euphoria, or elated mood, is the opposite emotional state from a depressed mood. It is characterized by an exaggerated feeling of physical and emotional well- being 8. Mood disorders are defined in terms of episodes—discrete periods of time in which the person’s behavior is dominated by either a depressed or manic mood. 9. The two primary types of mood disorders: (1) those in which the person experiences only episodes of depression, known as depressive disorders; and (2) those in which the person experiences episodes of mania as well as depression, known as bipolar disorder. 10. Many of the most important symptoms and signs of mood disorders, which can be divided into four general areas: emotional symptoms, cognitive symptoms, somatic symptoms, and behavioral symptoms. a. Emotional Symptoms i. Depressed, or dysphoric (unpleasant), mood is the most common and obvious symptom of depression b. Cognitive Symptoms i. In addition to changes in the way people feel, mood disorders also involve changes in the way people think about themselves and their surroundings. Guilt and worthlessness are common preoccupations. Depressed patients blame themselves for things that have gone wrong, regardless of whether they are in fact responsible. T They focus considerable attention on the most negative features of themselves, their environments, and the future—a combination known as the “depressive triad” c. The somatic symptoms of mood disorders are related to basic physiological or bodily functions. They include fatigue, aches and pains, and serious changes in appetite and sleep d. Behavioral Symptoms The symptoms of mood disorders also include changes in the things that people do and the rate at which they do them. The term psychomotor retardation refers to several features of behavior that may accompany the onset of serious depression. The most obvious behavioral symptom of depression is slowed movement 11. Two primary issues have been central in debates about these systems. a. First, shoulc mood disorders be defined in a broad or a narrow fashion? A narrow approach to the definition of depression would focus on the most severely disturbed people—those whose depressed mood seems to be completely unrelated to any precipitating events, is entirely pervasive, and is completely debilitating. A broader approach to the definition would include milder forms of depression. Some recent critics have argued that the current diagnostic system has expanded the definition of depression to include normal sadness because it does not exclude reactions to a wide array of negative events, such as betrayal by a romantic partner or failing to reach an important life goal 11 b. The second issue regarding the diagnosis of mood disorders concerns heterogeneity. All depressed patients do not have exactly the same set of symptoms, the same pattern of onset, or the same course over time. Some patients have manic episodes, whereas others experience only depression. S Are these qualitatively distinct forms of mood disorder, or are they different expressions of the same underlying problem? Is the distinction among the different types simply one of severity? 12. DEPRESSIVE DISORDERS Depressive disorders include three main types among adults: a. major depressive disorder, b. persistent depressive disorder (also known as dysthymia) i. Persistent depressive disorder (dysthymia) differs from major depression in terms of both severity and duration. Persistent depressive disorder represents a chronic mild depressive condition that has been present for many years. , the person must, over a period of at least two years, exhibit a depressed mood for most of the day on more days than not. c. premenstrual dysphoric disorder. d. A fourth type of depressive disorder, known as disruptive mood dysregulation disorder, was added with the publication of DSM-5. ‘• It is intended to describe children with chronic, severe irritability (see Chapter 16). e. The distinction between major depressive disorder and persistent depressive disorder is somewhat artificial because both sets of symptoms are frequently seen in the same person. In such cases, rather than thinking of them as separate disorders, it is more appropriate to consider them as two aspects of the same disorder, which waxes and wanes over time. 13. BIPOLAR DISORDERS All 3 types involve manic or hypomanic episodes. The mood disturbance must be severe enough to interfere with occupational or social functioning. ;. A person who las experienced at least one manic episode would be assigned a diagnosis of bipolar I disorder. a. Some patients experience episodes of increased energy that are not sufficiently severe to qualify as full-blown mania. these episodes are called hypomania. . A person who has experience’ at least one major depressive episode, at least one hypomaniq episode, and no full-blown manic episodes would be assignee diagnosis of bipolar II disorder. b. . The differences between manic and hypomanic episodes involve duration and severity. c. Cyclothymia is considered by DSM-5 to be a chronic but less severe form of bipolar disorder. It 14. FURTHER DESCRIPTIONS AND SUBTYPE DSM-5 includes several additional ways of describing subtypes of the mood disorders. These are based on two considerations: (1) more specific descriptions of symptoms that were present during the most recent episode of depression (known as episode specifiers) and (2) more extensive descriptions of the pattern that the disorder follows over time (known as course specifiers). 15. Melancholia is a term that is used to describe a particularly severe type of depression, , 16. the course of a bipolar disorder can be specified as rapid cycling if the person experiences at least four episodes of major depression, mania, or hypomania within a 12-months 17. Researchers refer to a mood disorder in which the onset of episodes is regularly associated with changes in seasons as seasonal affective disorder^ 12 18. Depressive Disorders When a person’s symptoms are diminished or improved, the disorder is considered to be in remission, or a period of recovery. 19. Relapse is a return of active symptoms in a person who has recovered from a previous episode. 20. Causes of Depression a. Social Factors i. In these cases, rather than losing other people, some clinicians suggested that we may be losing “social roles” or ways in which we think about ourselves. ii. Do people who become clinically depressed actually experience an increased number of stressful life events? The answer is yes. iii. Stress Generation-Creating more stressful events for oneself iv. Kinds of events that precede the onset of mania tend to be different from those that lead to depression. While the latter include primarily negative experiences involving loss and low self-esteem, the former include schedule-disrupting events (such as loss of sleep) as well as goal attainment events. b. Psychological Factors i. COGNITIVE VULNERABILITY 1. E. One is the tendency to assign global, personal meaning to experiences of failure. A 2. “Y Cognitive theories concerning the origins of depression are based on the recognition that humans are not only social organisms, they are also thinking organisms, and the ways in which people perceive, think about, and remember events in their world can have an important influence on the way that they feel. 3. H. Another cognitive distortion associated with depression is the tendency to overgeneralize conclusions about the sell based on negative experiences.;.” A third type of cognitive error involves drawing arbitrary inferences about the self in the absence of supporting evidence (often in spite of contradictory evidence). 4. • The final type of cognitive bias related to depression is the tendency to recall selectively events with negative consequences and to exaggerate the importance of negative events while simultaneously discounting the significance of positive events. I 5. How do these self-defeating biases lead to the onset of depression? a. One cognitive approach to depression is focused on the importance of maladaptive schemas, which are general patterns of thought that guide the ways in which people perceive and interpret events in their environment. T. Schemas are enduring and highly organized representations of prior experience. b. S causal attributions. A similar view of cognitive vulnerability to depression has been described in terms of hopelessness ( Hopelessness refers to the person’s negative expectations about future events and the associated belief that these events cannot be controlled. Following a negative life event, the 13 probability that the person will become depressed is a function of the explanations and importance that the person ascribes to these events. c. Depressogenic attributional style. Some people tend to explain negative events in terms of internal, stable, global factors. For example, after failing an important exam, someone who uses this cognitive style would probably think that her poor performance was the result of her own inadequacies (internal), which she has recognized for a long time and which will persist into the future (stable), and which also are responsible for her failure in many other important tasks, both academic and otherwise (global). As in other cognitive views of depression, this kinc of attributional style is not considered to be a sufficient cause of depression. It does represent an important predisposition to depression, however, to the extent that people who use it are more likely to develop hopelessness if they experience a negative life event. d. The cognitive problems that depressed people experience seem to reflect primarily problems in the control of attention to, and memory for, negative emotional material. If depressed people begin to think unpleasant thoughts, they have difficulty inhibiting or disengaging from them 6. Solutions: a. I ruminative style. i. . Some people respond to feelings of depression by turning their attention inward, contemplating the causes and implications of their sadness. . Writing in a diary or talking extensively with a friend about how one feels is an indication of a ruminative style. b. Distracting style i. Divert themselves from their unpleasant mood. They work on hobbies, play sports, or Otherwise become involved in activities that draw their attention away from symptoms of depression. c. The first hypothesis of this model is that people who engage in ruminative responses have longer and more severe episodes of depression than do people who engage in distracting responses. The second hypothesis is that women are more likely to employ a ruminative style in response to depression, whereas men are more likely to employ a distracting style. Because the ruminative style leads to episodes of greater duration and intensity, women are more susceptible to depression than are men. ii. INTEGRATION OF COGNITIVE AND SOCIAL FACTORS 14 1. We do not need to decide whether cognitive vulnerabilities are somehow more or less important than stressful life events because they undoubtedly work in combination. 1. 2. The development of depression must be understood in terms of several stages: vulnerability, onset, and maintenance 3. ^he stressful life events that precipitate an episode frequently grow out of difficult person I and family relationships. The impact of these experiences depends on the meanings that people assign to them. People become depressed when they interpret events in a way that t diminishes their sense of selfworth c. Biological Factors i. .. Various studies suggest that genetic factors are somehow involved in both depression I and bipolar disorder, that hormonal abnormalities are regularly associated with depression, and that depression is associated with abnormalities in the activation of specific regions of the brain. ii. GENETICS 1. Genetic factors are clearly involved in the transmission of mood disorders .Studies that support this conclusion also suggest that bipolar disorders are much more heritable than depressive disorders. 2. TWIN STUDIES a. I). Several twin studies of mood disorders have reported higher concordance rates among MZ (identical) than among DZ twins (paternal) More on twin studies PG. 41 b. . The fact that the difference between the MZ and DZ rate was somewhat higher for bipolar than for depressive disorders may suggest that genes play a more important role in bipolar disorders than in depressive disorders. c. Twin studies also tell us that environmental factors influence the expression of a genetically determined vulnerability to depression. The best evidence for the influence of nongenetic factors is the concordance rates in MZ twins, which consistently fall short of 100 percent. i. 5. A twin pair is concordant when both twins either have the same disorder or are free from the disorder, for example, both suffer from schizophrenia. The twin pair is discordant when one twin has the disorder but the other does not, for example, one twin has schizophrenia but the co-twin does not. d. In complex behavioral disorders because there is no straightforward pattern of inheritance.e. All of the evidence indicates that mood disorders are polygenic—that is, they are influenced by many different genes rather than a single gene— and each of these genes on its own only changes risk for the disorder by a small amount 15 e. :r, two important cautions must be kept in mind regarding the complexity of the search for causes of mood disorders. i. One problem involves genetic heterogeneity. Within the general population, there may be more than one locus that contributes to the development of depression. Mood disorders may be linked to one marker within a certain extended family and to an entirely different marker in another family ii. Second, we also know that the environment plays an important role in the development of mood disorders. The onset of a mood disorder is determined by a combination of genetic and environmental risk factors that the individual experiences. f. How do genetic factors and stressful life events interact to bring about depression i. It. Genetic factors apparently control the persons sensitivity to environmental events g. THE NEUROENDOCRINE SYSTEM Various kinds of central nervous system events are associated with the connection between stressful life events and major depression. i. The endocrine system (e.g. pituitary, thyroid, and adrenal glands) plays an important role in regulating a person’s response to stress. h. In what ways might endocrine problems be related to other causal factors? i. In terms of the specift link between the endocrine system and the central nervous system, overproduction of Cortisol may lead to changes in brain structure and function ii. 1. At a more general level, hormone regulation may provide a process through which stressful life events interact with a genetically determined predisposition to mood disorder. R. Stress causes the release of adrenal steroids, such as Cortisol, and steroid hormones play an active role in regulating the expression of genes iii. BRAIN IMAGING STUDIES 1. J). The brain circuits that are involved in the experience and control of emotion are complex centering primarily on the limbic system and its connections to the prefrontal cortex and the anterior cingulate cortex. 2. Brain imaging studies indicate that severe depression is often associated with abnormal 16 patterns of activity as well as structural changes m various brain regions 3. Abnormal patterns of activation in regions of the prefrontal cortex (PFC) are often found in association with depression. .. Some areas show decreased activity, especially the dorsolateral prefrontal cortex on the left side of the brain. This area of the PFC is involved in planning that is guided by the anticipation of emotion. A . A person who has a deficit of this type might have motivational problems, such as an inability to work toward a pleasurable goal. Other areas of the PFC have been found to show abnormally elevated levels of activity in depressed people. Lie. These include the orbital PFC and the ventromedial PFC, areas of the brain that are important for determining a person’s responses to reward and punishment. More specifically, the orbital PFC inhibits inappropriate behaviors and helps the person ignore immediate rewards while working toward long-term goals. The ventromedial PFC is involved in the experience of emotion and the process of assigning meaning to perceptions. Overactivity in these regions of the brain might be associated with the prolonged experience of negative emotion. 4. The anterior cingulate cortex (ACC) provides a connection between the functions of attention and emotion. It allows us to focus on subjective feelings and to consider the relation between our emotions and our behavior. For example, the ACC is activated when a person has been frustrated in the pursuit of a goal, or when he or she experiences an emotion, such as sadness, in a situation where it was not expected. People suffering from major depressive disorder typically show decreased activation of the ACC. K A reduction in ACC activity might be reflected in a failure to appreciate the maladaptive nature of prolonged negative emotions and a reduced ability to engage in more adaptive behaviors that might help to resolve the person’s problems. 17 5. The amygdala is extensively connected to the hypothalamus. this system is responsible for monitoring the emotional significance of information that is processed by the brain and regulating social interactions. Higher metabolism rates of glucose are associated with more svere levels of depression. iv. NEUROTRANSMITTERS 1. ) Communication and coordination of information within and between areas of the brain depend on neurotransmitters, chemicals that bridge the gaps between individual neurons 2. Serotonin is the chemical messenger that is enhanced by medications, such as Prozac. Regulates: feeling of serenity and optimism and sleep and appetite. 3. We know that the relation between neurotransmitters and depression is complex, and the specific mechanisms are not well understood. There may be more than 100 different neurotransmitters in the central nervous system, and each neurotransmit is associated with several types of postsynaptic receptors.s. It seems unlikely that a heterogeneous disorder such as depression, which involves a dysregulation of many cognitive and emotional functions, will be hnked to only one type of chemical messenger Current theories tend to emphasize the interactive effects of several neurotransmitter systems, including serotonin, norepinephrine, dopamine, and neu \ ropeptides (short chains of amino acids that exist in the brain anc appear to modulate the activity of the classic neurotransmitters) 4. Rats exposed to 15 min forced swim in cod water from which they cannot escape, exhibit behavioral symptoms (e.g. deficits in motor activity, sleep, and eating behavior) that are smilar to depressed humans. This resulted in changes in the concentration of norepinephrine, serotonin, and dopami^ine in 18 the specific regions of the limbic system and the
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