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Exam 2 Reading Notes

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by: Samantha Snyder

Exam 2 Reading Notes 3230.0

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Samantha Snyder
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Abnormal Psychology

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This is a bundle of reading notes for chapters 5, 6 and 8. Highlighted in yellow is more detailed notes of material we discussed in class, and all key terms are italicized.
Abnormal Psychology
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This 36 page Study Guide was uploaded by Samantha Snyder on Saturday October 10, 2015. The Study Guide belongs to 3230.0 at University of Georgia taught by Cyterski in Fall 2015. Since its upload, it has received 200 views. For similar materials see Abnormal Psychology in Psychlogy at University of Georgia.


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Date Created: 10/10/15
Exam 2 Reading Notes Chapters 568 Chapter 5 Disorders of Trauma and Stress State of stress has two components Listed in DSM5 as quotTrauma and Stressor Related Disordersquot 51 Stress and Arousal The Fightor Flight Response 0 Physical indicators of fear and arousal are set in motion by the hypothalamus which uses the release of neurotransmitters to activate two systems 0 Two pathways by which the ANS and endocrine systems produce fear and arousal reactions SWIFIMHEW Parawmpathatlt nemus splatem quotenrolls waftem Eilatas xi Eontratts EMF 1 K J HIKE If pupil When I E r Elimulates I39ll 39I J I I quot39 I n l r n l V salivatian H Samaria Constmts Relaer f monthly E39s L Jlttelerales I 391 heartbeat llnhxibila dig SEWE w annuity 39 Stimulates f5 digestive attiuilly Stimulates Stimulalea release gallbladder a glucose Emimulales Hawaiian of Ep inephrlne and m 39 Eontratts bladdmr Retell35 l 7 lblE39IrilEIEI Stimulates Ejaculation in male v Allows blood Flow 1 to sextrrgams Pituitthr gland l Secretion of ACTH l M x l articulateminis 0 Reactions along these two pathways are collectively called 52 Acute and Posttraumatic Stress Disorders Acute Stress Disorder an anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month Posttraumatic Stress Disorder PTSD an anxiety disorder in which fear and related symptoms continue to be experienced long after a traumatic event with symptoms arising either shortly after the event or monthsyears later Symptoms o Experiencing a traumatic event 0 Avoidance 0 Reduced responsiveness 0 Increased arousalnegative emotionsguilt 521 What Triggers Acute and Posttraumatic Stress Disorders Statistics for ASDPTSD o 35 of ppl in the US any given year 0 79 lifetime rate in the US 0 23 of people seek treatment 0 As many as 80 of cases of acute stress disorder develop into PTSD 0 When faced with extreme trauma 20 of women develop ASDPTSD only 8 of men do ASDPTSD can develop at any age even childhood Combat Clinicians have known for years that soldiers develop anxietydepressionetc during combat quotshell shockquot in WW1 quotcombat fatiguequot in WW2Korean War but it wasn t until after Vietnam that they realized that these symptoms often continue after combat Statistics on PTSD after Vietnam 0 29 of Vietnam vets suffered ASD or PTSD o 22 experienced at least some stress symptoms 0 10 still experience PTSD symptoms Similar patterns in AfghanistanIraq veterans o 20 of deployed soldiers have reported symptoms of PTSD o 50 reported seeing friends injuredkilled o 45 reported seeing injuredkilled civilians o 10 reported being hospitalized themselves Individuals who serve more than one tour are 50 more likely to develop ASDPTSD Disasters Natural and accidental Civilian traumas causing the development of ASDPTSD is 10 times more likely than combat traumas At least 40 of victims of serious car accidents develop PTSD within a year of the accident Victimization Research shows more than 13 of physicalsexual assault victims develop PTSD As many as 12 of people exposed to terrorismtorture develop PTSD Sexual Assault Rape forced sexual intercourse or another sexual act against a nonconsenting person or intercourse with an underage person 200000 cases of rape reported in the US yearly around 1 in 6 women Rape rates differ among different races 0 46 of victims are white 0 27 African American 0 19 are Hispanic Psychological effects are usually immediate enormous stress during rst week after rises for 3 weeks peaks for about a month then begins to improve typically lasts 34 months can persist for 18 months and may result in long term health problems Terrorism Torture Torture the use of brutal degrading and disorienting strategies to reduce victims to a statue of utter helplessness Estimated that 535 of the 15 million refugees globally have experienced at least one episode of torture Various types Physical psychological sexual deprivation 3050 of torture victims develop PTSD 522 Why Do People Develop Acute and Posttraumatic Stress Disorders Stressful events alone may not be the only cause for ASDPTSD development Biological and Genetic Factors Researchers have found in bodily uids of combat soldiers rape victims and concentration camp survivors Brain studies show that after ASDPTSD sets in continuing arousal may damage key brain circuits 5 plays role in memory and regulation of stress hormones dysfunction may help produce stressful memories constant arousal 0 controls anxiety and other emotional responses dysfunction may cause repeated and especially intense emotional memories Studies have shown a possibility for the transmission of biochemical abnormalities to children of people with the disorder 0 Women pregnant during 911 that developed PTSDhad high cortisol levels gave birth to babies with abnormally high but naturally occurring cortisol levels 0 Twin studies Personality Certain personalities attitudes and coping styles are more likely to develop ASDPTSD Adjustment disorders this category lies between effective coping mechanisms and PTSD reaction to a major stressor with extendedexcessive anxiety depression or antisocial behaviors that onset within three months of the stressor Childhood Experiences People exposed to poverty as children are less likely to react well to later traumas Same with people whose family members suffered from psychological disorders assault abuse catastrophe or Social Support Weak familysocial support systems more likely to develop ASDPTSD Multicultural Growing suspicion that ASDPTSD rates differ among ethnic groups in the US 0 Hispanic Americans are particularly at risk higher rates found among Afghanistan amp Iraq combat veterans police officers hurricane victims post 911 NYC residents 0 Why are Hispanic Americans more vulnerable to ASDPTSD Culture 0 belief that traumatic events are inevitable and unchangeable emphasis on social relationships when a traumatic event deprives them of important relationships and support systems Severity of Trauma Generally the more severe the trauma and direct the expose is the more likely a person is to develop ASDPTSD Mutilation and severe physical injury and witnessing the injury or death of other people also increases the likelihood 523 How Do Clinicians Treat Acute and Posttraumatic Stress Disorders About 12 of PTSD cases improve within 6 months 13 of people fail to respond to treatment Treatment for Combat Veterans Most common treatment techniques behavioral exposure techniques insight therapy family therapy and group therapy Antianxiety drugs help control tension felt by combat vets Antidepressants may reduce occurrence of ash backs nightmares panic attacks and depression Some studies indicate that exposure treatment is the most effective treatment or combat veterans Eye Movement Desensitization and Reprocessing EMDR an exposure treatment in which clients move their eyes rhythmically from side to side while ooding their minds with images of objects and situations they ordinarily avoid Most clinicians believe that in addition to these therapy techniques vets must come to grips in some way with their combat experiences Rap Groups group therapy group meets to talk about and explore members problems in an atmosphere of mutual support Psychological Debrie ng People who are traumatized by disasters victimization or accidents bene t from many of the same treatments that combat vets do but may bene t more from immediate community interventions Critical Incident Stress Debriefing training in how to help victims of disasters or other horrifying events talk about their feelings and reactions to the traumatic events These techniques have become more popular over the last 25 years but has also come under scrutiny reminding the eld of the need for clinical research Psychological debrie ng has clients talk extensively about their feelings and reactions within days of a critical incident then therapists remind clients that their feelings are totally normal used with clients who have not yet developed any symptoms as well as those who have After largescale traumatic events columbine 911 etc debrie ng trained counselors often migrate to the location of the event to conduct sessions with victims Does Psychological Debrie ng Work Early 1990s 12 of postgulf war soldiers still developed PTSD symptoms by 9 months after group debrie ng sessions hospitalized burn victims shower higher worse rates of PTSD after debrie ng 53 Dissociative Disorders Dissociative disorders a group of disorders in which some parts of one s memory or identity seems to be dissociated or separated from other parts of one s memory or identity o In these disorders dissociative reactions are the mainonly symptoms signi cant arousal negative emotions sleep dif culties etc are not usually experienced Identity a sense of wholeness and continuity as we interact with the world perception as being more than a collection of isolate sensory experiences feelings and behaviors a sense of who we are and where we t in our environment Memory the faculty for recalling past events and past learning 0 ln dissociative disorders a person s memory or identity dissociates from other parts of memoryidentity Several types of dissociative disorders 0 Dissociative amnesia unable to recall important personal events and information o Dissociative Identity Disorder two or more separate identities that may not always be aware of each other s memories thoughts feelings and behaviors o DepersonaizationDereaization Disorder feeling of becoming detached from their own mental processes or are observing themselves from the outside Examples of famous works portraying dissociative disorders 0 The Three Faces of Eve Eve White had 3 sub personalities Eve White Eve Black and Jane who all eventually merged into Evelyn stable integration of the 3 subpersonalities Over her lifetime 22 personalities total 9 after Evelyn eventually settles on Chris Sizemore 35 years 0 Sybil o Included in television drama series often creating idea that dissociative disorders are common but most clinicians think they are rare 531 Dissociative Amnesia Dissociative amnesia a dissociative disorder marked by an inability to recall important personal events and information a person loses all memory of events that took place within a limited period of time almost always beginning with some very disturbing occurrence 0 Most common type 0 Forgotten period is called the amnestic episode 0 Soldier being able to remember up to and sine a particularly terrible battle but nothing about the actual battle people remember some but not all events that happened during a certain period of time 0 Second most common 0 Soldier being able to remember certain interactions or conversations that happened during a particularly terrible battle but not the most disturbing events forgetting continues into the present 0 Soldier may forget new and ongoing things rather than forgetting only what happened during battle Dissociative disorders usually only interferes with personal material memory of abstract or encyclopedic information usually remains in tact Clinicians don t know how common it is but that cases typically begin during serious threats to healthsafety combat natural disasters 0 Dissociative amnesia can also occur under more ordinary circumstances loss of a loved one due to death or rejection or extreme guilt people forget their identities details of their past life AND ee to an entirely new location can last hours or daysljmonths years 0 People may create a whole new identity and display new personality characteristics often more outgoing than before 0 Tend to end very abruptly 0 As people recover past memories some forget what happened during the fugue period 0 Majority of people who have a dissociative fugue regain all old memories and never have a relapse 0 Ex Reverend Ansel Bourne inspo for Bourne Movies 532 Dissociative ldentity Disorder Multiple Personality Disorder Dramatic and disabling 0 switching moving from one personality to the other usually very usually triggered by a stressful event or brought on by a clinician through hypnotic suggestion Cases of DlD were rst reported 3 centuries ago 0 Women receive DlD diagnoses 3x more often than men How do Subpersonalities Interact Varies casetocase but three general relationships reationships the subpersonalities have no awareness of ne another reati0nships each subpersonality is well aware of the others may hear one another s voices and even talk amongst themselves sometimes they get along and sometimes they don t reationships some subpersonalities are aware of others but the awareness is not mutual 0 Most common relationship 0 Coconscious subpersonalities aware called quotquiet observersquot watch and observe the actions and thoughts of other subpersonalities but don t interact with them sometimes a coconscious personality may make themselves known through auditory hallucinations or quotautomatic writingquot Average number of subpersonalities per patient is 15 for women 8 for men How do Subpersonalities Differ Often may have different names identifying features abilities and preferences and physiological responses Identifying Features May differ in age gender race family history Abilities and Preferences Abstractencyclopedic info is not usually destroyed in DID it is often disturbed Differences in ability to drive speak foreign languages play instruments Handwriting may differ taste in food friends music etc Physiological Responses Differences in blood pressure allergies Actual brain activity can differ between personalities How Common is Dissociative Identity Disorder Number of diagnosed cases has been increasing though it is still considered quotrarequot and uncommon Some clinical theorists argue that DlD is culturebound as DlD is far more common in North America but almost nonexistent in Great Britain Sweden Russia India and Southeast Asia 533 How do Theorists explain Dissociative Amnesia and Dissociative Identity Disorder Psychodynamic View Psychodynamic theorists believe that causes dissociative amnesia and dissociative identity disorder people excessively ght off anxiety by unconsciously preventing painful memories thoughts or impulses from reaching awareness Dissociative Amnesia is viewed as a single episode of massive repression the person unconsciously blocks out the memories of an event to avoid the overwhelming anxiety it would cause Dissociative Identity Disorder is the result of a lifetime of excessive repression o Believed to be motivated by childhood trauma especially abusive parenting Abused kids may come to fear their quotbadquot behaviors are project them onto other personalities Most psychodynamic support is drawn from case histories but not all people who suffer from DlD had traumatic childhoods The Behavioral View Behaviorists believe that dissociation is learned through people may nd that when their mind is focused on other things they get temporary relief from whatever is upsetting them leading to more future forgetting Support comes largely from case histories Fails to explain how short termtemporary escape from anxiety grows into such a large and complex disorder StateDependent Learning learning that becomes associated with the conditions under which it occurred so that it is best remembered under the same conditions 0 Ex If given a learning task while under the in uence of alcohol recall of the information will be stronger when again under the in uence of alcohol First discovered in animals then later discovered in humans with mood states What causes statedependent learning 0 Arousal levels 0 Normal people may learn something in one state but can typically recall it in various other states people with dissociative disorders typically have very stiff and narrow statetomemory links In DID different arousal levels can produce entirely different sets of memories thoughts and abilities SelfHypnosis the process of hypnotizing oneself sometimes for the purpose of forgetting unpleasant events Hypnotic amnesia the use of hypnosis to make people forget facts events and even alternate personal identities Selfhypnosis and hypnotic amnesia are so similar that some theorists think dissociative disorders are a form of selfhypnosis o It is thought that people may be consciously or unconsciously hypnotizing themselves into forgetting bad experiences DID typically begins between 46 years old when children are highly suggestible and great candidates for hypnosis which supports the idea that young children with traumatic lives mentally separate themselves from their bodies to ful ll wishes to become a different person thereby creating subpersonalities O 0 534 How are Dissociative Amnesia and Dissociative Identity Disorder Treated 0 People with dissociative amnesia often recover on their own but people with DID usually require treatment to recover How do Therapists Help People with Dissociative Amnesia Leading treatments 0 psychodynamic therapy guiding patients to search consciousness in hopes of bringing forgotten memories back to consciousness o hypnotic therapyhypnotherapy treatment in which the patient undergoes hypnosis and is then guided to recall forgotten events or perform other therapeutic activities 0 drug therapy injections of barbiturates like sodium amobarbital Amytal or sodium pentobarbital Pentothal often called quottruth serumsquot has been used to help patients regain lost memories because it calms and reduces inhibition 0 hypnotherapy and drug therapy are often used in combination with other treatment types 0 Support comes largely from case studies How do Therapists Help Individuals with Dissociative Identity Disorder 0 Very complex and difficult treatment because disorder is extremely complex and hard to understand Recognizing the Disorder 0 Therapists rst try to bond with the primary personality as well as with each subpersonality o Therapist then tries to educate and help patients recognize their disorder 0 Some even introduce the personalities to each other 0 Group therapy seems to help educate patients Recovering Memories Psychodynamic therapy hypnotherapy and drug therapy is often used to help clients recover memories 0 Works very slowly on people with DID as some subpersonalities may continue to deny a memory that the other recall 0 One subpersonality may assume a protector role to keep the primary personality from feeling the pain or remembering a trauma Integrating the Subpersonalities Integration is a continuous process that occurs throughout treatment until patients quotownquot all of their behaviors emotions sensations and knowledge 0 Many patients distrust this goal as some subpersonalities see it as a quotdeathquot A range of therapies is used to help merge subpersonalities Once fusion has occurred further therapy is typically required to maintain a complete personality teach social skills and coping skills to prevent future dissociations 535 DepersonalizationDerealization Disorder DepersonalizationDereaization Disorder a dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization derealization or both that cause considerable distress and may impair social relationships 0 Depersonalization feeling that one s own mental functioning or body is unreal or detached 0 Dereaization the sense that one s surroundings are unreal or detached People with this disorder feel like they are observing themselves from the outside experience quotmechanical dreamlike or dizzyquot states Doubling the sensation that your mind is oating a few feet above you People are aware that their perceptions are distorted Experiencing depersonalization or derealization separately on occasion doesn t institute a disorder 0 13 of all people say that on occasion they have felt like they were watching themselves on a movie 0 13 of individuals who confront a lifethreatening danger experience feelings of depersonalization or derealization Occurs most commonly in adolescents and young adults rarely in ppl 40 Usually comes on suddenly can be triggered by extreme fatigue physical pain intense stress or recovery from substance abuse Symptoms are long lasting can go away but return or intensity during times of extreme stress Chapter 6 Disorders of Mood 61 Unipolar Depression The Depressive Disorders 611 How Common is Unipolar Depression 0 Around 5 suffer from mild forms point in their lives 0 Higher rate among poor people 0 26 of women will have an episode in their lives 0 12 of men 0 About 95 of people diagnosed recover 612 What are the Symptoms of Depression Varies from person to person 0 Symptoms span 5 areas cognitive emotional motivational behavioral and physical Emotional symptoms 0 lose sense of humor low levels of pleasure from anything anhedonia inability to feel pleasure at all 0 anxiety anger agitation Motivational symptoms 0 Lose the desire to pursue usual activities 0 Force themselves to talk to friends go to work have sex eat 0 Becoming uninterested in life or wish to die Behavioral symptoms 0 Usually less active and less productive 0 May move and speak slower than othersthan before Cognitive Symptoms 0 Extremely negative selfview blame themselves often 0 Inadequate undesirable inferior maybe evil 0 Pessimistic procrastination o Confusion poor memory easily distracted unable to solve small problems poor reasoning Physical symptoms o Headaches indigestion constipation dizzy spells general pain 0 Loss of appetite and sleep more fatigued 613 Diagnosing Unipolar Depression Major depressive episode period of two or more weeks marked by at least 5 symptoms of depression including sad mood andor loss of pleasure In extreme cases it may include psychotic symptoms delusions hallucinations Major Depressive Disorder a severe pattern of unipolar depression that is disabling and is not caused by factors like drugs or another medical condition Dysthymic Disorder a mood disorder that is similar to but longer lasting and less disabling than Major Depressive Disorder Premenstrual Dysphoric Disorder a disorder marked by repeated experiences of signi cant depression and related symptoms during the week before a woman s menstruation cycle begins Disruptive Mood Dysreguation Disorder combination of persistent depressive symptoms and recurrent outbursts of severe temper emerges in midchildhood or adolescence 614 Stress and Unipolar Depression Episodes of unipolar depression are often triggered by stressful events On average depressed people have more stressful life events in the month before the onset of their depression than to others during the same time period Reactive exogenous Depression follows clearcut stressful events Endogenous Depression response to internal factors Today s clinicians concentrate on recognizing situational and internal aspects in all cases of unipolar depression 615 The Biological Model of Unipolar Depression Genetic Factors Research suggests people may inherit a predisposition to unipolar depression 0 Family Pedigree Studies select people with unipolar depression and examine their relatives do other people in their families have the disorder 0 Twin Studies support expectations of family pedigree studies 46 chance that other identical twin has unipolar depression 20 chance of other fraternal twin having unipolar depression 0 Molecular Biology Gene Studies Unipolar depression may be linked to chromosomes 1 4 9 10 11 12 13 14 17 18 20 21 22 and X Biochemical Factors o Discovered from blood pressure medications causing depression lowering of norepinephrine and serotonin activity in 1950 s Researchers used to think the activity levels of ONE of these neurotransmitters caused depression but research now points to interactions between the two and others are more likely to cause the disorder Endocrine system may play a role in unipolar depression people with unipolar depression have unusually high levels of cortisol a stress hormone and sometimes more melatonin during winter nights Some clinicians believe that unipolar depression is linked to what happens inside the neurons rather than between them that neurotransmitter inactivity causes permanent damage to the structure of neurons Research in this area is limited most is done in analogue studies symptoms produced then cured in lab animals Current research is beginning to use MRls and PET scans Brain Anatomy and Brain Circuits Brain circuit responsible for unipolar depression has begun to emerge in research 0 Prefrontal cortex activity and blood ow is especially high in some parts and especially low in others 0 Hippocampus undersized and new neuron production is low 0 Amygdala activity and blood ow are high 0 Brodmann Area 25 is undersized and overactive Prefrontal cortex Brodmann 391 Areaag Immune System While under intense prolonged stress the immune system may become deregulated which can lead to lower functioning of lymphocytes and increased Creactive Protein CRP a protein that causes in ammation What are the Biological Treatments for Unipolar Depression Electroconvulsive Therapy 0 612 treatments 24 weeks Discovered on accident in the 1930 idea came about that seizures could cure schizophrenia so they looked for ways to induce seizures 0 Early ways to induce seizures drugs metrazol or insulin 0 Ugo Cerletti discovered electric currents caused seizures Muscle relaxers and anesthetics are used today during ECT Memory loss is common 0 Typically events right before and after treatment are lost usually clears up within a few months 6080 of depression patients improve from ECT Antidepressant Drugs Antidepressant Drugs psychotropic drugs that improve the mood of people with depression 35 of people don t bene t from the use of antidepressants Three types of antidepressants o Accidentally discovered from a tuberculosis drug making patients happier o MAO normally breaks down norepinephrineMAO inhibitors stop that which increases norepinephrine activity levels About 12 of people improve on MAO inhibitors VERY strict dietary restrictions related to blood pressure can t ingest tyramine 00 o Tricyclics antidepressant drug that has three rings in molecular structure ex lmipramine 5060 of people who take tricyclics improve Clinicians try to keep patients on them for 5 months quotmaintenance therapyquot 00 o Tricyclics block the reuptake process reuptake process is too fast in depression thereby increasing neurotransmitter activity 0 second generation antidepressants increase serotonin activity speci cally without affecting other neurotransmitter activity 0 Ex Zoloft Prozac o Newly developed selective norepinephrine reuptake inhibitors and serotoninnorepinephrine reuptake inhibitors 0 Effectiveness is about the same as tricyclics but clinicians prefer it because it is harder to OD on them and there are no intense dietary restrictions 0 Side effects associated are loss of sex drive and weight gain Brain Stimulation Three approaches have been developed vagus nerve stimulation transcranial magnetic stimulation and deep brain stimulation Vagus Nerve Stimulation a treatment do depression where an implanted pulse generator sends regular signals to a person s vagus nerve that in turn stimulates the brain 0 FDA approved 0 Pulse generator implanted in the chest wire is connected and extended to left vagus nerve in the neck 0 40 of people improve signi cantly the individuals brain 0 FDA approved 0 Current goes through prefrontal cortex to stimulate neural activity 0 Administered daily for 24 weeks 0 Helen Mayberg experimental o Idea is to quotrecalibratequot the depression brain circuit 0 4 of the 6 patients in the experimental study became depression free within months 616 Psychological Models of Unipolar Depression The Psychodynamic Model Freud and Abaham developed rst psychodynamic explanation for depression focusing on dependence and loss Psychodynamic Explanations Began by identifying similarities between clinical depression and grief over the loss of oved ones weeping loss of appetite difficulty sleeping loss of pleasure withdrawal Series of unconscious processes is set in motion during grief 0 Unable to accept loss mourners regress to the oral stage of development merge their own identity with that of the person they lost symbolically regaining the lost person direct all feelings for the loved one toward themselves For some this is temporary for some ldepression Why do people who haven t lost a loved one become depressed o Symbolic or imagined loss according to Freud loss of a valued object that is unconsciously interpreted as the loss of a loved one A college student experiencing the failing of a class as losing her parents and believing they will only love her if she makes good grades Freud s theory continues to in uence psychodynamic thinking 0 Ex Object relations therapists propose that depression occurs when people s relationships leave them feeling unsafe or insecure parents who push people towards excessive self dependence or selfreliance Studies support idea that major losses especially early in life may set the stage for depression to develop later in life but does not support that loss is ALWAYS the source of depression 0 Less than 10 of people who experience major loss in life end up depressed What are the Psychodynamic Treatments of Unipolar Depression Basically same treatment as normal psychodynamic models encourage free association interpreting the client s associations dreams examples of resistance and transference help clients review past experiences and feelings Long term psychodynamic therapy is found to be only occasionally helpful 0 Depressed clients are typically passive may feel too weary to fully participate in therapy 0 Depressed clients are likely to become discouraged and quit therapy when it doesn t provide immediate relief 0 Shortterm approaches seem to work better The Behavioral Model Unipolar depression results from signi cant changes in the number of rewards and punishments a person receives in their lives Goal is to help clients build better patterns of reinforcement 0 Around 123 million new case of mood disorders emerge each year worldwide 0 Lewinsohn Ieading clinical theorist in behavioral model for clinical depression The Behavioral Explanation o Lewisohn combined behavioral and cognitive strategies Social rewards are particularly important in the development of depression What are the Behavioral Treatments for Unipolar Depression 1 Therapists identi es activities that the client enjoys and encourages them to set up a weekly schedule to engage in them Ensure that the person s behaviors are rewarded positively praising constructive behavior and statements and ignoring depressive behaviors Therapist may help teach client in effective social skills When 2 of these techniques are used the treatment does appear to reduce depressive symptoms Cognitive Model Suggests that people with unipolar depression usuay view events in a negative way which leads to depression N UL 0 People become depressed when they think they no longer have control of their own lives and that they themselves are responsible for this hepess state 0 Attributionhelplessness theory people begin to view events as outof their control why ask themselves why ex quotI m internal not good at anything global I do and won t ever be stablequot Theory of Negative Thinking 0 says negative thinking is central problem in depression o my general worth is tied to every task I performquot 0 Later in life maladaptive behaviors result in an extended round of negative thinking as a response to upsetting events Individuals interpret their experiences themselves or their futures in negative ways Arbitrary inferences negative conclusions based on little or no evidence Habits of minimizing positive experiences and magnifying negative ones Automatic thoughts numerous unpleasant thoughts that help to cause or maintain depression anxiety or other forms of psychological dysfunction that quotseem to happen like a re exquot o Theories are supported by research What are the Cognitive Treatments for Unipolar Depression 0 Cognitive therapy Helps people identify and change the maladaptive assumptions and ways of thinking that caused their psychological disorders 0 Has a lot of behavioral components 0 Usually requires less than 20 sessions has 4 phases 1 Increasing activities and elevating mood 2 Challenging automatic thoughts 3 Identifying negative thinking and biases 4 Changing primary attitudes 5060 of people to receive cognitivebehavioral therapy show a near total elimination of symptoms 0 New wave of cognitive theorists use an Acceptance and Commitment Therapy approach to depression accept negative thoughts as just a stream of thoughts rather than a valuable guide for behavior in order to better work around them 617 The Sociocultural Model of Unipolar Depression The Family Social Perspective 0 Depression is tied to the unavailability of social support 0 Research shows people who live in isolation and without intimacy are more likely to get depressed Length of depression is tied to availability of social support FamilySocial Treatments 0 Most effective approaches interpersonal psychotherapy and couples therapy Interpersonal Psychotherapy IPT Developed by Gerald Klerman and Myrna Weissman o Interpersonal Psychotherapy treatment for unipolar depression that is based on the belief that clarifying and changing one s interpersonal problems will lead to recovery 0 Requires around 16 sessions 0 4 areas of interpersonal problems 1 interpersonal loss loss of a loved one explore the relationship the client had with that person and express any feelings of anger discovered 2 interpersonal role dispute when two people have different expectations about the role each should play examine the role disputes and solve them 3 interpersonal role transition brought about by major life changes like divorce or having a baby therapists encourage the development of the social supports and skills that the new roles require 4 interpersonal de cits extreme shyness or awkwardness that prevents intimate relationship development therapists help clients recognize de cits and teach them social skillsassertiveness Studies show a similar success rate to cognitivebehavioral therapies for depression 0 Especially helpful for depressed people going through changes in their careers or social roles Couple Therapy Coupe Therapy therapy format in which a therapist works with two people who chare a longterm relationship 0 Behavioral Marital Therapy helps souses change harmful marital behavior by teaching them speci c communication and problem solving skills The Multicultural Perspective 0 Two issues in particular have been focused on by multicultural theorists links between gender and depression and cultural and ethnic backgrounds and depression Gender and Depression 0 Strong link exists between gender and depression 0 Women are twice as likely as men to receive a diagnosis of unipolar depression Artifact Theory women and men are equally prone to depression but therapists fail to detect depression in male clients women show more emotional symptoms 0 No real research support Hormone Explanation hormone changes trigger depression in women along with important social and life events surrounding puberty pregnancy and menopause o Postpartum depression Body Dissatisfaction Explanation women in Western society are taught to seek low body weight and slender body shape unreasonable unhealthy and often unattainable goals which results in peer pressure and a greater dissatisfaction with their bodies and weight 0 Cultural standard for men is much more lenient 0 Gender differences in depression appear rst during adolescence supporting this theory 0 May be caused by depression not the cause of depression Lack of Control Theory picks up on learned helplessness research women feel less in control of their lives than men women are more likely than men to be a victim of a crime crime induces feelings of helplessness Rumnation Theory women are more likely to ruminate than men tendency to keep focusing on one s feelings when depressed and consider repeatedly the causes and consequences of that depression Cultural Background and Depression symptoms of sadness joylessness tension lack of energy loss of interest loss of concentration ideas of insufficiency and thoughts of suicide seem to be similar worldwide but depression does differ between countries 0 nonWestern Countries more likely to be troubled with psychical symptoms fatigue weight loss sleep disturbance than cognitive symptoms selfblame low selfesteem and guilt Few differences in depression symptoms between races and ethnic groups Insigni cant differences in overall depression rates between minority groups Huge differences in recurrence of depression among different racialethnic groups 0 HispanicAfrican Americans are 50 more likely than white Americans to have recurrent episodes of depression Why Treatment levels vary around 54 of Americans get treated while only 34 and 40 of Hispanic Americans and African Americans respectively 0 Depression is distributed unevenly between some minority groups More common in US in Hispanic and African Americans that were born in the US Multicultural Treatments Culture Sensitive Therapies seek to address the unique issues faced by members of cultural minority groups Being increasingly combined with traditional forms of therapy 62 Bipolar Disorders 621 What are the Symptoms of Mania People in a state of mania experience dramatic and inappropriate rises in mood and activity Symptoms span the same ve areas emotional motivational behavioral cognitive and physical but affect those areas in the opposite way 0 Anger is typical when others get in the way of their exaggerated ambitions Manic people typically want constant excitement involvement companionship Very active quick movement amboyance Poor judgement and planning very optimistic Little or no sleep is ne 622 Diagnosing Bipolar Disorders 0 May even have delusions or hallucinations Two types of bipolar disorder Possible to have mixed episodes times where manic and depressive symptoms are expressed at the same time Untreated cases symptoms usually eventually subside but without treatment mood disorders tend to reoccur 126 of adults battle with a bipolar disorder at any time Equally common in men and women 0 More common in poorer people Onset between 15 and 44 years old o 04 of the population has cyclothymic disorder 0 Onset adolescence or early adulthood o Eventually turns into bipolar 1 or 2 623 What Causes Bipolar Disorder Neurotransmitters Electrically charged ions play a critical role in message relay inside neurons Positively charged ions sit on both sides of a neuron39s cell membrane 0 When a neuron is a rest more ions sit outside the membrane but when the neuron is receiving a message at its incoming receptor sites sodium ions move to inside the cell membrane causing the neuron to become positively chargedneural quot ringquot Brain Structure 0 Brain scans and autopsies have found abnormal brain structure in individuals with bipolar disorders 0 Basal ganglia and cerebellum tend to be smaller 0 Amygdala hippocampus prefrontal cortex have structural abnormalities Genetic Factors 0 Family pedigree research supports the idea of genetic predisposition o Identical twins have a 40 likelihood of developing the same disorder 0 510 chance for fraternal twins and siblings Genetic Linkage studies studies to identify the possible patterns of inheritance of bipolar disorders 0 Molecular biology used to study genetic predispositions o Bipolar disorders linked to chromosomes 1 4 6 10 11 12 13 15 18 21 and 22 624 What are the Treatments for Bipolar Disorders Lithium and other Mood Stabilizers 1970 FDA approved lithium use to stabilize moods Very well supported by research in treating mania 60 of patients improve Risk of relapse is 28x greater if patients stop taking a mood stabilizer Mood Stabilizing Drugs psychotropic drugs that help stabilize moods of people suffering from bipolar disorders 0 Ex Antiseizure medication carbamazepine tegretol and alproate Depakote 0 Some people respond best to a combination of mood stabilizing drugs and atypical antipsychotic drugs 0 Help manic episodes and depressive episodes help manic episodes more relatively Researchers don39t fully understand how mood stabilizing drugs work but suspect that they alter synaptic activity but in a different way than antidepressants o Antidepressants effect the initial reception of neurotransmitters in an action potential 0 Mood stabilizers appear to affect a neuron39s second messengers Second messengers chemical changers within a neuron just after the neuron receives a neurotransmitter message and just before it responds o Mood stabilizers increase the production of neuroprotective proteins which increases cell health and functioning reducing bipolar symptoms Neuroprotective proteins key proteins within certain neurons whose job it is to prevent cell death Adjunctive Psychotherapy Psychotherapy alone isn39t very helpful in treating bipolar disorders neither are mood stabilizers Many clinicians use individual group of family therapy in addition to the use of mood stabilizers 0 Therapy goals are to highlight the importance of continuing medication and solving social family school and occupational problems cause by their disorder 0 Little research but the research that exists says adjunct therapy is shown to reduce hospitalization improve social functioning and increasemaintain a client39s a client39s ability to hold a job Chapter 8 Disorders Featuring Somatic Symptoms Psychological factors may contribute to somatic bodily illnesses Mindbody dualism idea that the mind and body are totally separate 17th century Descartes 20th century idea and studies emerged suggesting that stress worry and even unconscious needs can contribute to bodily illnesses 81 Factitious Disorder Munchausen Syndrome give themselves medications research their supposed conditions induce symptoms When confronted patients typically deny the allegations and exit the situation Begins during early adulthood Particularly common among people who 0 Received extensive medical treatments as children 0 Carry a grudge against the medical profession 0 Have worked as a nurse lab technician or medical aide Factors like depression lack of supportive parental relationships as children extreme need for social support may contribute to the development of this disease No dependable treatments developed yet Doctors report annoyance with people with factitious disorder but the patients feel as though they can t help it 0 630 of Munchausen by proxy patients die as a result of their symptoms 0 8 of those who survive are permanently dis gured or physically impaired o Psychological education and physical development can also be affected 82 Conversion and Somatic Symptom Disorder 0 When a bodily ailment has an excessive and disproportionate impact on the individual has no apparent medical cause or is inconsistent with known medical diseases it may be diagnosed as Conversion Disorder or Somatic Symptom Disorder 821 Conversion Disorder Often very hard to distinguish from a real medical problem always possible that a diagnosis of conversion disorder is the result of an undetected neurological problem 0 Clues symptoms may be at odds with the way the nervous system is known to work 0 Physical effects of a conversion disorder may also differ from those of the corresponding medical problem When paralysis occurs from neurological nerve damage muscles atrophy or deteriorate But in conversion induced paralysis the muscles do not atrophy People with conversion disorder do not consciously want or produce their symptoms and believe that their medical problems are genuine Usually begins in late childhoodyoung adulthood 0 2x as common in women than men 0 Typically appears suddenly lasts a matter of weeks Ve ry ra re 822 Somatic Symptom Disorder Longer lasting but less dramatic symptoms than conversion disorder symptoms Causes of symptoms may or may not be able to be identi ed 0 Regardless patient s concerns about the illness are disproportionate to the seriousness of the bodily problems Somatization Pattern First described by Briquet as Individual experiences a that are often exaggerated and described dramatically can last for years some uctuation but rarely disappearing o Often including pain gastrointestinal symptoms sexual symptoms and neurologicaltype symptoms Patients typically go from doctor to doctor to seek relieftreatment Patients are often anxiousdepressed Pattern often runs in families Typically begins between adolescence and young adulthood Predominant Pain Pattern Person s primary bodily problem is pain Concerns and disruption caused by pain symptoms is disproportionate to its severity Appears to be fairly common more common in men and can start at any age Often develops after an accidentinjury that causes genuine pain which takes on a life of its own 823 What Causes Conversion and Somatic Symptom Disorders Late 19th century AmbroiseAuguste Li bault and Hippolyte Bernheim research helped foster the idea that psychological factors were the cause of hystericalquot disorders o Funded Nancy School in Paris for treatment of mental disorders where they produced hysterical symptoms in otherwise normal patients by hypnotic suggestion and then quotcurequot them by the same means suggesting if psychological changes could produce and remove symptoms maybe they really were psychological The Psychodynamic View Freud s psychoanalysis theory stemmed from his effort to explain hysterical disorders 0 After becoming interested in the work of Breuer a physician that treated a woman presenting hysterical symptoms with hypnosis Freud came to believe that hysterical disorders are a quotconversion of underlying emotional con icts into physical symptomsquot Because most of Freud s patients were women he centered his explanation around the needs of girls during their phallic stage 35yo o Electra compex girls experience sexual feelings for their fathers and also realizes she must compete with her mother for his attention but understanding the taboo and power position of her mother represses and rejects these feelings If parents overreact she may reexperience sexual anxiety throughout her life and eventually begin to hide their sexual anxiety by unconsciously converting them to psychical symptoms Today s psychodynamic theorists take issue with some parts of Freud s theories but do agree that conversion and somatic symptom disorders are caused by childhood anxiety that has been carried forth into adulthood that arouse anxiety that is converted into quotmore tolerablequot physical symptoms Psychodynamic theorists propose two mechanism at work within these disorders 0 People achieve primary gain when their bodily symptoms keep internal con icts suppressed 0 People achieve secondary gain when their bodily symptoms allow them to avoid unpleasant activities or receive sympathy from other Little research support The Behavioral View Behaviorist propose that the physical symptoms of conversion and somatic symptom disorders bring rewards to the sufferers etc o In response sufferers learn to display the symptoms more and more prominently People who are familiar with an illness will adopt its physical symptoms much easier Little research support The Cognitive View Cognitive theorists propose that conversion and somatic symptom disorders are People who know the quotlanguage of physical symptomsquot are prime candidates to employ this medium to express emotions Little research support The Multicultural View Most western clinicians believe that it is inappropriate to producefocus excessively on somatic symptoms caused by personal stress 0 Some call this the Western Bias idea that somatic reactions are an inferior way of handling emotions Other nonWestern cultures view somatic symptoms as a socially and medically correct and far less stigmatizing reaction to personal stress China japan and Arab countries have a high rate of somatic stress reactions tslllls 34 Diserders The Hve Semeliis Symplems S ympl ems Velluntery Linked is 7 An Cantrell at 7 F syshesesinl Apparent Di serdler Sa yrnpterns Faster Geel Melingieri mg rss Maybe 1 es Feslilieus diserder Ties r es Censersin sl isersler He lies Maybe Elemelis symlp lem diserder He quot T es Meybe Illness ensiew disersler Me Yes He Psychephysielegisel diserdler Me Yes He Physical illness He Maybe He llirss ep39t rr inesliitfsrll utteiltisni from Fundamentals of Abnormal Psychology Comer 824 How are Conversion and Somatic Symptom Disorders Treated Psychotherapy is usually a last resort they believe their symptoms are completely medical Therapists usually focus on the causes of the disorders the traumaanxiety tied to the symptoms o Psychodynamic theorists help clients identify underlying fears o Behaviorist therapists use 0 Biological therapists use Some therapists focus on the physical symptoms o Suggestion approach offering emotional support and hypnotically or persuasively telling clients that their physical symptoms will soon disappear o Reinforcement approach arrangement of rewards doe a client s sickness symptoms and increase the rewards for healthy behaviors 83 Illness Anxiety Disorder Most often begins in adulthood 15 of people experience the disorder men and women equally Symptoms rise and fall over the years 0 Theorists explain it typically like any other anxiety disorders 0 Behaviorists classical conditioning or modeling 0 Cognitive theorists people are threatened by bodily cues so they misinterpret them 0 Treatment Similar to obsessive compulsive disorder treatments Antidepressants Exposure and response prevention treatment Cognitive therapy Identifying challenging and changing the illnessrelated beliefs 0 000 831 Traditional Psychophysiological Disorders Ulcers lesions that form in the wall of the stomach or duodenum resulting in burning sensations pain occasional vomiting and stomach bleeding 0 Experienced by 25000 people in the US lifetime prevalence o Often caused by an interaction of stress factors Ex environmental pressure or intense anger or anxiety plus physiological factors like bacteria Asthma medical problem narrowing of the trachea and bronchi resulting in shortness of breath wheezing coughing and a choking feeHng o 25 million people in the US currently suffer from asthma o Onset most often in childrenyoung teens o 70 of cases appear to be caused by stress factors Insomnia difficulties initiating and maintaining sleep 0 10 of people about 14 of the population yearly experiences insomnia that lasts months or years 0 Dyssomnias sleep disorders disturbance in amount quality or timing of sleep 0 Parasomnias sleep disorders abnormal events that occur during sleep Chronic headaches frequent intense headaches not caused by another disorder 0 Muscle ContractionTension Headaches pain at the back or front of the head and back of the neck 45 million Americans suffer from tension headaches o Migraine Headaches severe headaches that occur on one side of the head often preceded by a warning sensation dizziness nausea vomiting Two phase development 1 blood vessels in the brain narrow restricting blood ow to the brain 2 same vessels later expand rapid blood ow overstimulation of neurons 23 million Americans suffer from migraines Hypertension chronic high blood pressure 0 Estimated 75 million people in the US suffer from hypertension 0 Essential hypertension hypertension caused by a combination of psychological and physiological factors Coronary Heart Disease heart illness caused by blockages in the coronary arteries 0 Myocardial infarction heart attack What Factors Contribute to Psychophysiological Disorders Biological Factors 0 Too easily stimulated overreaction may cause overstimulation of organs causing a psychophysiological disorder 0 People bay display favored biological reactions that raise their chances of psychophysiological symptoms 832 People that already experience a rise in blood pressure due to stress may be more likely to develop hypertension Psychological Factors People with styles are more likely to developing psychophysiological disorders personality pattern characterized by hostility cynicism drive impatience competitiveness and ambition which may lead to coronary heart disease 0 Friedman and Rosenman 73pe B Personality Stye personality pattern characterized by relaxed attitudes less aggressive and less concerned about time Sociocultural Factors The Multicultural Perspective Adverse social conditions may contribute to psychophysiological disorders as they produce excessive stress Most negative social condition Hispanic Health Paradox the relatively positive picture of Hispanic Americans in the face of clear economic disadvantage 0 May be due to stronger family and social support that is the norm in Hispanic culture New Psychophysiological Disorders Interaction between biological psychological and sociocultural factors can produce psychophysiological disorders Are Physical lllnesses Related to Stress Psychoneuroimmunology Immune System body s network of activities and cells that identify and destroy antigens and cancer cells Antigens foreign invader of the body a bacterium of virus o Helper T cels identi es antigens and multiplies and triggers the production of other immune cells 0 Natural killer T cels seeks out and destroys body cells that have been infected with a virus 0 Bcels produce antibodies protein molecules that recognize and bind to antigens and mark them to be destroyed Researchers now believe that stress can interfere with the activity of lymphocytes increasing susceptibility to illness Roger Bartrop landmark study 0 Compared immune systems of 26 normal people to 26 people whose spouses died eight weeks earlier 0 Blood testing shows dramatically low lymphocyte activity in grieving people Biochemical Activity Excessive norepinephrine contributes to low lymphocyte activity 0 After an extended amount of time high norepinephrine sends an inhibitory signal to stop the activity of lymphocytes Adrenal release of corticosteroids for extended periods of time sends an inhibitory message to lymphocytes 0 Also can increase the production of cytokines proteins that bind to receptors throughout the body that can lead to chronic in ammation Behavioral Changes Stress may produce feelings of anxiety or depression Sleeping and eating poorly smoke or drink more Personality Style Even under extreme stress people who are resilient optimistic and constructive copers experience better immune functioning Research surfacing that spiritual people tend to stay healthier under stress Research surfacing that certain personality traits are linked to a person s ability to ght off cancer some people even argue there is a link between personality and cancer outcome Social Support People with little social support who quotfeel lonelierquot typically have reduced lymphocyte activity during times of prolonged stress 833 Psychological Treatments for Physical Disorders Behavioral medicine a eld that combines psychological and physical interventions to treat or prevent medical problems People can be taught to relax their muscles at will a process that sometimes reduces feelings of anxiety Common treatment for high blood pressure 0 Patients are connected to machinery that gives them continuous readings about their involuntary body activities with the goal that the patient can learn to relax certain muscles at will 0 Can be used to treat pain migraines and asthma Meditation turning ones concentration inward achieving a slightly changed state of consciousness and temporarily ignoring stressors o Mindfulness Meditation meditators pay attention to the thoughts feelings and sensations that go through the mind during meditation with detachment and objectivity and without judgment Commonly used to manage pain and treat high blood pressure 0 Patient is put in a sleeplike suggestible trance Commonly used in treatment of pain insomnia skin diseases Cognitive Interventions 0 People with physical ailments have sometimes been taught new cognitive attitudes towards their ailments as part of their treatment 0 Ex selfinoculation training helps patients cope with pain by identifying and ridding themselves of unpleasant thoughts that emerge during pain episodes negative selfstatements Support Groups and Emotion Expression 0 Support groups that guide people to become more aware of their emotions and to express them tend to bene t ill people 0 Research shows that discussing or even writing down past and present emotions may improve a person s health Combination Approaches Psychological interventions for physical problems tend to be equally as effective and more effective than a placebo o Psychological interventions are often of greatest help when used in combination with each other and medical treatments


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