Clinical Psychology Exam 1 Study Guide
Clinical Psychology Exam 1 Study Guide 031:013
Popular in Introduction to Clinical Psychology
Popular in Psychlogy
This 36 page Study Guide was uploaded by Allysa Yi on Sunday January 11, 2015. The Study Guide belongs to 031:013 at University of Iowa taught by Teresa Treat in Fall2014. Since its upload, it has received 239 views. For similar materials see Introduction to Clinical Psychology in Psychlogy at University of Iowa.
Reviews for Clinical Psychology Exam 1 Study Guide
Report this Material
What is Karma?
Karma is the currency of StudySoup.
You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!
Date Created: 01/11/15
Clinical Psychology Exam 1 Contemporary Clinical Psychology Proliferation of pseudoscientific understandings asses ants and treatments 0 Pseudoscientific a claim belief or practice which is presented as scientific but does not adhere to a valid scientific method lacks supporting evidence or plausibility cannot be reliably tested or otherwise lacks scientific status 0 By understandings I mean instead on personal experience but on research Hterature Controversy about whether clinical is quotartquot or quotsciencequot bc of the personal experience than research Challenges Facing Scientific Clinical Psychology Overstatement of clinical phenomena such as depression I Precision of assessments Accuracy of predictions Treatment effectiveness Mental Disorder Clinically significant abnormal behavioral or psychological syndrome Associated with at lest one of the following inclusion criteria 0 Distress Painful or upsetting 0 Disability Impairment in functioning I Domains include work school relationships and family 0 Increased Risk of death pain disability loss of freedom Potential s harm to self or others I NOT associated with one of the following exclusion criteria 0 Expectable reaction to a particular event I Ex sad when a friend just died 0 Deviant behavior I Just unusual clothing and behavior cannot be exactly considered to be deviant behavior 0 Conflict bn individual and society I Ex homosexuality 9 So summary DSMS Definition A mental disorder is a syndrome characterized by clinically significant disturbance in an individual39s cognition emotion regulation or behavior that reflects a dysfunction in the psychological biological or developmental processes underlying mental functioning Mental disorders are usually associated with significant distress in social occupational or other important activities An expectable or culturally approved response to a common stressor or loss such as the death of a loved one is not a mental disorder f extended or complicated in unordinary ways can then be considered for a mental disorder Socially deviant behavior eg political religious or sexual and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above DSMIV 4 Used a multiaxial categorical approach Axis 1 Clinical Disorders Usually primary focus of treatment Usually more recent onset and usually more changeable or modifiable like throughout life as in it s more likely to be treatable and like can be changed Ex Anxiety Axis Personality Disorders Enduring patterns of perceiving relating to or thinking about environment and oneself Usually life long but treatments can make it adaptable just can t be completely treatedchanged like clinical disorders Maladaptive and inflexible and tend to cause impairment and distress Axis notice it s still axis 2 Mental Retardation DSM 4 Axis One Eating Disorders Criteria for Anorexia Nervosa Refusal to maintain body weight at or above a minimally normal weight for age and height for example weight loss leading to maintenance of body weight lt85 of that expected or failure to make expected weight gain during period of growth leading to body weight less than 85 of that expected Intense fear of gaining weight or becoming fat even though underweight Disturbance in the way one39s body weight or shape is experienced undue influence of body weight or shape on self evaluation or denial of the seriousness of the current low body weight Amenorrhea at least three consecutive cycles of missing period in postmenarchal girls and women Looks anorexic but still getting periods EDNOS Criteria for Bulimia Nervosa Recurrent episodes of binge eating characterized by both Eating in a discrete period of time eg within any 2hour period an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances A sense of lack of control over eating during the episode defined by a feeling that one cannot stop eating or control what or how much one is eating Recurrent inappropriate compensatory behavior to prevent weight gain Selfinduced vomiting most common Misuse of laxatives diuretics enemas or other medications Fasting Excessive exercise The binge eating and inappropriate compensatory behavior both occur on average at least twice a week for 3 months Self evaluation is unduly influenced by body shape and weight If you are diagnosed as anorexic you can t be diagnosed as bulimic as well Its one or the other Criteria for EDNOS Eating Disorder Not Otherwise Specified EDNOS includes disorders of eating that do not meet the criteria for any specific eating disorder Examples include For female patients all of the criteria for anorexia nervosa are met except that the patient has regular mensesperiods All of the criteria for anorexia nervosa are met except that despite significant weight loss the patient39s current weight is in the normal range All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur less than twice a week or for less than 3 months The patient has normal body weight and regularly uses inappropriate compensatory behavior after eating small amounts of food The patient engages in repeatedly chewing and spitting out but not swallowing large amounts of food Bingeeating disorder Recurrent episodes of binge eating in the absence of regular inappropriate compensatory behavior characteristic of bulimia nervosa o Binge eating common thing to associate with is obesity but obesity is not in DSM bc not mental disorder DSM 4 Axis 2 Disorders examples Antisocial personality disorder borderline personality disorder obsessivecompulsive personality disorder and moderate mental retardation DSM 4 Axis m General Medical Conditions Play a role in the development continuance or exacerbation of Axis I and II Disorders Axis m PsychosocialEnvironmental Problems Problems with primary support group Problems related to social environment Educational problem Occupational problem Housing problem Economic problem Problems with access to health care services Problems related to interaction with legal system crime Axis I Global Assessment of Functioning It s a scale from 0100 Superior functioning in a wide range of activities amp Symptoms are transient expectable reactions to psychosocial stressors Q Moderate symptoms eg flat affect and circumstantial speech occasional panic attacks OR moderate difficulty in social occupational or school functioning eg few friends conflicts with peers or coworkers 4O Some impairment in reality testing or communication 1O Persistent danger of severely hurting self or others OR persistent inability to maintain minimal personal hygiene OR serious suicidal act 9 Starting around 50 is serious consideration of hospitalization Examples of each Axis Axis I Anorexia Nervosa Major Depressive Disorder Recurrent Severe wo Psychotic Features Axis II ObsessiveCompulsive Personality Disorder Axis III Secondary Amenorrhea Malnutrition Dehydration Bradycardia Arrhythmia Hypophosphatemia Axis IV Recently leaving college midsemester because of severe conflict with family members over illness Axis V Scale from 0100 45 tends start getting serious Strengths of DSMIV Facilitates communication about disorders Criteria more specific objective and researchbased than in prior DSM editions 0 Greater reliability more consistency and greater validity the quality of being logically or factually sound Ideally guides treatment selection 0 Especially if homogeneous presentations within disorder Diagnosis used to justify thirdparty payment like insurance Promotes research in psychopathology o Epidemiology disorder distribution in population 0 Etiology causes of disorder 0 Course how disorder plays out over time 0 Treatment development and evaluation Concerns about DSMIV Mental disorders not infrequent 0 Prevalence of axis disorders are 26 Heterogeneity of symptom profiles within diagnosis 0 Heterogeneity 2 patients with the same disorder can have largely non overlapping features DSM overpathologizes as in treats more than necessary occurs more than they would eritto Many disorder subtypes and features not based on empirical data Comorbidity of diagnoses is substantial o Comorbidity cooccurrence of disorders 0 Ex those with major depression have anxiety disorders In fact 64 of them did Coverage of disorders in DSM 0 There are almost 400 diagnoses are there too many Too less Potential bias in diagnostic system or its application Bias based on primarily gender 0 Such as women being more diagnosed with depression than men Is that real or is that bias Culture differences 0 Are we underestimating their diagnoses Do we truly know their culture to make such diagnoses Why include things in DSM DISTRESS IMPAIREMENT INTEREFERENCE Interrater reliability Consistency of diagnostic judgments across raterstherapists Kappa index of interrater reliability of classification 0 O 40 poor 0 41 75 fair 0 76 10 excellent Diagnostic validity Extent to which diagnostic category accurately captures abnormal phenomenon of interest Typical indicators 0 Homogeneity across those receiving diagnosis in etiology course treatment response etc Lots of challenges 0 Low interrater reliability 0 High amounts of comorbidity o Heterogeneity of symptom profiles within diagnoses Approaches to organizingdeciding how to diagnose Categorical approach You either have it or you don t 0 This is what the current DSM is like 0 Dimensional approach More quantitative than qualitative 0 Patient can have various levels of characteristics 9 Research has shown that the difference bn quotnormalquot and quotabnormalquot behavior frequently is more to a degree rather than whether you have it or not Dimensional approach may provide more valid portrayal of many clinical phenomena What Changed in DSM5 Axes 1 2 and 3 were a merged Many new diagnoses were added 0 Premenstrual Dysphoric Disorder 0 Binge Eating Disorder Modifications to mood and anxiety disorders Modifications to substancerelated disorders Modifications to personality disorders Pros and cons of opening up suggestions online regarding DSM Pro have others back up on info and actual valuable insights sometimes Con Lots of crap from some people DSM5 Eating Disorder Changes 1 Anorexia bodyweight requirement 85 of ideal body weight replaced by requirement that weight be significantly low in the context of person s age sex developmental trajectory and physical health 2 Amenorrhea no longer required for anorexia diagnosis Which means men is included now 3 Frequency criteria for binging and purging decreased to once a week from twice a week for the bulimia diagnosis 4 Binge eating disorder now quotrealquot disorder no longer has provisional status in Appendix Note Obesity considered for inclusion as a psychological disorder in DSM5 but ultimately not included DSM5 Criteria for Anorexia Nervosa Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age sex developmental trajectory and physical health Significantly low weight is defined as a weight that is less than minimally normal Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain even though at a significantly low weight Disturbance in the way one39s body weight or shape is experienced undue influence of body weight or shape on self evaluation or persistent lack of recognition of the seriousness of the current low body weight DSMS Criteria for Bulimia Nervosa Recurrent episodes of binge eating Eating in a discrete period of time eg within any 2hour period an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances A sense of lack of control over eating during the episode defined by a feeling that one cannot stop eating or control what or how much one is eating Recurrent inappropriate compensatory behavior to prevent weight gain such as self induced vomiting misuse of laxatives diuretics enemas or other medications fasting or excessive exercise Binge eating and inappropriate compensatory behavior both occur on average at least once a week for 3 months Self evaluation unduly influenced by shape and weight DSMS Criteria for Binge Eating Disorder Recurrent episodes of binge eating as for bulimia Bingeeating episodes associated with three or more of the following Eating more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of feeling embarrassed by how much one is eating Feeling disgusted with oneself Depressed or very guilty afterward Marked distress regarding binge eating is present Binge eating occurs on average at least once a week for 3 months Binge eating not associated with recurrent use of inappropriate compensatory behavior and does not occur exclusively during anorexic or bulimic episodes DSMS Criteria for EDNOS Symptoms characteristic of an eating disorder that cause clinically significant distress or impairment predominate but do not meet the full criteria for any of the disorders in the eating disorders diagnostic class The otherspecified eating disorder is used when the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific eating disorder Examples Atypical anorexia nervosa weight withinabove normal range Bulimia nervosa of low frequency or limited duration Bingeeating disorder of low frequency or limited duration Purging disorder bulimia without binge eating Commonly occurs when there is insufficient information to make more specific diagnoses as in emergency room settings Sexual Aggression bn Acquaintances on College Campuses Prevalence of MaleInitiated Aggression toward Women 0 quot 2025 of undergraduate women report an attempted or completed rape by a man during college 0 quot 8 of undergraduate men report engaging in an attempted or completed rape of a woman during college Potential contributors to why 0 Alcohol Consumption Ra peSupportive Attitudes Impulsivity Highrisk contexts Sexual Aggression Child Abuse Peer Influences Misperception of sexual interest OOOOOOO Path Diagrams to Specify Hypothesis Path diagrams schematic depicting relationships 0 Doubleheaded arrow connecting two variables noncausal association bn two variables CORRELTIONAL o Sigheaded arrow connecting two variables causal effect of one variable on another CUASAL o Singeheaded arrow connecting first variable to path bn two other variables the first variable influences the relationship bn the other two variables Correlational variables related in noncausal fashion quotAlcohol MSI and SA associated with one another Double headed arrow Alcohol Sexual Consumption Aggression 0 Causal one variable or more causes another variable or more quotAlcohol and MSI cause SA Alcohol Sexual Consumption Aggression Misperception of Sexual Interest e I Specify Hypotheses gt Common forms of hypotheses 0 Mediational one variable at least partially accounts for relationship btw two other variables quotMSI mediates link btw alcohol and SA Relationship btw alcohol and SA gets smaller if MSI added to model Alcohol Sexual Consumption Aggression Misperception of Ssxualslnterest I Specify Hypotheses gt Common forms of hypotheses 0 Moderational one variable in uences relationship btw two other variables quotMSI moderates link btw alcohol and SA Strength of relationship btw alcohol and SA varies depending on how much MSI is present Eg Alcohol increases likelihood of SA only if MSI is present Misperception tells us the conditions under which an affect occurs With alcohol misperception increases the likelihood of sexual aggression l MSI Absent Alcohol Sexual Consumption Aggression l MSI Present 7 Sexual Aggression Misperception of Sexual Interest Alcohol Absent Alcohol Present l Specify Hypotheses gt Practice State in words what path diagrams say Sexual Aggression Peer In uences Alcohol consumption accounts for the effect of peer in uences on sexual aggression Alcohol consumption is the mediator bn peer in uences and sexual aggression Mediator The effect of peers is affected by whether alcohol is present Alcohol moderates peer in uences and sexual aggression Moderator Sexual Aggression Peer In uences Mediator variables specify how or why a particular effect or relationship occurs Moderator variables change the strength of an effect or relationship bn 2 variables 1 Receiving a nasty email from a coworker leads to feelings of anger which reduce overall job satisfaction Mediation 2 Access to free treats during break creates positive emotional responses for workers except for those who have high negative affect ie who are perpetually grumpy Moderation Important considerations 0 Internal Validity of Study 0 Extent to which causal interpretations justified and alternative causal explanations ruled out 0 Higher for experimental studies than correlational studies 0 Tells us how strongly our results are 0 External Validity of Study 0 Generalizability of findings beyond study 0 Tells us how broadly the results might generalize 9 As internal validity increases external validity decreases Research Designs Case Studies Detailed description of links btw variables for small number of people Ex evaluate whether alcohol related to MSI in interview with two students alleged to have exhibited SA Pros amp Cons 0 Internal validity low 0 External validity low Correlational Studies Examine associations bn variables for multiple people sample size is bigger Usually more than 30 0 Ex Does MSI correlate with SA risk Correlations r range btw 1 amp 1 0 1 Perfect negative correlation o O No association 0 1 Perfect positive correlation Correlations have both magnitude and direction 0 Magnitude is stronger as r increases doesn t matter if negative or positive just the one closer to 1 or 1 is stronger in magnitude 0 Direction of association is positive or negative I For positive correlation as X increases Y increases I For negative correlation as X increases Y decreases Pros amp Cons o More internal and external validity compared to case studies 0 Very hard to be confident about causality I Causal arrows may go in different directions I quotThirdquot variables may explain observed relationships I e internal validity weaker than in experimental designs Experimental Studies Examine effect of experimentally manipulated quotindependent variable IV on quotdependent variable DV or quotcriterion variable across multiple persons Random assignment to levels of IV 0 Ex evaluate whether manipulated level of alcohol consumption influences men s perceptions of women s sexual interest I IV alcohol consumption I DV perceptions of women s sexual interest Pros amp Cons 0 Relative to case and correlational studies internal validity higher 0 External validity varies across studies Notes 0 Can t manipulate all variables of interest 0 Clinical research designs often mix experimental and correlational strategies 0 Ex Does manipulated level of alcohol consumption have more impact on men s perceptions of women among highrisk men I DV alcohol consumption I Experimental influence alcohol consumption one group gets alcohol other may not or get other amounts I Naturally occurring nonmanipulated influence men s perceptions MetaAnalysis Integrates findings from multiple studies of similar research question 0 Ex Anderson amp Whitson 2005 examined effect of college sexualassault prevention programs on seven outcomes using 69 studies with 102 programs and 18172 participants Pros amp Cons o Greatly enhanced external validity o Greatly enhanced ability to detect small effects 0 Goldstandard approach to lit review and synthesis CrossSectional evaluates sample at single time Much cheaper less timeintensive good starting point Internal validity is generally lower Longitudinal follows same persons over time Helps understand development course and treatment of psychopathology Internal validity is generally higher Select Samples External validity of study hinges to great degree on representativeness of sample 0 Convenience samples 0 Random samples I Every person is equally likely to be chosen VERY challenging and expensive to get representative sample Koss et al 1987 National survey on scope of rape Administered to 6159 women and men 32 institutions representative of diversity of higher education settings in US Select A Measurement Strategy Self or other report Interview structured or unstructured O O O O Observational Biopsychological structural functional biochemical genetic physiological Performancebased eg intellectual cognitive or social functioning Archival Rapemyth assessment scale Burt 1980 11item scale measuring beliefs that rape is justified and women responsible for victimization Likertscale responses 0 1 strongly disagree 7 strongly agree Sample items 0 A woman who goes to the home or apartment of a man on their first date implies that she is willing to have sex One reason that women falsely report a rape is that they frequently have a need to call attention to themselves If a girl engages in necking or petting and she lets things get out of hand it is her own fault if her partner forces sex on her Many women have an unconscious wish to be raped and may then unconsciously set up a situation in which they are likely to be attacked Psychometrics adequacy of psychological measurement strategies Reliability Consistency of measurement 0 O TestRetest Reliability Consistency of responses over time Interrater Reliability Consistency ofjudgments across raters Validity accuracy of measurement 0 Content Validity extent to which item content reflects all aspects of concept of interest Are you measuring everything you should be measuring So like do you have all the content you need Face Validity extent to which measure appears to assess concept of interest quotg its face The extent to which a measure looks like what it s supposed to be measuring So like you have a list of symptoms per say and then give it to a specialist If they say it is what you are trying to measure then you re good Or you can give it to a lot of people and they all agree on the diagnosis then you re also good from that Concurrent Validity association of measure with another measure at same point in time Do the people who support rape attitude also say that they have sexually assaulted someone Predictive Validity association of measure with another measure at future point in time Do rape supportive attitudes predict someone sexually assaulting someone in the future o Convergent Validity association of measures intended to measure m or similar concepts Like those who support sexual assault also are violent in other ways The extent to which a measure comes togethercorrelates with other measures with similar concepts Ex compares your measure to like a quotgoldquot measure You want a strong positive correlation with other measures that are similar to what you are comparing So yes you are measuring what you are supposed to be measuring 0 Discriminant Validity association of measures measure intended to measure different concepts Ex endorsement of sexual assault and how you feel as your own sex role The extent to which a measure does not correlate with measures of other notrelated concepts So like it doesn39t correlate with another completely different concept You want to show a weak correlation So like you are not accidentally measuring something other than your intended measurement 0 Incremental Validity extent to which measure predicts more than what already could predict Example predicting psychopathic traits The extent to which a measure gives us a little bitsome more information than we had before we had that measure So did we get something new Did we get more data now compared to what we learned before Propose and Run Study Ethical Principles of Psychologists and Code of Conduct 0 American Psychological Association APA 2010 0 Relevant to all activities of clinical psychologist Five Principles 1 Beneficence amp nonmaleficence a Strive to benefit and do no harm 2 Fidelity loyalty amp responsibility are you taking care of what you need to take care of a Attend to professional and scientific responsibilities to society establish relationships characterized by trust 3 Integrity a Strive to be accurate honest and truthful 4 Justice a Foster access to and benefit from psychology recognize biases and boundaries of competence 5 Respect for people s rights and dignity a Respect and ensure protection of rights and dignity Standards Relevant to Research subset Seek approval from Institutional Review Board IRB Obtain informed consent 0 Procedures right to withdraw risks and benefits confidentiality limits incentives rights Do not offer excessive or coercive incentives for participation Keep responses confidential or anonymous Use deception only when other methods na Debrief participants about purpose of study Treat animals humanely Do not fabricate data or plagiarize Analyze Data and Interpret Findings Data Analysis Statisticalsignificance 0 Probability that effect occurred by chance alone quotpvalue 0 Effect is quotstatistically significant if p lt small value 05 0 Reliability of effect strongly influenced by N sample size 0 Ex p lt 05 so conclude alcohol does influence MSI 9 Relies heavily on sample size the smaller the p the better Practicalsignificance 0 Effect size I d standardized difference bn means SML small medium large 2 5 8 I r association btw variables SML 1 3 5 Statistical is about the reliability Practical is about the magnitude Report both statistical and practical or clinical significance Clinical Psych Discussion 3 3 purposes of the article on sexual assault with alcohol consumption 1 Review the literature 2 Critiquing the methods 3 Suggestions for future research to build on research and for fundingfunding is kind of the bigger one Why it39s hard to study sexual assault and alcohol consumption 0 Underreported 0 Women don39t know that it39s sexual assault andor rape bc it wasn39t by a stranger 0 Women feeling scared that people wouldn39t believe them 0 Guiltfeeling like it39s their fault 0 Can39t recreate the situation can39t be like rape them and let me watch you and study you kinda thing that39d be super awk Why do we want to know the amount of alcohol and sexual aggression 0 Want to make sure it39s valid Internal validity 0 How much control you have The more control the more confident you will be in your research External validity 0 How well you generalize your findings to other people or populations 0 Generalizability relies on sample size N the bigger the sample size the better Ways to go about this study Surveys pro anonymous fast and cheap big sample size cons lies and can39t ask followup questions Interviews pro you can followup con memory accuracy of recall expensive lower sample size Lab studies Pro 0 Labs have bars and they have certain amounts of people in there and give some people alcohol and others nonalcohol Then they put in a women who says and acts the same way to all men and then measuresobserves their sexual aggression 0 Establish cause and effect cause alcohol effect sexual aggression 0 High internal validity Con 0 Super expensive and takes a long time Major Depressive Disorder MDD DSMS Criteria A Five or more of the following symptoms Sx have been present during the same 2week period at least one of the Sx is either depressed mood 1 or loss of interest or pleasure 2 l Depressed mood most of the day nearly every day Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day Significant weight or appetite change Insomnia or hypersomnia nearly every day Psychomotor retardation or agitation nearly every day Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive guilt nearly every day Diminished ability to think or concentrate indecisiveness nearly every day Recurrent suicidal ideation plan or attempt lquot SDP NSBP1PP 9 MUST be nearly every day 36 are somaticbodily and 79 are cognitive B Significant distress g impairment C Sx not due to substance use or medical problem D Sx not better explained by another disorder E There has never been a manic or hypomanic episode Epidemiology Lifetime prevalence percent who will suffer at some point in lifetime 0 16 Current prevalence percent suffering now 0 quot6 Course and Outcome Age at onset 0 Average is 2429 years old 0 Earlier onset worsens prognosis so the younger you get it the more likely you ll get it again 0 Much more likely to have chronic when they are diagnosed earlier Number of episodes 0 Lifetime average 4 o 25 have 6 Duration of episodes 0 45 months Remission o 49 months if untreated Elevated suicide risk Etiology of MDD Biopsychosocial Model Biological psychological and social factors all influence the development of MDD Framework for organizing potential etiological influences on psychopathology Biological Influences Genes Abnormal genes typically in interaction with environment Neurotransmitter Systems Dysregulation of neurotransmitters and receptors Neurophysiology Abnormalities in structure and functioning of brain regions Neuroendocrine System Altered activity in hypothalamicpituitaryadrenal HPA axis Genetic Influences Behavior Genetics Study of degree to which genes and environment influence behavior Doesn t tell us m genes are responsible Helps to establish heritability of mental illnesses Percentage of variation in characteristic that is attributable to genetic influences TWIN STUDIES Identical twins monozygotic MZ Genetically identical share 100 of genes Fraternal twins dizygotic DZ Genetically as similar as nontwin siblings share 50 of genes So if both types were observed it was more likely for M2 twins to both get depression Estimation of Heritability h2 value Percentage of variation in characteristic that is attributable to genetic influences Ranges between 0 t0100 h2 62 for general cognitive ability in adult life h2 btw 30 50 for personality traits such as neuroticism and sensation seeking h2 for mental illnesses lt 50 Twin Studies eg Kendler et al 2006 Large nationally representative twin sample Concordance for MDD in M2 vs DZ twins Femalefemale M2 44 Femalefemale DZ 16 Malemale M2 31 Malemale DZ 11 MZ twins more similar than DZ twins so genetic effect on MDD is present Genetic effect is greater For females than for males hz quot 29 for males quot 42 females Molecular Genetics one example Serotonin transporter gene 5HTT Polymorphisms variations of gene ss two short alleles sl one short one long allele ll two long alleles 5HTT gene may influence vulnerability to depression when life stress occurs Caspi et al 2003 Life stress may moderate relation btw 5HTT gene and MDD 5HTT variant may moderate relation btw life stress and MDD 5HTT variant and life stress may interact to predict MDD Low in validity Molecular Genetics Study of influence of specific genes and environment on behavior Challenges facing molecular genetics Attempts to find specific genes involved in MDD and other clinical phenomena plagued by large number of nonreplications Genetic influences on mental illness polygenic Associated with configuration of several irregular genes not with singe disordered gene Genetic influences are not fixed but unfold and change across development in dynamic interaction with environmental factors Environmental factors can turn on and off genes Neurotransmitter Influences Neurotransmitter Systems Neurotransmitters are chemicals that facilitate communication across synapses btw neurons NTs released into synaptic gap to bind with receptors on postsynaptic membrane Abnormalities in number and sensitivity of receptors for monoamine neurotransmitters may be implicated in MDD Neurotransmitter Systems Norepinephrine Active in centralperipheral nervous systems Controlling heart rate blood pressure respiration Role in body s reaction to threat Serotonin Information processing movement coordination Inhibition restraint Regulation of eating sex aggression emotional reactions Dopamine Activation of other NTs Aid in exploratory and pleasureseeking behaviors MDD Initially thought serotonin and norepinephrine low Current view Balanceinteraction of three NT systems important Neurophysiological Influences BrainImaging Studies Structural Studies Focus on whether fewer cells or connections in brain region CAT scan MRI scan Structural and Functional Activation Studies Focus on whether change in activity of brain regions fMRI scan PET scan Abnormal Structure amp Function in MDD Prefrontal cortex Involved complex cognition approachrelated goals MDD decrease of gray matter decrease in metabolic activity Anterior cingulate Involved stress response emotional expression processing info MDD increased activity Amygdala Involved emotional processing MDD Increased activity Hippocampus Involved memory MDD decreased volume and decreased activity Neuroendocrine Influences Neuroendocrine system regulates hormones that influence basic motivational functions Hypothalamicpituitaryadrenal HPA axis produces stress hormones eg cortisol Depressed people show HPA hyperactivity and 1 cortisol levels Psychological Influences Stressful events 0 Stressful life events strongly related to onset of mood disorders 0 quot 90 of those who develop MDD had experienced a stressful event 0 Only 2050 of those experiencing severe events become depressed Diathesisstress model 0 Stress moderates effect of vulnerability factors or diatheses on depression 0 Stress acute stressful life events prior to depression 0 Diatheses stable chronic vulnerabilities that increase risk for mental illness biological social psychological Negative Cognitive Styles Beck s 1967 Cognitive Theory Depression results from negative interpretation of everyday events Beck s 1967 quotcognitive triad Negative views about selfworldfutu re Negative views about the world quotEverybody hates me because I am worthlessquot Negative views about Negative views about oneself the future quotI am worthlessquot HI39 new be 900d at anything because everyone hates mequot Burns 1980 quotErrors in thinking All or nothing thinking Seeing things in blackandwhite or absolute fashion Diego makes one mistake in a game and he sees himself as a total failure Overgeneralization Extrapolating from limited experiences or evidence to excessively broad generalizations Jing s relationship ends and she assumes that she will never have a lasting relationship Catastrophizing Anticipating worst possible outcome even when unlikely Joshua s new girlfriend does not call as promised and he spends the week convinced she39s going to break up with him Fortunetelling Predicting that things will turn out badly no matter what you say ordo Sara finds two typos in her paper after submitting it and tells herself she s going to fail the assignment Maladaptive Attributional Style Abramson et al s 1978 AttributionHelplessness Theory Depression results from tendency to explain events in maladaptive fashion Attribute negative events to stable global internal causes Example I couldn t play well because I m bad at sports in fact I m bad at everything Attribute positive events to unstable specific external causes Example when good things happen they say no it was just a fluke never credits themself Social amp Cultural Dimensions Gender amp Perceived Social Support Gender MDD twice as common in women as in men around world Nixed explanations Men less likely to report symptoms Hormonal explanations Possibilities ongoing research Women more likely experience chronic stressors as adults poverty caretaker responsibilities discrimination abuse Acceptance of established social roles among girls May intensity selfcritical attitudes about appearance which are related to depression May interfere with pursuit of quotnonfeminine rewarding activities May enhance perception of uncontrollability Rumination tendency to dwell on sad experiences and thoughts Perceived Social Support Persons with MDD have sparse and unsupportive social networks around world Low social support may i1 ability to handle stressful life events Complication Persons with MDD also tend to create interpersonal problems and i1 support of those around them Eg increase in negative affect and selfdisclosures increase in excessive reassurance seeking increase in rejection sensitivity Suicide What is suicide Centers for Disease Control 0 Suicide is death from injury poisoning or suffocation where there is evidence that the damage was selfinflicted and that the individual intended to kill himself or herself World Health Organization 0 Suicide is the act of killing oneself deliberately initiated and performed by the person concerned in the full knowledge or expectation of its fatal outcome Suicidal ideation 0 Thoughts about killing oneself Suicidal plan 0 Method the person could use to kill oneself Suicidal intent 0 Resolution to execute suicidal plan Suicidal attempt o Execution of suicidal plan Suicide 0 Death from deliberate selfinjury Nonsuicidalselfinjury o Behaviors intended to injure oneself without intent to kill oneself 0 1345 of adolescents engage in NSSI Epidemiology US Adults US Centers for Disease Control or CDC 20082009 quot 37 of adults report suicidal ideation in last year quot 10 of adults report suicidal plan in last year quot 05 of adults report suicide attempt in last year quot 02 of adults report suicide attempt in last year quot 12 out of 10000 commit suicide each year 2010 Suicide is 10th leading cause of death Varies with age gender race marital status Gender Suicide 45 times more likely among m Suicidal attempts 3 times more common among women Suicidal thoughts more common among women Most common method Males gunsfirearms Females Marital Status Suicide more common if divorced Varies with age gender race marital status Race Suicide rates higher for Caucasian Rates highest for Native Americans Age Suicide rates tend to increase with age Highest rates of suicide Caucasian males over 75 Epidemiology US College Students American College Health Association 2013 Surveyed 32964 students in 57 postsecondary institutions regarding last 12 months Percent Seriously considered suicide Q Attempted suicide 1i Intentionally injured self More Stats 2quot l leading cause of death Biological Factors Behavior Genetics Twin study example Glowinski et al 2001 Concordance rate for attempts among MZ twins 25 Concordance rate for attempts among DZ twins 128 Heritability HA25 Yes it can be heritable because it s higher in M2 twins than DZ twins Serotonin Low levels related to impulsive and aggressive behavior Genes regulating serotonin system may be involved Psychological Factors All mental disorders associated with increased risk quot80 of people who commit suicide have diagnosable mental illness 60 of suicides associated with mood disorder like depression or bipolar quot90 of people who attempt suicide have diagnosable mental illness Most with mental disorder do NOT attempt or commit suicide Alcohol use and abuse associated with 2550 of suicides Best predictor of suicide Previous attempt 30fold risk for male adolescents 3fold risk for female adolescents Hopelessness Impulsivity Emotional Reactivity Hopelessness Scale Beck et al 1974 My future seems dark to me Thinks just won t work out the way I want them to It is very unlikely that I will get any real satisfaction in the future H I look forward to the future with hope and enthusiasm H In the future I expect to succeed in what concerns me most H I can look forward to more good times than bad times Social amp Cultural Factors Stressful Life Events Economic hardship Serious illness Especially in older adults Natural disasters Loss and abuse and bullying Sexual minority adolescents As in gay bi and lesbians DiathesisStress Model Stress moderates effect of vulnerability factors or diatheses on suicide Stress Acute Stressful life events Diatheses Biological factors 39 Psychological factors Long term social factors Suicidal Behavior Clinical Psych Discussion DSM 4 either suicidal or not 0 The suicide scale is not in DSM 5 so it39s still whether you are or aren39t Best predictor of future suicidal attempt is past behaviorpast attempt Low baserate anything that does not happen freqaauently o Baserate how frequently something happens Suicide tends to be low baserate 0 Sometimes the psychologist will say that a patient is high risk when they are actually at low risk Anxiety Fear and Panic Attack Anxiety Apprehensionworry about a future threat Components Subjective what feel think Despair quotWhat am I going to do Behavioral Pace fidget panic avoid problemsolve Physiological what happens in body Increase in heart rate Stomach hurts Sweating Shortness of breath Tense Dizzy Fear Acute sudden short response to an immediate threat Urge to flee rapid increase in arousal Components Subjective what feel think Terrified Behavioral whatdo Scream Acting instinctually FIGHT FLEE FREEZE Physiological what happens in body Adrenaline Blood pumps throughout body fight or flight Lightheaded BOTH Anxiety amp Fear Involve physiological arousal Can be adaptive Moderate anxiety increases preparedness Fear triggers quotflight or fight response Panic Attack Sudden intense fear response accompanied by physical symptoms Symptoms Palpitations pounding heart or accelerated heart rate Sweating Trembling or shaking Sensations of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy unsteady lightheaded or faint Chills or het sensations Paraesthesias numbness or tingling sensations Derealization feelings of unreality or depersonalization being detached from oneself Fear of losing control or going crazy Fear of dying False alarm or quotmisfirequot of fear system No actual immediate threat Uncued vs cued Uncued Unexpected or out of the blue 9 Panic disorder Cued 9 Other Present across anxietyrelated disorders Panic attack can happen to any disorders notjust panic disorder Specific phobia Fear of objects or situations that is out of proportion to any real danger Social anxiety disorder Fear of unfamiliar people or negative evaluation by others Panic disorder Anxiety about repeated panic attacks Agoraphobia Anxiety about being in places where escaping or getting help would be dif cult if anxiety symptoms occurred Generalized anxiety disorder GAD Uncontrollable worry about a number of topics and associated symptoms irritability muscle tension fatigue restlessness for at least 6 months Obsessivecompulsive disorder OCD Repetitive intrusive uncontrollable thoughts or urges obsessions repetitive behaviors or mental acts that the person feels compelled to perform compulsions Posttraumatic stress disorder PTSD Aftermath of traumatic experience in which person reexperiences the traumatic event avoids stimuli associated with the event experiences negative changes in cognition and emotion and experiences increased arousal for at least a month Acute stress disorder Symptoms similar to those of PTSD but occur for less than 4 weeks after traumatic event AnxietyRelated Disorders Changes from DSMIV to DSMS Social phobia o Becomes social anxiety disorder 0 Panic disorder w or wo agoraphobia 0 Turned into two diff categories Addition of chapter on ObsessiveCompulsive and Related Disorders 0 New category amp so 0CD is no longer a disorder 0 Addition of chapter on Trauma and StressorRelated Disorders 0 New category no longer anxiety disorder Obsessivecompulsive disorder is not an anxiety disorder Acute stress disorder is not an anxiety disorder Generalized anxiety disorder is retained in DSMS as an official diagnosis Posttraumatic stress disorder is not an anxiety disorder Comorbidity Stats quot 75 with one anxietyrelated disorder experience another quot 60 with anxietyrelated disorder have MDD at some point in life 73 with MDD have anxietyrelated disorder at some point in life Validity Concerns Comorbidity challenges validity of diagnostic system Increasing development of quottransdiagnosticquot theories of and treatments for both anxiety and depression Across diagnoses similar diagnosis and then they can be treated the same ex is depression and anxiety might be able to be treated differently Depression and schizophrenia can be comorbidity bc they had both in the same lifetime That s what comorbidity basically means Epidemiology Course Outcome Prevalence of DSMIV Anxiety Disorders Lifetime 28 Current 18 Costly to those w disorder amp society Twice average rate of medical costs Higher rate of cardiovascular disease Twice risk of suicidal ideation relative to those wo psychiatric diagnosis Difficulties in employment Serious interpersonal concerns Substantial decrements in quality of life Biological Influences Disordered Genes Heritability h2 values 2040 for phobias GAD PTSD 50 for panic disorder which is same as suicide rate Polygenic influences Genes promoting corticotropinreleasing factor CRF Neurotransmitter Dysregulation i1 gammaaminobutyric acid GABA which inhibits anxiety Lower levels of GABA means higher level of anxiety i1 serotonin which regulates eating sex aggression 1 norepinephrine which produces high arousal NeurophysiologicalAbnormalities Elevated activity in quotfear circuit that is activated when anxious or fearful Amygdala Involved in assigning emotional significance to stimuli amp and in fear conditioning Sends signals to structures in circuit Overactive in anxiety disorders amp depression Neuroendocrine System Regulates hormones that influence basic motivational functions When face threat Hypothalamus releases corticotropinreleasing factor CRF to communicate with pituitary gland Pituitary gland sends ACTH hormone to adrenal glands Adrenal glands produce cortisol Anxiety 1 CRF and cortisol Psychological Influences Stressful life events Precede anxiety disorder in quot 7080 of cases Diathesisstress model Effect of stress on anxiety moderated by biological psychological or sociocultural vulnerability factors Neuroticism Personality tendency to react to events with negative affect High levels of neuroticism linked to both anxiety and depression Cognitive Factor Cognitive Style Beck Maladaptive cognitive style may maintainenhance anxiety Perceived uncontrollabilityunpredictability of life events Overestimation of probability of negative event They think they get it bad Ex one person thinks people will reject her while the other will be like other people like to talk to me Catastrophizing consequences of negative event Assuming the worst Cognitive Factor Vigilance Vigilance facilitated attention to disorderrelevant info aware of danger Visual search paradigm press button when find discrepant stimulus Anxious show faster reaction times for disorderrelevant targets 9 So this is basically being able to find the thing that s not right faster Example was the pictures of women smiling but one not smiling The one who found the not smiling one faster tended to be the people who were anxious Conditioning Classical Conditioning Person develops classically conditioned fear response Conditioned Response or CR to neutral stimulus Conditioned Stimulus or CS that is paired with intrinsically aversive stimulus the Unconditioned Stimulus or UCS Operant Conditioning Person gains relief from conditioned fear by avoiding CS Avoidance is negatively reinforced removing unpleasant stimulus decreases something undesirable Remember ADDING POSITIVE TAKING AWAY NEGATIVE Social amp Cultural Dimensions Elevated rates of anxiety disorders among women except 0CD among low income among AfricanAmerican Elevated rates of anxiety disorders in countries undergoing societal change political oppression war Crosscultural variability in manifestation of anxiety Eg Some focus more on physiological aspects of anxiety and fear and less on subjective aspects Alcohol Use Disorders TABLE MB DSMlVTR Criteria for Diagnosing Substance Abuse Note that you only need ONE or more and it has to be for a 12 month period The criteria for diagnosing substance abuse require repeated problems as a result of the use st a substance One or more at the following occurs during a 12month period leading te significant impairment er distress it Failure to idltill important obligations at work home or school as a result of substance use 2 Repeated use of the substance in situations in which it is physically hazardous t0 do sd 3 Repeated legal prebiems as a result of substance use 4 Continued use of the substance despite repeated social or legal probiems as a result of use Source Reprinted with permission from the Diagnostic and Statistical Manual 0f Mental Disorders qurth Edition Text Revision Copyright 2000 American Psychiatric Association TABLE 144 DSM lVTR Criteria for Diagnosing Substance Dependence Substance dependence often involves evidence of physiological dependence plus repeated problems due to the use of the substance A Maladaptive pattern of substance use leading to three or more of the following 1 Tolerance as defined by either a the need for markedly increased amounts of the substance to achieve intoxication or desired effect b markedly diminished effect with continued use of the same amount of the substance 2 Withdrawal as manifested by either a the characteristic withdrawal syndrome for the substance b the same or a closely related substance is taken to relieve or avoid withdrawal symptoms 3 The substance is often taken in larger amounts or over a longer period than was intended 4 There is a persistent desire or unsuccessful effort to cut down or control substance use 5 A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects 6 important social occupational or recreational activities are given up or reduced because of substance use 7 The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem caused by or exacerbated by the substance Source Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Copyright quotC 2000 American Psychiatric Association Epidemiology in US Alcohol Abuse Adults 74 Current 12 Lifetime Alcohol Dependence Adults 97 Current 17 Lifetime Age effects The older you are the less likely you will abuse and be dependent on alcohol Gender effects Female have lower rates for both abuse and dependency than male Note it s the opposite for depression rates Alcohol Use by College Students Binge drinking 0 Pattern of drinking that brings BAC to 08 o 4 or 5 drinks in 2 hour period 56 of men and 35 women binge drink 0 23 frequently binge drink Alcohol abuse in college is higher than not in college and about the samea little less in dependency in college rather not in college Controversy is it really a mental disorder if it s pretty frequent in college Negative consequences with alcohol use by college students 0 Death Assault Sexual Abuse Injury Academic Problems Health ProblemsSuicide Attempts Change from DSM 4 to DSM 5 DSM IV AbuseDependence distinction was taken off bc Reliability of abuse disorders low This means that in DSM 4 it said that abuse set the stage for dependence but it was not a strong proven statement Validity of abuse disorders suspect Abuse diagnosis based primarily on hazardous use quotDiagnostic orphans Defined as respondents who met one or two alcohol dependence symptom criteria did not meet criteria for alcohol abuse Structure of substance abuse and dependence criteria appears to be one dimensional Replaced with Alcohol Use Disorder At least 2 of 11 symptoms Used to be 3 or more Drop legal problems added craving Dropped the legal problems bc it correlated a lot to race and gender Graded severity based on of symptoms A A problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following occurring within a 12month period 10 11 Withdrawal as manifested by either of the following Specify current severity Mild Presence of 23 symptoms Moderate Presence of 4 5 symptoms Severe Presence of 6 or more symptoms TABLE 111 Diagnostic Criteria for Alcohol Use Disorder 1 Alcohol is often taken in larger amounts or over a longer period than was intended There is a persistent desire or unsuccessful efforts to cut down or control alcohol use A great deal of time is spent in activities necessary to obtain alcohol use alcohol or recover from its effects Craving or a strong desire or urge to use alcohol Recurrent alcohol use resulting in a failure to fulfill major role obligations at work school or home 9915 Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol 7 Important social occupational or recreational activities are given up or reduced because of alcohol use Recurrent alcohol use in situations in which it is physically hazardous 9 Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol Tolerance as defined by either or both of the following a A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b A markedly diminished effect with continued use of the same amount of alcohol a The characteristic withdrawal syndrome for alcohol refer to Criteria A and B of the criteria set for alcohol withdrawal b Alcohol or a closely related substance such as benzodiazepine is taken to relieve or avoid withdrawal symptoms DSM 5 From American Psychiatric Association 2013 Diagnostic and statistica manual of menta disorders 5th ed Washington DC From Astrology Reading Discussion Made age range similar and had a control group Multiple attempts2quot l attempt to figure out correct answer They let astrologers to be a part of the college students trying to pair birthdays with personalities Astrologers ended up allowing personal experience trump science Characteristics of clinical science 1 Test claims empirically 2 4 measures Objective Rehathy Useful Replicable Rule out alternative answersexplanations f Against personal beliefs Beware of confirmation bias the tendency to pay attention to information that confirms your existing opinion rather than information that contradicts it 99962 From practice questions Testimonial evidence provides minimal support for claims can be comprised by personal biases and frequently overstates evidence for claims Primary sampling technique is convenience sampling Internal consistency reliability Consistencies of responses within the same measure Ex if depressed people said yes they lost sleep they should also say yes they lost appetite 1 What are the pros and cons of using personal experience vs the research literature to make decisions about how to treat clients A pro of using personal experience is that you can account for individual differences in your clients as opposed to relying on population characteristics in research studies A con of using personal experience is that the treatment you select may not be empirically supported A pro of using the research literature is that the treatment you select may have been shown to be reliable valid objective and useful In other words it has gone through at least some scientific scrutiny Under ideal circumstances it has been shown to be effective across numerous studies labs etc A con of using the research literature is that there are not EBTs empiricallybased treatments available for all disorders or combinations of disorders 2 You have developed a new treatment for depression and you want very much for it to work What are some ways to minimize bias in your evaluation of the treatment s effectiveness so that you don t wrongly conclude that the treatment works when in fact it does not To minimize bias collaborate with a diverse group of colleagues who can give feedback about your experimental design randomly assign participants to treatment and control conditions and encourage other labs to attempt to replicate your findings 3 The quotsciencepractice gap is a significant problem in psychological care today What may be some factors contributing to this sciencepractice gap Similarly how might the science practice gap affect an individual who is seeking care for psychological difficulties Many factors contribute to the sciencepractice gap Research outlining empirically supported treatments first takes time to gain enough well conducted replicated studies to be deemed effective Further after determining a treatment to be effective providers need careful training in order to be able to deliver the treatment as it is intended Therefore there may be a time lag between the findings of the research and its use in practice Also there may be barriers to actual implementation of the treatment For example some institutions may not have the personnel time resources finances or space to house a treatment known to be effective A study conducted in a research setting may be difficult to move out into the real world Third as Dr Treat mentioned social workers are the majority of the frontline service providers of psychological treatment today On average social work programs provide less training in empirically supported treatments than clinical psychology programs although some social work programs provide quite a bit of training in this area and some clinical programs provide very limited training in this area Thus much of the work force is not trained to provide evidencebased treatments and it can be very expensive and timeconsuming to quotre train in more evidencebased approaches Fourth there may be barriers due to attitudes and clinical beliefs some providers may be resistant to learning new techniques particularly those which differ from their training and clinical biases One consequence of the sciencepractice gap is that many clients do not receive evidence based treatments for their presenting problems Occasionally they receive treatments that have been shown in the literature to be harmful but more often they receive treatments that have not be evaluated in the literature or which have been shown to be ineffective Over time this influences public opinion about psychological services as some consider psychological care to be less scientific and trustworthy than medical care 1 Thought Question Discuss how the DSM becoming more reliable and specific helps psychologists in clinical practice and research a By making the DSM more reliable and specific the likelihood that two psychologists would diagnose oneperson with the same disorder increased this is an example of interrater reliability Additionally this allows researchers and clinicians to be more specific about what characteristics of people define each diagnostic category This allows treatments to be better tailored to each homogenous group that meets the criteria for a particular disorder 2 Thought Question In some cases the disorders included in the DSM are not well supported by research In these cases what are they based on a Pros Research suggests that PDD is real and is associated with significant distress and impairment for a number of women Including PDD in the DSM 5 allows thirdparty payment for therapeutic services provided to these women some of which have been shown in the research literature to be helpful Cons Some opponents to the inclusion of PDD in the DSM5 argue that PDD is a normal phenomenon common to many women and that including it in the DSM5 pathologizes normal behavior and is an example of bias against women 3 Thought Question Discuss some of the pros and cons of including Premenstrual Dysphoric Disorder in the DSM 5 a There are three main influences 1 Expert judgment may or may not be evidencebased 2 Consensus panel of experts who vote 3 Politics strong personal beliefs held by influential people in the field 4 Thought Question The DSMV includes binge eating disorder as a diagnosis Imagine that you are a provider who has been using the DSMIV in practice How might this impact the diagnoses you assign to patients a You may find yourself diagnosing fewer patients with an NOS diagnosis because you now can diagnoses patients with BED 5 Thought Question Why does the relative frequency of mental disorders raise concerns about the DSMIV and DSM5 a Disorders and quotabnormal behavior almost by definition should be rare At least a quarter of the adult population has a diagnosable Axisl condition however This raises questions about the extent to which the DSM pathologizes normality or overdiagnoses mental illness Thought question There is significant comorbidity of depression and anxiety disorders Consider the relevance of the operant conditioning theory introduced in the anxiety disorder lecture to the following case A woman experiencing symptoms of major depressive disorder recently lost herjob In the morning when she thinks about getting out of bed to search for a job she has distressing thoughts about her inability to find work and how pointless herjob search has been According to operant conditioning what is likely to happen next What type of reinforcement does this exemplify What would you predict about her likelihood of getting out of bed the following morning In operant conditioning the general principle of negative reinforcement indicates that removing an unpleasant stimulus will provide the individual with relief thus decreasing the likelihood that the person will engage in the behavior that brings them into contact with the unpleasant stimulus Therefore after considering getting out of bed and experiencing the thoughts about her inability to find work and the pointless job search the unpleasant stimuli she is likely to stay in bed which will provide her with relief she will no longer be faced with the pressure of finding a job and therefore will feel relief According to negative reinforcement engaging in this behavior that provided relief from distress is likely to happen again therefore the following morning she is likely to remain in bed again What was the rationale for the modifications to alcoholrelated diagnoses in DSMS Alcohol Abuse and Dependence were distinguished in DSMIV but receipt of the Alcohol Abuse diagnosis frequently was based on only a single criterion hazardous use typically drinking while driving and both reliability and validity were poor In DSMS these two diagnoses have been replaced with a single Alcohol Use Disorder Two symptoms must be present to receive the diagnosis and the number of present symptoms indicates a graded severity of the disorder
Are you sure you want to buy this material for
You're already Subscribed!
Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'