PSY101 Abnormal Psychology & Treatments Chapter 15-16
PSY101 Abnormal Psychology & Treatments Chapter 15-16 PSY 101
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This 9 page Class Notes was uploaded by May Wu on Saturday July 2, 2016. The Class Notes belongs to PSY 101 at University at Buffalo taught by Larry Hawk in Summer 2016. Since its upload, it has received 4 views.
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Date Created: 07/02/16
Abnormal Psychology Chapter 15 Normal vs Abnormal Behavior o Statistically Different or Deviant Societal (culture), developmental “norms” or standards Dysfunctional and/or Distressing? o Interfere with normal social, occupational and emotional functioning Origins (Etiology): Many theories o Dynamic/analytic has diminished o Biology has ascended o Cognitive o Behavioral approach persists o Humanistic o Sociocultural Current models: Biopsychosocial (An integrative model) o The biopsychosocial model ("BPS") is a broad view that attributes disease causation or disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc), and social factors (cultural, familial, socioeconomic, medical, etc). o Multiple factors play a role o Diathesis-stress model Perspective proposing that mental disorders are a joint product of a generic vulnerability called a diathesis, and stressors that trigger this vulnerability. Abnormal: Where do we draw the line? o How much distress? How deviant? How long does problem last? o Categorical vs Dimensional In categorical model, a mental disorder such as major depression, is either or absent with no in between. Categories differ from each other in kind, not degree. Pregnancy fits a categorical model because a woman is either pregnant or not. Do you meet diagnostic criteria or not? Diagnostic and Statistical Manual of Mental Disorders (DSM) In dimensional model, they differ from normal functioning in degree, not kind. Height fits a dimensional model because although people differ in height, these differences aren’t all or none. Using numerical values or scales rather than assigning them to a mental disorder category. Blood pressure fits dimensional rather than a categorical model because there’s no sharp diving line between normal and high blood pressure. On a continuum Incorporates quantitative criteria Categories: How common in Adults? o It depends Dimensions: Understanding comorbidity o Comorbidity- co-occurrence of two or more diagnoses within the same person. Ex: it’s extremely common for people with a major depression diagnosis to meet the criteria for one or more anxiety disorders. Preface to specific disorders: Things to keep in mind o Essential themes and issues Not every diagnostic criterion o The dimensional nature of the symptoms Avoid self/other diagnosis (med student syndrome) Medical student syndrome - condition frequently reported in medical students, who perceive themselves to be experiencing the symptoms of a disease that they are studying. o These are often debilitating problems Empathize, try to take the person’s perspective Summary o Abnormal behavior is challenging to define but we emphasize: Deviant – inconsistent with developmental, cultural & societal norms Functional impairment (dysfunction) and/or emotional distress Understanding and treating abnormal behavior requires consideration of multiple perspectives/factors But above all, we follow the evidence. Anxiety disorders o Very common (1/3 lifetime prevalence) o General features Excessive fear or anxiety (now/future) Imminent threat vs potential threat Physiology: True alarm vs false alarms Avoid or endure with intense discomfort Interference / distress Recognized as excessive/unreasonable Somatic symptom disorder – condition marked by excessive anxiety about physical symptoms with a medical or purely psychological origin Illness anxiety disorder – condition marked by intense preoccupation with the possibility of a serious undiagnosed illness o Relatively early age of onset o Etiology: diathesis-stress Genes and environment Specific phobias o Marked, persistent excessive gear o Most common of all anxiety disorder o Very common in childhood o Some common throughout adulthood o Fear might not be phobia o Treatment: Behavior therapy Exposure hierarchy o Social Phobias Fear you will embarrass or humiliate self Common (1-year US prev: 3-4%) Treatment: cognitive-behavior therapy (CBT), meds, exposure therapy Panic Attacks and Panic Disorder o Panic attack – Discrete period of intense fear and physical arousal, which develops abruptly ( usually peaks within 10 mins) May be expected and/or unexpected Symptoms: Pounding heart/palpitations Sweating Chest pain Fear of dying or fear or losing control What’s common: Think fight/flight, false alarm In a panic attack, it’s a false alarm, makes the symptoms worse Can happen in other anxiety disorders People develop panic attacks without having panic disorders o Panic Disorder Repeated and unexpected panic attacks, along with either persistent concerns about future attacks or a change in personal behavior in an attempt to avoid them Recurrent, unexpected panic attacks 1+ months of: Worry about attacks or their consequences Resulting maladaptive behavior May have agoraphobia – fear of being in a place or situation from which escape is difficult or embarrassing or in which help in unavailable in the event of a panic attack. Treatment: exposure, CBT (Cognitive behavioral therapy) Obsessive Compulsive Disorder o Obsessions and/or compulsions- condition marked by repeated and lengthy (at least one hour per day) immersion in obsessions, compulsions or both O: recurrent, intrusive thoughts/images that cause marked anxiety Ex: doubtful fears C: behavioral or mental acts, driven to perform (often repetitively) to reduce anxiety. Ex: Clean, check o Onset: childhood, adolescent o Treatment: Exposure and response prevention , meds o Some disorders are most common in men or women Generalized Anxiety Disorder o “worry wart” o People with GAD spend an average of 60% of each day worrying, compared to the 18% of the population o Tend to think anxious thoughts, often they worry too much about small things in life , like upcoming meeting at work or social event. o Most likely to be females than males. o Difficult to control; number of things o Restless/keyed up, fatigued, tense, irritable, sleep o Treatment: CBT (worry exposure), meds o People with GAD often experience other anxiety disorders including phobias and panic disorders. PTSD (post-traumatic stress disorder) o Traumatic event o Marked emotional disturbance after experiencing or witnessing a severely stressful event War, disaster, car, assault They might avoid things that reminds them of the trauma Can last for months if they have 3 of these symptoms Mood disorders o Depression o Bipolar o Suicide o Not chronic but episodic Depression o 6 months of depressed mood and/or loss of interest, pleasure o Feel worthless/guilty o Number of severity of sxs varies Genetic and environmental influences o Serotonin- transporter gene o Caspi et al (2003) gene-environment interaction involving this gene. Behavioral perspective o Lack of positive interactions with environment How does this relate to symptoms of depression we discussed previously? o Excess of negative interactions with environment Learned helplessness- the tendency to feel helpless in the face of events we can’t control o Helplessness theory – “depressogenic” attributional style Internal/external Global/specific Stable/Unstable Unstable – flexible, able to change Depression negative event Stable, internal, global Beck’s Cognitive Model of Depression o The cognitive causal model of depression is the model with the most empirical evidence in treating depression. According to this model, it is one's cognitions - thoughts and beliefs- that shape one's behaviors and emotions. The most prominent proponent of the cognitive model of depression is Aaron Beck. He proposed that depressive symptoms result when people's attributions for external. Dimensional affect model o NA/PA Negative affectivity: tendency to experience negative emotions such as sadness, anxiety, and anger Positive affectivity: tendency to experience positive emotions such as enthusiasm, joy, energy Motion, emotionality, temperament, personality Depression summary o Return to diathesis stress and consider multiple factors o Implications for treatment Bipolar Disorder o Both episodic depressed mood and episodic mania (formerly manic depressive disorder) o Condition marked by a history of at least one manic episode. o Long-term illness o Equally in men and women o Most generically influenced of all mental disorders. o Increase in dopamine and decrease in serotonin may boost the risk of bipolar disorder. Manic episode- experience marked by dramatically elevated mood, decreased need for sleep, increased energy, inflated self-esteem, increased talkativeness and irresponsible behavior. o Symptoms: o Affective symptoms Elevated, “high” mood o Cognitive symptoms Racing thoughts Flight of ideas o Behavioral symptoms Increased goal-directed activity o Increased focus on activation in DSM-5 o Bipolar most common in women than men o Stressful life events are associated with an increased risk of manic episodes. Suicide o Depression and beyond Also bipolar (depressive phase) 5% lifetime o Myths Seeking attention o Suicide facts: 10 leading cause of death (about 35k) 3 among 15-24 years old Gender (attempt 3:1, succeed 1:4) Firearms (56% vs 30%) o Suicide: What can you do? Believe Listen Urge them to seek help Crisis services 834-3131 Sometimes not enough (hindsight bias) And very hard to predict Schizophrenia o Psychosis- altered thought , perception, consciousness o Not “split personality” o Prev: 1% o Paranoid, disorganized, catatonic o Gerald o Positive symptoms: Excesses o Negative symptoms: Poverty of speech, avolition, affective blunting, anhedonia, attentional impairment Negative symptoms suggest poor prognosis. o Schizophrenia Thought disorder Hallucinations (auditory)- perception with no external cause Auditory (visual somatic) Delusions o Schizophrenia causal factors Genes, dopamine and beyond… Family dynamics Family dysfunction Also, family dynamics important for understanding relapse. o Expressed emotion (EE) Patients experience more than twice the likelihood of relapse when their relatives display high expressed emotion that is criticism, hostility and over involvement. Treatments o Many effective treatments Few cures People often have options o Psychotherapy and/or medication/biological medications o Note: cause doesn’t not dictate treatment Treatment does not dictate cause Psychotherapy – psychological intervention designed to help people resolve emotional, behavioral and interpersonal problems and improve the quality of their lives. o Numerous “schools” or orientations o Many probably work for some things Non-specific events Therapists matters too o Effective therapists are likely to be warm and direct, establish a positive relationship with clients and tend not to contradict clients. o But some treatments actually harm o And some treatments work better than others for specific problems Empirically-supported Treatments o Insight therapies- psychotherapies including psychodynamic, humanistic, and group approaches with the goal of expanding awareness or insight. Psychoanalysis – back to Freud Goal was to decrease guilt and frustration and to make the unconscious conscious by bringing to awareness previously repressed impulses, conflict and memories. Interpersonal Psychotherapy – depression; focuses on relationships between individual and others Humanistic Therapy- Therapies that emphasize the development of human and belief that human nature is basically positive. Action Therapies Behavior Therapy- Cognitive and Cognitive Behavioral Therapies Psychoanalysis o Unconscious conflicts maladjustments o Began in childhood, so go back to childhood Find “cause” of the dysfunction Person-centered therapy – therapy centering on the client’s goals and ways of solving problems, therapists don’t tell client how to solve their problems and clients can use the therapy hour however they choose. o Real-ideal self mismatch maladjustment o Nondirective o Key elements in therapy Reflection Unconditional positive regard – nonjudgmental acceptance of all feelings the client expresses. Empathy Authenticity o Carl Rogers A lot of therapists do behavioral therapies Behavioral o Based in learning principles Operant Behavior modification o Contingency management Reinforcement, shaping skills Extinction o Coach, Teacher Ex: Skinner and Watson Classical Exposure habituation/extinction of fear/avoidance Cognitive o Think rationally (not just positively) Cognitive distortions including attributions Cognitive restructuring o By thinking rationally, it affects how you feel o Very active Cognitive-Behavioral Therapy o Association for Behavioral and Cognitive Therapies (ABCT.ORG) o Active, collaborative, homework o Targeting better behavior o Very active, follow plan, usually oriented to last 12-16 visits Psychotherapy o Individual, group & self-help Non-specific vs specific factors Biological o Hypothesis: Behavior, problem behavior results from brain dysfunction Structure Neurotransmission: too much or too little So treat with meds to correct But, mechanisms of effect not always known, despite commercials Beyond meds: ECT, TMS Therapy vs meds vs combo? o Depends on the disorder o Schizophrenia: Meds > Therapy (but consider family, EE) o Depression: Meds = Therapy (we think), Meds + Therapy > Meds or Therapy (we think) o Bipolar disorder: Meds > Therapy o Anxiety: Meds? T; Meds + Therapy? M or T
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