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class notes

by: Hayoung Lee

class notes Psy 3315

Hayoung Lee
Texas State
GPA 3.9

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ch 3, 4, 5
Abnormal Psychology
\ Etherton
Class Notes
25 ?




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This 16 page Class Notes was uploaded by Hayoung Lee on Tuesday September 27, 2016. The Class Notes belongs to Psy 3315 at Texas State University taught by \ Etherton in Fall 2016. Since its upload, it has received 4 views. For similar materials see Abnormal Psychology in Psychology at Texas State University.


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Date Created: 09/27/16
Abnormal CH 3| lecture 4 CH 3: THEORETICAL VIEWS, part b  Biological perspective o 4 categories of biological factors relevant to maladaptive behavior  Generic vulnerabilities  Brain dysfunction and neural plasticity  Neuro-transmitter and hormonal abnormalities in brain and CNS  Temperament  Genetic influences o Heritability: the degree of variability in a characteristic that can be explained by generic variability o Methods:  Family history: incidence in population vs. relatives of proband  New cases in a period of time (incidence)  Target individual, person of interest (proband)  Twin method: concordance rate  Looking at difference of rates between identical twins (monozygotic) and fraternal twins (dizygotic)  Adoption method: concordance rates with _____  separating the nurture component with different genetics but same environment o The Neuron: basic unit of the nervous system  Neurons: cells of the nervous systems  4 major parts:  Cell body  Dendrites  Axons  Terminal buttons  Nerve impulse  Dendrites or cell body stimulated  Travels down axons to terminal  Synapse  Gap between neurons  Neurotransmitters and Psychopathology o Serotonin and dopamine  May be dysfunctional in depression, mania, and scizophrenia  Receptors may become overactive/underactive Abnormal CH 3| lecture 4  Excessive/insufficient for neurotransitters  Receptors not sensitive enough or not enough receptors o Norepinephrine  Anxiety, stress-related disorders o Gamma-aminobutyric acid (GABA)  Inhibitory, when released, it shuts down the next neuron, making less likely to fire  Calming effect  Benzodiazapenes, ativan, valium, xanax, enhance activity of GABA, for general quiet effect, less clear in thinking, slower  Not recommended for long term/chronic, feeling sedated, dependency, withdrawal symptoms  Low GABA activity  anxiety o Neurotransmitter dysfunction may involve:  Excessive or inadequate levels  Insufficient reuptake  Excessive number or sensitivity of post-synaptic receptors o SSRI (Selective Serotonin Reuptake Inhibitor) – meds such as zoloft, paxil, prozac,  Blocking the process of reuptake, leaving more transmitters available for more chances of absorption  Subcortical structures of the brain o Limbic system  Often implicated in psychopathology  Involved in the expression of emotions (heart rate, breathing, sweating, facial expressions, urge to flight/flee)  Amygdala: attending to emotionally salient stimuli, emotionally relevant memories  More active: higher levels of anxiety  Nervous System: o Central nervous system: brain and spiral cord o Peripheral nervous system: skeletal voluntary and automatic: sympathetic and parasympathetic for regualtion of activity  Psychological theories o Psychodynamic: derived from Freud’s psychoanalytic theory o Behavioral: Pavlov, Watson, Skinner as originators o Cognitive Behavioral: Aaron Beck, Albert Ellis, many additional contributers  Psychodynamic o Behavior results form interactions among:  Id – pleasure principle  Ego – reality principle  Superego – moral princople Abnormal CH 3| lecture 4 o Inability to resolve conflicts produces anxiety o Defense mechanisms to protect against anxiety o Conflicts are unconscious (outside of awareness) o Psychodynamic therapy: bring unconscious material to conscious awareness (gain “insight”) o Outside of awareness, struggling to get needs met,  Behavioral perspective o Behavior is influenced by experience and environment o Behavior is modified by consequences o Classical conditioning:  Prior to conditioning:  Conditioned stimulus (light) (CS) – orientation response to light (light)  Unconditioned stimulus (UCS) – unconditioned response (UCR) (pain and fear)  During conditioning:  Conditioned stimulus (light) (CS) + unconditioned stimulus (UCS) (painful stimulus)  conditioned response (fear) (CR)  Following conditioning  Conditioned stimulus (alone) (CS) – conditioned response (fear) (CR)  After classical conditioning experience  What happens to Pavlov’s dog after the bell is run several times and no food is presented? o Involuntary, bell is less associated with food, therefore halting salivation o Extinction occurs: if conditioned stimulus is presented several times without the unconditioned stimulus  What happens to the rat if the light is turned on repeatedly with no shock? o Extinction of the conditioned response of fear o Relation to humans by treatment of anxiety disorders, one of the core treatments with big success  Implications for psychopathology?  Avoidance behavior lowers anxiety (taking away unpleasant stimulus = negative reinforcement) – this can be such as avoiding the elevator after having an unpleasant experience and developing something to it o Operant conditioning:  Reinforcement: consequence of behavior (giving something pleasant, taking away something unpleasant) Abnormal CH 3| lecture 4  Punishment: consequence of behavior (giving something unpleasant, taking away something pleasant)  Probability of a behavior occurring is influenced by the consequences of the behavior (increased/decreased)  Ex. Tantrum in a grocery store o Kid wants candy bar, mom says no, mom gets fed up and eventually buys kid candy bar, positive reinforcement towards child having a temper tantrum, negative reinforment for allowing candy bar, noise goes down  Ex. Depressed person debating whether to go to work o Wakes up miserable and dreading the day, calling in sick, feeling better working as negative reinforcement of avoiding work (avoidance behavior) o Short term, temporary feeling better, feeling worse than felt before, tasks are overwhelming and not really able to handle, leading to avoidance o Inactivity, such as laying in bed (9/10) rather than going out, walking dog (5/10), short term negative reinforcement that leads to feeling worse o Observational conditioning:  Observing can aquire similar anxiety even without classical condition  Ex. Never seen a snake and can have a fear of them o Behavioral perspective  Maladaptive behavior due to  Failure to learn adaptive behaviors or competencies  Reinforcement of ineffective or maladaptive responses  Goals: modify target behaviors (increase, decrease, enhance, or acquire)  Reduce maladaptive classically conditioned emotions  Increase pleasant activities, decreased maladaptive/negative behaviors, reducing classically conditioned emotions (through exposure and leading to extinction)  The Cognitive – Behavioral Perspective o Schema: underlying representation of knowledge that guides current processing of information Abnormal CH 3| lecture 4 o Attributions: process of assigning causes to things that happen  Breaking up can be painful, attributions may include, thoughts like “because of me, not being enough,” (internal/stable/global/depressed)  May lead to change in behavior, and in this case, isolation, avoidance, strengthened/driven by thoughts leading to a cycle  however usually inaccurate…attribution can be “going through something else and was not able to because going through things” (external/temporary/specific/non- depressed) o Attributional style: characteristic way in which individual may tend to assign causes to bad or good events o When people make attributions internal (stupid, unlovable), more vulnerable to depression when bad things happen  Cognitive Therapy (or cognitive behavioral therapy) o Interpretations of events determines emotional reactions and behaviors in response  Ex. Friend has not returned a call in 2 days  Ex. Made a B- on a test  Because I’m dumb (internal), because I didn’t study enough (can be changed), can modify attributions to be more accurate o Cognitive therapy:  Identify maladaptive cognitions  Examine evidence for and against  Develop and rehearse more adaptive cognitions, behaviors Abnormal psych Ch 4 Assessment and Diagnosis  Jerry’s first meeting with psychologist o 42-year old white male, wife recommended he see a psychologist about problems she believed he was having: grouchy, not taking care of self, seems unhappy, not his “old self” o Jerry agrees that he is less happy, but does not really think he has any problems o Info needed? Duration of this pattern, consistency, recent event, severity of symptoms, o How do we get it?  Assessment o Gathering relevant information to make inferences about Jerry and make decisions o What inferences/decisions might be made about Jerry? o How do we start gathering this information? o Relevant info: duration, severity, pervasiveness of symptoms and alterations in behavior, link to DSM diagnosable conditions o Degree of impairment in different domains  Methods: o Overview: clinical interview: structures/semi-structures o Behavioral observations: may be done informally, psychologist can observe behavior o Psychological testing: go through series of questions, responses  Purposes of Assessment o Understand the individual o Predict behavior o Diagnosis (if warranted) o Treatment planning  Selecting appropriate treatment targets  Track response to treatment o Research  Establish well defined groups  Evaluate treatment outcome  Assessment as a Funnel o Wide range at the beginning o Narrow toward problem areas, possible diagnoses o Approach may be influenced by theoretical orientation (psychodynamic vs behavioral vs cognitive) o Clinical interview as a core method  Unstructured, semi-structured as most common  Structured clinical interview:  Advantages? Good for research, clear, good standardization Abnormal psych Ch 4  Disadvantages? Asking about symptoms rather than going in depth of themselves as a person  Settings?  Sitting down, face to face, designed to know more about patient while asking questions following up conversationally (unstructured) o Clinical interview can be supplemented by rating scale to quantify variables  Rate on a 1-10 scale current (or recent) the severity of  Anxiety/hopelessness  Rate on a 1-10 scale how frequently you  Avoid social interactions/feel worried/crave alcohol  Behavioral assessment o Jackie, an 8-year old, has been getting into physical fights with other kids in her 3 grade class. Her parents insist that they have no problems with aggression at home. The principal is considering what steps to take to stop Jackie’s fighting from disrupting elementary school.  How to assess? Observations, sample of behavior (in this case probably during recess and also in different class settings and interactions)  Relevant information? Sources of that information?  ABCs of Behavior o Antecedent/Behavior/Consequence o Reactivity: modify behavior by having virtue of observing  Self-monitoring  Technical terms o Reliability: cannot make good inferences if there are no reliable measures, test of consistency  Jerry’s case:  Inter-test: consistency  Test-retest:  Jackie’s case:  Inter-rater: o Validity: indicates whether test measures what it is supposed to measure, evidence that has been accumulated that supports using a test or a specific purpose  Measure of depression with good reliability, same score when taken, test for depression was used with tape measurer (?) Error: how tall someone is not correlated with height o Standardization: necessary for meaningful comparisons  Administering a test the same way with same procedures may have different effects in ways of influencing responses Abnormal psych Ch 4  General physical examination o Physical complaints or features  Caused by medial condition  Symptom of psychological disorder  Psychological test o Intelligence tests  Wechsler Adult Intelligence Scale (WAIS): would be compared to a general high/low scale  Wechsler Intelligence Scale for Children (WISC) o Projective Personality test  Rorschach: ambiguous stimuli projected onto (clouds, shapes) of their own interpretations of these figures, making inferences about personality or psychological functioning, constructs  Poor validity of linked interpretations  Thematic Apperception test: own interpretations of story o Objective tests  Roots in empirical tradition, examine differences of items that set them apart and compare  Test stimuli are less ambiguous  Require minimal clinical inference in scoring and interpretation o Personality tests  Minnesota Multiphasic Personality Inventory (MMPI)  Accused to have poor validity  Extensive reliability, validity, and normative database 5. Abnormal PTSD and Related Disorders  Adjustment Disorder  Single, multiple, or ongoing stressors o Divorce o Job loss o Starting college o Relationship conflict o Bankruptcy  Distress is greater than would be expected, or causes functional impairment  Symptoms reduce after resolution of stressor  Would not be diagnosed if explained by another disorder (such as major depressive  Post-Development o 24-year old man returns from 12-month combat deployment  previously happy, outgoing, with close relationships o sleeping ¾ hours a night o low tolerance/high irritability o anxious and watchful when driving, when in public o stays home as much as possible o difficulty feeling close with wife, children o nightmares 3-4 times a week  What features of a DSM disorder are present? Impairment in daily living, relationships, leisure; Anxiety for emotional distress  How do these changes affect areas of his life? Working, relationships  Dysfunction present? Anxious all of the time even when not in (immediate) danger  PTSD: o Combat veterans o Sexual assault o Violent crime o Natural disaster o Civilians in war zones o Vehicle accidents  Features of Iraq and Afghanistan Deployments o Frequent rocket, mortar attacks o Roadside IEDs o Suicide bombers o Unexpected attacks by allied soldiers (Iraqi or Afghan army members) o Difficulty distinguishing civilians from insurgence o Common features? Surrounded by people you don’t know, 5. Abnormal PTSD and Related Disorders  DSM – 5 Criteria for PTSD o Trauma exposure – experienced or witnessed o Re-experiencing – nightmares, intrusive images, physiological reactivity to trauma reminders o Avoidance – efforts to avoid thoughts, feelings, or reminders of trauma o Negative changes in conditions and mood – detachment, shame, anger, distorted blame self/others, loss of interest o Hyperarousal – hyper vigilance, excessive response when startled, aggression, reckless behavior, irritability/anger outbursts, sleep disturbance  1-month minimum duration o Acute stress disorder – PTSD like symptoms 2 days to 1 month following trauma, lasting at least 3 days. May convert to PTSD at 1 month.  Rates of PTSD after Traumatic Experiences o PTSD trauma due to human intent > PTSD natural disasters, accidents o Prevalence in US: 7% (about 4% of men, 10% of women), estimates vary o Risk factors for PTSD:  Female (even though men experience higher rates of traumatic events)  Symptom prevalence after sexual assault: o 2 weeks – 95% | 1 month – 63% | 3 months – 46%  Higher neuroticism  Family history of depression, anxiety, or substance abuse  Low levels of social support  Prolonged vs. single-incident trauma exposure o Higher cognitive ability is protective against PTSD following trauma  PTSD and co-morbidities o Co-occurring psychological disorders:  Major depressive disorder  Alcohol use disorder  Generalized anxiety disorder (involves chronic worrying)  Treatments o Medications  Antidepressants modestly better than placebo o Cognitive-behavioral treatments  Prolonged exposure  Evidence based, effective 5. Abnormal PTSD and Related Disorders  Higher drop out rate  Trauma memories – Fear/anxiety o Relaxation (association, strengthening connection)  Cognitive therapy (cognitive processing therapy)  Modify inaccurately negative interpretations of event  More meaningful, adaptive, helpful, setting even in context  More gentle than prolonged exposure  Virtual reality exposure therapy  EMDR (?) have patient sitting in chair and have follow back and forth while talking, possibly left brain and right brain association, exposure to the fear stimulus, extinction, habituation  Anxiety Disorders: o Panic disorders:  Un-cued panic attacks  “out of the blue” o Agoraphobia  Related to panic disorder  Avoidance of situations where they might not be able to escape to avoid panic attacks or anxiety attacks o Specific phobia  Excess anxiety avoidance o Social anxiety disorder  Embarrassment/humiliation  One of the most common o Generalized anxiety disorder  Excessive worry, repetitive, intrusive, hard to sleep, concentrate o Fear and Anxiety   Component:  Fear:  Anxiety: ****** o Anxiety  Fear – fight or flight activation (fear circuit)  Panic attacks – false alarm activation of fear circuit (maladaptive) 5. Abnormal PTSD and Related Disorders  Sympathetic activation  May be cued or un-cued (known to happen in situations, may not be known to happen in situations)  No difference between true fear response or anxiety attack except that fear circuit get activated with no real danger for anxiety attacks, and real danger for fear responses o Anxiety Disorders  Unrealistic, irrational fears or anxiety  Out of proportion to threat  Significant distress or impairment  Avoid or “endure with dread” the feared situations  1. Specific Phobia  2. Social anxiety disorder  3. Panic disorder  4. Agoraphobia  5. Generalized anxiety disorder o Specific Phobias  Subtypes:  animal  natural environment  blood injection injury: abnormality with normalizing circuit to the other direction by increasing pressure then decreasing, dropping the blood pressure in the end  situational: closed spaces, elevator  other: ex. Choking, vomiting, “space”, clowns o Phobias as learned behavior  ladder, ladder starts shaking, gets frightened, gets anxiety of going back up the ladder, stays down  Classical conditioning: being on a ladder (harmless), ladder threatens fear  Operant conditioning: going down feels better, avoiding ladder is negatively reinforced  Vicarious conditioning (observational learning): can observe other people or hear other people’s experiences and develop a fear  Evolutionary preparedness: cannot readily become afraid of something, hard wired to have feature detection of readily movements (such as 6 legged things such as insects, may be poisonous) o Treatment for phobias  Exposure therapy 5. Abnormal PTSD and Related Disorders  “in vivo”: “in real life” have a real life snake, touch, interact with snake (  Imaginal: close eyes and visualize interacting with snake (less intense, less effective, easier)  flooding vs. Systematic Desitization: start with snake around shoulders until no longer anxious vs. (higher dropout rate) strengthening the snake + relaxation, reducing the fear + snake relationship  Counterconditioning vs Extinction(?): facing fear systematically, waiting until anxiety goes away, high success rate  Anxiety hierarchy  1. Have snake around shoulder  5. Watch someone handle snake  7. Imagine handling snake  10. Imagine seeing snake o Social Anxiety Disorder  Excessive concern about: embarrassment, humiliation, negative evaluations from people from doing something socially awkward  Apprehension about social interactions  Meeting new people  Talking on phone  Eating in public  Giving speech  Job interview  Dating  Avoid or endure with dread/distress  Lifetime prevalence: 12%  Comorbidity with depression, other anxiety disorders, and especially alcohol abuse  Underperform educationally/socially/occupationally  Causes classical conditioning experiences  Evolutionary influences (sensitivity to angry or dominant expressions)  Cognitive biases toward social threat o Social Anxiety Disorder Treatment  Cognitive Behavior Therapy  Thought records: “my mind will go blank, ill say something stupid, they won’t like me” figure out a 5. Abnormal PTSD and Related Disorders rational response, did not go blank, I said a lot of appropriate responses, extinction  Role play  Exposure  Feedback – social skills enhancement (good for group format, making suggestions to better, knowing that they are not perfect and can improve)  SSRIs moderately effective  Helps people develop more realistic expectations o Panic Disorder  Recurrent uncued (unexpected) panic attacks  Concern about the panic attacks and possibility or future panic attacks  Worry about implication of panic attacks or consequences  Changes in behaviors: not going out, only going out when someone is with them  Safety behaviors: having phone in hand at all times, have someone around them  Physical sensations: increased heart rate, sweating, tingling/numbness, dizziness, shallow/rapid breathing, blurry (or tunnel) vision, intense, rapid increase fear o Timing of a First Panic Attack  First attack frequently follows feelings of distress or highly stressful life circumstance  Many adults who experience single panic attack do not develop panic disorder o The Panic Circle  Trigger stimulus (internal/external)  (no necessarily starting point)  Perceived threat  Apprehension or worry (ex. About having a panic attack or about any distressing situation)  Body sensations  Interpretation of sensations as catastrophic  Trigger stimulus (internal/external) (ex. Exercise, excitement, anger, sexual arousal, psychoactive drugs) o Panic Disorder: Panic Control Treatment  Involves interoceptive exposure  Therapist would explain what they are doing and why  Overestimating danger with sensations, inaccurate expectations  Anxiety will fade if they allow the experience  Exposing to the physical sensations of panic attack 5. Abnormal PTSD and Related Disorders  1. Realization of things being safe and not harmful, flipping a switch, extinction, 2. Have a sense of mastery over this and be okay,  more long term  Anti-depressant medication (SSRI)  More short term, especially when medication is stopped o Agoraphobia  Anxiety about being in locations where escape would be difficult (or help unavailable) in the event of onset of panic or other frightening sensations/condition  Avoidance  Lines, crowds, public transportation, open spaces, being alone, being away from home o Generalized Anxiety Disorder  Excessive worry (min duration: 6 months)  Perceived as being unable to control the worry – unproductive  Motor tension: tension in shoulders, headaches in the back/front,  Irritable  Sleep disturbance: chronic hyper arousal, keeps from going into sleep  Concentration impairment o Treatment for GAD  Cognitive-Behavioral Therapy  Worry exposure (finances, safety, family, job)  Stimulus control of worry behavior  Relaxation training  Downward arrow, think about an event and evaluate what does that mean, what will happen o Ex. Lost job  wouldn’t have money  lose house  homeless  seek help o Person can lay out in detail and expose them to ideas, reduce anxiety and helps realize what they can do to solve these problems  Problem solving  Medication (?)  Benzodiazepines: tolerance can be developed, can interact with other depressants such as alcohol, temporary o Obsessive-Compulsive Disorder 5. Abnormal PTSD and Related Disorders  Obsessions:  contamination fears o fears of harming oneself or others: checking ritual, like leaving iron, stove on, door unlocked, o need for symmetry o sexuality o religion, aggression  Compulsions:  Cleaning: often ritualistic, like counting to 100 when cleaning, serves as an uncertainty signal/mark  checking  repeating  ordering/arranging  counting  memory is remembered just as well, but confidence is lower for their memory o Psychological factors  OCD as learned behavior  Morwer’s two process theory of avoidance learning  OCD and preparedness  Evolutionary adaptive nature of fear and anxiety  Cognitive casual factors  Attempts to suppress thoughts cause increase o Treatment for OCD  Cognitive-behavioral treatment  ERP: Exposure with response prevention  Medication: Prozac, SSRIs  Neurosurgery: Cingulotomy  Only in severe, refractory cases 


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