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Abnormal Psychology

by: Geovany Crona

Abnormal Psychology PSY 320

Geovany Crona
GPA 3.6

Jerry Deffenbacher

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Jerry Deffenbacher
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This 33 page Class Notes was uploaded by Geovany Crona on Tuesday September 22, 2015. The Class Notes belongs to PSY 320 at Colorado State University taught by Jerry Deffenbacher in Fall. Since its upload, it has received 48 views. For similar materials see /class/210267/psy-320-colorado-state-university in Psychlogy at Colorado State University.


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Date Created: 09/22/15
PSY 320 Ch 1 9122011 113100 PM Psychological disorder pattern of abnormal behavior associated with states of emotional distressimpaired behavior or ability to function Abnormal psychology branch of psychology studying abnormal behavior and ways of helping people affected by psych disorders Psychological disorder vs mental disorderillness use psych disorder because mental illness refers to the medical model a bio perspective in which behavioral patterns are symptoms of an underlying illness Understanding of abnormal behavior is best achieved through taking into account bio environmental and sociocultural interactions Criteria for determining abnormality social context crucial 1 Unusualness 2 Social deviance Based on behavior deemed normal in a culture norms o Norms are relative standards not universal truths 3 Faulty perceptions or interpretations of reality Hallucinations delusions 4 Significant personal distress Abnormal if they persist after source of anguish has been removed most people would have adjusted or so intense impair ability to function 5 Maladaptive or self defeating behavior Behavior that leads to unhappiness rather than self fulfillment impairs ability to function in expected rolesadapt EX alcoholism 6 Dangerousness Agglxing the criteria Comorbid co occuring diseases not unusual Cultural bases of abnormal behavior Behavior that is normative within the cultural setting in which it occurs is not considered abnormal In our society psych disease is explained by models based on med icaIpsych factors in traditional native cultures abnormal behavior models invoke supernatural causes Historical De 39 on abnormal 39 39 Medieval abnormal behavior seen as possession in modern times it is viewed as abnormal due to psychosocial and physical factors The Demonological Model Ancestors believed abnormal behavior caused by inhabitation of evil spirits Trephination drilling of the skull to provide outlet for spirits but no written accounts of the reason for the procedure exist Some people did survive procedure fresh bone growth Also could have been performed to remove bone piecesblood clots from head injuries Demonology supernatural causes of abnormal behavior prominent until Age of Enlightenment Ancients explained things in terms of the gods Oriqins of the Medical Model In III Humor Hippocrates challenged beliefs of his time by arguing illnesses were result of natural causes foreshadowed medical model Humors the vital fluids whose balance the health of the body and mind depended on phlegm black bile blood yellow bile 0 An imbalance abnormal behavior Classified abnormal behavior patterns melancholia mania phrenitis Hippocratic oath oath of medical ethics medical students swear Galen concluded arteries carry blood not air Medieval Times After Galen Medievals believed in supernatural causes again due to Roman Catholic Church s influence Exorcists employed to persuade evil spirits bodies were no longer habitable o Horrible things to victim to persuade Fear of witches reached height in Renaissance period despite being the transition from medieval to modern Witchcraft Pope Innocent VIII declared witches be executed Malleus Maleficarum manual to identify suspected witches Witch hunting diagnostic tests The float test pure metals sink impurities float 0 Those who drowned dubbed pure So called witches actually people with psych disorders most falsely confessed to things because they were being tortured usually old unmarried women In England still relied on naturalistic causes to explain disordersillness Asylums Mad houses formerly leprosariums Appalling conditions some made public spectacles St Mary s of Bethlehem Hospital buy tickets to observe inmates The Reform Movement and Moral Theragx Modern era treatment begins w Jean Baptiste Pussin amp Philippe Pinel Mentally ill viewed as threats to society tried to convince people that they were people with diseases that should be treated humanely Pussin first to unchain a group of the incurany insane fired employees that were mean to his patients Pinel continued to treat inmates humanely and stopped harsh practices bleeding and purging and moved inmates to sunny rooms spoke to inmates for hours Moral therapy resulting philosophy humane treatment could restore functioning Benjamin Rush father of American psychiatry author of Medical Inquiries and Observations Upon Diseases of the Mind madness caused by engorged blood vessels to brain treated patients kindly Dorothea Dix traveled the country and brought horrible institution conditions into awareness 32 mental hospitals started because of her A step backward Apathyskepticism about the cu rability of mental disorders Mental hospitals had horrifying conditions patients restrained not hygienic Mental patients in back wards warehoused with little hope of recovery The Community Health Movement The Exodus from State Hospitals 1963 CMHCs offered as alternative to institutions to care for former hospital residents released from mental hospitals under policy of deinstitutionalization return to communities Some of these people marginally functioning and lacking housingresources homeless people Phenothiazines antipsychotic drugs that quelled flagrant schizophrenic behaviors Mental hospital population from 559000 to less than 100000 by 19905 1 alv Fe 39 on Abnormal quot 39 Diagnosis relied on bio chem physics astronomy Scientific models of abnormal behavior emerge The Bio Perspective Griesinger abnormal behavior rooted in brain diseases Kraeplin textbook linking mental disorders to physical diseases Developed classification system 0 Dementia praecox now schizophrenia believed to be caused by biochemical imbalance o Manicdepressive psychosis now bipolar disorder believed to be caused by abnormality in body metabolism General paresis degenerate brain disease from bacterium that causes syphilis invading brain tissue causing disturbed behavior supported medical model Psychological Perspective Charcot uses hypnosis to alleviate symptoms of patients with hysteria fainting Sigmund Freud inspired by hypnosis Breur and Anna O paralyzed until hypnosis brought her emotions to the surface and discharged them psychodynamic model first major model psychological factors outside of consciousness abnormal behavior caused by clashing forces within the personality Sociocultural Perspective Psychological problems rooted in the ills of society ex poverty family breakdown injustice ignorance The label mentally ill is hard to remove stigmatization alienation Biopsxchosocial Perspective Interactionist model Research in abnormal Scientific method method of conducting scientific research in which theories or assumptions are examined in light of evidence Four goals description explanation prediction control Theory formulation of the relationships underlying observed events Help explain and predict Control controversial In this context means helping people shape their behavior Hypothesis prediction tested in an experiment Ethics in Research IRBs institutional review boards review proposed research studies in light of ethical guidelines based on informed consent ampconfidentiality Informed consent people are free to choose whether or not to participate in studies given sufficient information in advance about the study free to withdraw from study Researchers may withhold information but then participants must be debriefed afterward have option of taking treatment if they were given placebo etc Confidentiality keep participation records secure Correlational Method Yadda yadda correlations Longitudinal study correlational study in which individuals are periodically tested over lengthy periods of time Experimental Method Yaddddaa yadddaaaa Experimental Validity Internalexternal Construct higher level of validity The degree to which treatment effects can be accounted for by the theoretical mechanismsconstructs represented in the N5 Ex A drug has construct validity if it works for the reasons proposed by the researchers Can never be certain Epidemiological Studies Examine the rates of occurrence of abnormal behavior in various settings or population groups Potential causal factors for illnesses Survey method questionnairesinterviews Rates of occurrence expressed in Incidence number of new cases in period of time Prevalence overall number of cases of a disorder in a population during a period of time 0 Include both new and continuing cases Kinshig studies Disentagle roles of heredity and environment in terms of behavior To determine if abnormal behavior runs in a family select a person with a disorder and and study the distribution of the disorder in the family Proband the index case or first case diagnosed If distribution in family of the proband approximates their degree of kinship may be genetic However keep in mind families may share environments Twin Studies Concordance rate the percentage of cases in which both twins have the same traitdisorder Higher in M2 identical than DZ twins fraternal Difficult to generalize the results because of expectations influencing behavior and self fufiing prophecies Adogtee Studies Children share environment with adoptive parents Compare traitsdisorders of child to adoptive and biological parents to see effect of genesenvironment Case Studies Intensive studies of individuals EX Freud studied Anna O and Leonardo da Vinci Can be of historical figures Distortionsgaps in memory may occur for self report stuff Single Case Exgerimental Designs Developed because of lack of control in case studies reversal design ABAB repeated measurement of behavior across four successive phases 1 Baseline phase A prior to treatment to establish baseline 2 Treatment phase B target behaviors measured in treatment 3 Second baseline A treatment temporarily suspended reversal positive effects should now be reversed due to withdrawn TX 4 Second treatment B Treatment reinstated and target behaviors reassessed ex Girl with squinting tick Ch 3 Classification and Assessment of Abnormal Behavior 9122011 113100 PM Diagnosis is a method of classification Kraepelin first theorist to develop model of classificiation associated w behavioral patterns Classification today Diagnostic amp Statistical Manual of Mental Disorders DSM published by APA How Are Abnormal Behavior Patterns Classified DSM IV is latest edition published in 2000 Criticized for relying too strongly on the medical model Abnormal behavioral patterns called mental disorders ICD published by the WHO compiles statistics on occurrences of disorders worldwide tenth revision The DSM and Models of Abnormal Behavior Treats abnormal behaviors as signssymptoms of underlying disorders but recognizes most of their causes are uncertain Biological psychogical and multifactorial origins Call disorders mental disorders but still much debate over this Features of the DSM Descriptive not explanatory Describes diagnostic features does not attempt to explain or adopt particular theory DSM is a CATEGORICAL model of classification classifies individuals in the event that they meet the criteria for particular categories Categories based on grouping abnormal B patterns by common features Five axes provide information about patient s functioning Axis 1 Clinical disorders impair functioning and cause stress Axis 2 Personality disorders ampmental retardation rigid enduring maladaptive ways of relating to others and adjustingdelay or impairment in intellectualadaptive abilities Axis 3 General medical conditions chronicacute illness that may be important to understandingtreating psych disorder Axis 4 Psychosocialenvironmental problems problems in socialphysical environment that affect diagnosis treatment outcome Axis 5 Global Assessment of Functioning overall judgment of current functioning Culture Bound Syndromes Patterns of abnormal behavior that occur in some cultures but are rareunknown in others Ex Excessive fear of embarrassing others most common in Japanese men Ex Anorexia nervosa in US Evaluating DSM System Must be reliable consistent diagnoses and valid diagnosis corresponds with behavior Predictive validity ability to predict behavior depending on Tx Whether DSM is valid or not is ongoing debate Cultural and ethnic factors 0 Mostly US trained psychologists determined criteria for DSM if there were diversity diagnostics might have varied more 0 Lastest edition of DSM does pay more attention to addressing cultural factors than previous editions 0 Some behaviors abnormal in one country and not another 39 and lquot 39 of DSM Svstem Advantages Designation of specific diagnostic criteria Multiaxial system paints comprehensive picture allowing for multiple diagnoses Criticisms Challenge reliance of medical model 0 Some issues too complex to be treated as symptomatic Challenge some of the specificed diagnostic criteria needing to be depressed for X amount of time Doesn t focus enough on external influences Should the categorical approach be changed to dimensional o Abnormal B represent extreme variations on a spectrum of emotional statesphysiological traits Threat of stigmatisminsurance claims 0 Sanism negative stereotype of people identified as mentally ill Standards of Assessment Methods of assessment must be reliable amp valid Reliability Consistency yield same result on separate occasions testretest reliability Assessment technique has internal consistency when different parts of the test yield significant results Interrater reliability raters must show high level of agreement in their ratings Validity Instruments must measure what they intend to measure Content validity Degree to which technique s content represents behaviors associated with the trait in question Criterion validity degree to which assessment technique correlated with independent external criterion One form predictive validity shows if it can be used to predict future B Sensitivity the degree to which a test correctly identifies the people who have the disorder a test is intended to detect Tests lacking S produce high of false negatives Specificity the degree to which the test avoids classifying people as having a particular disorder who truly do not have the disorder Tests lacking S produce high of false positives S amp 5 determine ability of test to correctly classify individuals Construct validity degree to which a test corresponds to theoretical model of the underlying construct or trait it purports to measure Requires results to predict other behaviors based on theory The Clinical Interview Most widely used means of assessment face to face with clinician Topics 0 Identifying data description of problem psychosocial history medicalpsychiatric history medical problemsmedication Interview Formats Unstructured clinician adopts own style of questioning no standard format Advantage spontaneity conversationality Disadvantage no standard may fail to touch on things Semistructured clinician follows general outline of questions but is free to ask them however More structure and uniformity at the expense of spontaneity Structured called standardized give highest level of reliabilityconsistency frequently used in research settings Comguterized interviews People may actually reveal more information about themselves to a computer less self consciousness However computers ack human touch sensitivity reading of facial expressions Computers are just as capable less expensive less time consuming Resistence to computers comes from clinicians more than clients Psychological Tests Structured method of assessment Intelligence Tests Wechsler scales most widely used intelligence test Measures capacity to understand the world and resourcefulness to cope with its challenges Include subtests to measure strengthsweaknesses combine to form overall IQ Binet constructed first intelligence test for French children in schools Test called Stanford Binet still in use today IQ intelligence quotient based on relatived deviance of person s score on intelligence test from the norms of their age group mean 100 Objective Tests Self report personality inventories Objective because they limit the range of possible answers and can be scored objectively Minnesota MultiPhasic Personality Inventog MMPI Z 500 tf statements regarding interests relationships habits etc Tests personalitydetects abnormal behavior patterns Items divided into various clinical scales to score for validity content etc A score of 65 on any scale is significant Cannot provide diagnoses but can suggest possible diagnoses Million Clinical Multiaxial Inventog MCMI Helps clinician make judgments about DSM system especially with personality disorders Evaluation of Objective Tests May reveal information not revealed during an interview EX a person harbors negative views of himherself Always certain potential issues with self report data Tell us little about unconscious processes Projective Tests such as Rorschach Inkblot Test amp Thematic AQQercthion Test TAT Offer no clear specified responses Present clients with ambiguous stimuli inkblots Argued that these are based more off of clinicians interpretations Rorschach Inkblot Test Inkblots everyone has a different response to Subjects tell the examiner what the ink blot might bereminds them of describe features of the blot Thematic 39 Test TAT Henry Murray Apperception interpreting new ides on th basis of existing ideas and past experience Series of cards with ambiguous scene Responses to the cards will reflect their experiences and outlooks on life Eval of Projective Technigues Examiners may interpret results of tests differently Some say Rorschach is valid some say it fails to measures up to other tests For TAT images may create too much of a stimulus pull and clients might react to stimulus more than projections of their personalities Some critics would like the projective techs scrapped some believe that they reveal material that might not be revealed in interviews because people are apt to offer more socially desirable responses Involves the use of tests to help determine whether psych problems reflect underlying neurological impairment or brain damage May be used with an MRI or CT scan Show that there isisn t brain damage andor what part of brain is affected Bender Visual Motor Gestalt Test One of first tests most widely used Copy geometric designs Signs of possible brain damage rotated figures distortions in shape and size 39 Reitan Ncul 39 Batterv Battery contains subtests measuring perceptual intellectual and motor skills Category Test measures abstract thinking groups of stimuli appear on the screen subject must discern linking characteristic Rhythm Test measures concentrationattention listens to pairs of recorded beats and decides if they re samedifferent Tactual performance test tests visual memory subject is blindfolded and fits blocks of diff shapes into form board then asked to draw the board from memory Behavioral Assessment MMPI Rorschach and TAT designed to measure underlying psych traits signs of traits Behavioral assessment is a SAMPLE of behavior in certain situations Aims to sample in settings as similar as real life as possible Functional analysis analysis of the problem behavior in relation to antecedents or stimulus cues consequences reinforcements Behavioral interview questions to learn about historysituational aspects of the problem Looks for information about thought patterns and reinforcers of the behavior Direct observation behavioral observation hallmark of behavioral assessment to observe and quantify a problem Advantages doesn t rely on self report suggest strategies for intervention Disadvantages observers may have response biases ex expectations reactivity lack of consensus defining problems in behavioral terms lack of reliability in coding of behavior or between observers Reactivity Tendency for behavior being observed to be influenced by the way in which it is measured 0 Covert observation techniques reduce this ex hidden cameras Observer drift Tendency of observers to deviate from coding system as time elapses SelfMonitoring Training clients to recordmonitor behavior in settings where it naturally occurs Highly accurate measurement as behaviors are recorded as they happen not from memory Help increase desirable but low freq B ex assertiveness Disadvantages some clients unreliablebad records Analogue Measures Intended to simulate natural settings but take place in labcontrolled settings Role playing exercises Behavioral Approach Task BAT analogue measure for a phobic person Measured by assigning a score to each level of approach Behavioral Rating Scales Checklist providing info about freq intensity and range of problem B Different than self report bc they assess specific behaviors rather than personality characters 0 Ex CBCL Child Behavior Checklist Cognitive Assessment Measurement of cog nitions help replaced self defeating cog with self enhancing One method thought recorddiary including the situation the thoughts the type of disordered thinking those thoughts represent a rational response and emotional outcome or final response ATQ Automatic Thoughts Questionnaire asks people to rate frequency and strength of belief in their thoughts DAS Dysfunctional Attitudes Scale inventory of relatively stable set of underlying attitudes or assumptions use scale to rate degree to which they endorse each belief Physiological Measurement Study of physiological responses EX sweating measured as electrodermal response or galvanic skin response using electricity on the hand more sweat more electricity conducted EEG Electroencephalograph measures brain waves through electrode on scalp EMG Electromyograph monitors muscle tension through sensors in target muscle groups BrainImaging and Recording Techniques EEG record of electrical activity in the brain Certain patterns associated w certain mental states CT scan computed tomography brain imaging technique Radiation measured from multiple angles reveals abnormalities in shapestructure PET scan Positron emission tomography studies functioning of various parts of the brain Radioactive tracer mixed with glucose which brain metabolizes to create image and emits positrons Areas of greater activity metabolize more glucose MRI Magnetic resonance imaging radio waves at head create computer image of the brain FMRI functional identifies parts of brain that become active when people engage in particular activities oxygen demanded in active parts of the brain BEAM Brain Electrical Activity Mapping sophisticated EEG using a computer to analyze brain wave patterns to reveal lesserg reater areas of activity moment to moment SocioculturalEthnic Factors in Assessment Researchers must be careful of translation Some psychological methods may work better or worse for different ethnicities and stuff Ch 2 and 4 9122011 113100 PM 22 101105 Intro to Hel2ing T 2es of hel2ing 2rofessionals Some states do not require licenses to practice therapy people seeking help advised to inquire about licensure Psychotherapy Systematic interaction between client and therapist that draws on psych principles to bring out change in client s behavior thoughts feelings systematic means they structure their interactions to reflect their theoretical points of view Assists three groups of people those suffering from AB people seeking help for personal problems and people seeking growth Psychotherapies are talking therapies Dialogueclient does most of talking Therapists listen actively express interest and show empathy Instill sense of hope no promisesguarantees 0 Response to positive expectancies 9 self fulfilling prophecy Due to placebo effectexpectancy effect Nonspecific treatment factors the common features to diff types of PT such as therapist attentivenessempathy etc 22 4349 amp 10510 Iquot 39 39 39 pen 39 amp treatment Psychodxnamic Models Based on contributions of Sigmund Freud amp followers Psychoanalytic theory roots of psych problems involved unconscious motives and conflicts that can be traced back to child hood Revolve around sexualaggressive instincts and the need to keep them out of consciousness We would be crippled with anxiety if we were to know our true unconscious desires AB patterns are symptoms of conversion of unconscious psych conflict into physical problem Structure of the mind Mind iceberg with only tip visible above surface Tip conscious Beneath surface preconscious and unconscious Preconscious memories not in awareness but can be brought into awareness by focusing on them ex telephone Unconscious largest part of the mind incredibly difficult to access repository for instincts Structure of personalitx Divided into three mental entities id ego superego Id unconscious psychic structure present at birth contains primitive instincts and is regulated by the pleasure principle Pleasure principle Governing principle of the id demands immediate gratification of needs wo consideration for social rulesother people Ego Psychic structure that corresponds to the concept of the self governed by the reality principle characterized by the ability to tolerate frustration Develops during first year allows gratification to be achieved but not at expense of social disapproval Reality principle governing principle of the ego which involves considerations of social acceptability and practicality Ground work for developing sense of self as individuals Superego The psychic structure that incorporates the values of parents and important others and functions as a moral conscience Monitors ego passes judgment on right and wrong allows for punishment like shame and guilt Ego stands between superego and id tries to satisfy both Part of ego is conscious other part is unconscious Defense mechanisms Reality distorting strategies used by the ego to shield the self from awareness of anxiety provoking impulses Constrain impulses from the id May also give rise to abnormal behavior ex infantile state LIST PAGE 45 Staqes of T 39 39 l 39 Freud says sexual drives are dominant in development of personality Child s relationship w world based on pursuit of sexual pleasure 0 Sexual might be closer to sensual in today s terms Reason for sexual drive is an instinct named Eros to preserve and perpetuate life Libido sexual energy energy of Eros As child matures libidinal energy expressed as sexual pleasure in different erogenous zones oral anal phallic latency genital Oral first year sexual gratification through sucking breasts mouthing anything nearby Anal second year contractionrelaxation of sphincter muscles Phallic third year penis boysclitoris in girls 0 OedipusElectra Conflict Incestuous desires for parents of opposite gender Latency 6 12 impulses remain in latent state Genital puberty achieved through sex Fixation too much or too little gratification in any of the above sexual stages Leads to development of characteristics of that stage Ex oral fixation smoking alcohol abuse overeating etc Other Psychodxnamic Theorists Psychoanalysis Others tended to place less emphasis on basic instincts like sexaggression more emphasis on conscious choice self direction creativity etc Carl Jung Analytic psychology Human behavior incorporates self awareness and self direction including the id and defense mechanisms We have a personal unconscious and a collective unconscious Archetypes primitive images or concepts that reside in the collective unconscious o Reflect history of human species influence thoughts dreams emotions Alfred Adler Individual psychology Creative self self aware part of personality that strives to overcome obstacles People are driven by inferiority complex which originated from small size during childhood Cause drive for superiority which in a healthy mind in hindered by need to help others Karen Horney Importance of child parent relationships in developing emotional problems Basic anxiety formed when parents are uncaring or harsh Basic hostility formed when children harbor deep seated resentment toward parents Ego psychology ego has motives of its own Heinz Hartmann Erik Erikson Focus on psychosocial development More importance in relationships and personal identity formation than unconscious Our personalities continue to be shaped through adulthood Ego identity clearly defined sense of who we areour beliefs Margaret Mahler Object relations theory viewpoint that focuses on the influences of internalized representations of the personalities of parents and other strong attachment figures We introject traits of our parents into our personalities Separation from mother during first few years of life is crucial to personality development Introjected attitudes battle with our own it is difficult to tell where our real selves begins and other people end Mahler sought to help clients separate their own ideasfeelings to develop as individuals Iquot 39 39 39 Views of Normalitv and Abnormality Mental health is a function of dynamic balance among mental structures id ego superego Psych disorders indicate balance is lopsided Unconscious impulses may leak causing anxiety Symptom expresses conflict while it protects the self from recognizing the inner turmoil Freud believed underlying conflicts came from childhood Psychosis the id gets past a weakened ego causing a severe form of disturbed behavior characterized by impaired ability to interpret reality and difficulty meeting demands of daily life Freud equated psych health with ability to love and work Addler health is compensating for feelings of inferiority by striving to excel Mahler AB is failure to develop distinctive identity 39 39 Iquot 39 39 39 Models Psychodynamic theory pervades normal culture Leads us to recognize we are not transparent to ourselves Critics think Freud May have put too much emphasis on sexualaggressive impulses Id ego and superego could be entirely fictional Not scientific because no way to test Growing body of evidence supports unconscious processes including defense mechanisms pp 105108 Psychodynamic Theragy Psychoanalysis method of psychotherapy developed by Freud First kind of psychodynamic therapy helps clients gain insight into and resolve struggles between forces of the unconscious believed to be root of AB Help find way of handling impulses so the ego can go do constructive things Free Association uttering uncensored thoughts as they come to mind let mind run freely not truly free repressed impulses have compulsion to utter Resistance unwillingness to inability to recall or discuss disturbing or threatening material ego continuing to avert disclosure often suggestive of meaningful material Dream analysis during sleep ego s defenses are lowered and unacceptable impulses find expression in dreams Defenses not completed eliminated symbolized form Dreams have two levels of content 0 Manifest material dreamer experiences and reports 0 Latent unconscious material dream symbolizes Transference Client s transfer or generalization to the analyst of feelings and attitudes the client holds towards important figures in hisher life Freud believed it provided a vehicle for reenactment transference neurosis Countertransference feelings the clinician projected onto clients Learn to monitor reactions in therapy Modern Psychodynamic Approaches Some continue Freud s method Some focus less on sexual issues and more on present relationships Greater emphasis on adaptive changes in relation to other people Greater emphasis on ego less on id Object relations like Mahler more on separating own ideasfeelings from those that they have introjected allows to develop as individuals pp 5355 amp 109110 Humanisticexistential perspective and treatment Humanisic Models Carl Rogers and Abraham Maslow Selfactualization people have this inborn tendency to strive to become all they are capable of being Live authentically with meaning by recognizing genuine needs amp feelings AB comes from roadblocks in striving for self actualization Humanistic concepts of abnormal behavior Results from distorted concepts of the self Unconditional positive regard tendency to strive to become all that one is capable of being the motive that drives one to reach one s full potential and express one s unique capabilities tool for parents to help children develop positive self concept children develop conditions of worth think of themselves as worthwhile only when they act in approved ways bad parenting can lead to distorted self concept strangers to true selves We cannot fulfill the wishes of others and remain true to ourselves Self actualization pathway requires self discovery and self acceptance Evaluating Humanistic Models Focus on conscious experience guide people towards self actualization Concepts of free choice inherent goodness personal responsibility authenticity Critics say self actualization cannot be proved or disproved or measured pp 109110 Humanistic Therapy Focus on subjective present conscious experience of client Personcentered therapy also client centered establishment of a warm accepting therapeutic relationship that frees the client to engage in self exploration People have natural motivational tendencies toward growthfulfillment Psych disorders come from roadblocks in path to self actualization Develop distorted self concepts as we try to be socially acceptable become deaf to inner voices Nondirective client directs the course of therapy not therapist Reflection technique used by therapist involves restating or paraphrasing client s expressed feelings without interpreting thempassing judgment Allows client to explore feelings without condemnation Four qualities of effective therapist 1 unconditional positive regard expression of unconditional acceptance of another person s intrinsic worth 2 empathy ability to understand someone s experiences and feelings from that person s point of view 3 genuineness ability to recognize and express one s true feelings 4 congruence fit bw one s thoughts behaviors and feelings In a congruent person all of these things are integ ratedconsistent pp 5557 amp 111113 Cognitive perspective and treatment Cognitive Models Study thoughts beliefs expectations attitudes in relation to reality Our interpretations of the events in our lives not the events themselves determine our emotional states InfoProcessing Models Apply concepts of computer science to human cognition Input memory storage manipulation retrieval output Psych disorders disturbances in these processes Cognitive distortions errors in thinking Social cog theorists share many basic ideas focus on ways social info is encoded Ex aggressive boys take everything as a threat when its not meant to be Albert Ellis Events themselves do not lead to psych disorders it s the irrational beliefs we have about our unfortunate experiences ABC approach Activating event 9 Beliefs 9 Consequences Apprehension and disappointment are normal but irrational beliefs that catastrophize feelings lead to profound distress Ex I must have the love and approval of everyone or else I am worthless Rational emotive behavior therapy help people dispute irrational beliefs and substitute more rational ones Key to happiness recognizingmodifying irrational self demands Aaron Beck Depression results from errors in thinking cog distortions by judging oneself entirely on basis of one s flaws or failures interpreting events negatively Four types of cognition distortions o 1 Selective abstraction People focus exclusively on parts of experience that reveal flaws ignore evidence of competency o 2 Overgeneralization Overgeneralize from a few isolated experiences rejection means a person will never marry etc o 3 Magni cation Magnify important of unfortunate events 0 4 Absolutist thinking Everything is black and white no gray ex a test less than and A is a complete failure Evaluating Cog Models Cognitive behavioral therapy focuses on modifying self defeating beliefs amp behaviors Combination of learning based and cog approaches Major issue range of applicability Cog models focus largely on anxietydepression pp 111113 Cognitive Therapy Help clients identify and correct faulty thinking distorted beliefs self defeating attitudes Negative emotions come from interpretation of events not events themselves Two types of cog therapy help clients identifycorrect fault cognitions Ellis s rational emotive behavior therapy Aaron Beck s cog therapy Rational Emotive Behavior Therapy Ellis Negative emotions come from interpretation of events not events themselves Focuses on helping clients replace irrational maladaptive beliefs with alternative more adaptive beliefs Ex Jane can t speak to attractive men because she is too anxious ends up feeling stupid and inaqequate Beck s Cog Therapy Encourage clients to realize cognitive distortions such as magnifying importance of negative events and ignoring personal accomplishments Dispute distorted thoughts replace with rational alternatives Reality testing asked to test negative beliefs in light of reality Ex calling friends to gather data about friend s reactions to the talk Cog behavior therapy a learning based approach to therapy incorporating cog and behavioral techniques Beck and Ellis s therapies can be classified here Pg 113 Table Overviewing Major Types of Psychotherapies Pp 5053 108109 113114 Behavior perspective amp treatment Learning models Ivan Pavlov and John B Watson Behaviorism study of observable B that focuses on the role of learning in explaining B Behavior is a product of genetics and environmentalsituational influences AB is learned just like normal B Role of Classical Conditioning Pavlov amp salivating dogs Conditioned response learned response salivation to bell Unconditioned stimulus stimulus that elicits unlearned response food Unconditioned response unlearned response salivation Conditioned stimulus previously neutral stimulus that evokes a CR after repeated pairings with and UCS that had previously evoked that response bell Classical conditioning form of learning in which a response to one stimulus can be made to occur in response to another stimulus by pairing or associating the two stimuli Ex drill making person nervous at dentist Ex fear of elevators after getting stuck in one Simple reflexive responses Learning involves adapting to stimuli Watson made Little Albert fear a white rat Role of Operant Conditioning BF Skinner 0C a form of learning in which behavior is acquired and strengthened when it is reinforced Reinforcement Stimulusevent that increases frequency of response it follows Positive reinforcers Rewards increase frequency of preceding behavior Negative reinforcers increase frequency of behavior when they are removed Punishment application of aversive stimuli that reduce frequency of B Punishment vs Reinforcement Punishment may temporarily suppress behavior but not eliminate it Cause hostility and anger rather than constructive learning Reinforcement more desirable but good behavior must be attended to not just misbehavior Social Cog Theory Bandura Rotter Mischel Emphasizes observational learning modeling and incorporates roles for cognitive variables in determining behavior Modeling learning by observing and imitating the behavior of others Expectancies beliefs about expected outcomes Need to be considered in explaining behavior Eval of Learning Models Created behavior therapy B modication Applying learning principles to change behavior Critics Human experience cannot be reduced to observable responses Dissatisfied with the view that environmental influences R and P5 mechanically control behavior Behaviorism does not address thoughts and dreams too little emphasis on subjective experience pp 108109 Behavior therapy Therapeutic application of learning based techniques Brief because focus is on changing behavior not personality Warm relationship with client but belief is that learning based techniques rather than nature of therapeutic relationship is responsible for efficacy Systematic desensitization behavior technique for overcoming phobias by means of exposure to progressively more fearful stimuli while one remains deeply relaxed If fear is evoked restore relaxation When client tolerates scene wo anxiety moves up in fear stimulus hierarchy continued until they can remain relaxed in most distressing scene in hierarchy Gradual Exposure in vivo in life exposure person with phobia puts himherslf in situations with fearful stimuli Combined with cog techniques that focus on replacing anxiety arousing irrational thoughts with calming rational ones Modeling Learn desired behaviors by observing others performing them then imitating receiving reinforcement from therapist Reinforcement techniques based on Operant Conditioning Token economy behavior treatment in a controlled environment constructed where people are reinforced for performing desired behaviors by receiving tokens that may be exchanged for desired rewards Institutional settings Aversive conditioning used in treating substance abuse Social Skills training treating social anziety and skills deficits assoc with schizophrenia 22 113114 CogBehavioral Therapy learning based approach to therapy incorporating cogbehavioral techniques Most therapists identify with this Assumes that thinking patternsbeliefs affect behavior an changing these can produce desirable changes Assortment of behavioral exposure to fearful situation and cog techniques changing maladaptive thoughts Impressive results on wide range of disorders 2L3543 amp 123129 Bioloqical Fe 39 and Treatment The Biological Persgective Gave rise to development of medical model not synonymous with bio perspective and drug therapy Nervous System Dendrites short fibers that project from cell body to receive messages from adjoining neurons Axon trunklike projection from cell body Terminals small branching structures at axon tips Messages conveyed in one direction dendrites 9 cell body 9 axon 9 axon terminals Synapse junction between one neuron and another through which impulses pass Neurotransmitters chemicals substances that transmit messages bw neurons Receptor site part of a dendrite on receiving neuron that is structured to receive a neurotransmitter Lock and key Loose neurotransmitters broken down by enzymes or reabsorbed reuptake by axon terminal Psychiatric drugs work by affecting availability of NTs in the brain Parts of the Nervous System CNS brain and spinal cord PNS Somatic and automatic nervous systems Made up of nerves that a receive and transmit sensory messages to brain and spinal cord and b transmit messages from the brain or spinal cord to the musclesglands CNS Structuralfunctional abnormalities result in forms of AB Lower part of brain medulla pons cerebellum Medulla vital life support functions heart rate resp blood pressure Pons transmits info about body movementinvolved in functions related to attention sleep resp Cerebellum regulates balancemotor muscle B Midbrain connects hindbrain to forebrain Reticular activating system weblike net of neurons in hind mid and forebrain that regulate sleep attention arousal Stimulation heightens alertness depression reduces RAS activity alocohol Forebrain structures Thalamus relays sensory info ex tactilevisual to higher regions of brain 0 Works with RAS to regulate sleepattention Hypothalamus pea sized structure involved in regulating body temp concentration of fluids in blood reproductive processes emotion and motivation Limbic system group of forebrain structures thalamus and hypothalamus that have roles in emotional processing memory hunger thirst aggression Basal ganglia base of the forebrain regulate postural movement and coordination Cerebrum responsible for higher mental functions thinking problem solving Cerebral cortex wrinkled surface area of cerebrum for processing stimuli and planning consciousness sense of self PNS Network of neurons connecting brain to sense organs Allow us to sense world around us and act upon it Two main parts somatic amp autonomic Somatic NS transmits messages from sense organs to the brain to experience visual auditory tactile and other sensations Transmits messages from brain to nerves to control skeletal muscles Autonomic NS Regulates activites of the glands and other involuntary functions also emotional processing Two branches sympathetic amp parasympathetic 0 Mostly opposite effects from one another 0 Sympathetic activity leads to heightened states of arousal fig ht or flight o Parasympathetic reduces state of arousal and regulates body processes that replenish energy reserves Cerebral Cortex Higher mental functions thought and language Two hemispheres four lobes Occipital lobe processing visual stimuli Temporal lobe processing auditory stimuli Parietal lobe sensations of touch temperature pain Sensory area skin receptors all over body Frontal lobe contains motor cortex Prefrontal cortex higher mental functions thinking problem solving language Eval Bio Perspectives on AB Genetic factors brain abnormalities disturbances in NT functioning all have a role Exact causes remain unknown for most disorders Genes often multiple acting together Study genes environment to better understand AB Do not dictate behavioral outcomes Create predisposition or likelihood Multiple genes involved Genes and environment interact 22 123129 Biomedical Theragies Psychopharmacology study that examines the effects of therapeutic or psychiatric drugs Dramatic success but some limitations side effects also potential for abuse Drug Therapy Act on NT systems in the brain Antianxiety drugs Drugs that combat anxiety and reduce states of muscle tension Valium Xanax Decrease activity in certain parts of CNS 9 CNS decreases level of sympathetic NS activity Extremely dangerous to mix with alcohol and addictive Side Effects fatigue drowsiness impaired motor coordination Tolerance physiological dependence need over time to increase dosage to receive same effect Rebound anxiety when drugs discontinued rebound of anxiety or insomnia returns in more severe form Antipsychotic Drugs Neuroleptics Used to treat schizo and other psychotic disorders with hallucinations delusions and states of confusion Reduced need for restrictive treatment and long term hospitalization Mass exodus from mental institutions in 19505 Potential side effects such as muscle rigidity and tremors tardive dyskinesia Antidepressants Treat wide range of psych disorders panic social phobia depression 0CD anxiety bulimia SSRIs have more specific effects on serotonin in the brain interfere w reuptake Modest antidepressant effects Lithium Helps stabilize dramatic mood swings of people w bipolar disorder Potential toxicity drug must be carefully monitored Electroconvulsive Theragx Treating severe depression by administering electrical shock to the head Ugo Cerletti got the idea from watching cows rendered unconscious at slaug hterhouses w electrical shock Believed to help with schizophrenia Antidepressants have limited ECT use Very controversial Memory loss MIGHT help correct NT imbalances in brain but no one knows how high rate of relapse relative effectiveness still under study considered last resort Psychosurge More controversial than ECT rarely practiced Prefrontal lobotomy Involved surgically severing nerve pathways linking thalamus to prefrontal lobes of the brain Theory that overexcitation from lower brain centers was emanating Did reduce violentaggressive behavior not always successful dangerous Moniz shot by one of his patients Some experimental surgical techniques for severe 0CD bipolar disorder and major depression Deep brain stimulation pacemaker for the brain surgically implanted electrodes Last resort treatment Eval of Biomedical Approaches Helped many many people However Some forms of psychotherapy can be as effective as drug therapy Side effectsabuseaddiction Medical professionals too quick to write prescriptions than describe other methods DD 5761 quot 39 quot a Pen Does AB rise from socialcultural factors such as ethnicity gender social class Sociocultutal theories explain AB with societal failures rather than problems with the person Szaz denies existence of psysch disordersmental illness 0 Abnormal is a societal label attached to people whose behavior deviates from the norm 6 just a STIGMA Ethnicity and Mental Health US used to be mostly Native Americans now they are a tiny minority Traditional racialethnic distinctions become increasingly blurry as people call themselves biracialmultiracial Ethnic Group Differences in Psych Disorders Need to recognize income levelsocioeconomic status must be considered when comparing rates of d iag nosis Whites have better access to quality care which could shorten length of psych disorders experienced Native Americans have highest rate but also the most impoverished Native Hawaiians Asians and Islanders suffer a lot due to higher disease rate and higher mental illness rates also from alienation and lack of traditional culture Loss of harmony with nature Most groups underutilize mental health services compared to white Americans I the n u a Fcl Lower socioeconomic groups more likely to be instittutionalized but also have less access to care Social causation model people from lower socioeconomic groups at a greater risk of severe behavior because living in poverty subjects them to greater level of stress Tested with Native American tribe and casino introduction reduced rate of problem behaviors Downward drift hypothesis Problem behaviors ex alcoholism cause people to drift downward in social status therefore linking low socioeconomic status to severe AB DD 6164 The Bi 39 39 39 Fe 39 The DiathesisStress Model Originally a framework for understanding schizophrenia but now is a model that proposes that AB involves interaction of a diathesis vulnerability or predisposition to a particular disorder and stressful life eventsexperiences Diathesis stress 9 development of disorder Whether disorder actually develops depends on diathesis amp severity of stressors The stronger the diathesis the less stress is generally needed to trigger disorder Diathesis usually genetic in nature but can be psychological maladaptive traitsways of thinking Eval of Bio2sychosocial Pers2ective Possibly too complex to pinpoint causes of disorders 22 114123 amp 22 129135 Other interventions and issues Eclectic therapy an approach to PT that incorporates principles and techniques from various systemstheories More psychologists identify with eclectic orientation than any other orientation 0 Electic approach normal among older more experienced therapists Technical eclectics therapists that drawn of techniques from different schools of therapy without necessarily adopting the theoretical positions that spawned the techniques Use approach they believe is most likely to work with client Integrative eclectics Attempt to synthesize diverse theoretical approaches into one integrated model of therapy Criticism is that this leads to hodgepodge of techniques with no framework Group Family Couples Therapy Less costly more effective at treating groups of clients with similar problems get social support and support from therapist Some patients like the individual better because they get more attention and don t want to disclose info to a group Family therag Aims to help troubled families solve their conflicts Learn to communicate more effectively air disagreements constructively Work together to solve disputes instead of scapegoating one member Cougle therag Resolving conflicts in distressed couples 39 39 quot quot J of 39 39 auv Use of MetaAnalysis Statistical technique that averages the results of a large number of studies to determine an overall level of effectiveness In study shown that average PT patient better off that 75 of untreated clients Positive results for PT not only in research but in clinical practice 0 Effectiveness of PT should be judged by effectiveness of therapist Greatest gains occur in first several months but many clients drop out prematurely Each form of therapy has about the same effect compared to the control Unresolved which therapies are necessarily better than others Strong therapist alliance corresponds with better treatment outcomes Empiricallv Supported T ESTs Specific psychological treatments that have been demonstrated to be effective in treating particular problem behaviorsdisorders through research studies Ef cacy studies whether a treatment works better than control conditions in tightly controlled research studies Effectiveness studies Examine whether particular treatments are effective when used by practitioners in real world clinical practice Growing evidence of effectiveness We need to ask which therapy works best for which type of problem quot 39 Care or quot J Costs Increasing role of managed care systems health care delivery systems that impose limits on the number of treatment sessions they will approve for payment and the fees they will allow for reimbursement Helps trim costs but concerns about the risks of sacrificing quality of care in interest of cutting cost May lead to need for more expensive care later Multicultural issues in PT Therapists must be aware that cultural difference affect the therapeutic process Avoid ethnic stereotyping amp be sensitive to values language etc Therapists with high ratings perceived as empathetic A given therapy may work with one population but not another population African Americans Coping mechanisms for managing pervasive racism heightened level of suspiciousnessreserve Must develop coping mechanisms to deal with racial barriers Must be aware of cultural characteristics of African American families Asian Americans Value restraint in talking about oneselfone s feelings public expression of emotions Should not be judged as shy uncooperative or avoidant for these reasons Physical symptoms of anxiety Hispanic Americans Should reach to work within Hispanic community Respect their interdepent families not impose cultural values of the majority Native Americans Greatest unmet health needs for this group May be extremely passive in treatment traditional healer expectation which is not conducive to the client focused approach of PT Therapists must recognize important of elements of tribal culture Indigenous ceremonies like cleansing rites 22 129135 quot 39 quot 39 and 1 39 Based Care Deinsitutionalization policy of shifting care for patients with severechronic mental health problems from inpatient facilities to community based facilities Exodus from state hospitals Roles for Hospitalization State hospitals care for people w severe psych problems Focus on preparing people for return to community Municipalcommunity hospitals short term care for people with psych problems who need hospital environment to get through crisis Much more human nowadays but deplorable conditions do exist The 1 39 Mental Health Center Help discharged mental patients adjust to community Day hospitals care and structured therapy for people during the day who return home at night Halfway houses Provide sheltered living environment to help discharged mental patients adjust to community and offer people in crisis alternative to hospitalization Prevention is major goal The Spectrum of Prevention Means interventions that occur before the onset of a diag nosable disorder Treatment interventions focus on lessening the impact of already developed disorders Primary prevention efforts to prevent problems from arising universal or selective Universal targeted towards the whole populationgeneral public 0 EX prenatal health childhood nutrition Selective targeted towards individuals or groups known to be at higher than average risk of developing mental disorders Indicated preventative interventions toward individuals who have early signs of symptoms foreshadowing development but don t yet meet diagnostic critera Secondary prevention attempts to nip developing problems in the bud prevention efforts take many forms from vaccines to suicide prevention programs Ethnic Group Differences in Use of Mental health services Racial and ethnic groups have lower access and receive lower quality care Uninsured or underinsured Mental health clinics are not the first places people turn to sometimes churches or hospitals perceive mental health facilities as coldimpersonal African Americans churches Latinos friends relatives spiritualists Barriers to treatment 1 Cultural mistrust 0 Personal history of oppressiondiscrimination 2 Institutional barriers o Inaccessible due to lack of transport open during the day so inaccessible to working people made to feel stupid for not understanding clinical procedures 3 Cultural barriers 0 Mental health seen as less severe than physical problems 0 Resist outside help 0 Little previous contact with mental health professionals 0 Problems are supposed to be brought to trusted elders not strangers 4 Language barrier O 5 Economic and accessibility barriers Racial Stereogping and the Mental Health System Lower socioeconomic status offers partial explanation as to why there are ethnicracial differences in rates of diagnoses Clinician biases judging behavior signs Evaluation of Deinstitutionalization Not up to expectations Are hospital patients dumped into the community without adequate resources to adjust Psychiatric homelessness Deinstitutionalization and the Psychiatric Homeless Pop 13 of the homeless suffer from psych disorders Some people move back and forth between hospital and community May turn to drugs Do not seek out mental health services typically 9122011 113100 PM


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