Abnormal Psychology Study Guide

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What do "distress," "dysfunction," "deviance," and "danger" mean in the context of psychopathology?

Defining abnormality: 1. Deviance: different, extreme, unusual 2. Distress: unpleasant or upsetting to the person 3. Dysfunction: interfere with the person’s ability to carry out his/her everyday life 4. Danger: pose some amount of danger to self and others DEDI DADY

What role did Hippocrates play in the development of ideas about abnormality?

Greek and Roman Times C: Hippocrates- diseases result from a physical imbalance of the humors (yellow bile, black bile, blood, phlegm) T: physical treatment (excess black bile causing melancholia could be reduced by quiet life, exercise, celibacy)

What was the relationship between witchcraft and mental disorders in the Middle Ages?

Middle Ages: Conceptualization of mental disorders: result of evil Treatment: exorcisms

What was moral treatment?

was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns. The movement is particularly associated with reform and development of the asylum system in Western Europe at that time. 19th Century Conceptualization: Philippe Pinel argued that individuals with mental illnesses were sick and needed to be treated with compassion and kindness Treatment: asylum reform; moral temperament

Who provides most of the treatment in the United States?

Social Workers (42%) Others Counselors (37%) Psychologists (17%) Psychiatrists (4%)

What is a hypothesis? What is the null hypothesis?

hypothesis: testable statement of what we predict will happen (EX: exercise influences mood) null hypothesis: (opposite) alternative version of our hypothesis, opposite outcome (EX: exercise does NOT influence mood)

What are the dependent and independent variables? Be able to identify them in a description of a research study.

dependent = measured, changes, expected to change as independent variable is manipulated (ex: depressive symptoms) independent = manipulated, controlled (ex: type of medication)

What are some advantages and disadvantages of case studies?

detailed description of a patient’s psychological functioning Pros 1. tentative support for a new theory or techqniue 2. study uncommon problems Cons 1. biased observers 2. subjective evidence (bias) 3. difficult to replicate 4. low internal and external validity

What are some advantages and disadvantages of correlational studies?

degree to which events or characteristics vary with each other; correlations index the relationship between two variables Pros 1. high external validity (can be generalized) Cons 1. low internal validity -Third variable problem (they describe a relationship between two variables, but do not explain the relationship)

What is the difference between a cross-sectional and a longitudinal study?

(Correlational Method) Cross-sectional: A cross-sectional study is an observational one. This means that researchers record information about their subjects without manipulating the study environment. The defining feature of a cross-sectional study is that it can compare different population groups at a single point in time. Think of it in terms of taking a snapshot. Longitudinal study: examine same individuals over time and calculate changes in variables of interest; A longitudinal study, like a cross-sectional one, is observational. So, once again, researchers do not interfere with their subjects. However, in a longitudinal study, researchers conduct several observations of the same subjects over a period of time, sometimes lasting many years. (able to detect developments/changes in the target population at both group and individual levels)

What do correlations of ‐.9, 0, and +.9 mean?

.8 and .9 are high correlations (there is a very close relationship between scores on one of the variables with the scores on the other); .2 and .3 low correlations (correlations range between -1 and 1) -.9: (do opposite things) negative magnitude – as one variable decreases, the other once increases (or vice versa) (EX: as hours of sleep decreases, fatigue increases) .9: (both do same thing) positive magnitude – as one variable increases/decreases, so does the other one (EX: weight increases as height increases) 0: A correlation of 0 means there’s no relationship between the two variables

What does "statistical significance" mean?

a relationship is estimated to occur at least 95% of the time (EX: going for a 10 minute walk reduces symptoms of anxiety); statistically significant if result unlikely to have occurred by chance; if so- then Null Hypothesis is REJECTED (good thing to be rejected) (p less than .05)

What is epidemiology?

(part of correlational method) study of the frequency and distribution of disorders in a population (incidence, prevalence, risk factors); think- epidemic (populations) the study of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and informs policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive medicine.

What are incidence and prevalence?

incidence: number of new cases that emerge during a given period of time; epidemiological studies prevalence: total number of cases in the population during a given time period (includes old and new cases); epidemiological studies

Be able to identify the control group and experimental group in a research design.

procedure in which a variable is manipulated and its effect on other variables is examined (independent and dependent variables) EX: control group- placebo; experimental group – antidepressant Pro 1. allows us to control for potential confounds (EX: we could make sure that both groups have comparable levels of depression before treatment) 2. allows to balance internal and external validity

What is random assignment and why is it important?

andom assignment or random placement is an experimental technique for assigning subjects to different treatments (or no treatment). The thinking behind random assignment is that by randomizing treatment assignment, then the group attributes for the different treatments will be roughly equivalent and therefore any effect observed between treatment groups can be linked to the treatment effect and is not a characteristic of the individuals in the group. Step 1: Begin with a collection of subjects. Example 20 people. Step 2: Devise a method to randomize that is purely mechanical ( e.g. flip a coin) Step 3: Assign subjects with "Heads" to one group : Control Group. Assign subjects with "Tails" to the other group: Experimental Group

What are demand characteristics and what are some ways to reduce them?

In research—particularly psychology—demand characteristics refers to an experimental artifact where participants form an interpretation of the experiment’s purpose and unconsciously change their behavior to fit that interpretation; Typically, they are considered a confounding variable, exerting an effect on behavior other than that intended by the experimenter.

What are wait list control groups and placebo control groups?

In a study dealing with a therapy outcome, a wait list control group is a group that is assigned to a waiting list to receive an intervention after the active treatment group does. A wait list control group serves the purpose of providing an untreated comparison for the active treatment group, while at the same time allowing the wait-listed participants an opportunity to obtain the intervention at a later date. Placebo – Placebo-controlled studies are a way of testing a medical therapy in which, in addition to a group of subjects that receives the treatment to be evaluated, a separate control group receives a sham "placebo" treatment which is specifically designed to have no real effect.

What does "double-blind" mean in a therapy outcome study?

Treatment outcome research is designed to answer six basic questions: Is treatment better than no treatment? Is treatment worse than no treatment? Is one treatment better than another? If a treatment is effective, is a little just as good as a lot? Double-blind studies, in which both evaluators and patients are unaware of which patients receive which treatments, keep research results objective (1). When testing medications, neither patients nor evaluators can distinguish between a placebo and the actual medication. However, with verbal therapies (common in most alcoholism treatments), only the evaluators can be blinded

What are some of the challenges of studying abnormal behavior?

1. Abnormal behaviors, feelings and thoughts are difficult to measure 2. Usually rely on self report 3. More abnormal behaviors have multiple causes

Be able to discuss ethical issues when conducting research on human participants.

CONFIDENTIALITY (privacy): Psychologists and consumers of psychological services are frequently concerned about the issue of who is allowed to see and use information about individuals generated during research, consultation, or therapy INFORMED CONSENT (advising about research procedures or possible risks) DECEPTION (should not be used if alternative procedure available; can have negative impact on the participant; make them distrustful towards psychology) – debriefing required afterwards

What are neurotransmitters, receptors, and synapses?

NT: chemicals that transmit signals from a neuron to a target cell across a synapse. (stored into synaptic vesicles) Receptors: a molecule most often found on the surface of a cell, which receives chemical signals originating externally from the cell. Through binding to a receptor, these signals direct a cell to do something Synapses: In the nervous system, a synapse is a structure that permits a neuron (or nerve cell) to pass an electrical or chemical signal to another cell Synaptic Transmission (4 steps) 1. An electrical impulse reaches the neuron’s ending 2. This stimulates the release of a neurotransmitter 3. The neurotransmitter travels across the synapse (space between neurons) and comes in contact with other neuron’s receptors 4. This stimulates electrical impulses in this neuron

What are the most studied neurotransmitters? (SNDGG)

1. Serotonin (mood, impulse control) 2. Norepinephrine (mood, response to drugs) 3. Dopamine (pleasure/pain, implicated in schizophrenia) 4. GABA (stress response, anxiety, inhibitory) 5. Glutamate (epilepsy, excitatoy) SNDGG (Send Gigi)

Be able to describe the different biological treatments we discussed in class

1. Psychotropic medications 2. Electroconvulsive therapy 3. Psychosurgery 4. Experimental techniques (SEE FLASHCARD SECTION)

What are the major classes of psychotropic medications?

Psychotropic medications (5) 1. Antidepressants 2. Anxiolytics 3. Antipsychotics 4. Mood Stabilizers 5. Stimulants

What are the most common side effects of psychotropic medications?

dry mouth, blurry vision, drowsiness, anxiety, sexual dysfunction, blood pressure, extrapyramidal effects on motor control (Parkinson’s-type movements); weight gain, lowered white cell count

What is transference? What is countertransference?

psychodynamic terms transference: redirection towards the therapist of feelings associated with important figures in the patient’s life countertransference:reactions that the patient evokes in the therapist

Be able to describe classical and operant conditioning

classical:(behavioral model); Pavlov’s dogs 1. Unconditioned stimulus (food) leads to -> unconditioned response (salivate) 2. Conditioned stimulus (bell) paired with the unconditioned stimulus (food) leads to -> conditioned response (salivate when hear bell) operant:(behavioral models); B.F. Skinner showed that behaviors that are reinforced are strengthened over time; behaviors that are punished are weakened Classical: associations (conditioned stimulus and response) Operant: reinforcement (rewards and punishments)

What is modeling? How is the Bobo Doll experiment important to our understanding of learning?

modeling: learning new behaviors by imitating behaviors of others This experiment is the empirical demonstration of Bandura’s social learning theory. It shows that people not only learn by being rewarded or punished itself (behaviorism), they can learn from watching somebody being rewarded or punished, too (observational learning). These experiments are important because they sparked many more studies on the effects of observational learning and they have practical implication e.g. how children can be influenced watching violent media.

What happened to Little Albert?

Operant conditioning (behaviors reinforced) 1. Little Albert would avoid furry things to reduce anxiety 2. Thus, avoidance behavior was reinforced 3. Avoidant behavior increases 4. Because he avoids white furry things, he also avoids the opportunity for the association between furry things and loud noises to be extinguished 5. Exposure to the unconditioned stimulus in the absence of the conditioned stimulus is at the core of behavioral treatments for anxiety

What is Mowrer’s two-stage fear conditioning? How does it relate to anxiety disorders?

1. Classical conditioning leads to fear 2. Operant conditioning maintains it +avoidance of experience makes unable to extinguish the association

What are automatic thoughts? What are cognitive distortions?

individuals engage in automatic thoughts that are based on cognitive distortions; such thoughts perpetuate viscous cycles of depression, anxiety, eating disorders, etc. (EX: "I’m never going to finish that paper") 1. All-or-Nothing Thinking 2. Overgeneralization 3. Mental Filters 4. Disqualifying the Positive 5. Jumping to Conclusions 6. Magnification/Catastrophizing or Minimization 7. Emotional Reasoning 8. "Should" Statements 9. Labeling and Mislabeling 10. Personalization

What is a thought record?

The thought record: cognitive therapy; Feeling, Situation, Thought, Alternative Perspective – chart 4- FSTA

What is third-‐wave CBT?

more recent CBT approaches that include the following processes: 1. Emotion regulation skills (techniques to manage difficult and painful emotions) 2. Mindfulness (ability to remain in contact in the present, non-judgmentally, even if we are experiencing unpleasant emotions/thoughts/physical sensations) 3. Radical acceptance (learning to embrace our feelings, thoughts, and behaviors "as they are")

What are humanistic-‐existential therapies?

a kind of psychotherapy that promotes self-awareness and personal growth by stressing current reality and by analyzing and altering specific patterns of response to help a person realize his or her potential. This process may be facilitated in a group setting, where additional aspects of problems are revealed through interaction with others. Kinds of humanistic existential psychotherapy are client-centered therapy: A system of psychotherapy based on the assumption that the patient has the internal resources to improve and is in the best position to resolve his or her own personality dysfunction.

What is validity and what are some types of validity? – FPCC (4 types)

extent to which a measure assesses the construct it is supposed to assess 1. Face (extent to which the measure appears to measure a CONSTRUCT) 2. Predictive (…FUTURE construct) 3. Concurrent (…agrees with OTHER measures that assess the same construct) 4. Construct (…CAPTURES the construct it is supposed to assess)- A test designed to measure depression must only measure that particular construct, not closely related ideals such as anxiety or stress. FPCC

What is reliability and what are some types of reliability?

consistency of an instrument Across time: test-retest Used to assess the consistency of a measure from one time to another. (same group twice) Across testers: interrater Used to assess the degree to which different raters/observers give consistent estimates of the same phenomenon.

What is a differential diagnosis? (ddx)

the systematic method used to identify the condition, syndrome or disorder causing a patient’s signs and symptoms.; The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by Emil Kraepelin. first make list of possible diagnoses and attempt to remove them (process of elimination)

What is the difference between structured, semi-structured, and unstructured interviews? What are the main advantages and disadvantages of each?

1. Structured interviews interviewer codes answers exactly as provided by patients (EX: MINI- Mini International Neuropsychiatric Interview) (easy to analyze, but may miss out on important data; short; epidemiological studies) 2. Semi-structured interviews interviewer can make judgment calls (EX: Structured Clinical Interview for DSM-IV) Pros: carefully trained interviewers (good interrater reliability) Cons: can be quite lengthy 3. Unstructured interviews interviewer asks patients a series of questions in no specific order; widely used in clinical practice Pros: easier to administer than the structured and semi-structure interviews Cons: lower reliability

What is the basic assumption underlying projective testing?

(assumption that patients will identify with one character) psychodynamic; people project aspects of their personality into tasks 1. ask patient to interpret ambiguous stimuli (interpret personality facets that are projected) 2. very popular in the early 20th century; now used to obtain additional info 3. LOW reliability and validity EX: Rorschach Test and Thematic Apperception Test a personality test designed to let a person respond to ambiguous stimuli, presumably revealing hidden emotions and internal conflicts. This is different from an "objective test" in which responses are analyzed according to a universal standard

What are differences between self-‐report and interview-‐based assessment?

Self-reports: individual fills it out (their own opinion); affordable, standardized scoring; may not be able to assess themselves correctly (in denial) Interview-based: interpreted by the researcher; room for more bias if not standardized

What are some special problems in assessing children’s mental health problems?

Barriers to Assessment: 1. Patient factors (inability to provide information because of age/cognitive factors; self-representation biases; resistance) 2. Informant discrepancies (parent/child/teacher- whose report do you believe?)

What is the multiaxial system of the DSM? (5)

Axis I:clinical disorders (e.g. major depression, panic disorder, schizophrenia, panic attack) Axis II: pervasive developmental disorders, personality disorders Axis III: acute medical conditions (diabetes) Axis IV:psychosocial and environmental factors contributing to the disorder (family death, divorce) Axis V:Global Assessment of Functioning (GAF) 0-100 rating of a patient’s functioning

What are conclusions that can be drawn from twin studies?

IDENTICAL: have identical genes so can see if something is genetic

What can we learn from neuropsychological tests?

measure cognitive, perceptual, motor performance on tasks; allow clinicians to make inferences about brain functioning EX: Bender Visual-Motor Gestalt Test, Boston Naming Test, WAIS Neuropsychological tests are specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting for the diagnosis of deficits.

What are some barriers to assessment?

Barriers to Assessment: 1. Patient factors (inability to provide information because of age/cognitive factors; self-representation biases; resistance) 2. Clinician factors (biases; lack of competence with a particular population) 3. Patient/clinician factors (language, culture, ethnicity) 4. Informant discrepancies (parent/child/teacher- whose report do you believe?)

What are the behavioral, cognitive, and preparedness accounts of specific phobias?

Behavioral:traumatic experience leads to association between social situations and fear/anxiety 1. Conditioning (acquired through classical conditioning, maintained through operant conditioning — Little Albert) 2. Modeling (through observation and imitation — Bobo Doll) Cognitive: Preparedness: humans "prepared" by evolution to fear threatening faces (same as below?) Preparedness:(evolutionary account) – 1. Humans predisposed to experience certain fears of dangerous animals/situations 2. Those who develop fears more quickly can more effectively avoid such animals/situations 3. This maximizes their chances of survival

What are the basic steps involved in exposure to a specific object or situation (e.g., snake, spider)?

goal of exposure is to achieve extinction; gradually come into contact with feared object/situation Also- Flooding: sudden and repeated contact with fear (flood of fear) Modeling: therapist approaches feared object while patient watches

What are the behavioral, cognitive, and preparedness accounts of social anxiety disorder?

1. Behavioral: traumatic experience leads to association between social situations and fear/anxiety 2. Preparedness: humans "prepared" by evolution to fear threatening faces 3. Cognitive: dysfunctional assumptions (e.g., embarrassment is intolerable) – attention biases

What are some symptoms of panic disorder?

at least four, reach peak within 10 minutes, uncued (random): pounding heartbeat, numbness, chills/hot flashes, sweating, trembling, chest brain, shortness of breath, nausea/faintness, feelings of unreality, fear of dying/losing control 1. Recurrent unexpected panic attacks 2. At least one has been followed by month of more of: persistent concerns about another attack, worry about consequences of an attack, significant change in behavior due to attacks

What is the difference between cued and uncued panic attacks?

Panic Disorder symptoms: uncued = random, cued = triggered by something at least four, reach peak within 10 minutes, uncued (random): pounding heartbeat, numbness, chills/hot flashes, sweating, trembling, chest brain, shortness of breath, nausea/faintness, feelings of unreality, fear of dying/losing control

What are basic gender differences in mood and anxiety disorders?

Female: Male (more women, except for OCD) Specific Phobias: 2:1 Social Anxiety Disorder: 3:2 Panic Disorder: 5:2 OCD: 1:1 Generalized Anxiety Disorder: 2:1 PTSD: 9.7% female : 3.6% men (2:1 or 3:1)

What are basic differences in prevalence and treatment seeking in the context of anxiety disorders?

Highest for prevalence: specific phobias, social anxiety disorder (phobias have highest prevalence but lowest treatment) Highest for treatment: OCD, panic disorder (and they have the smallest prevalence!) Specific Phobias: 8.7% have (19% – T) Social Anxiety Disorder: 7.1% have (24.7%) Panic Disorder: 2.8% have (35%) OCD: 1-2% have; (41.3%) Generalized Anxiety Disorder: 4% (25.5%) PTSD: 3.5% past year, 6.8% lifetime (30%?)

What is agoraphobia?

when people become afraid to leave their house because they might have a panic attack (also- anxiety about being in places where escape may be difficult or help unavailable in event of panic) + 1/3 to 1/2 of people with panic disorder develop agoraphobia + Qualifier of Panic Disorder diagnosis

What conclusions did we reach in class regarding antidepressants and CBT for the treatment of panic disorder?

+ CBT and medication EQUALLY effective in reducing panic attacks + Combination of CBT and medications better at preventing relapse (Medication was a tricyclic antidepressant- impipramine –NOT a benzodiazepine such as Xanax/Ativan)

What is the major problem of (mis)using benzodiazepines in the context of anxiety disorders?

. Benzodiazepines (e.g., Xanax, Klonopin)–GABA agonists, short-term relief, sedative, might produce dependence

How does the fight or flight system work?

in dangerous situations –> hypothalamus releases neurotransmitters which activate two systems 1. Sympathetic nervous system (increases heart rate, etc.) 2. Endocrine system (Hypothalamic-pituitary-adrenal pathway: HPA) Pathway: 1. Hypothalamus 2. Pituitary gland 3. Adrenocorticotropic hormones (ACTH) 4. Adrenal cortex 5. Corticosteroids (e.g., cortisol)

What are obsessions? What are compulsions?

recurrent and persistent thoughts, impulses or images experienced as intrusive and inappropriate (cause anxiety or distress) Compulsions: repetitive behaviors or mental acts that the person feels driven to perform (in response to the obsession, ritualistic) aimed at preventing or reducing distress or preventing some dreaded event (not connected to dreaded event in a realistic way)

What are the psychodynamic and cognitive and behavioral accounts of OCD?

Psychodynamic: + Anxiety emerges when children come to fear their id impulses and use ego defenses to reduce their anxiety + In OCD, the battle is conscious id impulses: obsessive thoughts Ego defenses: compulsions (isolation, undoing, reaction formation) + Anal stage (fixation) Cognitive:+ everyone experiences repetitive, unwanted, intrusive thoughts + some people blame themselves for such thoughts and seek to neutralize them + Efforts at neutralization reduce anxiety and become reinforced + At the same time, person becomes convinced his/her thoughts are dangerous Behavioral:+ people coincidentally engage in a compulsion in the context of an anxiety-provoking situation + Over time, the compulsion becomes ASSOCIATED with reductions in anxiety

What is interoceptive awareness?

panic disorder patients acutely aware of bodily sensations; heightened awareness of bodily cues that a panic attack may soon happen

What is anxiety sensitivity?

Cognitive account: patients are acutely aware of bodily sensations (interoceptive awareness) – misinterpret bodily sensations in a negative way (anxiety sensitivity)

What are medications usually prescribed for OCD?

in the late 1960s with the observation that clomipramine, not other tricyclic antidepressants such as imipramine (Tofranil), was effective in treating OCD Clomipramine (Anafranil) has a number of different chemical properties, including the ability to latch on to the serotonin reuptake several selective SRIs have been shown effective in treating OCD, including fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).

What is trichotillomania?

compulsive hair pulling; feel sense of tension that is relieved by pulling hair; can begin in childhood (also- dermatillomania – skin picking)

How is OCD different from OCPD?

The biggest difference between OCD and OCPD is the presence of true obsessions and compulsions. Obsessions and compulsions are not present in OCPD. (more TIME spent in rituals with OCD; also- OCD rituals are more irrational) OCD: recurrent and persistent thoughts, impulses or images experienced as intrusive and inappropriate (cause anxiety or distress)+ thoughts, impulses, images NOT simply excessive worries about everyday problems (person attempts to ignore, suppress, or neutralize thoughts/impulses/images) OCPD: Axis II (personality disorder) pervasive preoccupation with orderliness, perfectionism, and control indicated by four or more of certain symptoms

What are the symptoms of GAD?

Excessive anxiety and worry about a number of events or activities, occurring most days for at least six months + Difficulties controlling the worry + 4% Americans; 2:1 female:male + Develops early in life (0-20 years) + 25.5% receive treatment + HIGHLY comorbid with depression (more so than rest of the anxiety disorders) + The "basic" anxiety disorder (at least three) fatigue, difficulty concentrating, restlessness or feeling on edge, irritability, muscle tension, difficulties sleeping

Be able to explain Borkovec’s avoidance theory of worry

worries are linguistic processes +participants asked to relax for 10 minutes and then worry about a current concern for another 10 minutes + 3, 7, and 10 minutes during each phase, experimenters asked participants whether content was thought or image + Worry allows individuals to avoid the experience of unpleasant somatic arousal and emotions (becomes reinforced over time) + "experiential" avoidance -attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long-run (maintained throguh negative reinforcement- short-term relief of discomfort achieved through avoidance increasing likelihood behavior will persist (a particular behavior is strengthened by the consequence of the stopping or avoiding of a negative condition.)

What are the cognitive factors most frequently associated with GAD?

+ hyper vigilance to threat-related stimuli + difficulties tolerating uncertainity + indecisiveness

What are the components of Mennin’s emotion dysregulation model of GAD?

1. Deficits in Emotion Generation 2. Deficits in Emotion Regulation (Doug Mennin) 1. generation: dispositional tendency for strong emotional responses mediated by motivational salience to perceived threats/safety cues in the face of reward gains/losses 2. regulation: + early, non-elaborate deficits including rigidity in attentional ersponses to exteroceptive and interoceptive emotional stimuli + Later, elaborative deficits, including increased use of poor compensatory strategies (e.g.,worry) and inability to implement adaptive strategies (e.g.,reappraisal) that are more efficient at inhibition Consequences of emotional dysregulation: narrowed/rigid behavioral repertoires (inability to develop new learning repertoire – lack of opportunity for extinction or reward activation – to promote valued life directions)

What are medications usually prescribed for GAD?

1. Benzodiazepines (e.g., Xanax, Klonopin)–GABA agonists, short-term relief, sedative, might produce dependence (antidepressants?) 2. Venlafaxine (Effexor) – SNRI (usual side effects: sexual dysfunction, suicidal ideation (antidepressants?) 3. BuSpar (buspirone) – serotonin receptor agonist; no sedative effects, no potential for dependence

What is the biggest challenge of conducting exposure in the context of GAD?

exposure is difficult because may make things worse (exacerbate issue, traumatize further)

What is the difference between PTSD and Acute Stress Disorder?

ASD: similar to PTSD, but occurs within one month of the stressor and lasts four weeks or less PTSD: person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self/others; symptoms for at least one month

What are the symptom clusters for PTSD?

Criterion A: Stressor Criterion B: Intrusive recollection Criterion C: Avoidant/numbing Criterion D: Hyperarousal

Describe the work on rumination and PTSD

Susan Nolen-Hoeksema; Stanford students who scored higher on a measure of rumination before the earthquake were more likely to show symptoms 10 weeks later; repetitively thinking about feelings and problems without problem solving; "getting stuck" Nolen-Hoeksema’s research has found that "when people ruminate while they are in depressed mood, they remember more negative things that happened to them in the past, they interpret situations in their current lives more negatively, and they are more hopeless about the future." Solve by reducing rumination, engaging in positive activities, problem solving, positive self-reflection

What are usual treatments for PTSD?

1. CBT: Prolonged exposure (imaginal and in vivo exposure to the trauma and its reminders; virtual reality – very effective) 2. Couples/family therapy 3. Eye movement desensitization and reprocessing (EMDR) 4. Medications (antidepressants alleviate some symptoms)

What is virtual reality therapy?

1. CBT: Prolonged exposure (imaginal and in vivo exposure to the trauma and its reminders; virtual reality – very effective)

What are psychosomatic disorders?

Psychosomatic disorders (actual physical illnesses exacerbated by psychological symptoms–hypertension exacerbated by stress) – different from somatoform disorder (physical aliment that has no apparent cause)

What is conversion disorder?

-hysterical somatoform disorder One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological disorder or other medical condition Requirements: + Psychological factors judged to be associated with the symptom or deficit + Symptom or deficit not intentionally produced or feigned + Symptom or deficit not fully explained by a general medical condition or substance + Significant distress or impairment

What is somatization disorder?

hysterical somatoform disorder History of many physical complaints, beginning before the age of 30, that occur over a period of several years and result in treatment being sought or in significant impairment Requirements: (physical complaints include all of the following) + Four different kinds of pain symptoms + Two gastrointestinal symptoms + One sexual symptom + One neurological-type symptom + Not explained by general medical condition or a drug + Symptoms not intentional or feigned

What are pain disorders?

hysterical somatoform disorders Significant physical pain as the primary problem; Psychological factors judged to have the major role in the onset, severity, exacerbation Requirements: + Not explained by general medical condition or a drug + Symptoms not intentional or feigned

What is hypochondriasis?

Preoccupations with fears or beliefs that one has a serious disease, lasting for at least 6 months +Persistence of preoccupation despite evaluation and reassurance +Absence of delusions +Significant distress or impairment

What is body Dysmorphic disorder?

Preoccupation with an imagined or exaggerated defect in appearance +Significant distress or impairment +Of note, people go to extremes to "fix" their bodies (e.g., several surgeries, excessive dieting)

What is the difference between primary and secondary gains?

Primary gain or secondary gain are used in medicine to describe the significant psychological motivators patients may have in reporting symptoms. Primary: internal, conversion disorder Secondary: external, malingering Primary gain produces positive internal motivations. For example, a patient might feel guilty about being unable to perform some task. If he has a medical condition justifying his inability, he might not feel so bad. Primary gain can be a component of any disease, but is most dramatically demonstrated in conversion disorder (a psychiatric disorder in which stressors manifest themselves as physical symptoms without organic causes, such as a person who becomes blindly inactive after seeing a murder). Secondary gain can also be a component of any disease, but is an external motivator. If a patient’s disease allows him/her to miss work, avoid military duty, obtain financial compensation, obtain drugs, or avoid a jail sentence, these would be examples of secondary gain. These may, but need not be, recognized by the patient. If he/she is deliberately exaggerating symptoms for personal gain, then he/she is malingering.

What are psychodynamic and cognitive behavioral accounts of psychosomatic disorders?

Psychodynamic: Psychosocial conflict is manifested into dramatic physical symptoms Freud – unresolved Electra complex Current view – unresolved childhood anxiety Primary gain: symptoms keep internal conflict out of awareness Secondary gain: symptoms further enable individual to avoid unpleasant activities and/or elicit sympathy from others Cognitive: Physical symptoms are forms of communication; Emotions converted into symptoms; Purpose of conversion is not to defend against anxiety but to communicate extreme feelings Behavioral: Physical symptoms bring rewards that get reinforced; Rewards are similar to secondary gains, but behaviorists consider them primary mechanisms

What are dissociative disorders?

when people experience major disruptions in their memory 1. Dissociative amnesia 2. Dissociative fugue 3. Dissociative identity disorder

What are different types of dissociative amnesia?

1. Dissociative amnesia (inability to recall important personal info related to trauma) 2. Dissociative fugue (forgets past, new identity) 3. Dissociative identity disorder (multiple personalities)

What is the difference between dissociative amnesia and dissociative fugue?

Amnesia: inability to recall important details or personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness Fugue: person forgets the past and goes to a new location and assumes a new identity (sudden, unexpected travel away from home with inability to recall one’s past, confusion about personal identity, or the assumption of a new one); very rare, ends abruptly

What is dissociative identity disorder? What are the psychodynamic and behavioral perspectives on it?

person has two or more identities that might not always be aware of each other (each with its own set of memories, thoughts, feelings, etc.); Transition from one personality to another one –> switching + Very rare Psychodynamic:+ Caused by repression, the most basic ego defense + Dissociative amnesia and fugue are single episodes of repression + Dissociative identity disorder thought o result from lifetime of excessive repression traced back to childhood trauma Behavioral:+ Dissociation grows from normal memory processes, such as drifting or forgetting + Produces relief of unpleasant events + Reinforced via operant conditioning + State-dependent learning

What is malingering?

(deliberate faking of illness to avoid unpleasant situations)

How is malingering different from factitious disorders?

Malingering (deliberate faking of illness to avoid unpleasant situations); motivated by external incentives (goal is apparent; use symptoms to their benefit) – financial gain, drugs, social interaction, avoiding a military service/work; mitigation in court Factitious disorders (deliberate faking of illness to gain medical attention – Munchausen’s disorder); not usually aware of the motivation

Psychotropic Medications

biological treatment; medications are effective; have a wide range of intense side effects; compliance difficulties; cocktails (mixing kinds) 1. Antidepressants 2. Anxiolytics 3. Antipsychotics 4. Mood Stabilizers 5. Stimulants

Electroconvulsive therapy

1. brain seizure induced by passing electrical current through the brain (65-140 voltz) 2. 6-12 sessions 3. Patients are anesthetized or given muscle relaxants 4. high response rate, but high relapse rate; memory loss


biological treatment; modern technologies are derived from lobotomy (1930s): surgeons would cut connections between the frontal lobes and lower regions of the brain today, techniques are more precise (but still considered experimental and last line of treatment)

Experimental techniques

1. Transcranial magnetic stimulation (TMS) 2. Deep brain stimulation 3. Vagus nerve stimulation 1. TMS: experimental techniques, transcranial magnetic stimulation; expose patients to high-intensity magnetic pulses focused on particular brain structures in order to stimulate activity 2. Deep brain: experimental technique; surgically plant electrodes in specific areas of the brain that deliver stimulation via a pulse generator 3. Vagus nerve: experimental technique; attach electrodes to vagus nerve and deliver stimulation through a pulse generator; stimulation travels to certain brain areas (parasympathetic control of the heart)

Topographic model of the mind

iceberg analogy: (id, ego, superego- all in constant struggle with one another – expressed as symptoms) 1. tip is the CONSCIOUS (contract with the outside world) – EGO 2. PRECONSCIOUS (material just beneath the surface of awareness)- EGO (reality principle, secondary process thinking- reality testing) 3. UNCONSCIOUS (difficult to retrieve material- well below the surface of awareness); ID (pleasure principles, primary process thinking, wish fulfillment) and SUPEREGO (social component, moral imperatives) -superego spans all parts

Defense Mechanisms (SEE OTHER CARDS)

George Vaillant (1977) categorized defenses according to psychoanalytic development level Level 1: pathological defenses Level 2: immature defenses Level 3: neurotic defenses Level 4: mature defenses (PINM)

Freud’s Developmental Stages (5) – OAPLG

1. Oral (0-18m, focus on mouth; id dominates; learn delayed gratification) 2. Anal (18m-3y toilet training, conflict between id and ego regarding waste elimination; autonomy) 3. Phallic (3-5y conflict between id and ego regarding wanting attention of one parent; Oedipus/Electra complex) 4. Latency (5-12y, consolidation of previous stages; identity formation) 5. Genital (12y+ further consolidation, symbolism; goals) OAPLG (Oh, a plug)


instinctual needs, drives, and impulses (anxiety, sexual, anger; pleasure principle); unconscious, pleasure principle, primary process thinking; biological component (the instincts Eros and Thanatos are associated with the unconscious mind and the id)


develops mechanisms to defend against unacceptable impulses and uncontrollable anxiety (reality principle); conscious and preconscious


rules and norms incorporated from our parents and society; conscience

Reliability and Validity

Reliability – consistent and repeatable Validity- measures what intended (operational definitions)

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