Biological belief

·      PP is a disease of the body that can be cured by changing the body

o   Mental illness is a disease of the body and can be cured by changing the body

o   Focus on observable, bodily symptoms

Psychological belief

o   Focus on cognitive symptoms (a belief about something)

·      biological approach, the biological symptoms occurring in the body cause a psychological belief (ex: fast heart rate and difficulty breathing = belief you are having a heart attack)

·      psychological approach, the psychological state causes the physical symptoms (ex: belief that your having a heart attack causes fast heart rate and difficulty breathing)

o   Looks to the information available on the patient (their background/experiences)

o   Looks at research/literature to determine the best treatment

Developmental psychology

o   Study what changes across lifespans, and how genes and their expressions change as people develop

Reasons why our vulnerability to psychological problems changes as we develop

o   Accumulating life experiences (our concerns change throughout our life)

Different aims of treatment:

·      sometimes merely symptom relief (usually through use of medication), other times the aim is to cure  (aim of psychotherapy)

Outcome studies

evaluate and report on the success of different treatments 

Efficacy studies

test a treatment under controlled laboratory conditions

Effectiveness studies

test a treatment as it is actually delivered in the field

the belief that everyone and everything has a soul

Common explanation of mental illness à spirits (ancestors, animals, gods) had take possession of an individual and controlled that person’s behavior

·      By middle of the fifteenth century, tolerance for bizarre behavior was limited (response to those “possessed” changed from respect to fear)

Hysteria

o   The mad cannot control themselves and need to be contained/controlled

Psychogenic

·      “originating in the soul”, common view of mental illness (they originate in the mind and can be treated through psychological therapies)

Mesmerism

o   Eventually, the public proclaimed his a fraud and his treatments were discontinued

Hypnotism

o   However, he was also discovered to be a fraud because others could not replicate his techniques

Hysteria

§  Had patients tell about their problems while not under hypnosis à psychoanalysis

o   This was because of animalism (they believed that the insane were no different than animals, and should be treated as such)

·      Moral treatment: “the unshackling of the insane”

What is abnormal?

(is difficult to define, as “normal” behaviors change across cultures, time, etc.)

o   Violation of standards: when the person does not do what is considered “normal” (is an adult and doesn’t work, to be too shy or aggressive, etc.)

§  People are generally more inclined to see themselves in a positive light

·      People/students have the tendency to diagnose themselves with diseases when they are learning about them (they see the signs/symptoms in themselves)

Psychological assessment

o   Must be reliable (must generate the same findings with repeated use) and valid (it must actually measure what it is intended to measure)

·      They observe not only what the person says, but how they say it (manner, tone, body language, degree of eye contact)

o   But this can be biased à based on the clinician’s experience and own personal judgment of the individual, and suggestions made by the clinicians can make the clients say things that are inaccurate

§  Focuses on child’s level of functioning in school, peer relationships

Behavioral assessment

o   Disadvantages: client-bias (they don’t realize something is having an effect on them)

Psychophysiological assessment

o   Benefit: measures reactions that humans are not aware of (we cannot know what our brain activity levels are)

·      have the client directly observe the changes that occur in a physical indicator of a biological variable (heart rate, blood pressure, pulse) (ex: having the client use relaxation techniques to relax neck muscles to reduce migraines)

o   MEG: detects weak magnetic fields produced by brain electrical activity. New, noninvasive and has no radiation

Varies in focus and format

o   Format: manner in which it is administered (either by an examiner, or self-report)

Psychological inventory

§  Highly reliable

MMPI (Minnesota Multiphasic Personality Inventory)

§  Contains “validity” scales to make sure patients are not lying (ex: if answer yes to  “I never lie” and “I read the paper everyday” then they are probably just trying to appear to be a good person

Projective tests

o   utilize ambiguous stimuli, such as inkblots or pictures.  The goal is to minimize reality constraints, and maximize the opportunity for unconscious concerns to emerge.

Rorschach Test

·      What is considered “abnormal” for a person to see?

Thematic Apperception Test (TAT)

§  Limitations: all the people depicted in the pictures are white (not all can relate), stories can be interpreted differently by different clinicians

o   These are standardized (the wording of the questions and order or presentation are described in detail in a manual)

o   Wechsler Adult Intelligence Scale (WAIS), the Wechsler Intelligence Scale for Children (WISC)

·      Performance IQ (mazes, picture completion)

·      Ex: a tremor that shows itself in an inability to draw a straight line or to copy small circles can arise from brain impairment (or it can simply be the cause of unsteady hands)

o   Trail Making Test

§  Used to show brain damage

o   Wisconsin Card Sorting Test

§  Dependent on the examiner’s response (they decide if the client is “right” or “wrong”), and then the client must resort the cards based on what the administrator said (they need to figure out the pattern of what is “right” and “wrong”)

o   Wechsler Memory Scales

§  Patients with damage to the hippocampus have difficult with this (as it relies on memory)

o   The Halstead-Reitan Neurospychological Battery

§  Assesses the individual’s ability to categorize items, place block into slots while blindfolded, detect if sounds are similar or different rhythms, strength of grip, remember a string of words, recognize nonsense words

o   The Luria-Nebraska Neuropsychological Battery

o   Predictive validity: do they enable one to predict the course and outcome of treatment?

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS 

Mental disorder

·      defined as a behavioral or psychological pattern that has either caused the individual distress or disabled the individual in one or more significant areas of functioning

·      Advantage to DSM: provides cultural sensitivity so that it addresses cultural differences that could appear when trying to diagnose someone (symptoms could manifest themselves differently in different cultures)

·      Multi-axial Classification

·      Social relations with family and friends, occupational functioning, use of leisure time

PSYCHODYNAMIC APPROACH

§  Interested in PSYCHIC ENERGY: believed that people’s emotions have energy, and if this energy is suppressed in one area, then it will emerge in another

ID

o   “It wants what it wants when it wants it”

EGO

o   Delays the impulses of the id until an appropriate, safe time to minimize negative consequences

SUPEREGO

·      opposite of the id, does not allow the person any desires, constantly saying no to everything, “wooden and moralistic”

Interaction between id, ego, and superego 

·      largely unconscious (UNCONSCIOUS LEVEL) à but ego is conscious (you must consciously decide which desires to follow and which to repress)

ANXIETY

o   Degree of anxiety you experience depends on the anticipated consequences to self

COPING STRATEGIES/DEFENSES

used to alleviate anxiety

REPRESSION

§  Can be fully repressed or only partially repressed (still remember some parts of the event) à the mind is an editor (can delete and rearrange things) so this allows us to delete those things that make a memory unpleasant and cause us anxiety

PROJECTION

§  Allows us to something about anger (take aggressive or retaliate in our own defense)

DISPLACEMENT

threatening (vent about work things at home)

DENIAL

o   used when our sense of security and of being loved are threatened, and when facing death

SUBLIMINATION

§  But loving makes us vulnerable so it creates anxiety, but is still a more mature form of coping

Psychodynamic theory

·      description of human personality, describes personality’s development and function.

NEO-FREUDIANS

·      attracted to Freud’s ideas, but elaborated on them and sometimes disagreed

·      Carl Jung

o   ARCHETYPES: universal ideas we are born with (ex: fear of fire or the darkness)

The self: CORE SELF

§  Gives each person his sense of separateness and identity

SUBJECTIVE-SELF

§  If one does not develop this self, then it makes us feel out of touch with others and ourselves

VERBAL SELF

§  Develops by using symbols and language

SELFOBJECTS

·      allows the individual to release their psychic energy/emotion by making conscious that which is repressed, and to treat the symptoms that arise because of it

FREE ASSOCIATION

saying whatever comes to mind without censoring

RESISTANCE

o   momentary blocking when dealing with a particular problem

CATHARSIS

uncovering and reliving of early traumatic conflicts 

It is important the therapists do not appear shocked by client’s admissions because... 

·      they are a blank screen onto which the client project’s their thoughts

TRANSFERENCE

§  Often, client’s talk to their therapists as if they were the person with whom the client was having a conflict

Strengths of Psychoanalysis

o   “the talking cure”: Freud à the success of this treatment improved psychological treatment overall (connected those with psychological issues to the rest of humanity)

·      Shortcomings of psychodynamic theories

o   emphasis on the role of the individual makes one overlook the situation

Existential thinking

·      stress the importance of freedom and choice, and that individuals must be free to make authentic choices based on their own desires and goals, not those of others

o   People try to avoid personal responsibility by saying things like “it broke” not “I broke it”

o   GOAL-DIRECTED: associated with future goals

§  Useful strategy for those who death fears take the form of loneliness, they make themselves indistinguishable from others, and hope there is strength in numbers

o   They want other to fulfill their silent wishes

BEHAVIORISM

·      effort to discover the laws of human and animal learning and apply these laws to general life

§  People change when their environment changes

o   then only present the neutral stimulus à leads to the conditioned response

ACQUISTION

·      the learning of a response based on the relationship between a CS and a US

EXTINCTION

o   Present the CS but don’t follow it with the US

Pavlovian Conditioning, Emotions and Psychopathology

·      By getting rid of the cause, you also get rid of the resulting symptoms and the overall disorder

Pavlovian Therapies

·      Two Pavlovian therapies for the extinction of emotional disorders: exposure and systematic desensitization

EXPOSURE

§  Claustrophobia à placed in a closet (CS), after some time the fear of small places/trauma would not occur (US)

SYSTEMATIC DESENSITIZATION

o   patient imagines a set of gradually more frightening scenes involving the phobic object (CS) but not respond with fear (UR)

OPERANT CONDITIONING

·      Learning what to do is gradual (we learn through trial and error – do those things that give us a successful outcome)

LAW OF EFFECT

when in a given stimulus situation, a response is made and followed by positive consequences, the response will be repeated. When followed by negative consequences, it will tend not to be repeated

OPERANT

·      a response who probability can either be increased by positive reinforcement or by the removal of negative reinforcement

DISCRIMINATIVE STIMULUS

§  Ex: child is hugged when it says “daddy” (operant), but only if the father (discriminative stimulus) is around

POSITIVE REINFORCER

·      event whose onset increases the probability that a response preceding it will occur again (rewards behavior)

NEGATIVE REINFORCER

·      an event whose removal increases the probability of recurrence of the response that precedes it

PUNISHERS

·      events whose onset will decrease the probability of recurrence of the response that precedes it

Acquisition

·      involves repeated reinforcement until the action is learned, while extinction involves the decrease and eventual end of positive and negative reinforces

SELECTIVE POSITIVE REINFORCEMENT

·      the therapist selects a target behavior or adaptive behavior whose occurrence is to be increased

SELECTIVE PUNISHMENT

·      there is a negative consequence when the patient performs the act they want to stop (punishment)

EXTINCTION

eliminates a behavior by not giving a highly desired reward if the patient takes part in the negative action

Avoidance Learning:

·      So Pavlovian conditioning helps the person to recognize the stimulus/associate the stimulus with the event, while operant conditioning trains the individual how to get away from it

THE COGNITIVE APPROACH

·      Believe that the symptoms are the disorder, and that changing cognitive/mental health can cure the disorder

Cognitive Therapy

·      Therapists looks into the individual’s thoughts – look to see if they are distorting their reality

·      Changing efficacy expectations

§  Difference: a person may be certain that a particular course of action will produce a given outcome (outcome expectation) but they may doubt that they can perform this action. 

·      Modifying Negative Appraisals

§  These thoughts are automatic and occur rapidly and always precede/create emotion

·      Changing Attributions

o   Goal is to switch the individual’s thinking style from internal to external, and to keep it specific

·      Changing Long-Term Beliefs

§  Often based on “shoulds” à things that society/family/friends think we should do rather than what we actually want to do

RATIONAL-EMOTIVE THERAPY

§  Encourages the patient to engage in behavior that goes against the irrational beliefs

COGNITIVE BEHAVORIAL THERAPY

·      combines techniques of both cognitive and behavioral therapy

o   Cognitive: believe that distorted behavior is caused by distorted thinking

o   Behavior: distorted behavior is caused by learned, past experiences

o   Lazarus à MULTIMODAL THERAPY

§  Disorder occurs in the patient at seven different levels and each level must be treated individually through the appropriate therapy for that level

§  Changing how one behaves gets rid of the symptoms but may ignore the underlying disorder