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Additional Psychology Flashcards




BioPsychoSocial Framework
- Look at all the factors, which have an additive effect
- Implications for stress
- Bio: brain dysfunction, neurotransmitters, hormonal imbalances, genetic vulnerability, temperament
- Psych: relationships, family, meaning you give events
- Social: cultural value – humor, wealth, intelligence. Every culture has it’s values. People will treat you well if you are the prototype of what people value and the opposite
- The most strikes against a person the harder they are to treat.
What is Abnormal Psychology

Diff Def. and disadvantage of each
- We still don't have a consensus on definitions but there is a consensus on what conditions are or are not a disorder
1. Suffering: internal psych pain
But, All people suffer: missing someone, studying
2. Maladaptive Behavior: hinders a person's ability to adapt to living with self, others, being in the world
But, what of psychopathic behavior that is adaptive (Hitler)
3. Deviancy: out of the ordinary, a few std dev away
But, geniuses and creative types deviate
4. Violations of Social standards: drowning your kids
But, mild violations would not be considered pathological: speeding
If societies gone insane, good to violate it (holocaust)
5. Causing discomfort in others: social discomfort
But, non conformity can be good: women's movement
6. Irrational and unpredictable: uncontrollable laughter at a funeral
But, unpredictability is the spice of life
7. Atypical: An adult who throws a temper tantrum
But, what of someone who have atypical energy for her age
8. Harmful dysfunction: deviant on the wrong side of the bell curve
Not without problems, but BEST DEF
genetic info inherited from parents
-physical, behavioral, psych features
- result of the interaction btw one's genes and environment
Imp factors that can affect you in environment
- goodness of fit
- friends
- family
- relationships
- intimate others
family aggregation
when a disorder runs int he family
family aggregation
when a disorder runs int he family
to be a good psychotherapist need to:
- ask the right questions
- make the person comfortable
- up to date on treatments
- more than a diagnostic label: behavioral hist, intellectual func, personality, envir pressure and resources.
Positives of Classification of Disorders
- provides us with a nomenclature (naming system)
- allows us to structure info in a more helpful manner
- helps us study disorders and perform research
- insurance
- can help manage and treat
- admin, need to know the range of problems that exist to have treatment facilities
Negatives of Classification
- produces shorthand form so lose info
- stigma
- streotyping
- stigma is perpetuated by LABELING - a person's self concept can be affected by a label and they may "act" the label out
- name
- pos
- problems
- Diagnostic and Statistic Manual of Mental Disorders
- doesn't provide causes of disease, management or treatment
- rules out behaviors that are cultural sanctioned
- Provides us with a working criteria that helps clinicians and researchers to identify & study specific & important problems in people’s lives
- Includes related information about disorders such as: Age, cultural, gender factors; Prevalence and incidence information
- essential for serious study
- still have problems: how much distress or disability should a person experience before thye are diagnosed, who determines what is culturally sanctioned, says cause is the dysfunction (circular), sometims problems of patient don't fit into precise lists of signs and symptoms; might sacrifice some validity for more reliability; author bias, secrecy, conflict of interest; def of illness and divisions lead to a lot of comorbidity
Culture and Abnormal Psych
- Cultures define normal and abnormal differently
- in some no word for depression, although ppl suffer from it, focus on physical concerns
- Culture shapes the presentation of disorders in some cases
- some disorders are culturally specific: Taijin Kyofusho
- BUT, some are universal: hearing voice, laughing at nothings etc
prevalence (point, 1 year, life time) vs. Incidence
- In us
Prevalence: # of active cases in a population in a certain period of time
Incidence: # of new cases that occur over a period of time (usually a yr).
- will be lower than P bc no old cases included
- In the US: 46.4% lifetime and 26% one year prevalence, and this excludes eating disorders, schizo etc
Most Common disorders groups and individual disorders
- anxiety, then mood, then substance
- depression, alcohol abuse, phobias
presence of 2 or more disorders at once
- esp common for ppl who have severe mental disorders
Prototype Model
The DSM uses this, but should really think about a continuum
Four themes in 19th and 20th century influenced abnormal psych
1. Bio Discoveries: that syphilis / general paresis was bc of brain pathology (proof that brain prob could cause specific disorders)
2. Dev of a classification system: each type of disorder is diff and have predetermined and predictable courses
3. Emergence of Psych Causation Views: psych disorders can have bio causes or psych causes or both
Mermerism: planets affected a universal magnetic fluid
The Nancy School: hysteria is a sort of self-hypnosis
4. Psych Research / Experimental Psych
- Wundt: Study psych obj.
- Witmer: founded first am psych clinic
Sources of info about disorders
- direct observation
- case studies
- self-report data
- brain imagery
criterion group

comparison or control group
- people with disorder in experiment
- people w/o disorder
retrospective research approach
- Focusing on ppl with disorders and look at their history to see what could have contributed to it
- probs: memory may be faulty
prospective research approach
- choose individuals with higher that avg chance of getting a disorder and focus on them before it develops and m. influences
causal pattern

knowing causes would be soo helpful in prevention, but human behavior is so complex that it's hard
Necessary Cause
A condition that must exist for a disorder to occur. If Y occurs, X must have preceded it.
- other factors may also be required, not necc sufficient
- exp: Huntington's cholera can only develop is have faulty gene
- many disorders do not have these, but research continues
Sufficient Cause
- cause x guarantees disorder Y.
- doesn't have to be necc, something else can cause Y
- exp: hopelessness for depression
Contributing Cause
- a cause that increases the probability of a disorder
- most commonly studied in psych
- exp: loss of a parents for depression
Distal Causal Factor
factors that occur early on byt may not show their effects until later
exp. parental rejection at a young age - depression as an adult
Proximal Causal Factor
factors that operate shortly before occurrence of symptoms of disorder - can trigger a disorder
- exp: a break up to depression or brain damage
risk factors involve

these can interact to cause a disorder
Reinforcing Contributory cause
A condition that tends to maintain maladaptive behavior that is already occurring
- exp: extra attention, sympathy, relief from unwanted job
Hard to determine what is the cause and what is the effect. Can act both ways
exp: a boy wiht bad parents misinterprets ppl's nice actions as patronizing and bc of his odd behavior to them they do become defensive, rejecting and hostile.
- subjective reality becomes objective
Diathesis-Stress Model
- diathesis and stress def
- diathesis: a predisposition towards developing a disorder - can derive from bio, psych, sociocultural factors
- Stress: the response of an individual to demands perceived as taxing
- Model: diathesis is a necc or contrib distal causal factor but usually not sufficient. Need a proximal stressor, which is also necc or contrib, but not sufficient to cause disorder.
Protective Factors
- Explains why some people with both a diathesis & stressor remain resilient to disorder
- influence and modify a person's response to stressors, making it less likely they will experience adverse affects
- Leads to resilience - ability to adapt well even in difficult situations
- exp: good parents, self-esteem, high intellect, school achievement, good friends
OR something bad: dealt with a bad sit. gives you coping methods and self-esteem
Integrative Bio Psycho Social Framework Model
-acknowledges that bio, psych and social factors interact and play a role in psychopathology
- only current attempt at a unified approach
5 Biological Causal Factors
1. Neurotransmitter & hormonal imbalances in the brain
2. Genetic vulnerabilities: never only from this but can be an influence, usually polygenetic one.
3. Temperament: a child's reactivity and characteristic ways of self-regulating
4. Brain dysfunction and nueral plasticity:
- plasticity: flexibility of brain in making changes to the organization and func in response to stress, disease etc
5. physical deprivation, disruption
four most imp nuerotransmitters
- nt reduce or inc chances that a nueron will fire, successful messages depend concentration of nt in synapse
1. norepinephrine: emergency reactions to danger or acute stress
2. dopamine: schizo and addictive disorders
3. serotonin: how we think and process environment and behavior and moods
4. GABA: reduced anxiety
Genetic-Environmental Correlates
when the genotype shapes a person's environment, three ways:
1. positive effect: results from gene similarity btw child and parents (provide stimulating envir)
2. evocative effects: evoked reactions from social envir
3. active effect: A child may seek out or build an envir that is agreeable (extroverted kids seek social envir)
genotype environment interaction
people with diff genotypes may be diff sensitive or susceptible to envir
Linkage Analysis and Associative Studies
- Genetic research strategy in which occurrence of a disorder in an extended family is compared with that of a genetic marker for a physical characteristic or biological process that is known to be located on a particular chromosome
- comparing frequency of certain genetic markers known to be located on particular chromosomes in people with and without a particular disorder
Psych Causal Factors
1. early deprivation or trauma
- lacking needed resources, institutionalized, abuse
- dev irreversible psych scars
2. Inadequate parenting styles
- can affect child's later ability to cope with life's challenges
- bidirectonal relationship: if a child has a neg temperament, a parent will be less warm towards them
- parental psychopathology
- 4 kinds of parents with diff degrees of warmth and control
3. Marital discord & Divorce
- include chances of parental rejection and stress
4. Maladaptive Peer Relationships
- if good ones can dev. social competence
- rejected children are: aggressive or very withdrawn
Sociocultural Factors
1. low economic status and unemployment
2. prejudice and discrimination
3. social change and uncertainty
4. urban stressors such as violence and homelessness
Psychosocial viewpoints
1. Humanistic
2. Psychodynamic: Self
3. Behavioral
4. Cognitive Behavioral
5. Existential
Humanistic Perspective - Roger's theory of psychological development
• Infancy: monitor pleasantness of environment - drawn towards fun
•Children: dev trust in reactions to envir
- As we become older we need to the approval of other people, and this is a huge problem. Some people don’t even know what they themselves want.
•People attach meaning to perceptions which become their subjective reality
• Some of these perceptions form the “self-concept”
• Conditions of worth: lead to incongruencey
• Psychological disturbance is related to the level of incongruence between individual experience & self-concept
Rogers Therapy
The work of a therapist is in “BEING” (not doing)

BEING: unconditional acceptance of the persons “subjective” reality

Psychodynamic Perspective
- Freud dev it and focused on role of unconscious, early dev, defense, insight, tranference; ig-ego-superego
- Trauma that happens in the family has a large effect on psychodanimcs
New psychodynamic
- interpersonal perspective
- Object Relations Theory
- Attachment Theory
- more focused on relationships
- I: emphasized social and cultural factors as determinants of behavior. Need to dev self and with others and find a balance.
- O: a child internalizes external figures such as a harsh parent and it takes on a role of self-criticism. Need to integrate all these into self or will have prob; part of human nature is to crave relatedness with others
- A:imp of early experiences with attachment
Bowlby’s Attachment Theory
Attachment is a vital biological function

For our survival we need to “attach” to a caregiver

People are built to be part of group
Behavioral Perspective
- Classical Cond
- Condition avoidance response
- Study only directly obs phenomenon
- Classical Cond: A specific stimulus may come to elicit a specific response
- Instrumental (operant) cond: an individual learns how to achieve a desired goal. New responses are learned and tend to reoccur if they are reinforced
- condition avoidance response - avoid the obj you have a phobia of, which reinforces the phobia
- maladaptive behavior is the result of 1. a failure to learn necc adaptive behaviors or competencies
2. the learning of maladaptive response
Cognitive Behavior Perspective
- attributions
- attribution theory
- how thoughts and info processing can become distorted and lead to maladaptive emotions and behavior
- maladaptive schemas can result bc of bad learning experiences
- a lot of info process is nonconcious
- Attributions - the process of assigning causes to things that happen
- attribution theory: we attrib behavior to external or internal events (he did it bc he is nice or bc he wanted money)
- dysfunction results from a tendency to attrib things in a certain way
- * the way we interpret events determines emotional reactions
Three stages of sepertion (traumatic)
initial protest, despair, detachment
Ainsworth: types of attachment
Margaret Mahler
• We were all in the womb, what everyone has in common
• Mommy and i are one – bc when in the womb they are one
• At 9 months the child need sot feel like it has a safe place with mom, and mother is internalized by age 2 and can be your own person then it’s a healthy development. Plays out in intimacy.
Alan Shore
During infancy emotionally important experiences are imprinted into unconscious memory
Defense Mechanisms in Psychodynamic perspective
- The ego often deals with neurotic or moral anxiety by resorting to irrational protective measures referred to as ego-defense mechanisms
- Patterns of:feelings, thoughts or
Behaviors that are relatively unconscious and arise in response to perceptions of psychological danger
- strategies that people use for self-protection
Unconscious blocking of recall
- a form of amnesia, usually assoc with traumatic event
- Through using repression the ego does avoids facing distress or anxiety
- Hippocampus deactives during this: evidence for active forgetting mechanism
- Cortisol is released during a ton of stress and weakens formation of memories
More intentional blocking of recall
Avoiding to think about something painful

- You gradually help client become aware of their suppression and start to bring up the past events they are going through
A refusal to acknowledge or accept to self a painful reality
- seen in alcoholism a lot
A symbolic negating of an unacceptable impulse
A way to make amends over a compulsive behavior
- wash hands after an angry thought
Isolation of Affect
Thinking and talking about emotional events without any feelings
- This is a way in which patients protect themselves from feeling overwhelmed with an unpleasant emotion
A temporary alteration in the integrative function of consciousness (mild to severe)
- this is adaptive, but can be maladaptive if you are so gone you aren’t cognizant at all.
- A type of barrier, a split in different segments of the personality

- These people have been very traumatized
Excessive abstract thinking to avoid painful emotions
Reaction Formation
Substituting the opposite of ones true feelings when they are difficult to accept
- If want to kill someone but then when you see them you act so nice. Or if in love with someone, act meanly towards them,
Self-serving explanations and justifications of ones behavior
- When someone finds our behavior unacceptable we come up with rational explanations why we acted a certain way
Attributing one’s own (unacceptable) feelings to others
- if angry, think the other person is angry
Projective Identification
- self-fulfilling prophecy
- If a person is obsessed with an emotion themselves, they make you feel like it and then tell you you are acting that way.
- Re-channeling unacceptable feelings or impulses
- Coming up with more socially acceptable way of expressing emotion
- e.g., Someone taking out their aggressive behavior through sports or something more productive
- Production of physical symptoms
in an effort to protect oneself from psychological pain
- usually cannot be medically explained
- exp: glove anesthesia: ppl can;t feel anything on hand, no medical explanation
Transferring a feeling from its actual object to a substitute (scapegoat)
Nervous Laugh
Use of humor to deflate a tense situation
Family Dynamics
• How someone finds his or her way in the family has profound consequences on their personality
- family will seek certain level of
homeostasis from which they will be resistant to change
Family Systems Model
A family is a system that operates through patterns to regulate family members behavior
- two systems of contraint:
1. Generic: Universal rules
- authority, complementary func
2. Idiosyncratic: mutual expectatios coming form specific fam.
the family system carries out it's functions through sub-systems of parents, spousal and siblings
Families fall on continuum of
- Enmeshed
- Disengaged
- families may have both types in diff subsystems
- Price of enmeshment: ppl don't develop selves, Lack of differentiation--inappropriate, diffuse boundary
- Disengaged: lacks feeling of belonging or conn, if one member under stress no one else feels it
- need ofr both - optimal health
Spouse Syb-systems
- ideal = team
- refuse from external stressors
- two patterns:
1. protective
2. requires protection - husband beats wife
- need firm boundaries to protect from other sub-systems
Parental sub-system
Spouse system may suffer

Ideally child should have access to both parents without intruding in the spouse functioning
Sibling sub-system
First place for siblings to experiment with:

Peer relations
- Important for parents to have enough access to children to prevent sibling abuse - dysfunction occurs if this is missing
Family Stress
- imp to have flexibility
- imp to see ow fam. deals with problems
- if whole fam is stressed can overload foam coping mechanism
two patterns in fam relationships that result in the diagnosis of psychopathology:
1. Parentification of Child: When there is stress in a spousal system a third party, child, may be brought in
2. Scape-goating: Bringing a third party (child) into a sub-system to alleviate stress
- child can absorb stress of marriage
Dynamic Formulation
All info that a therapist learns to understand her client. This involves LT personailty factors, if the client responds in maladpative ways to situations, social context etc...
- this is integrated into a meaningful picture
- this should allow the therapist to develop explanations and hypothesize about future behavior
Medical Evaluation (2 kinds)
- EEG, CAT scan, MRI, PET, fMRI
- Nuerological Assessment
-sometimes necc to start with to see if any physical abnormalities are causing or contributing to psych dysfunction
1. General physical Exam: good for problems such as addictive and organic brain syndrome and hormonal imbalances or pain

2. Neurological Exam: to check if brain pathology is involved
- EEG: electrical brain patterns; deviations reflect dysfunction: Dysrythmia
- CAT Scan:x-rays to find diseased brain parts
- MRI: similar to CAT but shaeper and safer
- PET scan: metabolic activity how organ is functioning; finds prob not in anatomical scnas; "hot spots"
- fMRI:m. change in blood flow that dep. on neurological activity

- N A: uses diff testing devices to m. a person's cogn,perceptual, and motor performance
- Bender-gestalt: copy over images
Psych Assessment
- flexible assessment methods (most widely used)
- Assessment Interviews
- Clinical Obs of Behavior
- Psych Tests
- attemps to see how a person interacts with her environment. Variety of techniques you can use
- AI: get info about patient's situation, behavior and personality; can be structured or unstructured - research shows s is better
- Obs: most traditional and useful; direct obs of behavior in diff contexts. Patient can help w/self-monitoring. Uses rating scales to indicate presence or absence of a trait and it's degree.
- P Tests: an indirect means of assessing psych characteristics
- personality
- intelligence
Types of Psych Tests
- Intelligence
- Personality
- projective measures
- Rorschach Test
- Thematic Apperception Test
- Sentence Completion
- Objective Tests
Pos and Neg of the above tests
Intelligence: Verbal and performance material. WISC-IV and Stanford-Binet are most common for children. WAIS-III for adults.
- most helpful when intellectual impairment or brain damage is the prob.
- looking at scatter can indicate dysfunction
Personality Test
- Projective Measures: unstructures and rely on ambiguous stimuli to learn about people's motives, preoccupations, conflicts, coping techniques etc..
- Rorschach Test: Inkblot; can be unreliable
- TAT: use simple pictures and ask for stories; ppl tend to project their own conflicts and worries. Also room for error
- Sentence Comp: "I wish..." "My mother...."; extremely subj and unreliable, no benefit in comparison
- Draw a Person (DAP): helpful in suicide, schizo, schizoid personality
- House Tree Person (HTP) - draw them; symbolic; not that great but can lead to some questions
- Draw a family. useful for children - who they leave out
- Draw a line - situation drawn by a line
- Empty chair: pretend someone is in a chair and tell them what u can't otherwise
- art therapy
- squiggle test: finish it up
- Objective Tests: Structured, use a questionaire, far more obj, more precise
- provies cost-effective way of getting a lot of info quickly
- MMPI: ans T/F for questions in physical cond, psych state, moral and social attitudes. Most widely used. Compare normal to those with disease; good bc no assumptions made about meaning of T/F just see the pattern a person makes ans see if it matches avg pattern of disease. Includes validity scale to see if ppl are truthful
- criticisms: out-dates, misses complexities, self-report bias
Ethical Issues
Decide if ppl are well enough to stand trial, remain with fam or be hospitalized etc need to keep some things in mind:
1. potential cultural bias of therapist
2. theoretical orientation of physician
3. underemphasis on external sit.
4. insufficient validation of some psych procedures
5. inaccurate data or premature evaluation
Classifications usefulness relies on it's reliability and validity
- give defs
- R: extent to which diff obs can agree is a person's behavior fits a diagnosis class
- V: if an instrument actually m. what its supposed to
ICD (more internationally used) and DSM use _____ to make diagnosis and determine
signs: obj obs
symptoms: patient's subjective description
- chronicity and severityy
5 Axes of the DSM
- I: clinical syndromes including schizo, anxiety disorders, adjustment disorders, depression, and substance dependence
- II: Personality disorders, broad category encompassing problematic ways of relating to the world + mental retardation
- III: General medical conditions relevant to understanding / managing a case.
- IV: Psychosocial and environmental problems, stressors that contribute to disorder
- V: global assessment of fucntioning (GAF) on a 1-100 scale
Clinical Assessment
- systematic evaluation of bio, psych, socio-cultutal factors to get a specific diagnosis
- evaluation potential causal factors, presenting problem, personal resources,
Process of Clinical assessment
1. make contact
2. how they were referred: word of mouth of clinic
3. set up initial interview
4. Hello - imp first impression for both
5. The clinical Interview: listed to subj reality while observing obj reality. Get chief complaint (why now?), their story (how a client "wrote" his book), family (attachments, how interacted with them), sex dev (transition), religious beliefs (imp can use useful and can be hurting them), cultural concerns (arranged marriage), edu achievement (work life, social life, balance), social interpersonal achievement (#1 issue is love),
5B. Obs during interview: pick up what is not said.
- Appearance & behavior
- thought process rate & flow of speech, clarity, content of speech & ideas)
- mood and affect (approp?, defense mech)
- Intellectual func: mem, vocab
- Sensorium: where are you, who are you, what's today's date?
DSM says it's categorical but is really prototypical
Axis II clusters (A, B, C)
-Cluster A: odd and eccentirc: paranoid, schizoid
- Cluster B: Erratic, Impulsive and Dramatic: antisocial, borderline, narcissistic
- Cluster C: Anxious and Fearful: avoidant, dependent, Obsessive-Compulsive
Self Psychology (psychodynamic theory)
- self-cohesion vs. fragmented
- Self Object
- Self Object experience (needs)
- It is a psychoanalytic theory that was developed here in Chicago, mostly in the 1960’s and 70’s
- Self Cohesion: wholeness, inner harmony, valued, loved....
- Fragmented: unwhole, emotionally unstable, low self-esteem, weak

- Self Object: Part of the self, which is the subjective experience of who you are; The “object” refers to another person. Consciously know they are separate.
- This merger provides the self with a feeling of cohesion. If the merger breaks there is fragmentation.
- Self Object Experience
- Mirroring needs: valued, recognized, appreciated, accepted etc...
- Idealizing Needs: Need to feel part of or connected to an admired & respected object
- - A child should have so much love that they actually need to push it away, and then they develop self-esteem when they realize their parents aren’t god and can become their own person and not need that adoration
Treatment Approaches
Pharmacological - science of determining which drugs work to alleviate which mental disorders and why they do so

Psychological therapy
Pharmacological Approaches
- Antipsychotic Drugs
- Anti depressant drugs
- Anti-anxiety drugs
- lithium and other mood stabalizers
- Electroconvulsive therapy
- neurosurgery
- Antipsychotic Drugs: can allieviate or reduce delusions in individuals with schizo or psychotic mood disorders by blocking dopamine receptors

- Anti depressant drugs: Inc availability of serotonin, norepinephrin, or both and inhibit re-uptake. SSRIs are safer than tryciclics. Also SNRI (new class, inhibit re-uptake of both)

- Anti-anxiety drugs:enhance activity of GABA receptors. Benzodiazepines are most widely used bc work quickly, but can become dependent on them and high relapse rate.

- lithium and other mood stabilizers: helps treat mania and bipolar; don't know how it works. Can be toxic if overdose. Other drugs exists too but bad side effects.
- Electroconvulsive therapy: passing an electric current through a patient's head. Good way to deal with patients who are very depressed or suicidal and have not responded to other therapy. Can be bilateral or unilateral. Can cause mem problems.

- Neurosurgery: prefrontal labotomy - was horrible, no emotion or impluse control
now can destroy minute portiona of brain and used as last resort for ppl with ocd or self-mutilation. Can also use deep brain stimulation.
Psychological Approaches to Treatment
- Behavioral Therapy
- exposure (systematic desensitization, flooding)
- aversion
- modeling
- systematic use of reinforcement
- token economics
- advantages
- cognitive-behavioral therapy
- rational emotive (REBT)
- Beck's cogn therapies
- Humanistic-Experiental Therapies
- Client-centered
- Gestalt
- process-expeeriental
- Psychodynamic therapy
- Freudian
- Interpersonal Therapy
- Marital and Family Therapy
- traditional behavioral couple therapy
- integrative behavioral couple ther
- structures fam ther.
- Behavioral Therapy: focuses on presenting problem, not history
- exposure (systematic desensitization, flooding): used to treat anxiety to learn better coping methods and unlearn maladaptive ones
- aversion: modify undesired behavior through punishment (used for drugs)
- modeling: copying another person (mentally retarded individual learns to eat)
- systematic use of reinforcement: to supress unwanted behaviors
- token economics: rewarded for good behavior
- advantages: results in short time bc targets specific behaviors, cheap, results comparable to others
- bad for vaguely defined disorders; good for anxiety

- cognitive-behavioral therapy: conviction that cogn processes influence emotion & behavior + use cogn and behavior changing techniques.
- rational emotive (REBT): attempt to change maladaptive thoughts; re-structures person's self-evaluation
- Beck's cogn therapies: problems arise from biased processing of external and internal events and stimuli. Clients taught to recogn these, identify logical errors and change them.
- best for healthy ppl cope with stress and depression.
- Humanistic-Experiental Therapies: prob stem from alienation, depersonalization, loneliness and failure to find meaning. Therapist acts as a guide to help client take control of therapy and change/control own behavior.
- Client-Centered: remove constraints that unrealistic expectations cause and feeling like it's not ok so feel emotions such as hostility. Listen w/o judgement.
- Gestalt: unity of mind and body, need to integrate thought, feeling and action to help clients inc self-awareness and acceptance.
- process-expeeriental: combines above and focuses on experiencing emotion during therapy. more active role of therapist.
- Psychodynamic therapy
- Freudian: uses free assoc, analysis of dreams, analysis of resistance, and analysis of transference (apply feeling to therapist that feel towards someone else) to get at unconscious. Takes yrs.
- Interpersonal Therapy: focusing on transference and counter-transference
- generally not great, long, costly
- Marital and Family Therapy: identifying problems from an in place system and relationships
- traditional behavioral couple ther: improving comm, and dev more adaptive problem solving. reinforcements in short term and guided by a manual. was gold standard
- integrative behavioral couple ther: for those which above didn't work. Focused more on acceptable of shortcomings than changing them.
- structures fam ther.:reduce high levels of stress and critisim that leads to relapses in patients. Change family context, get ppl to be more supportive.
Most therapists now are this. borrow from diff therapy tech and are relaxed and open to diff options
an organism's biological and psych responses to adjustive demands that obstacles toward total happiness place on us
- adjustive demands, create stress
- Can be pos (eustress - from a wedding) or negative (distress from a death)
Behavioral Madicine
-focus on role psych factors play in occurrence, maintenance and prevention of medical problems
- interdisciplinary field
Health Psychology
deals with psychology’s contributions to the diagnosis, prevention, and treatment of psychological components of physical problems
Coping Strategies
- efforts to deal with stress
Factors that affect how a person experiences stress
- crisis
- stress tolerance
- everyone faces a unique pattern of demands
- Nature of stressor: how serious, how long it lasts
- the experience of a crisis: when a stressful situation approaches or exceeds adaptive capacity of a person. It's outcome has an profound impact.
- Life changes, even positive ones can place new demands
- A person's perception of the stressor. Expectations are imp; ppl have diff tolerance, diff vulnerability
- stress tolerance: an individual's ability to withstand stress with out becoming seriously impaired
- Lack of external resources and social support
Stress Response
- cortisol
- HPA Axis
-bio changes that prepare the organism for fight or flight
- hypothalamus -> sympathetic nervous system -> secrete adrenalin -> inc heart rate, faster metabolize of glucose
AND leads to release of cortisol - prepares for f or f and inhibits immune response (won't feel pain for a bit), Help the body sustain prolonged activity
- too much cortisol damages brain cells, but good in ST
- receptors detect cortisol and stop it: HPA Axis
Allostatic load

- bio cost of adapting to stress
- high stress inc suseptibility ot illness
- may interfere with body's normal defense functions
- Allostasis–the process of adaptation or achieving stability through change
General Adaptation syndrome: model of stress
- model that explains bio decompensation under stress. 3 phases
1. alarm reaction i which body's defense is called to arms
2. resistance - bio adaptation at max level
3. exhaustion - resources depleted
immune system
specialized white blood cells (B-cells and T-cells)
respond to antigens (foreign bodies) such as viruses and bacteria
- reduces immunocompetence for 1-3 yrs following a very stressful event such as death of a spouse
Old way of looking at stress
- life change
- add stress units: Social readjustment rating scale
Social readjustment rating scale: life stress in terms of units
- ppl with 300 or more have an inc risk of dev disorder in next 2 yrs
- criticized: subj of scoring, nothing about specific disorders, mood changes ratings etc.

- Some stressors may accompany specific developmental events: school, becoming a parent, retirement...
New ways of looking at stress
- Personal Appraisal
- Personality Type
- Personal Habits
- Level of Socail support
- tendency toward
- Personal Appraisal: challenge vs threat, explanatory style, percieved control
- Personality Type: individuals stress tolerance
Type A: competative, always on the go/hurry, demands perfection, workaholic
Type B: noncompetative, relaxed, understanding, forgiving, confidence and happy in job, enjoys leisure
Can be good and bad of both
Type D: Tendency to experience negative emotions and feel insecure and anxious - inc risk of heard attack
- Personal Habits
- Level of Social support
- tendency toward
Psych factors imp to health and wellbeing
- optimism
- negative affect
- Hopeless and helpless attitudes can have devastating effects

- Optimism appears to Serve as a buffer against disease and Accelerate recovery
Potentially prevent a person from seeking necessary medical treatment
- Negative affect and anxiety appear to increase our susceptibility to certain health problems
Cardiovascular Disease: Hypertention
Hypertension (high blood pressure) is more common among
- African Americans (possibly due to sociocultural factors or diet)
- People who do not use or show anger constructively
- people with depression x3 more likely to have heard disease and inc future change of having cardiac death
- anxiety is a risk factor
- social isolation is a risk factor

- shows link btw psych and physical disease
Personal Habits impact on stress
- Stress can be *fuel* to a workout
- Eating well
- Good night sleep and happiness
- Learn how to be assertive (vs aggressive or passive)
Bad habits: smoking
Aerobic Exercise
decrease in depression, anxiety, stress
- mkae all good chemicals circulate: endorphins, morphine, serotonin
Coping and Reducing Stress
1. On biolevel immunological defenses
2. psych level and interpersonal: learned coping patterns, self-defense, fam, support
3. sociocultural level: group resources such as religion, unions, law enforcement
confronted with 2 challenges by stressor

Can do this in two ways:
1. meeting it's demands
2. protecting self psych and physically from danger

1. Task-oriented coping: making changes in self, surroundings or both
2. Defense-oriented coping: behavior directed at protecting self from hurt and disorganization, rather than resolving sit
- crying, mourning etc
- ego-defense mechnaisms
- if only way and excess can be bad
Relaxation techniques help cope with stress

- Progressive Muscle Relaxation
- Autogenic Relaxation
- bottom up
- Progressive Muscle Relaxation: Concentrate on specific muscle group, note tension, then relax
- Autogenic Relaxation: Directing blood flow toward specific muscles, warm & relax
positive psych
focuses on human traits and resources that may have direct implications on our health and wellbeing
Adjustment Disorder
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant as evidenced by either of the following:
(1) marked distress that is in excess of what would be expected from exposure to the stressor
(2) significant impairment in social or occupational (academic) functioning

E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Prevention Treatment
- stress inoculation
- preparing a person to deal ahead of time if its a predictable traumatic event like a surgery or break up
- stress inoculation: teaching a person to dev. more realistic and adaptive attitudes towards situation. 3 stages
1. given info
2. statement that promotes effective adaptation is rehearsed
3. applied in a ego-threatening or pain stressor to practice
Thinking Errors
- black and white
- catastrophizing
- Discounting or disqualifying (the positive)
- Emotional Reasoning
- Labeling
- Mind reading
- personalization
- tunnel vision
- learned schemas of dealing with things that are wrong
- Black & White Thinking: All or nothing thinking (no continuum)
- catastrophising / fortune telling: Predict the future negatively without considering other, more likely outcomes, mountains out of molehills
- Discounting or disqualifying (the positive): You unreasonably tell yourself that positive experience, deeds or qualities do not count
- Emotional reasoning: You think something must be true because you ‘feel’ it so strongly
- Labeling: A fixed global label on self or others without considering all evidence
- mind reading: You believe you know what others are thinking; Basically project your fears onto another person
- personalization: You believe others are behaving negatively because of you, with out considering more likely explanations
- Magnification/ minimization: unreasonably magnify neg and min positive when evaluating yourself or another person
- Should” “Must” “Ought” “Have to”: You have a precise, fixed idea of how you or others should behave & you overestimate how bad it is that these expectations are not met
- Tunnel vision: You only see the negative aspects of a situation
Adaptive vs. maladaptive anxiety
Adaptive: concerns realistic, fear in proportion to possible harm, fear subsides when threat ends

Maladaptive: not realistic, out of proportion, persists when threat passes, anticipatory, interferes with functioning
- General feeling of apprehension of possible danger
- more future oriented and diffuse than fear
- Anxiety and fear have: cognitive/subject (I'm anxious / afraid), physiological (inc heart rate) and behavioral components ( a strong urge to flee)
Abnormal Anxiety

Anxiety disorders are similar in:
- intense anxiety where there is no danger
- overwhelmed with anxiety is not adaptive

- basic biological causes, psychological causes and effective treatments
Primary features of anxiety disorder
- anxiety symptoms
- avoidance behaviors
Depression and Anxiety
- relationship in prevelance
- similar symptoms
- different symptoms
- most people who are depressed also experience anxiety
- not the other way around
- when anxiety runs in the family, so doesn't depression
- Overlapping symptoms: insomnia, hopelessness, negative affect, poor concentration and mem, figure's, irritability
- pure anxiety symptoms: apprehension, tension, trembling, excessive worry, nightmares
A phobia is a persistent & disproportionate fear of some specific object or situation that presents little or no actual danger
3 categories of phobias
- specific (5 types)
- specific
1. animal
- biological preparedness / evolutionary preparedness - affects which stimuli we can easily acquire a fear of and is resistant to extinction
2. nature/environment
3. blood-injection-injury: unique bc has as much disgust as fear and has an inc in hear rate / blood pressure and then a drop, poss resulting in fainting. Others just see an quick increase and gradual drop.
4. situational
5. other
- social
- agoraphobia
Specific Phobias
- M/F
- Age of onset
- common
- causes individual immense problems
-phobic deals with fear by avoiding feared situation
- 16% F, 7% M
- age of onset varies for diff phobias
- rel common: flying, heights, elevators
- Do not cause much trouble, for some, because they are not around the feared stimulus
Explanations of phobias
- psychodynamic
- self psych
- Behavioral
- pd: projection of frightening impulses that are inside the self are projected onto another object
- SP: Relationship mirroring (monkeys and fear response study) - vicarious or observational classical cond.
- B: Classical conditioning, operant conditioning (behavior cond by the responses we get), avoidance: avoidance removes adverse stimuli so more likely to avoid in future
- people who feel like they lack control are more vulnerable
CBT Model of Anxiety
Trigger Event -> Auto thought -> arousal -> EITHER anxiety or avoidance

- Auto thought: make interpretation, the cerebral cortex makes this decision that this is scary and sends of system into fight or flight
Factors that affect Specific Phobia
- genetic and temperamental affect the speed and strength of conditioning of fear
- individual's prior experiences with object before traumatic event occurs
- perception of uncontrolability and unpredictability
Treatment for Specific Phobias
- exposure therapy: Habituating to the fear
- most commonly used
- Participant modeling
- virtual reality therapies
- Combining cognitive techniques with exposure-based therapies
Social Phobia
- disabiling fear of 1 or more distinct social situation in which a person fear s/he may be exposed to the negative evaluation and scrutiny by others
- generally involve learned behaviors shaped by evolutionary factors: learn social signals of dominance and aggression
- Such learning is most likely to occur in people who are genetically or temperamentally at risk
- exp: humiliated, blushing, eating in public, public speaking, using public restrooms, interacting in small groups, parties
Treatment on Social Phobias
- Social skills training
- group therapy
- antidepressant drugs: almost as good results as CBT, but need to take for a long time to make sure relapse doesn't occur

- Problem: It is not uncommon for Phobics to resort to alcohol usage or drugs to reduce the level of anxiety in certain situations
Panic disorders (with and without agoraphobia)
- def
- diagnosis
- diff from anxiety
- Panic disorder is characterized by the occurrence of “unexpected” panic attacks that often seem to come out of the blue (in sense that aren't provoked by identifiable aspects of immediate sit)
- Episode in which intense anxiety & physiological symptoms are suddenly experienced… recurrent, unpredictable
- depersonalization (detached from body), derealization (external world is strange or unreal), fear of dying, fear of going crazy, shortness of breath, chest pain and heart palpitations, feeling of chocking, tingling in hands and feet, hot and cold flashes, sweating and shaking
- At least one of the attacks has been followed by:
- A persistent concern about having additional ( future ) attacks
- Worry about the implications, e.g., going crazy
- A significant change in behavior
- Feel terror

- diff from anxiety bc: brief and intense
- involves fear of having panic attacks in situations where it would be hard to get help
- Feel trapped, difficulty being assertive
- a type of negative reinforcement: A person is rewarded by pulling themselves away from what they perceive to be the punishment: humiliation
- 1/3 of cardiac practice may be panic attacks
- Many people with panic disorder also develop an agoraphobic fear of situations in which they might have an attack
- frightened by bodily sensations so avoid activites that will create arousal
- Rarely can occur with full-blown panic attacks have limited symptom panic attacks or bc of an unpredictable;e illness such as epilepsy
Panic disorder
- M vs F
- prevalence
- timing of first attack
- 3.5-4.7% of the adult population
- 2X’s as prevalent in women as men
- 50 % of people with panic disorder have additional diagnoses
- usually first one after a very stressful event, not all ppl, but some go on to have future oanic attacks
Biological Causal factors of panic disorder
- Panic disorder has a moderate genetic component
- There is a broad range of biochemical panic irritant agents
- There are also several areas of the brain implicated in panic attacks
- anticipatory anxiety is thought to be in limbic system
- panic attacks may arise from abnormal activity in the amygdala which is where the "fear network" is
Integrative Model of Panic attacks
Biological Vul -> catastrophic cogn -> attack -> hyper vigilance
- endless cirlce.
- afraid of having attack so interpret an irregular heart beat as being about to have one, or have a heart attack, get more anxious, then start having physiological symptoms, which again makes you more anxious etc..
Treating Panic Disorder and Agoraphobia
- cogn-behavioral
- meds
- Behavioral

- Cogn-behavioral: de-catastrophize. Reappraisal a thought that about to have a heart attack with I'm excited. Then the body won't get the signals from anxiety so no panic attack
- Cogn-Behavioral Treatments: relaxation -> identify cogn -> induce panic in therapy -> relaxation and reinterpretation -> systematic desensitization
-meds: antianxiety: benzodiazepines or antidepressants
- some people can get very addicated
or mild tranquilizers
Obsessive-Compulsive Disorder
- exp of each
- Defined by the occurrence of unwanted & intrusive obsessive thoughts(or distressing images)and compulsive behaviors, usually performed to neutralize the obsessive thoughts or prevent some dreaded event and reduces tension that is fleeting
- a person may have obs, compulsion ot both
- Anxiety is the affective symptom and compulsions dec anxiety
- afraid something bad will happen to them or someone they know and it will be their fault: judge risks unrealistically
- exp of obsessive thoughts: violence, contamination, lack of symmetry, pathological doubt
- exp of compulsions: cleaning,checking, repeating, ordering/arranging, counting AND hoarding
- M vs F
- prevalence
- both genders equally
- 2.5 % lifetime, 1.6% year
Causal Factors
- Psychosocial
- evolutionary roots
- suppression
- Barlow
- attention
- Biological
- According to Freud a person with OCD has been unable to cope with conflicts of the Oedipal stage
- evolutionary roots: Obsessions with contamination and dirt
- Attempting to suppress unwanted thoughts may increase those thoughts
- People with OCD seem to think bad thoughts are equivalent to bad deeds Barlow: OCD pts seem to think that certain thoughts are dangerous
- attention is drawn to disturbing material relevant to their obsessive concerns
- Biological: moderately heritable
- Slight structural abnormalities in the caudate nucleus
- high metabolic levels in other parts of the brain
- Serotonin is strongly implicated in OCD
Treatments for OCD
- Behavioral
- B: involving a combination of exposure and (compulsive) response prevention
- may be the most effective approach to obsessive-compulsive disorder
Generalized Anxiety Disorder
- def
- M vs F
- prevalence
- diagnosis
- Free floating anxiety; anxious apprehension; chronic, obsessive and unreasonable anxiety
- worry process if central feature
- twice as common in W
- 3% year prevalence
- often co-occurs with other AXIS I disorders
- Excessive worry and anxiety about a number of events or activities more days than not for at least 6 months.
The worry is difficult to control.
At least 3 of the following:
Sleep disturbance
Easily fatigued
Restlessness/keyed up/on edge
Difficulty concentrating/mind going blank
Causal Factors
- Psychosocial
- psychoanalytical and others
- Biological
- Freud:conflict between id & the ego
- history of unpredictable and uncontrollable events; lacking safety signals in environment
- Automatic attentional bias toward threatening information in the environment

- Biological: modestly heritable
- Neurotrasmitters: deficiency in GABA, Serotonin, maybe norepinephrine play role in anxiety; so does CRH -> leads to release of cortisol
Treatment CBT
- session 1: goals and expectations, person's history, adaptive/non-adaptive anxiety
- 2: personalize model
- 3: focus on triggers, early cue detection, muscle relaxation technique
- 4: more muscle relaxation, diaphragm breathing, journal or "small joys", present moment focus
- 5,6,7: cogn restructuring: getting rid of automatic thoughts
- 8,9,10: worry exposure

Drugs: Valium - not great, addictive
Anti-depressants - better
cognitive theory of panic
- panic patients are hyper-sensitive to bodily sensations and give them the more dire interpretation
- this causes more physical symptoms of anxiety which leads to further thoughts and creates a circle
- not clear how tendency to catastrophize dev.
Comprehension Learning theory of panic disorders
- initial panic attack becomes assoc with internal or external stimuli which can cause it in the future - usually heavy breathing or heart palpitation
- this can be done unconsciously which is better are explaining the occurrence of panic attacks without any bad thoughts as well as nocturnal panic attacks
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