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FINAL – PSYCHOLOGY 101 – FALL, 2011 – REVIEW SHEET Gang: The final examination will be on chapters 13 and 14, and 15 and will be held on Tuesday, December 13th, at 12:00 (in our regular classroom). The review sheet highlights the topics that you should focus on. Any material that I, Erin or Daryl covered in class is also fair game. As with the first three exams, the format will be multiple choice. There are a total of 65 items on the exam and you will have a maximum of two hours to complete it. Finally, any video clips shown in class (or demonstrations) are fair game. The entire lecture by Erin and Daryl is also fair game. A few of the items are from the text only. The majority were covered both in the book and in the text. Erin, Daryl and I really enjoyed working with you this past semester and we wish you all the best in the future. Good luck on the exam!PRIVATE Chapter 13 – Psychological Disorders Know the different approaches for understanding abnormal behavior Mental Disorder – behavior is unusual and infrequent Can be positive/negative Norm violation – people behave in ways that deviate from society Problem is that diff socieites have diff perceptions of what is normal Personal Suffering – person experiences stressful/traumatic symptoms Consistent w/ ego-dystonic (external view) Not all mental disorders associated w/suffering Mental illness interferes w/ functional behavior Affects day to day functioning Medical Perspective – abnormal behavior due to biological factors Includes genetics, neurotransmitters like serotonin, areas of neural function such as parts of brain areas Says that mental illness is like a physical disease Behavioral – abnormal behavior is learned and subsequently reinforced; conditioning Eg: Little Albert from Pavlov Inadequate social skills depression Phobias, anxiety disorders Socio-cultural – best understand mental illness in context of culture Prejudice, cultural norms, cultural class Groups that are prejudiced against can get a kind of “anxiety” Universalistic/pan-cultural view – criteria of mental illness same around world Realistic view – criteria of mental illness varies across cultures They think that DSM is white, western values Cultural general - some mental illnesses are consistent across all cultures; some disorders that are seen within all cultures Eg: depression occurs everywhere though manifest diff in east/west culture West = more cognitive; east = more physical Cultural Specific – some disorders unique to certain cultures Eg: Ataques de Nerivios – occurs in Puerto Rico/Dominican Republic in women; stress disorder with shaking and shouting and seizures Book DSM contains disorders not seen in U.S. but in other countries too Cognitive/ Cognitive-Behavioral – faulty thinking patterns/faulty interpretations, biased interpretations of world leads to emotional distress and psychological disorders Cognitive theory of evolution (ABC) 1. Antecedent – event 2. Belief – cognition 3. Consequence – emotion Basic Cognitive Principle People are upset not because of events or situations that occurred but by the meaning people give to events or situations When meaning is (--), neg emotions result When meaning is (+), pos emotions result People misinterpret what they see Eg: Prof says “see me in my office” you think something is wrong Eg: youtube clip (Forgetting Sarah Marshall): man self-deprecates while playing piano Diathesis – stress – people are born with diathesis (biological vulnerability) Precursors (genetic, early experience) diathesis/vulnerability stress/poor understanding disorder Eg: history of diabetes in family eat poorly bc you feel like it stressful circumstances diagnosis of diabetes Eg: switching from HS to college Criteria for Disorders Deviance – from normal behavior Maladaptive behavior – everyday behavior is impaired Personal distress Know these terms: Etiology – causation of something Prognosis – likely outcome, forecast about probably course of an illness Eg: you are likely to recover/not recover Diagnosis –what the disease is; distinguishing one illness from another Eg: You have asthma Person’s relationship w/ symptoms & mental illness Ego syntonic – person views symptoms as who they are, defined by disorder In sync with your ego Eg: Personality disorders (find example in book) Ego dystonic – person views symptoms and illness as not who they really are; illness is an external thing Wouldn’t describe themselves as the illness Eg: Bob takes exam and is anxious – but isn’t usually Eg: I have the flu, but the flu isn’t who I am **Psychological disorders are more common than we think they are Point prevalence - % of population that have a psychological disorder within a specific amt of time (month, yr) 26% >18 yrs diagnosed with mental illness Anxiety most common, then mood disorders Lifetime prevalence – how many people over course of lifetime will develop psychological disorder 46% of people during lifetime will be diagnosed with mental illness For ½ people, problems start before 14yrs Gender differences Female: anxiety and depression Male: substance use disorder, anti-social personality Know what the DSM-IV is, what it is used for, and what information is coded on all five Axes Diagnostic and Statistical Manual IV (DSM4) – used internationally to diagnose people with disorders New edition in 2012 Info has tripled bc more people willing to get help Standards/criteria have changed; how we think about illness has changed Emergence of new mental illness Eg: cyberbulling, addiction to internet Muscle disorphia Are there a bunch of disorders or are they too specific Assumption that cause is NOT biological 5 categories/axes Advantages of classifying psycho disorders Implications for treatment! Facilitates communication among professionals Insurance implications Disadvantages of classifying psycho disorders Self- fulfilling prophecy – people come to believe diagnosis they have Diagnosed as something, believe that it defines who you are Eg: I failed the test bc I have sczhiophrenia Can we actually fit diagnoses in categories? Not always neat categories, not just one disorder Comorbidity – people have multiple disorders/problems Eg: anorexia and mood disorder Polythetic criteria – diff number/combos of symptoms to come up w/diagnosis All have same diagnosis but diff symptoms Eg: people w/ depression all have it but have diff symptoms/are slightly diff No uniform def. of depression Stigma – refers to labe being associated w/number of neg. connoctations Gives neg. attitude about people, usually factually incorrect People associate crime w/mental behavior Label people into diff stereotypes Axis I – Clinical Disorders Diagnosis all disorders (depression, anxiety, eating, substance, schizophrenia) Look at symptoms – have to have certain # of symptoms of certain # of times to be diagnosed DOESN’T include personality Adjustment disorder – adjusting to college, mild disorder Axis II – Personality Disorders Different axis bc ego-syntonic disorders Thought to be relevantly longstanding and stable over time Extreme versions of personality Most don’t want to go to therapy bc don’t think they have a problem Often brought in by others Borderline Personality Disorder – someone who is very erratic, doesn’t handle stress well, falls apart easily will try to split friends apart try to cut themselves emotionally volatile Antisocial Personality Disorder – people, mainly men, devoid of compassion for others No empathy; calculating Eg: Ted Bundy – serial murderer of women Eg: OCD Axis III – Physical/ Medical Problems Medical conditions relevant to understanding and managing person’s psychiatric condition Medical condition directly related to psychiatric condition (find egs) Axis IV – Psychosocial/ Environmental Problems Psychosocial and environmental stressors important in person’s psychiatric condition Problems w/primary support group Problems in social support Occupational, housing, educational problems Asks q: “what are psychosocial and environmental problems patient currently has?” Axis V – Global Assessment of Functioning (GAF) GAF – clinician judgment on symptom severity and adaptive functioning Only rate problems in psychological, social, occupational functioning (no physical/environment) Rating from 1-100 to estimate how well you are at moment Consider symptoms and social work func Puts weight on whatever doing worse at Higher score = better 10 pt error rate is normal -Score of 1-30: candidate for inpatient care -Score of 31-69: candidate for outpatient care -Score of 70 + : medical necessity not indicated b/c patient is functioning too well PHP – partial hospital program You should be familiar with all the disorders discussed in this chapter (and in the lectures) and be able to identify key symptoms associated with each one (e.g., obsessions are associated with OCD) and to identify the disorder from a short vignette (i.e., a description of someone with the symptoms). You should pay particular attention to the: A) Mood disorders - emotional disturbances that disrupt physical, social processes Major depression and dysthymia(not as severe as major depression) Have to have >5 symptoms for >2weeks Symptoms caused because people worry about themselves being anxious Depressed mood, lost of pleasure, change in appetite/sleep/energy Thoughts of death/worthlessness Could be hospitalized for this Eg: Youtube clip – very monotone, hard to find words to say, slow speech, flat emotion Unipolar disorder – experience only one feeling of depression Manic Disorder Need symptoms for >1wk (grandiosity, elevated mood, feelings of superiority, reckless behavior, talks really fast Lot of it due to irritability – not normal Mood congruence psychosis – he’s talking to me because he think I’m brilliant!” Psychosis – loss of contact w/reality When you have mania depression bipolar disorder Bipolar – eg: youtube video – giggly, can’t really focus, “I am part of the world”, eyes dart back and forth Bipolar disorder – emotional extremes at both ends of mood continuum 1. Depression - 2. Mania – excitement and elevation Etiology of Mood Disorders Genetic vulnerability – both major depression and bipolar disorder – identical twins have higher risk of getting them Genetic component of bipolar disorder is stronger Strongest component of major illness Neurotransmitters Abnormal low levels of norepinephrine and serotonin Depression shows reduced hippocampal volume and suppressed neurogenesis Negative thinking contributes to depression Depressed people tend to be depressing B) Anxiety disorders – phobia interferes w/ functioning Two components: irrational fear and avoidance of cause of fear Specific phobia –least debilitating Having fear involving objects in 1 of 4 domains: Environmental factors (lightning) Situational Animal (spiders) Blood injection/injury phobia – more heritable than others; tends to be associated w/fainting (other 3 domains more associated w/anxiety) eg: Youtube clip of woman w/phobia of clowns (situational) Coulrophobia – fear of clowns SUDS scale – subjective unit of discomfort scale (rate anxiety from 1-100) Social Phobia – fear of social situation in which you can be evaluated negatively by others Key component= FNE – fear of neg. evaluation Eg: public speaking, eating in front of others, meeting new people, acting, talking to people of authority, talking to people you find attractive Affects men/women equally Extreme forms of shyness that interferes w/ daily func. Eg: Youtube video of girl’s self video – scared of what people think of her, judging neg. Blushing, get nervous, always think they did badly GAD – generalized anxiety disorder Does not involve avoidance, BUT involves a free floating anxiety Always tense and anxious but not panicking, chronic level of worrying about anything, but no real reason to worry Get straight A’s but still worry about grades Not as much avoidance bc more you avoid something more you rebound PTSD – Post Traumatic Stress Disorder Induced by specific event: war, shell shock, automobile accidents, house burning, sexual/physical abuse DSM changed it from catastrophic events to those plus defining event in your life and how you interpret it Eg: watching 9/11 happen People often have re-experiencing of event that causes shock – can’t stop thinking about event Avoidance of places and things that remind them of the event Numbness – people report being dead inside, emotionless Hyper vigilance – eg: war veteran hears car backfire, jump in shock eg: man tries to move on with life and not think about it kids scream triggers it can’t be physically close to people Agoraphobia – “fear of the marketplace” Fear of being out in public (NOT fear of people) Afraid of being in places where escape is difficult, afraid of being in a diff place Usually become housebound Afraid because they’ll have a panic attack – reactions of panic that happens randomly w/no real cause Emotion: Intense fear which lasts a certain amt of time Physiological: Heart racing, intense fear, trouble breathing, Parasthesias – tingling in hands and feet Cognitive: fear of dying, fear of going crazy, depersonalization Panic attack people avoid things that raise heart rate (caffeine, exercise) Fear starts specifically then gets generalized classical conditioning People make their symptoms worse by thinking about it and hyperventilating – mess up pH balance of blood which causes flashes, trouble breathing, etc. Control through breathing w/stomach Eg: woman who had agoraphobia wanted to see her daughter’s wedding Panic Disorder – having panic attacks over period of time OCD (Obsessive Compulsive Disorder) Obsessions – recurrent repetitive thoughts that are intrusive and cause anxiety/distress not just worries about real-life problems person recognizes they are product of own mind eg: obsessions w/safety, contamination, symmetry, aggressive/sexual/religious images compulsions – repetitive behaviors or mental acts person feels driven to perform in response to obsession aimed to prevent distress but not realistically connected sense of “what if?” eg: checking behavior (checking stove), cleaning, hoarding, washing hoarding = most severe form of OCD thought action fusion - having a thought is as bad as doing the behavior have to do compulsion to combat that thought treatment – make them face their fears learning theory of negative reinforcement (cause of phobia) weird memory problem Did I remember to do something? C) Somatoform disorders – physical ailments that can’t be fully explained by organice conditions, largely due to psychological factors Psychosomatic disease – genuine physical ailments caused partly by psychological factors such as emotional distress Axis III diseases Somatization Disorder (Briquet’s syndrome) – Marked by history of diverse physical copmlaints that appear to be psychological in origin Mostly occurs in women Conversion disorder – sig. loss of physical function, usually in single organ system Eg: partial/complete loss of vision, hearing etc More severe than somatization disorder Body Dysmorphia – person is concerned w/ body image Thinks every part of them is defective Can cause severe depression/anxiety Unhealthy preoccupation w/body image Pain Disorder – experience chronic pain, caused by psychological stress Disables person from normal functioning Hypochondriasis – excessive preoccupation w/health and worry about developing physical illnesses Often skeptic and disbelieving Over-interpret every sign of illness D) Eating disorders; Anorexia Nervosa – 90% female; 4 main symptoms 1. Unable to maintain body weight (less than 85% of what it should be) 2. Intense fear of gaining weight 3. Disturbance in way body is viewed, bad perception, self-denial 4. Think about weight/food issues all the time Eat a restricted range of “safe” low cal foods Avoid social eating situations 2 types Restricting type – lose weight by restricting bad foods, eventually all food Show no variability in diet Purging type/Binge eating – lose weight by vomiting after meals, abuse laxatives, diuretics, engage in excessive exercise Like bulimics EXCEPT people with THIS type are sig. underweight People w/ this subtype may engage in binges Often have mood disorders Medical Complications In females, absence of 3 consecutive menstrual cycles Low body temp., low blood pressure, body swelling, reduced bone density (most severe) – bone is fragile, slow heart rate, metabolic/electrolyte imbalance Dry skin, brittle nails, poor circulation, lanugo hair – fine hair grows on body to try to keep it warm Treatment – cognitive treatment Bulimia Nervosa – disorder = pattern of behavior Binge eating w/ recurrent episodes – eating in discrete pd of time an amt of food larger than normal Sense of lack of control over eating during episode Binging usually w/ sweet foods Preceded by feelings of tension, stress, anxiety; neg. qualities to it Recurrent inappropriate compensatory behavior to prevent weight gain Eg: vomiting, laxative, diuretics, enemas, medication, fasting, exercise Vomiting only gives up 50% of what you consumed Binging/purging occurs >2 wk for 3 months Self evaluation influenced by body shape/weight 2 types Purging type – reg. engage in self induced vomiting/misuse of laxatives Vomiting: affects ability to feel satiated greater hunger/bingeing Affects gums, teeth enamel, burns esophagus, stomach Intestinal problems, rectal bleeding Laxatives – completely fail to reduce # calories consumed Non purging type – fasting, exercise Compensatory behaviors may temp. relieve neg. feelings but cycle develops E) Dissociative disorders- people lose contact w/ portions of their consciousness/memory disruptions in identity Multiple Personality/ Dissociative Identity Disorder (DID) – coexistence in one person of >2 largely complete and very diff personalities Multiple personalities, have more than one identity Dr. Jekyl , Mr. Hyde Diff personalities are unaware of each other Mistaken for schizophrenia Depersonalization disorder – when person has feeling of watching himself act “dream like”; feel like world is less sig. Loss of conviction of own identity Go through motions of life, but don’t experience it “out of body experience” Dissociative amnesia – sudden loss of memory for important personal info that is to extensive to be due to normal forgetting Can occur after traumatic event Dissociative Fugue – people lose memory for entire lives, along w/ sense of personal identity But remember things like how to drive, etc F) Psychotic disorders (particularly schizophrenia). Schizophrenia – marked by delusions, hallucinations Confused w/multiple personality disorder (which is a dissociative) Symptoms: hallucinations, delusions, thought disorder, impaired social functioning, poor insight hallucination – sensory perceptions that occur in absence of real, external stimulus/ gross distortion of perceptual input hearing voices Delusions – false beliefs maintained even though they clearly are out of touch w/reality odd beliefs, think people are after you, thinking people put thoughts in your head Grandiose delusions Thought disorder – when they talk it doesn’t make sense Impaired social function Poor insight – deny disorder, blame it on pot or something Positive v Negative Symptoms Positive symptoms – symptoms that are present in schizophreniacs but not in normal people Eg: consistent pattern of hearing delusions and having hallucinations Negative Symptoms – symptoms/behaviors present in normal people but NOT in schizophrenics Eg: expressive faces, having motivations Takes long period (wks, months, yrs) to get to decline into schizophrenia Current treatment is to get people ASAP so no LT illness Peak age is 18-22 yrs, 1% of pop. Types Paranoid – delusions of persecution w/ delusions of grandeur Believe that they have enemies coming after them Become suspicious of relatives Think that people are after them, therefore think that they are very important people Very common Disorganized – server deterioration of adaptive behavior Emotional indifference, frequent incoherence, virtually complete social withdrawal Aimless babbling, giggling Delusions centered on bodily functions “my brain is melting out my ears” Catatonic – striking motor disturbances (muscular rigidity to random motor activity) Catatonic stupor – extreme form of withdrawal Remain motionless/seem oblivious to environment for long periods of time Catatonic excitement – hyperactive, incoherent Not very common Undifferentiated – clearly schizophrenic but don’t fit into any above categories Fairly common Eg: Youtube Clip – didn’t see himself as sick (lack of insight) Said he could understand what animals were saying Ideas of reference – play song from HS, think that radio DJ is trying to tell you something Take random events and personalize them Know all the causal factors that have been implicated in mood disorders, anxiety disorders, eating disorders, and schizophrenia; which neurotransmitters have been implicated in these disorders? Etiology of Anxiety Disorders Cognitive Factors – interpretations of events, situations, bodily sensations, physical experiences can lead to anxiety Interpret ambiguous situations in a threatening manner Women usually neg., men usually pos. Stroop Test – interference in naming colors also occurs when words involve some kind of threat People w/social phobia= lonely w/ panic disorder = hospital, doctor, breathe OCD = germs Takes longer to name color of word if word they see affects neg. Theory of Preparedness – development of phobias is not random, but people are biologically prepared to develop fears to certain things There is always a reason for phobias We develop fears of things that historically have threatened our survival Phobias based on biological history Eg: monkeys developed fear of toy crocodiles not toy flowers Kind of like Young’s collective unconscious (biological fears) Problems: doesn’t consider current environment Some things that people develop fears to that don’t threaten survival Eg: prepardness doesn’t account for spiders because they aren’t poisonuous, more because of presentation of different objects Movement scares/disgusts you (if a cat slithered like a snake, probably would be afraid) Genetics (concordance rate) More likely to get if it twin has it (study of identical and fraternal twins) Neurotransmitters Altering GABA synapses reduces anxiety Conditioning (Mowrer’s two factor theory) Mowrer’s Two Factor Model – neutral stimulus (snow) gets paired w/ aversive event fear combines classical conditioning to acquisition of phobia people reduce fears by neg. reinforcement – but this isn’t good! Want people to interact w/ their fear Personality (neuroticism) Etiology of Somatoform Disorders No genetic factors Cognitive: excessive over thinking Personality factors: high neuroticism = high chance of somatoform disorder Insecure attachment styles Play “the sick role” Etiology of Eating Disorders Cultural Factors – issue of US/western perceptions/culture (rare to see models not 00) Initially thought of white middle class disorder but present everywhere, rates vary (blacks lower than whites) Ideal body image (white perception thinner than blacks) Subcultural diffs. Over controlling families, history of dieting Genetics – siblings of anorexics are 6-7x more likely to develop Cognitive distortions – neg. attitude towards being overweight/fat Tendency towards “all or nothing” thinking “I already blew it, might as well eat everything” Thin/fat, no gray area Personality Characteristics – tendency towards obsessive compulsive behaviors Anorexicx: OCD spectrum behavior, over controlling Bulimics: impulsive behaviors, behavior disinhibition – can’t hold back Etiology of Dissociative Disorders Usually attributed to excessive stress Some think people use disorder as excuse for personal failings Some think that therapists encourage multiple personalities Attributed to traumatic events Etiology of Schizophrenia: Casual Factors Genetics – genetics is closely related Kid w/ 2 parents w/disorder at high risk; identical twins at high risk Neurotransmitters Excessive Dopamine Overactivity at dopamine synapses = schizophrenia Too many dopamine receptor cites drugs to cure schizophrenia dampens amt of dopamine drugs bind dopamine receptor sites to block dopamine activity Excessive Serotonin Excessive marijuana use Neurological Problems Enlarged ventricles – hollowed cavaties in brain that are filled with CSF (cerebrospinal fluid) Frontal lobe underactivation Neurodevelopmental hypothesis – disruption of maturing of brain before birth Expressed Emotion (EE) - degree which relative of schizophrenic displays highly critical/emotionally overinvolved attitude towards patient High EE = relapses in patient Stress Different theories of depression Cognitive Theory of Depression Core belief – “I am unlovable” Intermediate belief – “I will never have a romantic relationship” Automatic thought – caused by a situation (strike out w/ potential dating partner) “It’s because I’m no good; No one will ever date me” Reaction – feel depressed, depressive behavior all-or-none thinking catastrophizing/fortune telling overgeneralization “should” “must” statements Beck’s Cognitive Model (3 Levels) Beck = father of cognitive approaches, how you interpret how the world affects everything Etiology Negative Triad – people w/depression have neg. view of self, world, future Don’t think things will change Explains how depression is maintained Negative Schema – pan situational view of world that underlies automatic thoughts Interpret things in neg. way See world through ‘neg’ glasses World view that you carry w/you Automatic Thoughts – thoughts in a situation that come up spontaneously In-situation appraisals that lead to feeling down/depressed Use emotions to decide facts when in reality, it’s not always right All or nothing thinking – either people love/hate you; no middle ground schema provides situation of having automatic thought stoplight effect – you think everyone’s focused on you Seligman’s Cognitive Model of Learned Helplessness did research w/dogs for animal model of sczhiophrenia gave dogs electric shock and didn’t let them escape when they finally opened gate, dogs sat and cowered dogs learned to become helpless, learned that their behavior has applicability to outcomes when people have a number of neg. outcomes happen to them, after a while they give up locus of control animal model of depression attributional style – also interpretation of events that matter, explanation of events eg: “Why won’t they say hi to me?” think of it in 3 dimensions 1. Internal: you take responsibility of event Didn’t say hi bc I’m a jerk, it’s my fault Opposite is external: blame on someone else 2. Stable: stability of your problem I’m not just a jerk today, I’m a jerk in multiple situations and will be in the future, I won’t change 3. Global: applicable to everywhere I’m not just stupid in PSYC 101, I’m stupid in everything Therapy tries to go to attributional style Know the learning approaches to anxiety disorders (e.g. Mowrer’s two factor theory). Theory of Preparedness – development of phobias is not random, but people are biologically prepared to develop fears to certain things There is always a reason for phobias We develop fears of things that historically have threatened our survival Phobias based on biological history Eg: monkeys developed fear of toy crocodiles not toy flowers Kind of like Young’s collective unconscious (biological fears) Problems: doesn’t consider current environment Some things that people develop fears to that don’t threaten survival Eg: prepardness doesn’t account for spiders because they aren’t poisonuous, more because of presentation of different objects Movement scares/disgusts you (if a cat slithered like a snake, probably would be afraid) Mowrer’s Two Factor Model – neutral stimulus (snow) gets paired w/ aversive event fear combines classical conditioning to acquisition of phobia people reduce fears by neg. reinforcement – but this isn’t good! Want people to interact w/ their fear Chapter 14 – Treatment Know the different types of mental health professionals who provide therapy. Social worker – most have a master of social work (MSW) BUT NOT EVERYONE DOES Trained in therapy, case management (manage all aspects of client’s life) Helps with housing, dentist, way to get job Kind of like a personal assistant Usually doesn’t get training in abnormal behavior Psychiatrist – can prescribe medication Went to medical school Focused on medication – approach from medical mind Specialize in psychiatry Traditionally trained in psychodynamic approaches, NOW are being trained in cognitive behavioral approaches that are usually good for anxiety disorders Psychologist – training in therapy and assessment (personality or intelligence test Goes to grad school; Ph. D Focus on assessment and treatment Focused on approach from psychological aspect (psychiatrists more focused on medication) Training in cognitive behavioral approaches good for anxiety, depression Don’t have right to prescribe meds Patients are referred back and forth, ideally want all three people working as a team Therapy A way for people to confront their fears, a place for people to express themselves 15% of US population goes, women more than men Social stigma to being helped People my age aren’t big help seeking people Problems that women have are easier to treat with therapy than those associated with men Can be expensive, most people use their medical insurance People with insurance more likely to get treatment Some therapists don’t accept insurance bc they get less money Full range of human problems (depression to schizophrenia) Not everyone goes willingly into therapy – eating disorders and mood disorders usually don’t go people who seek treatment usually have a higher education level Different types of Therapy Insight therapy – verbal interactions intended to enhance clients’ self-knowledge and promote healthful changes in personality and behavior Psychodynamic Therapy – insight oriented therapy associated w/ Sigmund Freud) Goal: get insight into condition, working through conflicts Insight therapy – understand unconscious conflicts, motives, defenses want to function well in productivity and relationships w/others Technique: Free association – speak whatever comes to mind Interpersonal dynamics Interpreting resistance – trying to understand when patients are resisting to address important issues Eg: said we’ll start talking about mom next appt, patient cancels next appt Dream analysis – using dreams as window to person’s unconscious What you dream is sig. Interpretation – psychodynamic therapist use info from therapy session as relevant to unconscious Eg: mention old BF by accident (slip of tongue is imp) Transference – therapist interprets client’s behavior as reflective of how he deals w/ other people Eg: deals w/ prof belligerently that’s how he deals w/ other older men How you act w/ therapist how you act w/ others ***this is why therapists sit at head of client transference Counter transference – can’t let psychiatrist’s feelings get in the way Client Centered Therapy – Humanistic Approach Also insight oriented Forms basis of all therapies Carl Rogers – says “mmhm” a lot, focuses on feelings, doesn’t offer soln., keeps on repeating what she says, lets her talk more, tries to get her to come to own conclusion Assumptions Treatment is encounter among equals Clients will improve on own given proper conditions Reflective listening – repeating back what person says Purpose is to make them explain their feelings Client has to be totally accepted/supported as a human being in therapy Client is responsible for choosing how they will think/act why therapists let clients do all the talking Goal: let patient improve on their own Help individual eliminate obstruction that stands in the way of congruence Major elements of therapy Apathetic – “sounds like you’re upset” Therapeutic alliance – empathy, warmth, active listening Associated w/ people doing better in therapy Unconditional positive regard Congruence Therapy is there for them to listen to you, friends are there to offer advice Rogers said that incongruence develops mental illness (You can’t be something you’re not) Tries to create atmosphere where no conditions of worth; accepting environment Eg: positive psychology, positive psychotherapy (Seligman) – good for depression Effectiveness of Insight Therapies (Psychodynamic and Client Oriented) Spontaneous remission – psychological disorder clears up by itself What are the assumptions underlying behavior therapy? How can we understand phobias from a classical conditioning perspective? Know the techniques associated with behavior therapy, such as aversion therapy, imaginal and in vivo exposure, systematic desensitization, exposure, and social skills training. Know which techniques are based on operant and classical conditioning. Behavioral Therapy – diff than insight bc beavhior therapists don’t help clients achieve insights, doesn’t believe in the why but the actual result Based on learning therapy, classical and operant conditioning (Skinner), modeling (Van Doren) to change maladaptive behavior Components of therapy: Good therapeutic relationship Listing of behavior/thoughts to be changed Eg: anxiety in social situations Therapist as teacher Unlike Rogers, teach relaxation skills, change beliefs or thoughts of a specific situation, teach specific skills Continuous monitoring and evaluation of treatment and problem behaviors Eg: self evaluation Tends to be effective for anxiety disorders and depression Depression: try behavioral operation – to make them to more activities more likely to enjoy something Types of behavioral therapy based on classical conditioning 1. Exposure Therapy – expose people to their fears eg: expose OCD people to dirt and not wash hands exposure w/ response prevention more exposed = less likely to be scared when people are afraid, they usually avoid fear when people are exposed and can’t escape, realize not as bad as they think “if you fall off the horse, get back on” Kind of like habituation – when you watch scary movie, first time is scary, fifth time is funny Undoes neg. reinforcement of people escaping Involves in vivo exposure – directly confronting your fears Eg: take PTSD person who is afraid of place to that place to confront fear of place 2. Systematic desensitization (Wolpe)– good for phobias/anxiety exposure in baby steps 1. Find out what someone is afraid of 2. Make them list a fear hierarchy from least to most scary 3. Teach relaxation response Rate fears, relaxation, then reassess their fears 4. Pair feared item w/ relaxation 5. Move up the hierarchy Associated w/ classical conditioning – associate something neg. w/ pos. Want to weaken association btwn CS and CR People do therapy outside of office too In vivo – feared situations are experienced in order to dec anxiety Faced with a hierarchy from least to most anxiety 3. Imaginal exposure – imagine your fear (in case it’s not safe to directly confront it ie: PTSD can’t go back into battlefield) 4. Aversion therapy – associate something you want to get rid of w/ something aversive Uses classical conditioning, associate neg. response w/ CS Eg: show pics of porn w/electric shock Clockwork orange Good for substance abuse, sexual, stuttering, overeating Problem: only takes away bad behavior and doesn’t increase appropriate behavior Types of Behavior Therapy based on Operant conditioning 1. Time Out – take person out from where he’s getting reinforcement and put him in situation where he’s not getting reward for that behavior Response burst: when kids in time out and start getting really loud bc they want parents to hear 2. Token Economy – giving people rewards for certain behaviors Challenge is finding out what the reward is Eg: stickers 3. Social Skills Training – intervention meant to strengthen or develop new social skills Good for schizophrenia, ADD, social anxiety 1. Review rationale for skill 2. Reviebiomedicalw specific steps of skill Break down into steps, discuss reason for each step, check for understanding 3. Model steps and ask for feedback plan out role play in advance, explain what skill is demonstrated Keep role play simple 3. Engage person in role play Discuss and make sure client understands 4. Provide feedback, start with the positive 5. Provide suggestion for improvement and role play again Elicit suggestions for improvement Limit feedback, communicate in positive manner 6. Provide additional feedback Be generous but specific, focus first on behavior requested to change Have person practice in real world (homework) Therapy doesn’t stop in just therapy session – have to apply to real world Know the assumptions underlying cognitive (or cognitive behavioral therapy) and the people who helped to develop this area (e.g., Albert Ellis). What are the three components of Ellis’ ABC model? Cognitive-Behavioral Therapy (aka Cognitive Therapy= depression) In order to change neg. feelings/behaviors, you got to change how you think first Therapist tries to challenge your belief objectively Eg: afraid of public speaking bc afraid of looking stupid therapist asks “how many times has that actually happened? Basic assumption: thinking affects how we act and feel Techniques: monitoring thoughts/behaviors therapist tries to find pattern in fears modeling role modeling cognitive restructuring use a thought record (situation, behavior, emotions, thoughts, responses) grading papers gave up trying so watched t.v. thoughts associated w/ situation rate most upsetting thoughts how you think and act affects how you feel how you feel affects how you act and think thoughts/behavior/mood affect one another Types Rational Emotive Therapy (RET) Albert Ellis’s ABC Model 1. Activating event – final exam night 2. Beliefs about activating event – “I’m stupid; If I don’t get A I’m worthless” Focused on changing beliefs 3. Consequence – fear; severe anxiety, poor test performance When use should or must, usually sets up beliefs that lead to neg. feelings Try to find out what drives anxiety “what’s so bad about xyz” Talk more; confrontational Different than straight behavior function Cognitive Distortions (also in eating disorders) All/nothing thinking “unless everyone loves my art, I am a failure” “must” “should” “never” statements “I should always be loved by everyone” Overgeneralization “If I didn’t get an A, I am a failure at school” Catastrophizing “If I didn’t get the A, I will never succeed in college” Mind-reading “My teacher doesn’t seem to be enjoying my presentation” Emotional reasoning “If I don’t think I am doing well, I’m not” Disqualifying the positive “My teacher gave me a compliment, but gives one to everyone” Personalization “Mike is mad, I bet he’s mad at me” Cognitive structuring – challenging and changing people’s thought patterns Use a thought record (situation behaviors emotion thoughts response) 1. Rate worst thoughts 2. Therapist challenges it 3. Find that most people ignore teaching advice 4. Apply reasoning so people come up with own solution Know the different types of medications used to treat psychological disorders and their side effects. Biomedical Approaches (medication) – physiological approaches meant to reduce symptoms Tranquilizers/anti anxiety drugs – anxiety disorders reduce tension, apprehension, nervousness side effect: drowsiness, lightheadedness, nausea, constipation, depression Antidepressants – elevate mood, used for depression MAO inhibitors – good for atypical depression Last line of treatment bc lethal dietary/drug interaction Tricyclics – replaced by SSRIs SSRIs – selective serotonin reuptake inhibitors Slow reuptake process at serotonin Not that good for bipolar Increases risk of suicide Mood stabilizers – drugs used to control mood swings in patients w/ bipolar mood disorders Lithium – bring bipolar patients out of current manic/depressive episodes High levels of lithium = fatal Antipsychotics/neuroleptic – schizophrenia Reduces psychotic symptoms ie: hyperactivity, mental confusion, hallucinations, delusions Decreases activity at dopamine synapses Typical – 1st generation (1950s) Atypical – 2nd generation (introduced 1970s) Fewer bad side effects Increase vulnerability to diabetes More expensive Better Side effects: effective but work gradually Drowsiness, constipation, cottonmouth, tremors, muscular rigidity, impaired coordination Can cause tardive dyskinesia – involuntary writhing movement of mouth, feet Electroconvulsive Therapy (ECT) – depression Uses electric shock to produce cortical seizure w/ convulstions Used for major depression Side effects: temporary confusion, memory loss Psychosurgery – schizophrenia, depression, OCD Side effects: listlessness, overemotionality, epilepsy Psychoactive drugs – anxiety, depression, OCD, mania, schizophrenia Alters neurotransmitter systems in the brain Side effects: movement disorders, physical dependence What are factors (or non-specific therapy skills) go into the therapeutic alliance? Effectiveness of Therapy “meta-analysis” indicates that behavioral and cognitive behavioral therapies are effective for depressions, anxiety, substance use, eating, sxhizophrenia Therapeutic alliance is important Therapeutic alliance – empathy, warmth, active listening Associated w/ people doing better in therapy Goal: what client hopes to gain from therapy Unconditional, positive regard congruence Avg treated person has better improvement than avg untreated (two bell curves) What is the community mental health movement and deinstituitonalization? What are the problems associated with desinstitutionalization? Community Mental Health Movement Began in 1960s Goal: 1. Local, community based care 2. Reduced dependence on hospitalization 3. Prevention of psychological disorders Associated w/ deinstitutionalization Deinstitutionalization – transfer treatment of mental illness from inpatient institutions to community based facilities that emphasize outpatient care Pros: avoid unnecessary hospitalization Cons: those w/chronic psychological disorders have no one to go to pop. Of people who go in/out of psychiatric facilities big pop. Of homeless mentally ill Chapter 15 Attributions – inferences people draw about causes of events, others’ behavior, and own behavior; explain behavior Internal attributions – cause of behavior bc of personal dispositions, traits, abilities, and feelings External attributions – cause of behavior bc o/ situational demands and enviornmnetal constraints Eg: son crashes (internal: parents blame on son’s carelessness; external: parents blame on slippery road) Fundamental attribution error – observers’ bias in favor of internal attributions in explaining others’ behavior view of own behavior diff from view of someone observing you eg: normally you are a calm quiet person but today you get mad; people around you think you are always a mad person f.a.e.error Self-serving bias – tendency to attribute one’s success to personal factors and one’s failures to situational factors I did well bc I’m smart; I failed bc the test was hard Weiner’s Stability Model Unstable cause – temporary Stable cause – permanent 4 types of attributions for success and failure Social Psychology – investigation of how people’s thoughts, feelings, and actions are influenced by the real or imagined presence of other people Two core principles Situationism – social context is very powerful Social situation portrays behavior better than traits or individual differences Social context most powerful, more than personality Subjective construal – how people interpret events is more powerful than actual event itself Interpretations drive behavior Four Studies Cognitive dissonance/Self Deception – conflict between two elements in the mind Perception of self vs. what you’ve done Rationalization vs. self-perception Egs: Judgment Day – what happens to people who believed in this Rationalize it by intensifying own beliefs “we just predicted wrong and miscalculated” Have good self-esteem but smoke cigarettes Reduce dissonance by changing behavior/attitude/cognition Hazing from sororities and frats people who go through training end up liking group more Experiment: diff groups get money for saying activity is fun Dissonance about counter-attitudinal behavior does cause attitude change Solomon Asch – study of 3 lines, people conform Influence We are more influenced by people around us than we expect Conformity – results from unspoken group pressure that is either real or imagined Solomon Asch – people conform w/wrong answer More people that disagree = more conformity Tapers off at 5 people Normative social influence – everyone makes wrong judgment, but you comply bc you want to fit in Informational social influence – look at everyone else to see how they respond when you don’t know what to do Compliance – people adjust behavior upon request Robert B. Cialdini Went to diff biz to see how they influenced people Foot in the door technique – get people to agree to small things first makes them easier to comply for larger requests Start small, get big Door in the face technique – start w/ request that will be denied ask for something smaller More likely to comply afterwards Evil Obedience/Harm Stanley Milgram – Role of Teacher/Student Shock Experiment Inc shock level if student does wrong (actors pretend pain) How far were people willing to go to inc shock under experimenter’s authority? 2/3 go all the way to 450 V Blind obedience Stanford Prison Experiment – Philip Zimbardo Led to dehumanization, end in just 6 days bc so bad Social roles more important than personality Good Altruism – helping someone else at true cost to self Does true altruism exist? A) We only help others to relieve own aversive arousal to sight of someone suffering B) Gain social/self-esteem rewards for helping C) To avoid punishments for not helping D) socially acceptable Benson’s Empathy Hypothesis Instances when we do desire to help, not for ego reasons Empathic concern altruistic motivation YES there is TRUE altruism Social Loafing – tendency to exert less effort when working on a group task in which individual contributions can’t be monitored eg: group assignments Bib Latane – experiment on cheering People shout as loud as they can in a microphone when they’re alone/when in groups of diff sizes Told either held accountable for how loud they were shouting by self, voice is identifiable in group, or never identifiable When told identifiable – louder Never identifiable – lower Identifiable alone – less effort when thought they were with more people Happens because of diffusion of responsibility, decreased evaluation apprehension, perceive that your efforts don’t matter, don’t care about group/task, individual differences How do you avoid social loafing? Make people individually accountable Bystander Effect – as # of bystanders inc, probability that individual bystander intervening goes down Eg: Kitty Genovese 1964 – stabbed for 30 min, neighbors heard but didn’t do anything until it ended If people are aware, won’t do anything about it Darley and Latane – tendency to help student w/ seizures decreased when size of group inc Influenced by others Diffusion of responsibility – everyone thinks that someone else will do it Eg: Penn State Abuse Case Stereotype – social category defined by set of features that are presumed to be more or less characteristic of group members Exist bc people like to categorize Illusory correlations sustain them Illusory Correlation – false impression that 2 distinct events correlate Makes minority members particularly vulnerable Eg: Minority member: blacks Distinct Event: Illegal behaviors Whites overestimate arrest rate of blacks Blacks = minority Arrest rate = distinct event Prejudice – neg. attitude held towards members of a group Explicit Measures – measures you usually encountered Direct measure “how do you feel about UNC” Used to measure attitude towards race was old fashion racism skills Through time, people more hesitant to express racism bc not socially acceptable Old fashioned racism Symbolic racism and aversive racism – not blatant prejudice, subtle neg. feeling based on skin color or race High in symbolic racism = more neg. behavior towards that group of people Diff measure than explicit, but still predics behavior Implicit – measures quick reactions to stereotyping and prejudice Measures subtle quick association, present in semantic network, don’t think you think something but subtly you do Implicit Association Test (IAT) – most popular Affect Misattribution Procedure (AMP) Diff btwn implicit and explicit – implicit is more subtle Belief component – “I believe that women are only there to make babies” Emotional component – “I get angry whenever I see a woman do anything but make babies Feel emotion bc of belief Behavioral predisposition – how you think you would behave “I wouldn’t let my daughter play sports” Discrimination – involves behaving diff, usually unfarily, towards members of group Egs: Robbers cave studies – boy summer camp Boys put into random groups, more competitive than expected, physically and verbally abusive Classic social psychology Blue eyes vs brown eyes experiment
