Abnormal Unit Flashcards
(20 cards)
What is culturally sensitive treatment?
Culturally sensitive treatment is focused on incorporating the deep beliefs of the patient’s culture, as well as the inclusion of traditional, local, and religious healers.
Cultural factors can affect the patient’s willingness to follow thru with treatment.. (Kinzie et al. 41 depressed Asians..)
Discuss one or more ethical considerations in relation to the treatment of one or more psychological disorders.
- Informed consent; right to withdraw; do no harm.
- Culturally sensitive treatment (Kinzie)
- Considerate of one’s age, gender, economic status, etc. (IB HABITS)
- Short / long term effects of treatment
- Social sensitivity to discrimination / stigmatization of illness
Discuss the use of one or more psychological treatments of one psychological disorder?
Counseling vs. Meds
Using a combined approach is consistent with Biopsychosocial Model.
- different treatment options target different symptoms of depression. (Fournier 2013)
- meds work faster and geared for more severe cases, (Elkin 1989)
- CBT has less relapse rate (Hollon 2005)
Discuss the use of one or more psychological treatments for one psychological disorder?
Combined approach
The use of a “combined” approach (meds and psychotherapy) is combined with the following theories.
Diathesis-Stress Model - Genetic predisposition and environmental stress lead to depression.
Biopsychosocial Model - a combination of factors that lead to the formation of depression.
How does psychotherapy work? (A)
Psychotherapy has its basis in Sigmund Freud and Carl Jung -> psychoanalytic therapy.
- The goal is to discover what’s in the unconscious
- Free association (saying what comes to mind. The “Freudian Couch”)
- Projective Tests (Rorschach Inkblot test, TAT / Thematic Apperception Test)
- Studying resistance, transference.
Which therapy is better? Wampold says all! It’s not the style or school, it’s the other factors (patient trust, willingness)
How does psychotherapy work? (B)
Client-centered therapy is inherently humanistic, with its basis in Carl Rogers and Maslow.
Form of therapy that it is assumed that the “patient knows best” (judgment-free). The patient sets the goal for the session.
Techniques are used to make the patient feels heard.
Active-listening skills: Reflective speech, minimal encouragers, body language, note-taking, asking questions, eye contact…
How does psychotherapy work? (C)
Cognitive Therapy - works by changing one’s irrational thinking patterns. Changing schemas.
Advantages: long-term cognitive restructuring.
Disadvantages: not very helpful in severe situations where patient is suicidal with attempts.
Or if the patient is a young child or incarcerated adult.
Behavioral Therapy - based in B.F. Skinner. Focuses on outward behavior through use of reward system.
Other methods are systematic desensitization, flooding, aversion therapy (ex. getting baby off pacifier by using lemon juice), token economics (ex. Cougar Credit)
Disadvantages: superficial value, dependent on extrinsic motivation.
Discuss the use of one or more psychological treatments of one psychological disorder.
Counseling vs. Counseling
Define psychotherapy (talk therapy. Includes CBT).
- Assumptions of psychotherapy (How does it work? The patient has to want to improve. The patient is doing the best they can. etc…)
- Compare with other treatment method (ex. bio treatment) > medical / pharma vs. psychotherapy.
- All psychotherapy is equally effective (Smith, Gloss) What’s important is the non-specific factors like the patient’s reception to therapy, trust, and similar goals / therapeutic alliance with the therapist.
Discuss two research methods used in the investigation of the etiology of abnormal psychology.
Relevant research methods include – but are not limited to: interviews, naturalistic observations, CORRELATIONAL STUDIES, case studies, and experiments.
- Caspi (2003). Correlational study on the development of depression within participants with shorter 5-HTT alleles… CORRELATION DOES NOT MEAN CAUSATION.
- Considerations of surveys: halo effect (positive qualities are exaggerated based on client-therapist attraction, etc.)
- Consideration of observation: consent must be considered but person may act differently when told of this intention. (Hawthorne Effect). Real-world applications + Brown and Harris (Depression with women and the five specific criteria)
Discuss the role of one or more classification systems in the diagnosis of one or more disorders.
DSM-5 Classification System
Pros:
- More objective way of diagnosing illnesses. Reduces clinician subjectivity.
- Allows easier communication between clinicians.
Cons:
- labeling can stigmatize the patient (ethical?)
- Only describes symptoms. Does not deal with causes on treatment.
- Categorical system. Not everyone fits some criteria, but still exhibit the condition.
- As validity goes up, reliability goes down. Vice-versa
Is there a study showing genetic cause of depression?
- Swedish National Twin Study > 42,000 twins were interviewed through the phone. They were contacted through national twin registry.
Conclusion: Major Depression was moderately influenced by genetics. About 38% of twins, using the Falconer Model.
Describe a study showing a cognitive explanation for depression.
Alloy et al. 1999 > correlational
- College freshmen were given questionnaires. Based on their answer, they were divided into two groups: those who had negative explanatory style, and those who had a positive outlook.
- Those who had negative explanatory style had a high risk of depression (est. 17% vs 1%)
- make sure to explain what “negative explanatory style” is…. blaming, pessimistic… ex.
Effectiveness: Is XX effective?
YES, so long as these non-specific factors are present (TRUST, MINDSET, GOALS, WILLINGNESS) > Even placebo.
^ Created by Wampold.
Jacobson et al. concludes that no evidence that full cognitive treatment is more effective than any of its components
Talk Therapy vs. Medication? (Elkin et al 1989). In mild cases, it makes no difference. In the most serious of cases, where patient is attempting suicide or has any extreme symptoms > Medication. Since it’s faster.
Fournier (2013). CBT Counseling targets different things / symptoms than medication. Meds targets physical symptoms (ex. insomnia) meds target suicidal thoughts.
Discuss the prevalence rates of one or more disorders.
- Compare two cultures prevalence rates. Cross National Study of Depression Rates (Kessler, 2013). 17% US vs 1% CR.
- Then discuss cultural factors that could contribute to t he differences.
- Talk about general prevalence rates in general. Can be influenced by several social factors. (Malik et al)
Discuss normality vs abnormality.
Normality and abnormality can be defined by several factors.
- Jahoda’s concept of Ideal Mental Health (Positive attitude of self and world, self-actualization) Limitation: Completing all 6 criteria is not feasible. Majority of the world, by this definition, would be abnormal. Also the Autonomy criteria is ethnocentric > limited to Western individualistic societies.
- Carl Rogers’ descriptions of the fully functioning person (same as Jahoda)
- Rosenhan and Seligman’s 7 features of abnormality: irrationality, maladaptiveness, suffering, etc.
Considerations:
1) assumption and biases in defining the concepts of abnormal and normal
2) areas of uncertainty in diagnostic manuals (comorbidity)
3) methodological considerations in research
4) Influence of social and cultural norms (culturally-recognized disorders)
5) Historical changes in our understanding of what is considered normal (Women’s behavior and lobotomy treatment, LGBTQ…)
6) Ethical considerations related to labelling and stigmatization.
Normality vs. abnormality
The revised quick-written version
- Abnormality as a deviation / something “not acceptable” by society.
Limitations: societal and cultural perception of behaviors malleable.
- This idea could be ethically dangerous in countries where leadership is heavy-handed and controlling.
- Social norms also differ in other contexts / regions.
- Rosenhan and Seligman’s Inadequate functioning / Individual Suffering.
Limitations: over-inclusive, very few behaviors meet all 7 criteria. (violation of moral standards, unconventional behaviors, etc)
- Jahoda’s Ideal Mental Health
Limitations: not everyone can fulfill this criteria every single day. (Not feasible). Does not make them depressed or abnormal.
- Statistical infrequency
“I’m special / one-of-a-kind.” For better or for worse? - Medical Model
Limitations: Not all behavior is observable.
Why is it difficult to establish validity? (Why is it hard to five the right diagnosis?)
- Each patient could show a different set of symptoms for the same diagnosis. Sophia can exhibit the first set (procrastination, anxiety, slurring words), while Karla can exhibit the second set (hallucinations, heart palpitations, uncalled for stress.) Both can still have IB-itis.
- Patient can have comorbidity (blurred diagnosis of depression, schizophrenia, and ADHD).
- The severity of an illness can change over time.
- Clinical biases (clinician / therapist’s training and preferred school of thought, beliefs, etc.)
- Rosenhan study (mental hospital’s diagnosis were not valid)
- Problems vary because of diagnostic manual too. DSM-5 might recognize ADHD, but a CCMD user in China might not. Cultural difference affect this. Shown in existence of amok, latah, susto)
What is the relationship between reliability and validity of diagnosis?
First, define term. Reliability refers to consistency in diagnosis among clinicians / professionals. (How likely are several doctors to agree based on the same manual?) Validity refers to whether the diagnosis given is accurate and reflects the condition of the patient.
- The relationship between the two is inverse. As R inc. V dec.
- In the DSM, reliability was initially low (I and II) due to its heavy basis in psychoanalytic theory. It started to improve by DSM-IV.
- Surprisingly, reliability in the DSM-5 is lower because the testing method used to determine reliability became more stringent. (See DSM-5 Testing flashcard)
What methods were used to test for DSM-5’s reliability?
Video Recording Method - Dr. Mateo interviews patient, Carl and gives a diagnosis. Dr. Bruehl would watch a tape of that and see if he comes up with the same diagnosis. Problem is, this is artificial because perhaps the patient’s behavior was response to doctor (anger in response to name-calling for ex., or gender-divide)
Test-Retest Method - Dr. Mateo would interview patient, Carl. Then Dr. Bruehl would go interview same patient. This method is used to determine if the diagnosis is reliable, but it must be conducted almost immediately. Otherwise, patient behavior might change.
(also IB Habits of Mind)
Discuss the role of two or more clinical biases in diagnosis.
Clinician variables (theoretical training) > schools of thought such as behavioral, cognitive, etc. (Langwieler and Linden).
Patient variables - reporting biases, somatization
Classification systems - DSM-5, CCMD-5, ICD-11.
Racial / ethnic / gender (male clinician vs. female patient) considerations and biases (Again, IB Habits of Mind)
Cultural biases and social norms (Malik et al)
Ethical considerations.
