Exam 1: Ch 1, Ch 3 Flashcards
(208 cards)
1
Q
Def of Stigma
A
- Destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some way
- Psychological disorders remain the most stigmatized condition in the 21st century
2
Q
Psychopalogy def
A
The field concerned with the nature, development, and treatment of psychological disorders
3
Q
Four Characteristics of Stigma
A
1) distinguishing label is applied
2) label refers to undesirable attributes
3) people with the label are seen as different
4) people with the label are discriminated against
==> leads to stigma
4
Q
Ending Stigma
A
- People’s knowledge has increased, but stigma has not decreased
- Social Media: Websites and blogs serve as a medium to share personal stories, raise awareness, and increase social connectedness
- Public figures speaking about their experiences with mental illness may help to reduce stigma
5
Q
Defining Psychological Disorders: DSM-5
A
- The disorder occurs within the individual
- It involves CLINICALLY SIGNIFICANT difficulties in thinking, feeling, or behaving
- It usually involves personal distress of some sort
- It involves dysfunction in psychological, developmental, and/or neurobiological processes that support mental functioning
- It is not a culturally specific reaction to an event
- It is not primarily a result of social deviance or conflict with society
6
Q
Three Characteristics of a Comprehensive Definition of Psychological Disorder
A
Personal Distress, Violation of Social Norms, Disability and Dysfunction
7
Q
Personal Distress
- def
- examples
A
*A person’s behavior causes significant distress
-Examples of distress:
Difficulty paying attention;
Emotional pain and suffering
-An individual may violate the law without guilt, remorse, or anxiety
-Not all behaviors that causes distress are disordered
E.g., Distress of hunger due to religious fasting
8
Q
Disability:
A
*Impairment in an important area (e.g., work, relationships)
Chronic substance abuse resulting in job loss
Rejection by peers due to social anxiety
9
Q
Dysfunction
A
- Developmental, psychological, and/or biological systems are not working as they should (impairment)
- These systems are interrelated
10
Q
Violation of Social Norms
A
*Social norms are widely held standards
Beliefs and attitudes used to make judgments about behaviors
Behaviors that violate social norms may be classified as disordered
11
Q
why is “violation of social norms” criticized
A
- Too broad and too narrow of a definition
- Criminals violate social norms (too broad)
- Highly anxious people typically do not violate social norms (too narrow)
- Social norms vary across cultures and ethnic groups
12
Q
History of Psychopathology
A
- Supernatural explanations
- Early biological explanations: Hippocrates (5th Century BC)
- Dark Ages (2nd century AD)
- Lunacy Trials
- Asylums
- Pinel’s Reforms and moral treatments
- Dorothea Dix
13
Q
Supernatural explanations (history of Psychopathology)
A
- Displeasure of the gods or possession by demons
- Treatment: Exorcism—Ritualistic casting out of evil spirits
(I belive this was the first thing in the history of psychopathology)
14
Q
Early biological explanations: Hippocrates (5th Century BC)
A
Mental disturbances have natural causes (brain pathology)
- Three categories of mental disorders: Mania, melancholia, & phrenitis (brain fever)
- Healthy brain functioning depended on balance of four humors: Blood, black bile, yellow bile, & phlegm
- Treatment: Physicians restored natural balance (e.g., tranquility, sobriety, care in choosing food)
15
Q
Dark Ages
- when
- treatments
A
-Dark Ages (2nd century AD)
-Christian monasteries replaced physicians as healers
-Return to the belief of supernatural causes
-Treatments: Cared and prayed for by monks;
Touched with relics; Drank potions in the waning phase of the moon
16
Q
Lunacy Trials
A
- after dark ages
- Began in 13th century England
- Trials held to determine a person’s mental health: Orientation, memory, intellect, daily life, habits & - Strange behavior attributed to physical illness or injury
- Municipal authorities assumed responsibility for care of people with psychological disorders in hospitals
- Lunacy attributes insanity to misalignment of moon (“luna”) and stars
17
Q
Asylums
- when
- example
- treatment
A
- Asylums (15th century)
- Establishments for the confinement and care of people with psychological disorders
- Treatment non-existent or harmful at asylums
- Priory of St. Mary of Bethlehem (founded in 1243)
18
Q
Pinel’s Reforms
-date
A
*Philippe Pinel (1745–1826)
Pioneered humane treatment in asylums
People should be approached with compassion and dignity
Humanitarian treatment reserved for upper class
19
Q
Biological Origins
A
General paresis and syphilis
-Deterioration of mental and physical abilities, and progressive paralysis (general paresis)
-Some people with general paresis also had syphilis
In 1905, biological cause of syphilis found:
Causal link between infection, damage to the brain, and psychopathology
Biological causes of psychopathology gained credibility
20
Q
Genetics
A
Galton’s (1822–1911)
- Originator of genetic research with twins
- Work lead to notion that mental illness can be inherited
- Nature (genetics) and nurture (environment)
- Eugenics
21
Q
Biological Treatments (3)
A
- Insulin-coma therapy : Sakel (1930s)
- Electroconvulsive therapy (ECT) : Cerletti and Bini (1938) + Induce epileptic seizures with electric shock
- Prefrontal lobotomy : Moniz (1935)
- Destroys tracts connecting frontal lobes to other areas of brain
- Often used to control violent behaviors
- Led to listlessness, apathy, and loss of cognitive abilities
22
Q
Psychological approaches
A
- Mesmer (1734–1815): Hysteria caused by a disruption of a universal magnetic fluid in the body. Used rods and stares to influence the fluid and induce behavioral change. Early practitioner of hypnosis
- Charcot (1825–1893): His support legitimized hypnosis as treatment for hysteria
- Breuer (1842–1925): Used hypnosis to facilitate catharsis in Anna O. Cathartic Method: Release of emotional tension triggered by expressing previously forgotten thoughts about an earlier emotional trauma
23
Q
Freud
A
*Psychoanalytic theory
Psychopathology results from unconscious conflicts
*Mind is divided into three principle parts: Id, ego, superego
*Id, ego, and superego continually in conflict
-Conflict generates anxiety
*Defense mechanism: Strategy used by ego to protect itself from anxiety
24
Q
Freuds Structures of the Mind
A
- Id: Present at birth. Biological and unconscious. Seeks Immediate gratification.
- When id is not satisfied, tension is produced and id drives a person to get rid of tension (e.g., eat when hungry).
- Ego: Primarily conscious. Mediates between demands of reality and id’s demands for immediate gratification
- Superego: A person’s conscience. Develops as we incorporate parental and society values
25
Psychoanalytic Therapy
- Goals of Psychoanalysis
- Transference: Responding towards an analyst in a similar way as towards important people in the person’s past
- No formal research on the causes and treatment of psychological disorders
26
-Goals of Psychoanalysis
* Understand early-childhood experiences, the nature of key relationships, and the patterns in current relationships
* Therapist is listening for core emotional and relationship themes
27
Major Techniques of Psychoanalysis
Free association, Interpertation, Analysis of transference
28
Continuing Influences of Freud and His Followers
* Childhood experiences help shape adult personality: Childhood experiences and environmental events are crucial. Early relationships influence adult relationships
* There are unconscious influences on behavior: People can be unaware of the causes of their behavior
* The causes and purposes of human behavior are not always obvious: Look under the surface to find hidden meaning in behavior
29
Operant Conditioning examples (2)
* E. Thorndike (1874–1949)
| * B.F. Skinner (1904–1990)
30
B.F. Skinner (1904–1990)
- Operant conditioning
* Principle of Reinforcement: positive and negative reinforcement
* Positive reinforcement: Presentation of a pleasant event strengthens a response
* Negative reinforcement: Removal of an aversive event strengthens a response
31
Modeling
* Learning by watching and imitating others’ behaviors: Can occur without reinforcement
- Modeling can increase or decrease diverse kinds of behavior : Sharing, aggression, fear, etc.
32
Behavior Therapy
* Systematic Desensitization
* Intermittent Reinforcement : Rewarding a behavior only occasionally is more effective than continuous schedules of reinforcement
33
Cognition
How we think, or appraise, a situation influences our feelings and behaviors
34
Cognitive Therapy
* How people construe themselves and the world is a major determinant of psychological disorders
- Focus on becoming more aware of maladaptive thoughts
- Changing cognitions to change feelings, behaviors, symptoms
35
Have We Learned from History?
- We have made several advancements and still have much to learn!
- Do “reality” TV shows depicting psychological disorders educate or perpetuate stigma?
- People with psychological disorders are more likely to be housed in jails than in a hospital due to gaps in available services
- Many are unable to work and thus have very little income, limiting housing resources
- Medications have unpleasant side effects
36
Psychologists
Advanced graduate training in the assessment and diagnosis of psychopathology and how to practice psychotherapy
Ph. D. (additional emphasis on research) or Psy. D.
37
Psychiatrists
```
Medical degree (M.D.) with postgraduate training (residency) in diagnosis and pharmacotherapy
Can prescribe psychotropic medications
```
38
Mental Health Professions
Psychologists, Psychiatrists, Psychiatric Nurses, Social Workers
39
Psychiatric Nurses
* Bachelor’s or master’s level training
| * Nurse practitioners receive specialized training to prescribe psychotropic medications
40
Social Workers
* Master of Social Work (M.S.W.)
* Typically requires 2 years of graduate study
* Trained in psychotherapy
* Not trained in psychological assessment
41
Diagnosis
Agreed-on definitions and classification of disorders by symptoms and signs
42
Advantages of diagnosis:
- First step in good clinical care
- Facilitates communication among professionals
- Advances research for causes and treatments
43
Reliability
-Consistency of measurement (results are consistance)
-Measured from 0 to 1.0
(Higher the number the better the reliability)
44
Types of Reliability (4)
Interrater
Test-retest
Alternate Forms
Internal Consistency
45
Alternate Forms
Similarity of scores on tests that are similar but not identical
46
Internal Consistency
- slide 6 has an example
| - Extent to which test items are related to one another
47
T/F Reliability does not guarantee validity
TRUE
| ex: Height can be measured reliably, but it is not a valid measure of anxiety
48
Content validity
* Whether a measure adequately samples the domain of interest
- E.g., all of the symptoms of a disorder
49
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Published by American Psychiatric Association
First edition published in 1952
Revised 5 times
50
For each psychological disorder, the DSM-5 provides:
* Diagnostic criteria for a diagnosis : Criteria have become more detailed and concrete over time
* Description of associated features: Laboratory findings, results from physical exams
* Summary of research literature: Age of onset, course, prevalence, risk and prognosis factors, cultural and gender factors, differential diagnosis
51
Defines diagnoses on the basis of _________
-symptoms
| Our knowledge base is not yet strong enough to organize diagnoses around etiology
52
Criticisms of the DSM:
Too Many Diagnoses, Categorical vs. Dimensional Classification, Many risk factors increase risk for multiple disorders, Research Domain Criteria (RDoC), Reliability of DSM in Everyday Practice
53
Why say that Too Many Diagnoses is a criticism for DSM?
*Number of diagnoses continues to increase
-Should relatively common reactions be pathologized?
Trying to be more inclusive… but creates stigmas at the same time
*Comorbidity
-Presence of a second diagnosis
45% of people diagnosed with one DSM-IV disorder meet criteria for a second disorder
54
the current DSM is categorical or dimensional?
categorical but has added some dimensional classification by adding severity rating for nearly all disorders
55
Life stressors
Environmental problems that trigger the subjective sense of stress
56
Personality Inventory
Self-report questionnaire
Standardized
(a personality test)
57
Ecological Momentary Assessment (EMA)
Collection of data in real time using diaries or smart phones
A person is signaled and asked to enter responses directly into the device in real time
- an example of self-monitoring
58
Dysfunctional Attitude Scale (DAS)
example of Cognitive-Style Questionnaires
59
Dysfunctional Attitude Scale (DAS)
example of Cognitive-Style Questionnaires
60
Electrocardiogram (EKG)
Measures heart rate using electrodes on chest
61
what remains the most stigmatized condition in the 21st century?
*Psychological disorders remain the most stigmatized condition in the 21st century
62
way to reduce stigma
-Public figures speaking about their experiences with mental illness may help to reduce stigma
63
according to the professor, a better word for abnormal psychology is...
psychopharmacology: "brain illness"
64
syntonic (Def and example)
does not necessarily feel bad to have this
| *example= mania
65
Egodystonic
do NOT feel good for us to have this disorder; usually easier to get people to treat
66
syntonic disorders vs egodystonic disorders
syntonic- does not necessarily feel bad to have this; --example= mania
Egodystonic: do NOT feel good for us to have this disorder; usually easier to get people to treat
67
A psychological disorder must be ... in order to be classified by the DSM-5
clinically significant
68
T/F : Not all psychological disorders cause distress
TRUE
* E.g., Antisocial personality disorder
- An individual may violate the law without guilt, remorse, or anxiety
69
T/F If a behavior causes distress then it is considered a disordered
FALSE
| E.g., Distress of hunger due to religious fasting
70
T/F Not all psychological disorders involve disability
TRUE
71
T/F All disabilities are considered to be psychological disorders
FALSE
72
Violation of Social Norms examples (2)
* Repetitive rituals performed by people with obsessive-compulsive disorder
* Talking to nonexistent voices that some people with schizophrenia experience
73
do Social norms vary across cultures and ethnic groups
Yes, this is a criticism of social norms
74
Early biological explanations for abnormal psychological disorders: Hippocrates (5th Century BC)- what are the humors?
Healthy brain functioning depended on balance of four humors:
Blood, black bile, yellow bile, & phlegm
75
Treatments used in the Dark Ages
Treatments:
Cared and prayed for by monks
Touched with relics
Drank potions in the waning phase of the moon
76
Priory of St. Mary of Bethlehem
| -when was it founded
-(founded in 1243)
One of the first mental institutions
-The wealthy paid to gape at the patients
-Origin of the term bedlam (wild uproar or confusion)
-Treatment non-existent or harmful at asylums
77
Origin of the term bedlam (wild uproar or confusion)
Priory of St. Mary of Bethlehem (founded in 1243)
78
Benjamin Rush recommended:
-@ asylums
-(father of American psychiatry) recommended: Drawing copious amounts of blood to relieve brain pressure +
Fear as a cure (e.g., convince patient that death is near)
79
Moral Treatment
* Small, privately funded, humanitarian mental hospitals
- Friends’ Asylum (Pennsylvania, 1817)
* Patients engaged in purposeful activities (e.g., gardening)
* They talked with attendants and led lives as close to normal as possible
80
Dorothea Dix
(1802–1887)
* Crusader for improved conditions for people with psychological disorders
* Worked to establish 32 new public hospitals
* Took many of the people whom private hospitals could not accommodate
* Small staffs at public hospitals could not provide necessary individual attention that was a hallmark of moral treatment
81
what caused Biological causes of psychopathology to gain credibility
*General paresis and syphilis
Deterioration of mental and physical abilities, and progressive paralysis (general paresis)
Some people with general paresis also had syphilis
In 1905, biological cause of syphilis found:
Causal link between infection, damage to the brain, and psychopathology
Biological causes of psychopathology gained credibility
82
-Eugenics under Galton (1822–1911)
-Eugenics
Promotion of enforced sterilization to eliminate undesirable characteristics from the population
Many state laws required people with psychological disorders to be sterilized
83
* Mesmer
| - date
A Psychological Approach
*Mesmer (1734–1815): Hysteria caused by a disruption of a universal magnetic fluid in the body. Used rods and stares to influence the fluid and induce behavioral change. Early practitioner of hypnosis
84
According to Freud what generates anxiety
* Id, ego, and superego continually in conflict
| - this conflict leads to anxiety
85
*Superego:
- A person’s conscience.
- Develops as we incorporate parental and society values
- Freud
86
Displacement
| -example
- is a defense mechanism
* Redirecting emotional responses from their real target to someone else
example: A child gets mad at her brother but instead acts angrily toward her friend
87
Submissive def
-is a defense mechanism
Converting unacceptable aggressive or sexual impulses into social valued behaviors
-example: Someone who has aggressive feelings toward his father becomes a surgeon
88
Def of contertransferance
- falls under psychoanalysis
| * the emotional reaction of the analyst to the subject's contribution.
89
T/F Transference and countertransference are used in therapy to inform therapist of how patient interacts to others.
TRUE
90
Transference:
- part of Psychoanalytic Therapy
| * Transference: Responding towards an analyst in a similar way as towards important people in the person’s past
91
Analysis of transference
-a Technique of Psychoanalysis
The person responds to the analyst in ways that the person has previously responded to other important figures in his or her life, and the analyst helps the person understand and interpret these responses.
92
who thought that there are unconscious influences on behavior?
Freud thought that people can be unaware of the causes of their behavior
93
Behaviorism
* Focus on observable behavior
* Emphasis on learning
* Three types of learning:
- Classical Conditioning
- Operant Conditioning
- Modeling
94
Three types of learning of Behaviorism
- Classical Conditioning
- Operant Conditioning
- Modeling
95
*Pavlov (1849–1936)
- a type of learning of Behaviorism
* Pavlov (1849–1936)
- Unconditioned Stimulus (UCS): Meat powder (automatically elicits salivation)
- Unconditioned Response (UCR): Salivation (automatic response to meat powder)
- Conditioned Stimulus (CS): Ringing of the bell
- Conditioned Response (CR): Salivation (automatic response to bell)
- Meat powder (UCS) is preceded several times by a neutral stimulus
- Ringing of bell (does not automatically elicit salivation)
- After pairing the ringing of the bell and the UCS, the bell now automatically elicits salivation
- Extinction: CS (bell) not followed by UCS (meat powder) causes gradual disappearance of CR (salivation)
96
Process of Classical Conditioning
slide 41
97
Classical conditioning examples
-a type of learning of Behaviorism
Watson & Rayner (1920)
Little Albert and the white rat experiment
*Pavlov (1849–1936)
98
The germ theory of disease
showed the link between syphilis and mental illness.
99
E. Thorndike
-example of operant conditioning
E. Thorndike (1874–1949)
-Learning through consequences
-Law of Effect: Behavior that is followed by satisfying consequences will be repeated; behavior that is followed by unpleasant consequences will be discouraged
100
Which structure involves only activity of the unconscious?
- the psyche
- id
- ego
- superego
- id
101
-Bandura & Menlove (1968)
-example of modeling (a learning of behaviorism)
| Modeling reduced children’s fear of dogs
102
Which is a limitation of "harmful dysfunction" as a definition of mental disorder?
- The dysfunctional mechanisms are largely unknown.
- Many dysfunctional mechanisms are not harmful.
- Harmful dysfunction also has an impact on others.
- It ignores the personal suffering of disturbed individuals.
- The dysfunctional mechanisms are largely unknown.
103
*Systematic Desensitization
- a type of behavior therapy
* Used to treat phobias and anxiety
* Combines deep muscle relaxation and gradual exposure to the feared condition or object
* Starts with minimal anxiety producing condition and gradually progresses to most feared
104
-Desensitization (a behavior therapy) works through ...
Exposure
105
Ellis’ Rational-Emotive Behavior Therapy
-has to do with cognition
Self-statements reflect unspoken assumptions (irrational beliefs)
Eliminate self-defeating belie
106
Hippocrates' early views on mental health contributed to an enduring emphasis on
- natural causes.
- spirituality.
- humors.
- classification.
- natural causes.
107
are we over treating people?
I think yes... and I think this is because of some experimetn where people went to the hospialt
108
Other jobs related to mental health:
example art therapy, music therapy,
109
DSM : -is looking at _____ to ______
-If not fitting into a category, but patient needs treatment: there is also a category called "not otherwise specified" so insurance will still cover it.
- is looking at differences to narrow down to a specific thing.
- If not fitting into a category, but they need treatment: there is also a category called "not otherwise specified" so insurance will still cover it.
110
Interrater reliability
* Observer agreement on what was observed
- Multiple people getting the same answer
- Behavioral observation
- When psychologist both get the same result
- The DSM is good for this
111
Test-retest reliability
Similarity of scores across repeated test administrations or observations
112
Reliability, as used in diagnosis, is the same as
- judgment.
- utility.
- agreement.
- validity.
- agreement.
113
Validity
Whether a measure measures what it is supposed to measure?
| Does a hostility questionnaire actually measure hostility?
114
Will unreliable measures have good validity ?
*Unreliable measures will not have good validity
| An unreliable measure does not yield consistent results. Therefore, it will not relate very strongly to other measures.
115
Validity
results satisfy objectives
116
If a physcian asked you : -are you having a racing heart beat? Having panic like symptoms? This would be for anxiety?
they are trying to determine _______?
By looking at a domain of interest they are trying to determine content validity
117
Construct Validity
* A construct is an inferred attribute
* Involves correlating multiple measures of the attribute
- E.g., showing that a self-report measure is related to other measures thought to measure the same construct
* An important part of the process of theory testing
118
(DSM)
Published by _____
First edition published in __
Revised _ times
Current edition: ______, Released in __
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Published by American Psychiatric Association
First edition published in 1952
Revised 5 times
Current edition: DSM-5 -Released in 2013
119
T/F homosexuality has never been considered a disorder
FALSE -in 1950s homosexuality is considered a disorder
120
Mania in DSM-II versus DSM-5
-was a lot shorter in the 1968 DSM-II
| slide 14
121
The DSM-5 defines diagnosis on:
* Defines diagnoses on the basis of symptoms
- Our knowledge base is not yet strong enough to organize diagnoses around etiology
(you either have the disorder or you do not)
122
DSM-5 chapters are organized to reflect _____
Chapters are organized to reflect patterns of comorbidity and shared causes
E.g., Obsessive-compulsive and other related disorders
123
Jackson appears to have social phobia. This diagnosis was made by looking at his scores on a particular measure of social fear. Scores like his in the past have been shown to be related to social phobia, and also correlated with a variety of measures of social and occupational disability associated with social phobia. The measure Jackson took would be said to have
- high criterion validity.
- high construct validity.
- high statistical validity.
- high content validity.
- high construct validity.
124
DSM-5 cultural sensitivity:
Discussion of culture-related issues for most disorders
Cultural formation interview questions for clinicians
Description of how syndromes present across cultures
125
Culture can influence:
Risk factors, symptom experience, stigma, willingness to seek help, and availability of treatments
126
DSM-5 Appendix describes ____ syndromes observed in specific regions or cultures:
E.g., ?
DSM-5 Appendix describes 9 syndromes observed in specific regions or cultures:
*E.g., Shenjing shuairuo (China): characterized by weakness, mental fatigue, negative emotions, and sleep problems
(Sounds like depression but maybe a little bit different)
127
Cultural Concepts of Distress
DSM-5 Appendix describes 9 syndromes observed in specific regions or cultures
* Cross-cultural approach
* Culture-specific approach
128
Cultural Concepts of Distress: Cross-cultural approach
Cross-cultural approach : Identify broad syndromes that can be identified across cultures
129
Cultural Concepts of Distress: Culture-specific approach
Cultural concepts of distress are key in understanding disorders
(I think this is what use to be done: based on white)
(so I feel like Prof was saying that the cross-cultural approach of distress was better)
130
America seems to have ___ anxiety disorder while China has ___ anxiety disorder
America seems to have high anxiety disorder while China has low anxiety disorder
131
__% of people diagnosed with one DSM-IV disorder meet criteria for a second disorder
45% of people diagnosed with one DSM-IV disorder meet criteria for a second disorder
(a criticism of the DSM is high comorbidity)
132
Research Domain Criteria (RDoC)
-somehow a negative of the DSM (low key confused)
Investigation of psychological variables relevant for many conditions
Use of basic science to develop a new classification system
133
how many categories did the DSM I have?
106
134
by DSM 5, have many more categories do you have ?
like 3.25ish
135
```
DSM-5:
___ classification
Do the symptoms ______?
One _____ with actual, ____ boundaries
A ____ can provide helpful treatment guidance
```
Categorical classification
DSM-5
Do the symptoms fit the category or not?
One threshold with actual, hard boundaries
A threshold can provide helpful treatment guidance
136
If Shaniqua wants to be sure that her bathroom scale has test-retest reliability, she should ___________.
- Weigh herself today and then again next week and see if her weight is the same
- get on-and-off the scale repeatedly and see if it shows the same weight each time
- ask others to weigh themselves later that day
- buy a second scale and see if they both give her the same weight when she steps on them
-get on-and-off the scale repeatedly and see if it shows the same weight each time
137
Dimensional classification
The degree of an entity that is present (i.e., severity)
A way to also describe subthreshold symptoms
DSM-5 added severity ratings for nearly all disorders
(Within one disorder… that people have that symptom to a certain degree)
138
Is this an example of a categorical or dimensional analysis?
| -Does the person have high blood pressure?
Categorical: Yes or No answer
139
A common method assessing neurotransmitters is
- analyzing metabolites.
- CT scan.
- X-ray.
- measuring dopamine.
- analyzing metabolites.
140
Reliability of DSM in Everyday Practice
a criticism of DSM
*Interrater reliability must be high to be helpful
Clinicians may adopt different definitions for symptoms
Achieving high reliability can be a challenge
141
Can a test have validity without also having reliability?
- Yes
- No
- No
142
Negative Effect of Diagnoses
*Diagnosis might contribute to stigma
-However, research suggests that people tend to view behaviors negatively more than the category labels
-Sometimes labels may relieve stigma by providing an explanation for the symptomatic behaviour
Example: ADHD – acting this way because of a medical reason.
(In many ways diagnosis can be a really good thing…)
*We may lose sight of the uniqueness of that person
Use person first language (e.g., a person with schizophrenia)
It is human nature to categorize
(Always treating a person with a disease, not treating the disease.)
(Importance of language )
143
Clinical interviews
Establish rapport
Empathize with client experiences
Encourage client to elaborate on concerns
*Structured interviews
-Standardized interview
-All interviewers ask the same questions in a predetermined order
-Good interrater reliability for most diagnostic categories
E.g., Structured Clinical Interview for DSM (SCID)
-Are good but not really used
*Most clinicians assess DSM symptoms in an informal manner
144
*Most clinicians assess DSM symptoms in an _____ manner
*Most clinicians assess DSM symptoms in an informal manner
145
Stress
Subjective experience of distress in response to perceived environmental problems
146
Life stressors
Environmental problems that trigger the subjective sense of stress
(People react in different ways to the same thing: example = PTSD, people may have different trauma)
147
is Stress subjective?
Stress is subjective
148
Bedford College Life Events and Difficulties Schedule (LEDS)
*Semi-structured interview covering over 200 stressors
*Evaluates the importance of an event in the context of a person’s life circumstances
*Excludes life events that are consequences of symptoms
*Carefully dates when a life stressor occurred
(prof doesn’t know anyone who uses it)
149
A personality inventory is standardized meaning:
Standardized: A person’s responses can be compared with the statistical norms
150
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
(personality test)
-Yields profile of psychological functioning
-Based on their results
-Validity scales to detect lying and faking “good” or “bad”
Used for standarized stuff (things scrutinized over): for court cases, workers comp, etc. been around for a long time
Pretty long: like almost 2 hours
151
Big Five Inventory-2
personality test
Assesses the broad five domains of personality:
Openness to experience, conscientiousness, extraversion, agreeableness, neuroticism
152
Meyers-Briggs
(personality test)
Not very reliable (low in test-retest)
Not good
153
IQ test
* Assess current cognitive ability
* Used to predict school performance, diagnose learning disabilities or intellectual ability, and included in neuropsychological examinations
* Highly reliable and good validity
* Explain only a small part of school performance
Impacted by stereotype threat
(If you think you are going to bad you are goin to do poorly)
154
(what does IQ stand for)
Intelligence quotient:
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IQ score curve
- revolving around the bell curve :
100: is 50% : that is exactly average
- the scores a the top are the standards school
- majority of people are within one standard deviation of the average
- 68% amount of the population is within 85 and 115 IQ score
(this works for any test
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Behavioral and Cognitive Assessment
Aspects of the environment
Characteristics of the person
Frequency and form of problematic behaviors
Consequences of problem behaviors
Methods: Direct observation, interviews and self-report measures, and other methods of cognitive assessment
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Problem (?) of direct observation for Behavioral and Cognitive Assessment
direct observation: taking notes, because people will see different things
Example: a person watching a kid for ADHD vs a person watching a kid for special needs
“a hammer only sees a nail”: observer bias
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Direct Observation of Behavior
| -reliability
-no good reliability
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Direct Observation of Behavior
Observe behavior as it occurs
Sequence of behavior divided into segments
Antecedents and consequences
Behavioral assessments often conducted in lab setting
E.g., mother and child interact in a lab living room
Interaction observed through one-way mirror or videotaped for later coding
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In regards to Direct Observation of Behavior- would you ever just watch the child for assessment?
-would never just watch them for assessment
| I dont think
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Self monitoring
| -example
Individuals monitor and track their own behavior
E.g., moods, stressful events, thoughts, etc.
ex: Ecological Momentary Assessment (EMA)
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Cognitive-Style Questionnaires
Use to help plan treatment targets
Can help to determine if change occurred in response to an intervention
Format often similar to personality tests
Dysfunctional Attitude Scale (DAS)
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Dysfunctional Attitude Scale (DAS)
“People will probably think less of me if I make a mistake”
Differentiates between people with and without depression
Scores decrease after interventions that relieve depression
-a type of Cognitive-Style Questionnaires
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the in class example looking at the T test
slide 45
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Tscore : average is _, standard deviation is _
average is 50, standard deviation is 10): clinicallly significant
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Psychometrician (?)
: person who is giving the test.
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Neurobiological Assessment Methods
* brain imaging
* neuropsychological assessment
* neurophysiological assessment
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neuropsychological assessment
- a Neurobiological Assessment Method
| * behavioral tests such as the ...
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Neurobiological Assessment Methods
* brain imaging
* neuropsychological assessment
* neurophysiological assessment
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neuropsychological assessment
- a Neurobiological Assessment Method
* behavioral tests such as the Halsteid-Reitan and Luria-Nebraska
- assesses ability tsuch as motor speed, spatial abiltiy and memory
- deficievys on particular tests help point to an area of possible brain dysfunction
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*Computerized Axial Tomography (CT or CAT)
-brain imaging: Neurobiological Assessment Method
*Computerized Axial Tomography (CT or CAT)
Brain structure
Detects differences in tissue density or structural abnormalities
*E.g., enlarged ventricles, locations of tumor and blood clots
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Magnetic Resonance Imaging (MRI)
-brain imaging: a Neurobiological Assessment Method
Magnetic Resonance Imaging (MRI)
Brain structure
Similar to CT but higher quality
Electromagnetic signals translate into a picture of brain tissue
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brain imaging: a Neurobiological Assessment Method
| 4 ways
*Computerized Axial Tomography (CT or CAT)Magnetic Resonance Imaging (MRI)
Functional MRI (fMRI)
Positron Emission Tomography (PET)
Single Photon Emotion Computer Tomography (SPECT)
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Functional MRI (fMRI)
- brain imaging: a Neurobiological Assessment Method
* Brain structure and function
* Measures blood flow in the brain, proxy for neural activity
* BOLD signal=blood oxygenation level dependent
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BOLD signal
=blood oxygenation level dependent
| *Functional MRI (fMRI)
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Positron Emission Tomography (PET)
-brain imaging: a Neurobiological Assessment Method
* Brain structure and function
* More invasive than fMRI
* Radioactive isotope is injected into the bloodstream
* Used to assess neurotransmitter functioning in the brain
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Single Photon Emotion Computer Tomography (SPECT)
-brain imaging: a Neurobiological Assessment Method
| *Radioactive isotope is injected into the bloodstream
*Less invasive than PET
SEE IMAGE
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Neurobiological Assessment: Studies of Connectivity
Connectivity: Areas of the brain that communicate with one another
*Structural (anatomical) connectivity
How different parts of the brain are connected via white matter
The axon is white matter because the axon looks white (covered with a substance)
*Functional connectivity
How different parts of the brain are correlated based on fMRI BOLD (blood oxidation level dependent) signals
*Effective connectivity
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Connectivity:
Areas of the brain that communicate with one another
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*Effective connectivity
Reveals correlations between BOLD activation and direction and timing of those activations
(Real time image of the way the brain thinks)
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What can a CT scan reveal?
a tumor!
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reading a FMRI
If a lot of stuff lighting up in the occipital lobe: something going on with vision. A lot of activity, what part of the brain being used
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*Used to assess neurotransmitter functioning in the brain
PET scan
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* Radioactive isotope is injected into the bloodstream
| * Less invasive than PET
SPECT scan slide 57
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* Radioactive isotope is injected into the bloodstream
| * Less invasive than PET
SPECT scan slide 57
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Neurobiological Assessment: Neuropsychological Assessment
*Neuropsychological Tests
Often used in conjunction with brain-imaging
Detect brain dysfunction and reveal performance deficits
Looking at things like Executive function and Fine motor
*Halstead-Reitan battery
*Luria-Nebraska battery
Assesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc.
*Neuropsychological Assessment Battery (NAB)
Alertness, language, memory, spatial reasoning, executive functioning.
He uses this at his practice
Each of these words has its own subtests
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*Neuropsychological Tests
Often used in conjunction with brain-imaging
Detect brain dysfunction and reveal performance deficits
Looking at things like Executive function and Fine motor
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Halstead-Reitan battery
-Neurobiological Assessment: Neuropsychological Assessment
Tactile Performance Test-Time
Tactile Performance Test-Memory
Speech Sounds Perception Test
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*Luria-Nebraska battery
-Neurobiological Assessment: Neuropsychological Assessment
| Assesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc.
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Neuropsychological Assessment Battery (NAB)
-Neurobiological Assessment: Neuropsychological Assessment
Alertness, language, memory, spatial reasoning, executive functioning.
He uses this at his practice
Each of these words has its own subtests
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Neurobiological Assessment: Psychophysiological Assessment
* Psychophysiology
| * Measure of the autonomic nervous system
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Psychophysiology
Study of bodily changes associated with psychological events
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*Measure of the autonomic nervous system
-part of Neurobiological Assessment: Psychophysiological Assessment
Often assessed to understand aspects of emotion
Electrocardiogram (EKG)
Measures heart rate using electrodes on chest
Electrodermal responding (skin conductance)
Sweat-gland activity measured by electrodes placed on hand
Anxiety, fear, anger increase sweat-glad activity
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Measuring the skin conductance can be used as
Measure of the autonomic nervous system
-part of Neurobiological Assessment: Psychophysiological Assessment
Electrodermal responding (skin conductance)
(see image)
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Cautionary Note about Neurobiological Assessment (1 of 2)
Measures do not differentiate between different emotional states
Certain things can show up that might now reflect the exact thing you are thinking of
Scanning environment may induce change
Example looking at different places in environment
Unable to manipulate brain activity and then measure change in behavior
It is important to consider alternative explanations for findings
A complete assessment must include multiple methods
Must understand preexisting abilities prior to diagnosis to understand consequences of dysfunction
Example a surgeon should have high moto skills. So if a surgon has average motor skills then maybe something is wrong
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People don’t come in for the ____ test unless there was some sort of accident
People don’t come in for the battery test unless there was some sort of accident
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Cultural and Ethnic Diversity and Assessment
Measures developed for one culture may not be valid or reliable for another
Not simply a matter of language translation
People who speak spanish from spain and people who speak spanish from peru is not the same/very different
Most were developed for upperclass white people
Guidelines for translating and adapting tests exist, but are not always followed
Cultural biases may cause a clinician to over- or underestimate problems in members of a culture
Want to have good culture competence
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Strategies to Avoid Bias
Increase graduate students’ cultural awareness
Or understand how that process works
Sooooo like is he gona do this
Ensure participants understand task
Distinguish “cultural responsiveness” from “cultural stereotyping”
Conclusions should be tentative and alternative hypotheses should be entertained
Stereotype: saying everyone is the same
Learning about the culture is good but understand that not eveyrone in that culture is gonna be this thing
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Video How does the Rorshach inkblot test work? Damion Searls
```
Said to bring out the persons mind
Inkblots
How they approach the tast
When distributed properly it is helpful
Can quantify and look at it
Asked to explain what you see: what do these little differences imply
```
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Extinction involves
learning new associations to stimuli that inhibit activation of the fear response.
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What was the rationale behind the DSM-5 change in the name of the diagnosis "social phobia" to "social anxiety disorder"?
Social phobias tend to be more pervasive and cause more interference with daily routines than other phobias.
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is panic disorders its own chapter in the DSM
NO
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does culture of origin increase risk for more than one anxiety disorder
NO
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specific phobia
an anxiety disorders that involves fear of objects of situations that is out of proportion to any real danger
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A major psychological hypothesis regarding the onset of panic involves
a concern with, and misinterpretation of, bodily sensations.
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According to Borkovec and colleagues, worry
serves as an avoidance mechanism.
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Some of the most commonly prescribed medications for social anxiety disorder are __________, which are proposed to work by ____________.
beta blockers; diminishing the effects of adrenaline on the body
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About __________ of people who have experienced a major depressive disorder will experience at least one more episode during their lifetime.
a. One quarter
b. Half
c. Two thirds
d. Three quarters
d. Three quarters
