Midterm 3 Flashcards

1
Q

Personality

A

Personality: Stable traits within people that affect how they react to their surroundings

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2
Q

Traits

A

Traits: a fixed habit that affects how we behave in a number of situations

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3
Q

Two approaches to studying personality:

A
  • Nomothetic method - tries to generalise people by looking for universal principles in nature rather than principles that are specific to an individual
  • Idiographic approach: focuses on recognising one’s individuality by identifying the particular combination of traits and experiences that make up one’s life history (individual differences)
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4
Q

Causes of Personality

A

Behaviour-genetic methods

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5
Q

Behaviour-genetic methods

A

Behaviour-genetic methods attempt to disentangle the effects of:
– Genetic factors
– Shared environmental factors (those that make people within a family
similar)
– Nonshared environmental factors (those that make people within a family including twins - different)

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6
Q

Sigmund Freud

A

Viennese neurologist who developed first
comprehensive theory of personality

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7
Q

Psychoanalytic Theory Principles

A

3 primary principles:
1. Psychic determinism: the assumption that all psychological events have a cause
2. Symbolic meaning: no action, no matter how seemingly trivial, is meaningless and is symbolic of something else
3. Unconscious motivation: we rarely understand why we do what we do

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8
Q

Freud’s Model of Personality Structure

A

Freud thought that the psyche consisted
of three components
– Id – basic instincts, operates on pleasure principle
– Superego – sense of morality
– Ego – principal decision maker

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9
Q

Psychoanalytic Theory

A
  • Freud thought that our dreams reflected an unconscious struggle among the 3 psychic genies
  • Said all dreams reflected wish fulfillments but that some were in disguise (as symbols)
  • Contrary to pop psych, did not say that all symbols mean the same to everyone
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10
Q

Anxiety and Defense Mechanisms

A
  • The ego will try to minimize anxiety via defense mechanisms
    – Operate unconsciously
  • Although essential for psychological health, Freud thought over reliance on one or two could cause problems
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11
Q

Defense Mechanism Examples

A
  • Repression – motivated forgetting of emotionally threatening memories or impulses
  • Denial – motivated forgetting of distressing experiences
  • Projection – unconscious attribution of our negative qualities onto others
  • Displacement - Directing an impulse from a socially unacceptable target onto a more acceptable one
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12
Q

Stages of Psychosexual Development

A
  • Freud believed that we pass through stages, each of which is focused on an erogenous zone
  • Insisted that sexuality begins in infancy
  • Too much, or too little, gratification can be a problem
  • Individuals who get fixated on a stage and have difficulty moving on
  • Oral stage – birth to 18 months
    – Orally fixated persons react to stress by becoming intensely dependent on others for reassurance
  • Anal stage – 18 months to 3 years
    – Anally fixated individuals—anal personalities—are prone to excessive neatness, stinginess, and stubbornness in adulthood
  • Phallic stage – 3 to 6 years
    – Oedipus complex: conflict during the phallic stage in which boys supposedly love their mothers romantically and want to eliminate their fathers as rivals
    – Electra complex & penis envy
  • Latency stage – 6 to 12 years
    – Sexual impulses are submerged into the unconscious
    – Most children during this stage find members of the opposite sex to be “yucky” and utterly unappealing
  • Genital stage – 12+ years
    – Sexual impulses awaken and typically begin to mature into romantic attraction towards others
    – If serious problems weren’t resolved at earlier stages, difficulties with establishing intimate love attachments are likely
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13
Q

Evaluated Scientifically (personality)

A
  • Very influential in thinking about personality, but there are major criticisms
    – Unfalsifiable
    – Failed predictions
    – Questionable understanding of the unconscious
    – Unrepresentative samples
    – Too much focus on the shared surroundings
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14
Q

Neo-Freudians

A

Most neo-Freudian theories focus how early experiences shape personality and how unconscious influences on behaviour might shape behaviour.

In two key aspects, they differ from Freud’s theories:
1. Lower focus on sexuality, heavier focus on social motivations
2. More positive about personal development

  • Afred Adler believed that the principal motive in human personality is not sex or aggression, but striving for superiority
    – Our overriding style of life is to better ourselves
  • Inferiority complex: feelings of low self-esteem that can lead to overcompensation for such feelings
    – Develops among those who were pampered or neglected by their parents
  • Adler’s hypotheses are difficult to falsify
  • Carl Jung (Yoong)
    – Collective unconscious: our shared storehouse of memories that ancestors have passed down to us across generations
    – Archetypes: cross culturally universal emotional symbols (e.g., mother, goddess, hero, mandala)
  • Difficult to falsify
  • Shared experiences may account for commonalities in archetypes across the world rather than a collective unconscious
  • Karen Horney: Feminist Psychology
    – women’s sense of inferiority as stemming from culturally enforced dependency, not penis envy
    – Argued that the Oedipus complex is a symptom of psychological problems, not a cause, because it arises only when the opposite-sex parent is overly protective and the same-sex parent overly critical
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15
Q

Neo-Freudians Evaluated Scientifically

A
  • Neo Freudians pointed out that anatomy isn’t always destiny when it comes to psychological differences between the sexes
  • Argued that social influences must be reckoned with in the development of personality
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16
Q

Behavioural Approaches
(Behavioural and Social Learning Theories)

A
  • B. F. Skinner - Argued that differences in our personalities stem largely from our learning histories
  • Personalities are bundles of habits acquired by classical and operant conditioning (learning)
  • Radical behaviorists view personality as under the control of genetic factors and contingencies in the environment
  • Like psychoanalysts, radical behaviourists are determinists: They believe that all of our actions are products of preexisting causal influences
    – Free will is an illusion
    Behavioural views of unconscious processing
  • According to Skinner, we were initially unconscious of the reasons for our behaviour because we were unaware of the environmental cause of this behaviour
  • For radical behaviourists, there’s no such storehouse because the unconscious influences that play a role in causing behaviour are external, not inside our heads
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17
Q

Social Learning Theories

A
  • Saw learning as important, but argue thinking plays a crucial role as well
  • Emphasize reciprocal determinism rather than Skinnerian determinism
    – Reciprocal Determinism—a form of causation whereby personality and cognitive factors, behaviour, and environmental variables mutually
    influence one another
  • Proposed that much of learning occurs by watching others (observational learning)
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18
Q

Behavioural Approaches Evaluated Scientifically

A
  • Placed psychology on firmer scientific footing
  • However…
    – Radical behaviourists’ ignoring of cognition is not supported by research
    – Social learning’s emphasis on shared environment is not supported
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19
Q

Humanistic Models

A
  • Rejected notion of determinism and embraced free will
  • Proposed self-actualization as core motive in personality
    – Self-actualization: the drive to develop our innate potential to the fullest possible extent
  • View human nature as inherently constructive
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20
Q

Carl Rogers’ Model

A
  • Believed that we could all achieve our full
    potential for emotional fulfillment if only
    society allowed it
  • Three major components of personality:
    1. The organism (innate, genetic blueprint)
    2. The self (set of beliefs about who we are)
    3. Conditions of worth (expectations we place
    on ourselves – can result in incongruence)
    § E.g., conditional love
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21
Q

Abraham Maslow and Self-Actualization

A
  • Maslow focused on individuals who
    [he believed] were self-actualized
    – E.g., Martin Luther King, Jr., Helen
    Keller, Mahatma Gandhi…
  • Self-actualized people:
    – Tend to be creative, spontaneous, accepting of themselves and others, self-confident, and not self-centered
    – They tend to focus on real-world and intellectual problems and have a few deep friendships rather than superficial ones
    – Can come off as difficult to work with or aloof
    – Prone to peak experiences: transcendent moments of intense excitement and tranquility marked by a profound sense of connection to the world.
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22
Q

Self-Actualization Evaluated Scientifically

A
  • Comparative psychology (compares behaviour across species)
    challenges Rogers’ claim that our nature is entirely positive
  • Rogers’ and Maslow’s research was fraught with methodological difficulties
    – Confirmation bias
  • Many non-falsifiable assumptions
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23
Q

Trait Models

A
  • Interested primarily in describing and understanding the structure of personality
  • For trait models to be useful, they must avoid
    circular reasoning
    – Must demonstrate that personality traits
    predict behaviours in novel situations or
    correlate with biological or laboratory
    measures
  • Factor analysis: statistical technique that analyses the correlations
    among responses on personality inventories and other measures
    – Trait models use this to reduce diversity of personality descriptors to
    underlying traits
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24
Q

Big Five Model

A

*Openness to Experience (closed or open)
*Conscientiousness (spontaneous or conscientious)
*Extraversion (introvert or extrovert)
*Agreeableness (Hostile or agreeable)
*Neuroticism (stable or neurotic)

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25
Q

Big Five and Behaviour

A
  • Predict many important real-world behaviours
    – Job performance and grades in school (high openness to experience, low neuroticism, and perhaps high agreeableness)
    – Physical health and life span (high conscientiousness)
  • Relatively similar traits seen across cultures (e.g., China, Italy, Turkey)
    – Openness doesn’t emerge in all cultures
  • Some investigators have found dimensions in addition to the Big Five
    – Chinese tradition factor encompasses aspects of personality distinctive to
    Chinese culture, including an emphasis on group harmony and saving face to avoid embarrassment
    – Honesty and Humility factor Cultural differences in prevalence rates (some traits are more common
    in some cultures than others)
  • Individualist vs. collectivist societies
    – Focus on personal goals vs. relations to others
    – Personality traits may be less predictive of behaviour in collectivist than individualistic cultures
    § Could be that behaviour in collectivist cultures is more likely to be influenced by social norms
    § But we must be careful not to make overgeneralizations and we need to be aware of stereotypes
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26
Q

Other Models

A
  • HEXACO
    – Similar to Big Five, but with honesty-humility as 6th trait
    – E = emotionality (neuroticism)
    – X = eXtraversion
  • Big Three
    – Impulse control (combo of agreeableness, conscientiousness, (low) openness to experience)
    – Extroversion
    – Neuroticism
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27
Q

Can Personality Change?

A
  • Some variability prior to age 30, but little thereafter
  • Between late teens and early thirties:
    – openness, extroversion, and neuroticism tend to decline a little
    – conscientiousness and agreeableness tend to increase a little
  • Levels of most traits don’t change much after age 30 and change even
    less after about age 50
  • Personality is quite stable once we reach adulthood
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28
Q

Personality Change Evaluated Scientifically

A
  • Highly influential through the early and mid-twentieth century
  • Criticisms by Walter Mischel concerning behavioural inconsistency
    – Found low correlations among different behaviours that supposedly were to reflect the same trait
    – Argued measures of personality aren’t especially helpful for what they were designed to do—forecast behaviour
  • Counterargument by Seymour Epstein: traits are predictors of aggregate, not isolated behaviours
  • Trait theories primarily describe individual differences rather than what causes them
    – Pro: improved our understanding of personality structure and helped psychologists predict performance in jobs
    – Con: don’t provide much insight into the causes of personality
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29
Q

Personality Assessment

A
  • Plagued by number of dubious methods
    – Phrenology (head shape)
    – Physiognomy (facial characteristics)
    – Sheldon’s body types
  • All lacked two key criteria – reliability and validity
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30
Q

Structured Personality Tests

A
  • Paper-and-pencil tests consisting of questions
    you respond to in one of a few fixed ways
  • Prepared using a rational/theoretical method
    – Requires test developers to begin with a clearcut conceptualization of a trait and then write
    items to assess it
  • Some have strong reliability and validity (NEO
    PI-R; measures big five) but others do not
    (Myers-Briggs)
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31
Q

Projective Tests

A
  • Ask examinees to interpret or make sense of ambiguous stimuli
  • Based on projective hypothesis
    – When interpreting ambiguous stimuli, people project aspects of their
    personality
  • Controversial, because reliability and validity are in dispute
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32
Q

Rorschach Inkblot Test

A
  • Consists of ten symmetrical inkblots: five in
    black-and-white and five containing colour
  • Examiners ask respondents to look at each
    inkblot and say what it resembles
  • This supposedly tells you about personality
    traits of the respondent
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33
Q

Rorschach Evaluated Scientifically

A
  • Unknown test-retest and problematic interrater reliability scores
  • Little evidence that it detects features of mental disorders or predicts
    criminal behaviours
    – Studies have replicated associations between Rorschach scores and
    schizophrenia, bipolar disorder, and other conditions involving abnormal
    thinking
    – Not many replicated associations between Rorschach scores and other
    mental illnesses
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34
Q

Thematic Apperception Test (TAT)

A
  • Requires subject to construct a story based
    on pictures
  • Include in the story descriptions of:
    – What has led up to the event shown
    – What is happening in the scene
    – The thoughts and feelings of characters
    – The outcome of the story
  • Responses are then scored based on the
    extent to which respondents’ stories
    emphasize achievement-oriented themes
  • Little evidence for adequate reliability
    or validity for most applications
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35
Q

Other Projective Tests

A
  • Human figure drawings require you to draw a person(s) in any way you wish – drawings interpreted based on features (e.g., large eyes =
    suspiciousness)
  • Graphology – analysis of handwriting – is another projective test
  • Neither has scientific support for its use and claims
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36
Q

What Is Mental Illness?

A
  • Psychopathology (mental illness) is often seen as a failure of
    adaptation to the environment
  • Failure analysis approach tries to understand mental illness by
    examining breakdowns in functioning
  • Mental disorder does not have a clear-cut definition
  • Many different conceptions of mental illness, each with pros and cons
    1. Statistical rarity
    2. Subjective distress
    3. Impairment
    4. Societal disapproval
    5. Biological dysfunction
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37
Q

Historical Conceptions of Mental Illness

A
  • During the Middle Ages, mental illnesses were often viewed through a
    demonic model
    – Odd behaviours were the result of evil spirits inhabiting the body
    – Exorcisms and witch hunts were common during this time
  • During the Renaissance, the medical model saw mental illness as a
    physical disorder needing treatment
    – Began housing people in asylums – but they were often overcrowded and
    understaffed
    – Treatments were no better than before (e.g., bloodletting)
  • Reformers like Phillippe Pinel and Dorothea Dix pushed for moral
    treatment
    – Focused on treating patients with dignity, respect, and kindness
  • Still no effective treatments, though, so many continued to suffer with
    no relief
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38
Q

Modern Era (mental illness)

A
  • Psychiatric treatment
  • In early 1950s, a drug was developed called chlorpromazine (Thorazine)
  • Moderately decreased symptoms of schizophrenia and similar problems
  • With advent of other medications, policy of deinstitutionalization was
    enacted
    – Goals: releasing hospitalized psychiatric patients into the community, closing
    mental hospitals
  • Deinstitutionalization had mixed results
  • Deinstitutionalization had mixed results
  • Some patients returned to almost normal lives
  • Tens of thousands had no follow-up care and went off medications
    – Continues to be a problem today due to lack of affordability
    – A key cause of housing insecurity and homelessness
  • Community mental health centers and halfway houses (free or lowcost care facilities in which people can obtain treatment) attempt to
    help this problem
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39
Q

Diagnosis Across Cultures

A
  • Certain conditions are culture-bound
    – Koro involves believing your genitals are shrinking and receding into your
    abdomen
    – Windigo involves craving the consumption of human flesh and fear of
    becoming a cannibal
  • Many severe mental disorders (schizophrenia, alcoholism, psychopathy)
    appear to be universal across cultures
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40
Q

Psychiatric Diagnoses

A
  • Common Misconceptions:
    1. Psychiatric diagnosis is nothing more than pigeonholing (putting
    people into a “box”)
    2. Psychiatric diagnoses are unreliable
    3. Psychiatric diagnoses are invalid
    4. Psychiatric diagnoses stigmatize people
  • Psychiatric diagnosis serve two critical functions:
    – Pinpointing the psychological problem
    – Facilitating communication between professionals
  • Robins and Guze Criteria for Validity
    – Distinguishes that diagnosis from other, similar diagnoses
    – Predicts performance on laboratory tests, including personality measures,
    neurotransmitter levels, and brain-imaging findings
    – Predicts family history of psychiatric disorders
    – Predicts natural history (change over time)
    – Predicts treatment response
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41
Q

The DSM-5

A
  • Diagnostic and Statistical Manual of Mental
    Disorders (DSM) is a system that contains the
    criteria for mental disorders
    – Fifth edition, DSM-5 (DSM-V) released 2013
    – Text revision, DSM-5-TR, published in 2022
  • Contains diagnostic criteria and decision rules for each condition
    – Warns to “think organic” (rule out physical causes of symptoms first)
  • Contains information on prevalence (percentage of people within a
    population who have a specific mental disorder)
  • Uses a biopsychosocial perspective
    – Recognizes that there’s more to people than their disorders
    – Acknowledges cultural and social diversity
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42
Q

DSM Criticisms

A
  • Not all diagnoses meet Robins and Guze criteria for validity (e.g.,
    mathematics disorder)
  • Not all criteria and decisions rules are based on scientific data
  • High level of comorbidity (two or more diagnoses in the same person)
  • Reliance on categorical model rather than dimensional model of
    psychopathology
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43
Q

Minnesota Multiphasic Personality Inventory
(MMPI)

A
  • Used in the assessment of psychopathology
  • Developed using empirical method
    – approach to building tests in which researchers begin with two or more criterion
    groups and examine which items best distinguish them
  • Test has low face validity
    – extent to which respondents can tell what the items are measuring
  • Low face validity is thought to be an advantage
    – Cannot “fake” responses
  • Considered to have good validity, can distinguish between disorders
  • Can be interpreted manually or via a program
  • Problematic in some aspects
    – Some overlap between scales
    – Cannot be the sole basis of diagnosis
    – One scale alone does not predict an illness
  • 567 true-false questions, 10 basic scales
  • Contains three validity scales designed to detect various types of
    distorted responses
    – L (Lie) detects impression management
    – F (Frequency) detects malingering (i.e., faking symptoms)
    – K (Correction) measures defensive responding
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44
Q

Anxiety Disorders

A
  • Most anxieties are transient and can be
    adaptive
  • They can also become excessive and
    inappropriate
  • One of the most prevalent and earliest onset
    of all classes of disorders
    – 31% will meet the diagnostic criteria for one or
    more anxiety disorders at some point in our lives
  • Inappropriate anxiety exists in other
    disorders and problems
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45
Q

Somatic symptoms

A
  • Somatic symptom disorders are physical symptoms with psychological
    origins
  • Illness anxiety disorder (formerly hypochondriasis) is a preoccupation
    that you have a serious disease, despite no evidence
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46
Q

Generalized Anxiety Disorder

A
  • Continual feelings of worry, anxiety, physical tension, and irritability
    about many areas
  • About 3% of the population
  • 1/3 develop it after major stressor or life change
  • More prevalent in females and Caucasians
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47
Q

Panic Disorder

A

Panic attack: brief, intense episode of extreme fear characterized by
sweating, dizziness, light-headedness, racing heartbeat, and feelings of
impending death or going crazy
– Many patients feel like they are having a heart attack.
* Panic disorder is characterized by repeated, unexpected panic attacks,
along with either
– Persistent concerns about future attacks
– A change in personal behaviour in an attempt to avoid them
* Can be associated with specific situation or come “out of the blue”

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48
Q

Phobias

A
  • Intense fear of an object or situation that’s greatly out of proportion to
    its actual threat
  • For a fear to be diagnosed as a phobia, it must restrict our lives, create
    considerable distress, or both
  • Most common anxiety disorder (11%)
  • Different forms of phobias
    – Agoraphobia: fear of being in a place or situation in which escape is
    difficult or embarrassing, or in which help is unavailable in the event of a
    panic attack
  • Specific phobia vs social anxiety disorder
    – Specific phobia: intense fear of objects, places, or situations that is
    greatly out of proportion to their actual threat
    – Social anxiety disorder: intense fear of negative evaluation in social
    situations
49
Q

Posttraumatic Stress Disorder

A
  • PTSD
  • Marked emotional disturbance after you experience or witness a
    severely stressful or traumatic event
  • To qualify for a diagnosis of PTSD, the event must be physically
    dangerous or life-threatening, either to oneself or someone else
  • Symptoms include:
    – Flashbacks and recurrent dreams
    – Avoiding reminders of the trauma
    – Increased physiological arousal (e.g., increased heart rate, sweating)
50
Q

Obsessive-Compulsive Disorder

A
  • Marked by obsessions - persistent ideas, thoughts, or impulses that are
    unwanted and inappropriate and cause marked distress
  • This distress is relieved by compulsions – repetitive behaviours or
    mental acts they undertake to reduce or prevent distress, or relieve
    shame and guilt
  • Must spend at least 1 hour per day engaging in obsessions, compulsions,
    or both to warrant diagnosis of OCD
  • OCD is NOT the same as being particular, meticulous, or organized
    – If OCD simply caused people to want everything to be neat, organized and colorcoded all the time, it would not be an illness
  • Falsely claiming to have OCD trivializes the illness for people who are
    clinically diagnosed
51
Q

Explanations for Anxiety Disorders

A
  • Learning models focus on acquiring fears via classical conditioning
    (recall: Pavlov’s salivating dogs), then maintaining them through
    operant conditioning (rewards and punishment)
  • Anxious people tend to think about the world in different ways from
    non-anxious people
    – Catastrophic thinking (catastrophizing) - predicting terrible events despite low
    probability
  • Biological influences
    – Twin studies suggest genetic influence
    – Genes affect whether we inherit high levels of neuroticism (tendency to be
    high-strung and irritable), which can set the stage for excessive worry
    – Those with GAD are genetically similar to those who experience major
    depression
52
Q

Mood Disorders

A
  • Over 20% of North Americans will experience a mood disorder
    – Major Depressive Disorder (MDD) is the most common, at 16%
    – Bipolar Disorder
  • Major depressive episode: state in which a person experiences
    – a lingering depressed mood or diminished interest in pleasurable activities
    – along with symptoms that include significant weight loss (when not dieting) or
    gain
    – and sleep difficulties
  • Major Depressive Disorder (MDD): chronic or recurrent experience of a
    major depressive episode
  • More prevalent in females, most likely to develop in 30s
  • Depression symptoms can develop gradually or suddenly, but are often
    recurrent
  • Average episode lasts 6 months to 1 year, most people experience 5-6
    episodes
  • Can also be chronic – present for years/decades with no relief
  • Generally, the earlier depression strikes the first time, the more likely it
    will persist or recur
  • Can cause extreme functional impairment across all areas
53
Q

Sample MDD Symptoms

A
  • Feeling sad or irritable
  • Sleep difficulties
  • Fatigue
  • Loss of energy
  • Weight changes
  • Self-harming behaviours
  • Thoughts of death or suicide
54
Q

Explanations for MDD
* Complex interplay of biological, psychological, and social influences

A
  • Complex interplay of biological, psychological, and social influences
  • Life events such as loss of something that is dearly valued can set stage
    for depression
  • Depression can create interpersonal problems, which cause lack of
    social support
    – James Coyne found that when people become depressed, they seek excessive
    reassurance, which in turn leads others to dislike and reject them
    – Constant worrying, mistrust, and socially inappropriate behaviours can be a
    social turn-off to many people
55
Q

Explanations for MDD
* Behavioural Model

A
  • Lewinsohn’s behavioural model: depression results from a low rate of
    positive reinforcement in the environment
    – (i.e., when people with depression try different things and receive no payoff for
    them, they eventually give up)
    – People with depression sometimes lack social skills, making it even harder for
    them to obtain reinforcement from others
    – If people respond to individuals with depression with sympathy and concern,
    they may reinforce and maintain these individuals’ withdrawal
56
Q

Explanations for MDD
* Cognitive Model

A
  • Beck’s cognitive model - depression is caused by negative beliefs and
    expectations
    – Cognitive triad – negative views of oneself, the world, and the future
    (negative schemas)
    – Cognitive distortions – skewed ways of thinking
    § Polarized thinking (black-and-white or all-or-nothing thinking)
    § Negative mental filtering (focus on the bad, ignore the good)
    § Overgeneralization (drawing negative conclusions about future based on single
    negative experience)
    § Catastrophizing (magnification: over-exaggeration of a negative thought)
57
Q

Explanations for MDD
* Learned helplessness

A
  • Learned helplessness - tendency to feel helpless in the face of events
    we can’t control
    – Depressed people tend to differ in their beliefs regarding the attribution of
    outcomes - why did this happen?
    § Negative outcomes due to internal factors
    § Positive outcomes due to external factors
58
Q

Explanations for MDD
* The role of biology

A
  • The role of biology
    – Genes exert a moderate influence on MDD
    – Depression is often associated with low levels of the neurotransmitters
    serotonin (often called the “feel good” chemical) and dopamine (the
    neurotransmitter most closely tied to reward)
59
Q

Bipolar Disorder

A
  • Have both depressive and manic episodes
  • Manic Episode: experience marked by dramatically elevated mood, decreased need for sleep, increased energy, inflated self-esteem,
    increased talkativeness, and irresponsible behaviour
    – First manic episode often after early 20’s
    – Equally common in men and women
  • Bipolar disorder: condition marked by a history of at least one manic episode
  • Heritability as high as 85%
  • Produces serious problems in social and occupational functioning
  • Brain imaging studies suggest that people with bipolar disorder experience:
    – increased activity in structures related to emotion (e.g., amygdala)
    – decreased activity in structures associated with planning (e.g., prefrontal cortex)
  • Very heavily genetically influenced, but stressful life events can cause episode onset
    – These can be negative or positive events
60
Q

Suicide

A
  • MDD and bipolar disorder are at higher risk for suicide than most
    disorders
  • Suicide is the 12th leading cause of death in Canada (2020)

– 3rd leading cause of death among children aged 10-14
– 2nd leading cause of death among youth and young adults (15-34)
– Risk is 5-7 times higher among Indigenous youth
* Prediction is difficult due to lack of research and low base rates
(prevalence)
– 30 to 40 percent of all people who die by suicide have made at least one prior
attempt
– Males 3x more likely to die by suicide, though women attempt more

61
Q

Myths and Misconceptions About Suicide

A

1 Talking to persons with depression about suicide often makes them more likely to carry out the act.

2 Suicide almost always occurs with no warning.

3 As a severe depression lifts, people’s suicide risk decreases.

4 Most people who threaten suicide are seeking attention.

5 People who talk a lot about suicide almost never actually carry out the act.

62
Q

Diathesis-Stress Model of Psychopathology

A

– The diathesis-stress model proposes that psychopathology results from the interaction over time of:
§ a predisposition or vulnerability to psychological disorder (diathesis) AND
§ the experience of stressful events

63
Q

Personality Disorders

A
  • Distinguishing normal variations in personality and sense of self from
    personality and identity disorders can be challenging
  • Historically the least reliably diagnosed
  • Should only be diagnosed when
    – Personality traits first appear by adolescence
    – Traits are inflexible, stable, and expressed in a wide variety of situations
    – Traits lead to distress or impairment
64
Q

Key features: Borderline Personality Disorder

A
  • Marked by extreme instability in mood, identity, and impulse control
    – Relationships often alternate between extremes
    – Often highly self-destructive
  • Prevalence: about 2% of population, mainly women
  • Sociobiological model: individuals with BPD inherit a tendency to
    overreact to stress and experience lifelong difficulties with regulating
    their emotions
    – Twin studies suggest substantial heritability
65
Q

Key features: Psychopathic & Antisocial Personality

A
  • Psychopathic personality: Condition marked by superficial charm, dishonesty, manipulativeness, self-centeredness, and risk taking
    – Guiltless & callous, yet also tend to be charming, personable, engaging
    – NOT listed in the DSM-V, but overlaps with ASPD
  • Antisocial personality disorder (ASPD): condition marked by a lengthy history of irresponsible and/or illegal actions
  • ASPD describes behaviours, psychopathic personality describes
    personality traits
  • Primarily males
  • Heightened risk of crime: ~25% of the prison population qualifies
  • Commonly have history of conduct disorder in childhood
    – a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
    ▪ Aggression to people and animals
    ▪ Destruction of property
    ▪ Deceitfulness and theft
    ▪ Serious violations of rules
  • Causes are largely unknown, but may stem in part from a deficit in fear
  • Alternatively, they may be perpetually under-aroused and experiencing stimulus hunger
66
Q

Key features: Dissociative Disorders

A
  • Involve disruptions in consciousness, memory, identity, or perception
  • Depersonalization disorder: frequent experiences of feeling detached
    from oneself and/or the sense that the external world is strange or
    unreal
    – often accompanies panic attacks
  • Dissociative Amnesia: inability to recall important personal
    information—most often related to a stressful experience
    – Beyond ordinary forgetfulness
  • Controversial
    – Memory gaps regarding nontraumatic events are common in healthy individuals
    – Unmotivated to remember negative events
    – Lack of research evidence
  • Dissociative Fugue: forget significant events in their lives AND flee their
    stressful circumstances
    – Rare
67
Q

Dissociative Identity Disorder

A
  • Characterized by presence of two or more distinct identities (alters)
  • More often among women, who report more alters than men
  • Intriguing differences between alters shown (e.g., brain wave activity)
    – But differences are often easily explained in other ways
  • Posttraumatic model: DID arises from a history of severe abuse during childhood, which leads individuals to “compartmentalize” their identity
    into alters as a means of coping
    – Little evidence to support this view
    – Early abuse is not specific to DID
  • Sociocognitive model: origin and maintenance of DID can be explained by certain psychotherapeutic procedures and cultural influences that shape people’s expectancies and beliefs
    – Most DID patients don’t show alters prior to therapy
    – Treatment reinforces idea person has alters and tends to increase the number of alters
68
Q

Childhood Disorders
- Autism Spectrum Disorders

A
  • Marked by severe deficits in language, social bonding, and imagination
    – Often accompanied by mental deficits
  • Two defining features of autism in DSM-5
    – Social and communication deficits
    – Restricted and repetitive interests and behavior
  • Individuals with ASD vary tremendously in the degree, nature, and
    causes of their deficits and characteristics
  • Distinct categories are no longer used:
    – “Classic” autism
    – Pervasive developmental disorders
    – Child disintegrative disorder
    – Asperger syndrome
  • ASD diagnoses – a spectrum
  • Dramatic increase in autism diagnoses from early 1990s to today
    – 1987: autism affected 4 or 5 of every 10,000 children
    – 2006: 1 in 110
    – Two years later: 1 in 88
  • Is there an epidemic?
  • Why are rates rising?
    – NOT due to vaccines: the study linking vaccinations to autism was found
    to be fraudulent and incorrect
    ▪ Celebrities continue to perpetuate this myth
    ▪ Illusory correlation: Symptoms of ASD appear around same time as infant
    vaccinations (15 months)
    – Increased awareness
    – Broader definition that includes the entire spectrum (even the more mild cases)
    – Increased diagnosis of children who were previously diagnosed with language
    impairments or learning disabilities
    – Policy changes
  • Suspected causes
    – NOT bad parenting
    – Genes are a contributing factor
    ▪ If one identical twin has ASD, the other twin will be as well in 60-70% of cases
    – Environmental triggers could interact with genetic predisposition
    – Certain viruses and chemicals, such as rubella, alcohol, and thalidomide
    are also known to contribute to ASD
69
Q

Attention-Deficit/Hyperactivity Disorder

A
  • Primary symptoms:
    – Inattention: Easily distracted, misses details, forgetful
    – Hyperactivity and impulsivity: Restless, fidgety, and difficulty in taking turns
  • Diagnosable in 3-7% of school children
    – Males more likely to be diagnosed than females (3:1)
    – Females are underdiagnosed because their symptoms are often less obvious
  • Related to numerous functional problems in both children and adults
    – Children often struggle with learning disabilities, verbal processing difficulties,
    and poor balance and coordination
    – Most children with ADHD also have other comorbid conditions (e.g., conduct
    disorder, anxiety, depression)
  • Highly genetically influenced
  • Can often be successfully treated with stimulant medication
  • Environmental influences are also important
    – Help determine whether a genetic risk turns into a reality
70
Q

Schizophrenia

A

Schizophrenia: Severe disorder of thought and emotion associated with a loss of contact with reality

71
Q

Schizophrenia symptoms

A
  • Symptoms include disturbances in attention, thinking, language, emotion, and relationships
  • Less than 1% of population, but over half of people in mental institutions
  • Usually develops in mid- (men) to late-twenties (women)
  • A hallmark symptoms:
    – Delusions – strongly held, fixed beliefs with no basis in reality
    – Psychotic symptoms: psychological problem reflecting serious distortions in reality
    – Hallucinations: sensory perceptions that occur in the absence of external stimuli
    ▪ Can affect any of the senses
    ▪ Command hallucinations: tell patients what to do
    – May be associated with a heightened risk of violence toward others
  • Researchers believe that individuals with language that skips from topic-to-topic results from thought disorder
    – Word salad: Disorganized speech that is impossible to understand
  • Catatonic symptoms: motor problem, including extreme resistance to complying with simple suggestions, holding the body in bizarre or rigid
    posture, or curling up in a fetal position
    – Echolalia: repeating a phrase in conversation in a parrotlike manner
    – May occasionally engage in bouts of frenzied, purposeless motor activity
  • Deterioration of self-care, personal hygiene, and motivation
72
Q

Schizophrenia Theories

A
  • Early theories of schizophrenia mistakenly laid the blame for the
    condition on mothers, with so-called schizophrenogenic mothers being
    the culprits
  • Modern theories suggest that psychosocial factors play a role in
    schizophrenia, but only trigger it in persons with genetic vulnerabilities
    – Family members don’t “cause” schizophrenia
    – Family members can influence whether patients will relapse
    ▪ Patients 50-60% more likely to relapse after leaving hospital when relatives
    display high expressed emotion: (criticism, hostility, and over-involvement)
73
Q

Schizophrenia Potential causes/origins

A
  • Highly genetically influenced disorder * Number of brain abnormalities seen – Enlarged ventricles – Increased sulci size – Hypofrontalitiy * Use of marijuana in adolescence may
    increase risk of developing
    schizophrenia, especially for those who
    already have a genetic vulnerability
  • Neurotransmitter differences also found (e.g., dopamine, glutamate,
    serotonin)
  • Dopamine hypothesis: schizophrenia is causes by excess in dopamine
    and rests on the following evidence:
    – Most antischizophrenic drugs block dopamine receptor sites
    – Amphetamine, a stimulant drug that blocks the reuptake of dopamine, tends
    to make the symptoms of schizophrenia worse
  • But it’s not that simple
  • A better supported rival hypothesis is that abnormalities in dopamine
    receptors produce symptoms of schizophrenia
74
Q

Vulnerability to Schizophrenia

A
  • Approximately 10% of the population has a genetic predisposition to
    schizophrenia
  • Diathesis-stress models propose genetic vulnerability (diathesis) and
    stressors that trigger mental illness
  • Early warning signs of schizophrenia vulnerability
    – Social withdrawal
    – Thought and movement problems
    – Lack of emotions, decreased eye contact
75
Q

Dangers of “Dr. TikTok”

A
  • “Dr. Google” & “Dr. TikTok”
  • Recent increase in teens and young
    adults using Google and social media
    to self-diagnose conditions
    – ADHD and Autism seem to be
    particularly common
  • There are many accounts, hosted by educated, trained, and licensed
    professionals where reliable information can be found
    – but not all posts contain accurate, science-backed information
76
Q

Dangers of online self-diagnoses

A
  • Making a psychiatric diagnosis is a complicated process that should
    only be conducted by trained mental health professionals
    – Big difference between experiencing symptoms and having a disorder
    – May be pathologizing ordinary human behaviour (recall discussion of
    being “so OCD”)
    – Could be missing another treatable medical condition
  • If you suspect that you may have a mental condition, the best step is to
    seek professional confirmation
    – First step is usually a visit to your primary doctor, who may refer you to a
    mental health professional for further evaluation and treatment
77
Q

Psychotherapy

A
  • Psychotherapy is a broadly defined as a psychological intervention designed to help people resolve emotional, behavioural, and interpersonal problems and improve the quality of their lives – Often known simply as “therapy”
  • Over 600 “brands” of psychotherapy
78
Q

Who Seeks and Benefits? (Psychotherapy)

A
  • The effectiveness of therapy depends on a host of individual differences
  • In 2018, 17.8% of Canadians aged 12 and older (roughly 5.3 million people) needed some help with their mental health
    – Half felt their needs were fully met
  • Females go more than males, Caucasians more than minority groups
  • Research shows therapy can benefit all these groups equally
    – Culturally sensitive therapy is important
  • Indigenous peoples at greater risk of mental health issues
    – In large part due to the colonial history (and present) of Canada and assimilationist practices (e.g., residential “schools”, foster care systems)
  • These same traumas can result in the avoidance of treatment or therapy
  • Need culturally sensitive approaches that respect and work to restore traditional knowledge and practice
    – Supports individual healing
    – Promotes holistic and Indigenous worldview
79
Q

Who Practices Psychotherapy?

A
  • Clinical psychologists, psychiatrists (medical doctors who specialize in
    mental health), counsellors, and clinical social workers with
    professional degrees and licenses
  • But people with non-advanced degrees also often offer psychological
    services
    – Religious, vocational, and rehabilitation counsellors
    – Social services agencies, crisis intervention centers
80
Q

Who Practices Psychotherapy?
* Professionals vs. paraprofessionals

A
  • Paraprofessionals: People with no professional training who provide mental health services
    – May obtain agency-specific training or workshops to enhance education
    – Help to compensate for the sizeable gap between the high demand for and meagre supply of licensed practitioners
    – Quality of care is a concern, but studies have found few differences in effectiveness between experienced and novice therapists
  • Professionals can operate within the system and choose more effective, evidence-based treatments
    – Adhere to ethical guidelines
81
Q

Effective Therapists

A
  • Warm and direct
  • Establish a positive working relationship
  • Tend not to contradict clients
  • Select important topics to focus on in session
  • Match treatments to needs of clients
    – The choice of therapists is every bit as important as the choice of
    therapy
82
Q

Insight Therapies

A
  • Insight therapies: psychotherapies where the goal is to expand awareness or insight
  • Includes psychodynamic, humanistic, and group approaches
83
Q

Psychodynamic Therapy

A
  • Psychodynamic therapies refer to treatments inspired by classical psychoanalysis and influenced by Freud’s techniques
  • Share the following approaches and beliefs:
    1. The causes of abnormal behaviours stem from traumatic or other adverse childhood experiences (ACEs)
    2. Analyze avoided thoughts and feelings, wishes and fantasies, and significant past events
    3. When clients achieve insight into unconscious material, the causes and significance of symptoms become evident
    4. This insight then often causes symptoms to disappear
84
Q

Psychoanalysis

A
  • Developed by Freud, one of the first forms of therapy
  • Goal is to decrease guilt and frustration and make the unconscious conscious
  • Try to bring to awareness previously repressed impulses, conflicts, and memories, which cause psychological distress
85
Q

Psychoanalytic Approaches

A
  • Key Approaches:
    1. Free association: patients express themselves without censorship
    2. Interpretation: forming and sharing hypotheses regarding the origin of the patient’s difficulties
    3. Dream analysis: therapist interprets the dream’s symbolic significance
    4. Resistance: attempts to avoid confrontation and anxiety associated with uncovering previously repressed thoughts, emotions, impulses
    – Therapists minimize resistance by making patients aware they’re unconsciously obstructing therapeutic efforts
    5. Transference: projecting intense, unrealistic feelings and expectations from the past onto the therapist
    6. Work through is the last stage where patients confront and resolve problems, conflicts, and ineffective coping responses in everyday life
86
Q

Freudian vs. Neo-Freudian approaches

A
  • Neo-Freudians are more concerned with conscious aspects of the client’s functioning
  • Emphasize the impact of cultural and interpersonal influences on behaviour
  • More positive, emphasize needs for power, love, status (not just sex and aggression)
  • More optimistic regarding health prospects
  • Henry Stack Sullivan’s influence:
    – The analyst’s proper role is that of participant observer
    ▪ Through the therapist’s ongoing observations, the analyst discovers and communicates to clients their unrealistic attitudes and behaviours in everyday life
    – Interpersonal therapy (IPT): treatment that strengthens social skills and targets interpersonal problems, conflicts, and life transitions
    ▪ Short term (12-16 sessions), originally developed for depression
    ▪ Also effective at treatment of substance abuse and eating disorders
87
Q

Criticisms of Psychodynamic Therapies

A
  • Research shows that insight is not necessary to relieve distress
  • Many concepts are difficult to falsify (non-scientific)
  • Research shows no evidence for repressing hurtful memories
    – Disturbing events are more memorable and less subject to forgetting
88
Q

Psychodynamic Therapies Evaluated Scientifically

A
  • Many are questionable from a scientific standpoint, difficult to research
    – Freud’s research was highly flawed
  • Still, brief psychodynamic therapy is better than no treatment, for issues just as depression, substance abuse, & eating disorders
    – But less effective than cognitive-behavioural methods
  • Not effective for psychotic disorders (e.g., schizophrenia)
89
Q

Humanistic Psychotherapy

A
  • Humanistic therapies emphasize:
    – Development of human potential
    – Belief that human nature is basically positive
  • Reject interpretive techniques of psychoanalysis
  • Strive to understand clients’ inner worlds through empathy and focus on clients’ thoughts and feelings in the present moment
  • Stress importance of assuming responsibility for our lives and living in the present
90
Q

Humanistic therapies (Person-Centered)

A
  • Carl Rogers’ person-centred therapy centers on the client’s goals and ways of solving problems (therapist doesn’t tell patients how to solve
    their problems)
  • To ensure positive outcome, therapist must
    – Be authentic and genuine
    – Express unconditional positive regard
    – Show emphatic understanding
  • Tries to increase awareness and heightened self-acceptance
  • This is intended to cause people to
    – Think more realistically
    – Become more tolerant of others
    – Engage in more adaptive behaviours
91
Q

Humanistic therapies (Gestalt Therapies)

A
  • Gestalt (configuration) = organized whole
  • Gestalt therapists believe that people with psychological difficulties are “incomplete gestalts” – they’ve excluded from their awareness experiences and aspects of their personalities that trigger anxiety
  • Gestalt therapy aims to integrate differing and sometimes opposing aspects of our personality into a unified sense of self
  • Keys to personal growth: – Becoming aware of and accepting responsibility for one’s feelings
    – Maintaining contact with the here and now (remain present, not focused on the past)
  • Utilizes two-chair technique
92
Q

Humanistic Therapies Evaluated

A
  • Refers to therapies that treat more than one person at a time
  • Range from 3-20 people, can be efficient, time-saving, and less costly than individual therapies
  • Effective for a wide range of problems and about as helpful as individual treatments
93
Q

Self-help Groups

A
  • Self-help groups are composed of peers who share a similar problem; often they don’t include a professional mental illness specialist
    – Have become very popular and widespread
  • Alcoholics Anonymous (AA)
    – The largest organization for treating alcoholics, with more than 1.7 million members worldwide
    – Argues that total abstinence is required for recovery
    – Based on “12 Steps” method, but there is little research demonstrating its effectiveness
94
Q

Group Therapies (Self-help groups like AA)

A
  • Behavioural view of alcoholism: excessive drinking is a learned behaviour that therapists can modify/control without total abstinence
    – Programs that teach people skills to cope with stressful life circumstances and tolerate negative emotions are at least as effective as programs like AA
  • Controlled drinking programs encourage people to set limits and drink moderately
    – Can be effective for many people
    – Relapse prevention treatment assumes people will “slip up” and plans accordingly (lapse does not equal total relapse)
95
Q

Group Therapies (Family Therapies)

A
  • Family therapists see most psychological problems as rooted in a dysfunctional family system
  • The “patient” is the whole family system, not one individual
  • Focus on interactions among family members
  • Strategic family interventions are designed to remove barriers to effective communication
    – E.g., scapegoating one family member as the one with problem, when the real difficulties lie within the dysfunctional ways of the family
    – Identify the family’s unhealthy communication patterns and unsuccessful approaches to problem solving
    – Invite family members to carry out planned tasks (directives)
  • Structural family therapy has the therapist immerse themselves in the family to make changes
  • Both are more effective than no treatment and at least as effective as individual therapy
96
Q

Behavioral Approaches

A
  • Behaviour therapists focus on specific problem behaviours and variables that maintain them
  • Assume that behaviour change results from the operation of basic principles of learning
    – Classical conditioning
    – Operant conditioning
    – Observational learning
  • Behavioural therapists seek to:
    – Pinpoint environmental causes of the person’s
    problem
    – Establish specific and measurable treatment goal
    – Devise therapeutic procedure
  • Progress is evaluated based on whether there is
    measurable improvement in target behaviours
97
Q

Exposure Therapies

A
  • Exposure therapy: aims to reduce a fear by exposing the patient to that fear
  • Earliest was systematic desensitization, which gradually exposes clients to anxiety-producing situations through imagined scenes
    – Patients are taught to relax as they are gradually exposed in a stepwise manner to what they fear
    – developed by Joseph Wolpe in 1958
98
Q

Systematic Desensitization

A
  • Based on principle of reciprocal inhibition – the idea that patients can’t experience two conflicting responses simultaneously (e.g., we can’t be
    anxious and relaxed at the same time)
  • Uses counter conditioning by repeatedly pairing an incompatible relaxation response with anxiety
  • Desensitization can be imagined, or it may occur in vivo (in real life)
  • Effective for a wide range of phobias, anxiety, and some cases of problematic substance use
  • Behavioural therapists strive to discover not only what works, but why
  • Can evaluate many therapeutic procedures by isolating the effects of each component and comparing these effects with that of the full
    treatment package (dismantling)
    – Helps rule-out rival hypotheses about the effective mechanisms of various treatments
99
Q

Dismantling research

A
  • Dismantling research showed that no single component of systematic desensitization was essential
  • Led to development of exposure with response prevention therapies like flooding
    – Flooding therapists jump right to the top of the anxiety hierarchy and expose patients to images of the stimuli they fear the most for prolonged
    periods, while therapists prevent patients from performing their typical avoidance behaviours (called response/ritual prevention)
  • Very effective for many anxiety disorders, like phobias, OCD, social phobia, and PTSD
100
Q

Modelling in Therapy

A
  • Participant modelling has the therapist:
    – Model a calm encounter with the client’s feared object or situation
    – Guide the client through the steps of the encounter until she can cope unassisted
  • Used in assertion and social skills training along with behavioural rehearsal
    – Assertion training: therapists teach clients to avoid extreme reactions to others’ unreasonable demands (e.g., submissiveness or aggression)
    – Behavioural rehearsal: patient engages in role-playing with a therapist to learn and practice new skills
101
Q

Operant & Classical Conditioning Procedures

A
  • Token economies reward clients for desirable
    behaviours with tokens to exchange for items
  • Aversion therapies: use punishment to
    decrease the frequency of undesirable behaviours
    – Mixed support (e.g., Antabuse and alcohol)
102
Q

Cognitive-Behavioural Therapies

A
  • Cognitive behavioural therapies (CBT): treatment that attempts to replace maladaptive or irrational cognitions and behaviours with more adaptive, rational ones.
  • Three core assumptions
    1. Cognitions are identifiable and measurable
    2. Cognitions are key in both healthy and unhealthy psychological functioning
    3. Irrational beliefs or thinking can be replaced by more rational and adaptive cognitions
  • The most popular theoretical orientation in Canada
103
Q

Rational Emotive Behaviour Therapy (REBT)

A
  • Developed by Albert Ellis starting in 1950s
    – Argued that we respond to an event with a range of emotional and behavioural consequences
    – The crucial difference in how we respond to the same objective events depends on our belief systems
    ▪ Some are rational and promote self-acceptance and others are irrational and are associated with unrealistic demands
  • REBT emphasizes changing how we think, but also how we act
  • How we feel about the consequences of an event is determined by our beliefs or opinions
  • Our vulnerability to psychological disturbance is a product of the frequency and strength of our irrational beliefs
  • To the ABC, Ellis added D (dispute the beliefs) and E (adopt more effective ones)
    Activating event
    Beliefs
    Consequences
    Dispute the beliefs
    Adopt more Effective ones
104
Q

Other CBT Approaches

A
  • CBT therapists differ in the extent to which they incorporate behavioural methods
  • Cognitive therapy developed by Aaron Beck
    – Focuses on identifying and then modifying distorted thoughts and longheld core beliefs
    – Works best with depression, evidence for bipolar disorder and schizophrenia
105
Q

Third Wave of CBT

A
  • After behavioural (1st wave) and cognitive (2nd wave), 3rd wave CBT therapies focus on acceptance
    – Consistent with this goal, research suggests that avoiding and suppressing disturbing experiences, instead of accepting or confronting them, often
    backfires, creating even greater emotional turmoil
  • Highly eclectic
    – Acceptance and Commitment Therapy
    – Dialectical Behaviour Therapy
  • More research needed to determine whether these are superior to accepted CBT methods
106
Q

CBT Evaluated Scientifically

A
  • More effective than no or placebo treatment
  • At least as effective, and in some cases more effective than psychodynamic and humanistic therapies
  • At least as effective as drug therapies for depression
  • In general, CBT and BT are about equally effective for most problems
  • Third wave approaches are successful in treating a variety of disorders, including depression and alcoholism, but more research needed to determine whether these are superior to accepted CBT methods
  • Can be combined effectively with other forms of treatment
107
Q

Is Psychotherapy Effective?

A
  • Prior to 1970s, considerable
    controversy on it – Argued that all therapies
    appeared to be helpful but are roughly equivalent in their outcomes
  • Meta-analysis studies proved that therapy does work in alleviating human suffering
108
Q

Are all therapies equally effective?
* Specific vs. nonspecific factors

A
  • Behavioural, psychodynamic, and person-centered approaches shown to be more successful than no treatment, but no different from each other in their effect
  • But there are clear cut exceptions, like
    – BT and CBT best for childhood and adolescent behaviour problems
    – BT and CBT best for anxiety disorders
  • Some therapies may actually be harmful
109
Q

Some Potentially Harmful Therapies

A
  • Facilitated communication (autism “treatment” discussed earlier in the term)
  • Scared Straight Programs
  • Crisis debriefing
  • DARE programs (Drug Abuse Resistance Education)
  • Coercive restraint therapies
  • Self-help book industry
110
Q

Common Factors

A
  • Many therapies may be comparable due to nonspecific factors that are common across therapies
    – e.g., empathetic listening, instilling hope, etc.
    – Essential components for instilling in clients the motivation to change (not just a placebo effect)
  • Specific factors are those that characterize only certain therapies
    – e.g., exposure, challenging irrational beliefs, social skills training
  • Most agree that both matter, but are divided over the degree of each
111
Q

Empirically Supported Therapies

A
  • Scientist-practitioner gap: sharp divide between psychologists who view psychotherapy as more an art than a science and those who believe clinical practice should reflect well-replicated scientific findings
  • Empirically supported therapies (ESTs): interventions for specific disorders supported by high-quality scientific evidence
    – BT, CBT, acceptance, and interpersonal therapies have emerged as ESTs
    – If a treatment is not on the list of ESTs that does not necessarily mean it isn’t effective!
  • Concept of ESTs is controversial
    – Underdeveloped research to determine superiority for many treatments
  • However, practitioners have an ethical obligation to rely on ESTs unless there’s a compelling reason not to
112
Q

Fooled by Ineffective Therapies

A
  • 5 reasons why bogus therapies can gain a dedicated public following:
    1. Spontaneous remission
    2. Placebo effect
    3. Self-serving biases:
    ▪ e.g., convincing yourself/others that you are improving because you spent so much time and money on a treatment
    4. Regression to the mean:
    ▪ Extreme scores statistically more likely to be less extreme when retested
    5. Retrospective rewriting of the past:
    ▪ Misremembering pre-treatment condition as worse than it truly was
113
Q

Biomedical Treatments

A
  • Attempt to directly alter the brain’s chemistry or physiology to treat psychological disorders
  • Psychopharmacotherapy – use of medications to treat psychological problems
    – Most common biomedical treatment today
    – Began with use of thorazine to treat schizophrenia in 1954
    – Today, almost 15% of the population are on antidepressants
114
Q

psychopharmacotherapy

A
  • Today, medications are available to treat most psychological disorders
  • Antianxiety, antidepressants, mood stabilizers, antipsychotics, psychostimulants
  • Unfortunately, we don’t know exactly why most of these work
  • Many medications may exert their effects largely by affecting the sensitivity of receptors rather than the levels of neurotransmitters
    – But there’s no scientific evidence for an “optimal” level of dopamine, serotonin or other neurotransmitters in the brain
115
Q

Cautions to Consider (psychopharmacotherapy)

A
  • Most meds have numerous side effects that need to be weighed
  • Most dissipate after discontinuing the drug, but not all
    – A serious side effect of some antipsychotic medications includes tardive dyskinesia (involuntary movements of the facial muscles and
    mouth and twitching of the neck, arms, and legs)
  • One dose doesn’t “fit all”
    – Weight, age, and even racial differences often affect drug response
    – Physicians try to determine the lowest dose possible to achieve positive results and minimize unpleasant side effects
  • Questions about efficacy and safety of SSRIs, particularly among children and adolescents
    – Risk of suicidal thoughts (though not completed suicide)
  • Overprescription is also a concern for many, especially of psychostimulants for ADHD
  • Polypharmacy: prescribing many medications at the same
    – Can be hazardous due to potential interaction effects
  • Pharmacotherapy is not a cure-all
116
Q

Evaluating Psychopharmacotherapy

A
  • In many cases, therapy alone can produce as great or better benefits for many disorders as Psychopharmacotherapy
    – CBT is at least as effective as antidepressants, even for severe depression, and perhaps more effective than antidepressants in preventing relapse
    – Psychotherapy alone is also effective for a variety of anxiety disorders, dysthymia, bulimia, and insomnia
  • Clear advantages to combining meds and therapy when
    – Symptoms interfere greatly with functioning
    – Therapy alone hasn’t worked for a 2 month period
117
Q

Electrical Stimulation
* Electroconvulsive therapy
* Misconceptions

A
  • Electroconvulsive therapy (ECT) involves patients receiving brief electrical pulses to the brain that produce a seizure
    – Used to treat severe problems (intractable depression, schizophrenia) as a last resort
    – 6-10 treatments given three times a week
  • Misconceptions about ECT: false beliefs that ECT is painful or dangerous and that it invariably produces long-term memory loss,
    personality changes, and even brain damage
    – These are not true
118
Q

Electrical stimulation
* Risks and potential outcomes

A
  • Most who undergo ECT would do so again, and report improvements
    – However, even if patients report feeling better after ECT, they don’t always show evidence of parallel changes on objective measures of
    depression and mental functioning
  • Must weigh benefits against potential adverse effects
    – Over 50% relapse in six months
    – Short-term confusion and clouded memory (but generally subsides within a few weeks
119
Q

Psychosurgery

A
  • Brain surgery to treat psychological disorders, like prefrontal lobotomies
  • Used today as an absolute last resort with a handful of conditions
    – Severe OCD, depression, bipolar disorders
  • To most critics, the benefits of psychosurgery rarely, if ever, outweighed the costs of impairing memory, diminishing emotion and creativity, and
    the general risks of brain surgery
  • Institutional review boards (IRBs) must approve each operation
  • Brain surgery to treat psychological disorders, like prefrontal lobotomies
  • Used today as an absolute last resort with a handful of conditions
    – Severe OCD, depression, bipolar disorders
  • To most critics, the benefits of psychosurgery rarely, if ever, outweighed the costs of impairing memory, diminishing emotion and creativity, and
    the general risks of brain surgery
  • Institutional review boards (IRBs) must approve each operation