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A historical procedure in which a section of the skull is removed to allow spirits to flee the body



The study of environmental modification of gene expression rather than alteration of the gene itself



How past vulnerabilities interact w/ current environmental pressures to produce psychopathology



The presence of two or more disorders co-occurring in the same person



Saying whatever comes to mind without censoring thoughts in order to know unconscious material

-Free Association


When a client reacts to the therapist as if he or she is an important figure from childhood



Evaluating the antecedents and consequences of a behavior to help modify problematic behavior

-Functional Analysis


The ability to endure or overcome difficulties in living



A cluster of behavioral, emotional, and/or cognitive symptoms



An experiment that involves pre-determined groups, such as gender or those with vs. without a DO



The extent to which the results of a study can be generalized to people who were not in the study

-External Validity


The ability of a diagnostic instrument to get the same result with repeated use



A study where participants and experimenters do not know who is in which comparison group

-Double-Blind Design


A common finding that all therapy techniques are equally effective

-Dodo Bird Effect


A perspective that therapies are equally effective because therapists & clients try things until they work

-Goldilocks Effect


4 D’s of Abnormal Behavior





-Don’t need all four to be diagnosed, but having majority is seeked

-All four exist on a spectrum



-Occurs infrequently in person’s culture



-Interferes with person’s ability to maintain:
-Relationships (get with and hold friends, romantic partners, family)
-Jobs (get a job, hold it, keep it)
-Life (hygiene, finances, cook for yourself)



-Physically harmful to the person or others



-Causes the person or others psychological pain
-Required for all disorders
-For most, causes the person themselves pain, not others


4 Ancient Humours

-1. Blood:
-Ancient name: Sanguine
-Characteristics: Courageous, hopeful, amorous
-Ex: Picture of two people really close

-2. Yellow Bile:
-Ancient name: Choleric
-Characteristics: Easily angered, bad tempered
-Ex: Picture of domestic violence

-3. Black Bile:
-Ancient name: Melancholic
-Characteristics: Despondent, sleepless, irritable
-Ex: Picture of sleeping person

-4. Phlegm:
-Ancient name: Phlegmatic
-Characteristics: Calm, unemotional
-Ex: Picture of person playing music


Views and treatments for psychopathology from the Stone Age

-Where the work of evil spirits began

-(1) Trephination - a spirit has become trapped inside of you, and you need to release it; boring hold into skull to release it (ex: roll down windows top hope wasp flies out)

-(2) Exorcism - ritualistic set of behaviors (particular steps) that are meant to allow you to connect with spiritual world
-Anneliese Michel (1975) (today would probably be diagnosed with encephalitis and schizophrenia)

-Abnormal behavior as “the birth of a healer”
-Depression, bipolar, schizophrenia, OCD


Views and treatments for psychopathology from Ancient Greece/Romans

-500 B.C. to 500 A.D.

-Hippocrates → illness had natural causes
-Imbalance of the four fluids, or humours
-Must “rebalance” humours


Views and treatments for psychopathology from the Middle Ages

-500-1350 A.D.

-Church rejects scientific forms of investigation

-Abnormality is the conflict between good and evil
-Abnormal behavior increases
-Mass madness common, e.g,.
-(1) Tarantism (dancing uncontrollably due to spider bite)
-(2) Lycanthropy (people think they become an animal, like werewolves; people think they have it; animal part has overcome you)
-Revival of demonological treatments (things like exorcism, torture, to make the body too uncomfortable for the demon to possess)


Views and treatments for psychopathology from the Renaissance

-1400-170 A.D.

-Religious shrines devoted to humane and loving treatment

-Physician Johann Weyer
-Mine was susceptible to sickness, like the body

-Rise of asylums to care for mentally ill

-Why do asylums fail?
-Economic downturn in society → decline in facility funding → decline in recovery rates and increase in admittance rates → facility overcrowding → enhanced prejudice against facility patients


What is moral treatment? How did it differ from earlier asylum conditions? What time period was it emphasized in?

-Moral Treatment: Care that emphasized moral guidance and humane and respectful techniques

-Difference between asylums and moral treatment: ?

-Emphasized in 19th century


What is mass madness? When was it most common?

-Groups of individuals afflicted at the same time with the same disorder or abnormal behaviors

-Includes tarantism and lycanthropy

-Most common when high levels of fear and panic exist, believing they're "taken over"; eating substances such as fungi on food that led to odd beliefs and visions; during last half of Middle Ages


What is Tarantism and Lycanthropy?

-Tarantism: dancing uncontrollably due to spider bite; individuals became victims of a tarantula’s “spirit” after being bitten

-Lycanthropy: people think they become an animal, like werewolves; people think they have it; animal part has overcome you; belief that a person has been transformed into a demonic animal, such as a werewolf


Two competing perspectives on psychopathology in the early 20th century?

-(1) Somatogenic Perspective
-Abnormal functioning has PHYSICAL causes
-Untreated syphilis leads to general paresis
-Kraepelin - 2 forms of mental illness:
-Manic Depression (today, bipolar disorder)
-Dementia Praecox (today, schizophrenia)

-(2) Psychogenic Perspective
-Abnormal functioning has PSYCHOLOGICAL causes
-Mesmer → hypnosis
-Freud → the talking cure, outpatient


Important people to know?


-Philippe Pinel

-Dorothea Dix



Hippocrates - Contributions?

-Said illness had NATURAL causes

-He came up with the 4 humours
-Said illness was imbalance of the 4 fluids, or humours
-Must “rebalance” humours


Philippe Pinel - Contributions?


-Said instead of just giving them basic needs, he said we need to interact with them as human beings, show them care, and they’ll get better; give them tasks; moral treatment

-Worked with Tuke (England) who had friends die with mental illness; said they should open their own moral treatment place


Dorothea Dix - Contributions?

-Boston school teacher; nurse

-Advocated for treatment centers for mental illness, for state mental hospitals; used her connections and was influential


Kraepelin - Contribution?

-Said fatigue causes mental dysfunction

-Said there were 2 forms of mental illness
-(1) Manic Depression (today, bipolar disorder)
-(2) Dementia Praecox (today, schizophrenia)

-Termed “syndrome” - Said we’re gonna know a disorder not by common symptoms, but common patterns of symptoms


According to Freud, what is fixation? How does it help explain psychopathology?

-The failure to “pass” developmental stage

-Stuck in that psychosexual stage, then causes problems in life adaptation
-Oral (0-1) - mouth: biting, sucking, eating, chewing; psychopathology = addictions
-Anal (1-3) - holding and witholing feces; psychopathology = control, OCD
-Phallic (3-6) - primary sex organs, oedipus/electra complex; psychopathology = deviance, sexual dysfunction


According to Freud, what are the 3 core parts of the mind? What guides them?

-Guided by the Pleasure Principle → What you want to do (instincts)
-Creates (ex: kid likes to build legos)
-Destroys (ex: kid likes to destroy legos)

-Guided by the Reality Principle → What you can do (reality)
-Compromises (how can I get what I want and still be good)

-Guided by the Morality Principle → What you shouldn’t do (morality)
-Punishes (when doing bad things, or even thinking it)

-Unconscious nature is big part


Defense Mechanisms?

-Respression: (a.k.a. denial) push desire out of awareness (“I’m not drunk”)

-Projection: blame another person for having desire (“You’re hungover”)

-Displacement: redirect desire to appropriate object (boss calls me out, and I’m mad and want to yell at her but can’t. Go home and yell at husband.)

-Reaction Formation: behave opposite of desire (“I feel awesome”’ ex: want to stab boss, but at Christmas, buy them an iPhone)

-Ex: For all, except displacement: Have fun night, get really drunk, and are hungover the next day.


What are the 4 steps common to many psychodynamic therapies?

-(1) Use of projective techniques to learn unconscious drives
-Free association

-(2) Therapist’s interpretation of the meaning of your actions/struggles

-(3) Working through resistance

-(4) Catharsis of internal conflict

-Goal: Understand and accept unconscious conflicts and defense mechanisms at play


Which model informed the first DSM?

-Psychodynamic Model
-1st and second


Which model increasingly informs the DSM now?

-Biological model; a medical perspective


From the biological model, problems in what 3 aspects of the body produce psychopathology?

-(1) Brain anatomy

-(2) Brain chemistry

-(3) Genes


Core functions of left and right hemisphere?

-Left: language, analytic thinking, details

-Right: influenced by emotion, intuition, the big picture


Core functions cerebral cortex?




Core functions frontal lobe?

-Planning, organization, decision making


Core functions of forebrain?

-Limbic system → Regulation
-Hippocampus: memory
-Amygdala: emotion


How does the brain’s structure differ in terms of complexity and adaptability?

-Brain becomes more complicated from inner to outer
-Subcortical = less complex
-Cortex = more complex



What is the difference between genotype and phenotype? How do methyl and histones modify gene expression?

-Genotype: Your inherited genetic composition (can live in you, but can be dormant)

-Phenotype: How your genotype is expressed/activated

-Methyl: ON/OFF Gene switch - Determines which genes turn on and off (Is it built or torn down?)

-Histones: Dimension/Volume - Determines how much of the gene is expressed (How big is it built?)


4 Types of Distorted Thinking?

-(1) Ellis’s Rational Restructuring
-Interpretation of event’s meaning causes distress -- not the event itself (the belief causes the emotion, not the event that actually caused the emotion)

-(2) Beck’s Depression Therapy
-Challenge thoughts
-(1) Self: I am worthless
-(2) Future: I never will be good
-(3) World: Everyone hates me
-Ex: I’m bad, it’ll always be that way, and everyone knows about it
-Assertiveness training (ex: Yeah, I’m bad, but it won’t always be that way)

-(3) Systematic Desensitization
-(1) Learn relaxation skills
-(2) Construct a fear hierarchy
-(3) Confront feared situation

-(4) Token Economy
-Positive reinforcement for desired change in behavior (reward them for good behavior)


What are the 3 areas of distorted thinking for Beck?

-Beck’s Depression Therapy
-Challenge thoughts
-(1) Self: I am worthless
-(2) Future: I never will be good
-(3) World: Everyone hates me
-Assertiveness training


Roger’s therapy is called _____? How are conditions of worth problematic? What are 3 components of a supportive climate?

-Client-centered therapy

-Conditions of worth are problematic because they create anxiety and depression; health depends on unconditional positive regard
-I’m good IF I do or am “X”... (people think they’re only good IF…; Rogers tries to get rid of this

-3 components of a supportive climate:
-(1) Unconditional positive regard
-(2) Accurate empathy
-(3) Genuineness

-”The good life is a process, not a state of being. It is a direction, not a destination.”

-Cycle: Increased self-awareness → increased self-acceptance → increased self-expression → reduced defensiveness → increased openness


T. Szasz’ critique of abnormality?

-Psychological disorders are a way society enforces cultural norms and maintains existing distribution of power


From the sociocultural model, psychopathology is often caused by ____ and ____.

-Prejudice and discrimination
-Lack of power, choice, material resources
-Traditional therapies often LESS effective for underrepresented groups
-Culturally sensitive therapies
-Consciousness raising


What are the 2 dimensions of the family circumplex that help explain psychopathology?

-(1) Enmeshed-Disengaged
-Enmeshed = know too much
-Disengaged = don’t know much

-(2) Rigid-Chaotic
-Rigid = specific rules that need to be followed
-Chaos = no structure

-Family circumplex helps make up family system? (Abnormal family functioning leads to abnormal behavior)


What is triangulation?

-Avoid talking one-on-one

-Team up against one another

-Triangulation helps make up family system? (Abnormal family functioning leads to abnormal behavior)


With respect to the models, which are deterministic? Which emphasize free will? Which have strong research report?

-Deterministic Models:

-Emphasize Free Will:
-Humanistic-Existential Model

-Strong Research Report:
-Biological Model


What is the median age of onset for DOs? How does the age of onset of anxiety and depression differ?

-Median age onset = 14

-Age of onset for anxiety = 11

-Age of onset for depression (mood DOs) = 30

-Scientists propose anxiety and mood DOs are not separate; being so anxious wears down the body and mind, and when older, person can no longer hold it under control, which turns into depression (mood DO)

-Anxiety leads to depression


Based on the lecture, anxiety is especially comorbid with what two DOs?

-Anxiety and depression

-Anxiety and bipolar

-Anxiety and substance use (?)


What is substance use comorbid with?

-Almost everything else


When people have comorbid DOs, the DOs tend to be ____ in severity and more ____ to treat.

-Higher rates of severity

-Lower rates of recovery; difficult to treat?


Common risk factors?

-Risk factors: characteristics (personal or environmental) that precede the development of a disorder

-Fixed: (mostly) assigned at birth
-(1) Gender (for most disorders, women at greater risk)

-(2) Race and Ethnicity

-(3) Neuroticism (strongly, genetically informed)

-Dynamic: (can change over time)
-(4) Age (if not diagnosed with ADHD by age 40, probably don’t have it)

-(5) Socioeconomic Status (SES) (lower economic status = higher risk)

-(6) Quality and Quantity of Social Relationships (few people in life and low support quality = higher risk factor)

-(7) Locus of Control (what happened to you and how you influenced it; internal: I control my destiny; external: they control my destiny; if you have an external locus of control = higher risk)

-(8) Childhood Trauma


What are the 3 types of ACEs? How are they related to having a DO?

-ACE = Adverse Childhood Experiences

-(1) Abuse: emotional, physical, and sexual
-(2) Neglect: emotional and physical
-(3) Household Dysfunction: mental disorder, incarceration, divorce, and substance use (other family members in household did these things, not you)

-Environments of childhood trauma influence behavior and epigenetics


Common protective factors?

-Protective Factors: characteristics (personal or environmental) associated with lower rates of having a DO

-(1) Social Support (counter-example: co-rumination - talk with friend about how much life sucks, and they do the same)

-(2) Extraversion (counter-example: Narcissistic DO - people who are especially extraverted)

-(3) Financial Wealth (counter-example: Eating DOs - grow up with money, food is seen differently)

-(4) Intelligence (counter-example: bipolar DO - people who have manic episodes tend to be smarter; intelligence → greater sense of yourself, discern something is wrong sooner, and get help sooner)

-(5) Hardiness → i.e., transformational coping - if someone breaks up with me, I could think negatively OR be like “Now, I get to ask out this other person I’ve liked for a while”

-(6) U.S. Cultural Power Groups → e.g., being male and white


Civil Commitment

-No crime, but found unstable

-A danger to oneself/others

-Forced to receive treatment in mental institution


Criminal Commitment

-Charged with a crime and found to be unstable

-Forced to receive treatment in mental institution


Not Guilty by Reason of Insanity

-Mentally unstable at time of crime

-M’Naghten rule: mental disorder prevented person from knowing right from wrong

-Guilty by Mentally Ill: Acknowledgement that mental disorder was involved, but you are still responsible for actions


Mentally Incompetent

-Mentally unstable at time of trial

-Person does not understand charges and is unable to help lawyers prepare defense

-Forced to receive treatment in mental institution until capable of standing trial


Therapeutic ethics of dual relationships, sexual relationships, and maintaining and breaking confidentiality?

-Dual Relationships - Must avoid dual relationships
-Cannot be therapist and friend, business partner, lover, etc.
-(Discussion of sexual relationships discussed right below)

-Sexual Relationships - No sexual relationship until 2 years after therapy ends (if a person calls you to ask you to be their therapist, you set an appointment, and they never show up, then the two year mark starts the day they called you

-Maintaining and Breaking Confidentiality: Must adhere to confidentiality (HIPPA)
-Who is the client?
-Legal obligation to inform when danger to self or others
-Can’t tell law officers about things done in the past (ex: killed someone), but yes, if the patient talks about doing it in future (ex: they are planning to kill someone)


The Two Types of Clinical Interviews

-1. Unstructured:
-Open-ended questions
-Tailored to the client
-Unreliable (no way to compare clients because its tailored around client)

-2. Structured
-Protocol instructions in the If-then format
-Same for all clients
-E.g. Structured clinical interview for DSM
-1-2 hours
-Enhanced reliability


3 Types of Clinical Observations

-Systematic Observations of Behavior:
-(1) Naturalistic: e.g., at home, school, job
-(2) Controlled: e.g., in therapy room, experiment
-(3) Self-Monitoring: e.g., mood and behavior ratings throughout day


How do projective tests work? What are the common tests reviewed in lecture?

-Ambiguous stimuli evokes unconscious
-Developed from psychodynamic approach
-Overall, poor reliability and validity for clinical use (can’t be reliable if two different researchers come up with different answers/conclusions)
-Excellent when used as ice breakers to generate conversation

-Ex: Rorschach inkblot
-Location: What part of image (blank space, whole image, detail of image) that the interpretation comes from
-Determinants: What aspect of the image (color, texture) that the interpretation focuses on
-Content: The interpretation itself

-Other Examples?:
-Thematic Apperception Test (TAT) - Images we looked at and analyzed in class
-Sentence Completion - “I wish ____________”
-Draw a Person (DAP)
-Placement of Figure:
-Right = future; left = past
-Lower left = depression; upper right = suppress past
-Big head = desire to be smart
-Large eyes or ears = paranoid
-Missing parts = identity confusion
-Legs and Feet
-Confidence vs. insecurity
-Younger = infantilism


MMPI-2. - What two types of scales are measured? How are the results typically presented and assessed?

-Personality Clinical Test

-Minnesota Multiphasic Personality Inventory

-550 self-statements: “true,” “false,” or “cannot say”

-Two types of scales:
-(1) Self-Report
-Physical concerns
-Attitudes toward religion, sex, and social activities
-Psychological symptoms
-(2) Behavior (Do you respond consistently?)
-Careless responding
-Lying, manipulation

-Score range from 0 to 120 for ten scales
-Above 70 = of concern
-Graphed to create a “profile"


What are the common psychophysiological tests? How do they help assess psychopathology?

-Physiological response as a sign of stress/anxiety
-Electrocardiogram → heart rate
-Galvanic Skin Conductance → sweat gland activity
-Electroencephalogram (EEG) → brain electrical activity
-Polygraph (lie detector) - no longer used in court because people likely to commit crimes, pass them, and regular people who wouldn’t are so nervous that they don’t pass


What are the 4 common neuroimaging tests?

-(1) Computerized Axial Tomography (CT)
-Uses x-rays to identify structural abnormalities; uses iodine
-Can detect brain tumors and other abnormalities (enlarged ventricles; hollow spaces, which is related to schizophrenia)

-(2) Magnetic Resonance Imaging (MRI)
-Can produce high-resolution images of brain structure
-Can detect tumors, blood clots, and other abnormalities
-Uses big cylindrical magnet

-(3) Functional MRI (fMRI)
-Asses brain structure and function as well as metabolic changes
-Asses how brain is working

-(4) Positron Emission Tomography (PET)
-Invasive way to assess brain structure and functioning
-Can identify seizure activity and even brain sites activated by psychoactive drugs


What do you do in the Bender Visual-Motor Gestalt Test? What kind of test is it?

-To help assess people with ADHD
-Given sheet of paper with 9 images, given blank sheet and told to draw them. You get to see their hand-eye coordination. Bad at first, but see if after treatment, it gets better
-Tests immediate memory, spatial perception, and perceptual-motor coordination

-Neuropsychological Test


The most common way to assess overall functioning with the DSM-5? Areas of functioning it assesses?

-World h=Health Organization Disability Assessment Schedule (WHO-DAS 2.0)

-Areas of functioning:
-Cognition - understanding and communicating
-Mobility - moving and getting around
-Self-Care - hygiene, dressing, eating, and staying alone
-Getting Along - interacting with other people
-Life Activities - domestic responsibilities, leisure, work, and school
-Participation - joining in community activities


What are the core ways that diagnosing can cause harm?

-(1) Misdiagnosis
-Reliance on clinical judgement
-Ex: bipolar disorder sometimes gets misdiagnosed as schizophrenia

-(2) Labeling and Stigma
-Diagnosis may be a self-fulfilling prophecy


What are the 3 steps of systematic desensitization therapy? What model does it come from?

-Typically used to treat stress and phobia

-Traditional ERPT
-10-20 sessions
-(1) Learn relaxation skills
-(2) Construct a fear hierarchy
-(3) Confront feared situation

-Model: Cognitive Behavioral Model


The ABCDE’s of Ellis’ Rational Emotive Restructuring therapy. What model does it come from?

-Typically used to treat mood and anxiety issues

-Problem: ABCs:
-A = Activating Event - Fail Exam
-B = Distorted Belief - I’m stupid; I will fail this course
-C = Emotional Consequence of Belief - Depression
-Solution: DEs
-D = Dispute Belief - You can still pass this course; You are skilled, wise in other things
-E = Evaluate Emotional Consequences - Less depressed

-Model: Cognitive Behavioral Model


4 Common Factors of Treatment Effectiveness? Which 2 factors are most responsible for treatment effectiveness?

-(1) Extra Therapeutic Factors
-Client factors
-Illness course factors
-Social/cultural factors

-(2) Expectancy
-Client believes in therapy/therapist

-(3) Therapeutic Relationship
-Client-therapist alliance
-Empathy, positive regard (Rogers)

-(4) Technique
-Factors unique to approach

-2 Factors Most Responsible: Client factors (part of extra therapeutic factors) & Relationship factors (therapeutic relationship)


3 Things Therapists Can Do to Enhance the Effectiveness of Treatment?

-(1) Choose therapy that matches client’s theory of change
-Activates expectancy (placebo) effects

-(2) Invite and use extra-therapeutic factors
-Social support network, culture, motivation factors

-(3) Use active listening to build rapport and a supportive relationship
-(1) Paraphrase with attention to emotion
-(2) Don’t problem-solve soon
-(3) If disagree or disapprove of client, try to be non judgemental, be accepting, and respectful