Test 2 Flashcards
(96 cards)
1
Q
When false symptoms are reported for the purpose of material or other explicit benefit
A
-Malingering
2
Q
The reward associated with keeping internal conflicts out of conscious awareness
A
-Primary Gain
3
Q
The reward associated with avoiding unpleasant activities or receiving sympathy
A
-Secondary Gain
4
Q
Cultivating attention by paying attention on purpose on the present moment, nonjudgmentally
A
-Mindfulness
5
Q
How a drug’s result is enhanced or otherwise altered when you take multiple substances
A
-Synergistic Effects
6
Q
Resistance to a drug through continued use of another drug with similar pharmacological action
A
-Cross Tolerance
7
Q
Drugs that block the effects of a substance to help reduce dependence on that substance
A
-Antagonist Drug
8
Q
Feelings of discomfort, distress, and craving for a substance when use of the substance is stopped
A
-Withdrawal
9
Q
The phenomenon where women experience negative effects of substance use more rapidly than men
A
-Telescoping
10
Q
Systematic use of reinforcement in which a person is rewarded for adherence to treatment
A
-Contingency Management
11
Q
The perspective that people abuse drugs because their brains are less capable of producing pleasure from normative reward behaviors, such as eating and sex
A
-Reward-Deficiency Syndrome
12
Q
The perspective that a drug will stimulate neurobehavioral systems at a great intensity than in the past, providing increased pleasure from the use of the drug
A
-Incentive-Sensitization Theory
13
Q
The phenomenon where a person perceives a lack of control over receiving reinforcements
A
-Learned Helplessness
14
Q
The lack of pleasure or interest in doing life activities that is associated with severe depression
A
-Anhedonia
15
Q
The communication of psychological distress through physical symptoms
A
-Somatization
16
Q
General Anxiety - Identify and Distinguish Symptom Presentation Gist
A
- “Free-floating”anxiety
- Excessive anxiety & worry under most circumstances
- Difficult to control worry (a lot of disorders are going to be difficult to control)
- Significant distress (about 95% of disorders require distress)
- > 6 months (most disorders will have a time frame)
- 3 or more
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
- 3 or more
- Usually begins in childhood or adolescence
- A mental disorder marked by constant worry about nondangerous situations and physical symptoms of tension
- GAD caused by stimulus generalization
- Responses to one stimulus are also elicited by similar stimuli (ex: in car accident, scared of cars (phobia), but then realize cars are everywhere; afraid now of trucks, buses, etc; start walking to school, but then you see at school that there are cars at school too, and you start to fear school; just get scared of generally everything
Probably don’t need to know?
- Poverty (less resources, fewer healthcare, less control, less ability to protect ourselves)
- Higher crime rates
- Fewer educational and job opportunities
- Greater risk for health problems
- Gender:
- 2:1 ratio, women
- Comorbidity, women: depression (women more likely to be comorbid with internal disorder)
- Comorbidity, men: substance abuse (men more likely to be comorbid with external disorder)
- 20% of Americans suffer from anxiety disorders, compared to 14.4% of Austrailians
- Why? Different lifestyles; why epidemiology is important
17
Q
Specific Phobia - Identify and Distinguish Symptom Presentation Gist
A
- Persistent and unreasonable fears of particular objects, activities, or situations
- Object almost always produces immediate anxiety
- Avoid the object or thoughts about it
- Fear is out of proportion to actual danger
- Causes clinical distress
- Most common: specific animals or insects, heights, enclosed spaces, thunderstorms, and blood
- A mental disorder marked by panic attacks surrounding, and avoidance of, objects and situations other than those involving social interaction and/or performance of others
What causes specific phobias?
- First onset triggered by
- Experiencing trauma (bad, life threatening experiences with these objects)
- Direct observation of trauma (watch it or see somebody go through it and get hurt by objects)
- Media coverage of trauma
- Panic attacks (attack so distressful and don’t want that to happen again, you avoid objects that were around you when you had attack)
- Conditioning & Modeling
- Once fears are acquired → avoid object → fear enhanced & maintained
- GAD caused by stimulus generalization
- Responses to one stimulus are also elicited by similar stimuli (ex: in car accident, scared of cars (phobia), but then realize cars are everywhere; afraid now of trucks, buses, etc; start walking to school, but then you see at school that there are cars at school too, and you start to fear school; just get scared of generally everything
-“Preparedness”: an evolutionary explanation (we’re afraid of things that can potentially kill us/hurt us; biologically, genetically prepared to be afraid of certain things because they were dangerous in the past, they survived because of fear and avoidance of snakes; passed down to you; ex: grandma and grandpa afraid of snakes, avoided them, and survived to have kids, while other couple didn’t make it because not afraid and died by getting close to one)
18
Q
Social Anxiety - Identify and Distinguish Symptom Presentation Gist
A
- Fear about one or more social situations person is exposed to (person develops idea that something is wrong with them, like feeling unpopular, go into social encounter thinking that, heart rate goes up, sweating, go to encounter person/people, everyone is noticing everything that’s wrong with them, sweating even more, and after, think of all indicators that people were finding everything wrong with them, and this creates a horrible model for the next time)
- Fear you will show anxiety & be judged in social situations
- Social situations avoided or endured
- Fear out of proportion to threat
- > 6 months
- Clinical distress
- Often kept secret, highly disruptive
- 3:2, women; Poverty: 50% more likely
- Often begins in childhood
- Child: More fear, specific situations
- Adult: Less fear, broad situations
- Help by giving anti-anxiety medication and social skills training to help (need both, either one alone is not very helpful)
- A mental disorder marked by panic attacks in, and avoidance of, situations involving performance before others or possible negative evaluation
19
Q
Agoraphobia - Identify and Distinguish Symptom Presentation Gist
A
- Fear about 2 or more:
- Public transportation
- Open spaces
- Enclosed places
- Standing in line or crowd
- Begin outside of home alone
- Situations provoke fear
- Feared situations are avoided
- Fear is out of proportion to actual danger
- 6 months or more
- Clinically significant distress
- 2:1, women
- Usually begins late adolescence
- Often associated w/ Panic DO (fear of going back into specific environment)
- A mental disorder marked by avoidance of places in which one might have an embarrassing or intense panic
- Treatment
- Behavioral → Similar to Specific Phobias
- Drug Therapy → Similar to Panic Attacks
20
Q
Panic - Identify and Distinguish Symptom Presentation Gist
A
-Abrupt surge of intense fear
- 4 or more, e.g., (experienced intensely in the body; can look like a heart attack, stroke)
- Palpitations, pounding heart
- Sweating
- Trembling
- Shortness of breath, smothering
- Feelings of choking
- Chest pain
- Nausea
- Feeling dizzy, faint
- Chills, or heat
- Feeling loss of control or going crazy
- Fear of dying
- 1 month or more of one or both:
- Persistent worry about additional attacks or their consequences (worry)
- Maladaptive change in behavior due to attacks (avoidant behavior) (ex: somebody who went to their romantic partner’s parents’ house, has panic attack while there, and now, that person refuses to go back to partner’s parents’ house; can also be in places like work, which is really bad)
- 2:1, women
- Poverty → 50% more likely
- Usually begins late adolescence
- Only 1 of 3 seek treatment
- A mental disorder marked by ongoing and uncued panic attacks, worry about the consequences of these attacks, and, sometimes, agoraphobia
21
Q
Obsessive Compulsive - Identify and Distinguish Symptom Presentation Gist
A
- Obsessions
- Persistent thoughts, urges, or images that are intrusive (ex: thinking cousin is going to get killed, die if I don’t keep my house very clean by vacuuming 12 times a day) (impulsive thought?)
- Compulsions
- Repetitive behaviors or mental acts performed by rules (this is behavioral; repeated, ritualistic behaviors; set of behaviors done in specific order that helps reduce distress)
- Time consuming ( > 1 hour / day) or cause clinical distress
-Begins in adolescence / young adulthood, gradually worsens (7, 8, or 9, and slowly gets worse)
- Specify:
- With good or fair insight (understand something is wrong with cousin example)
- With poor insight (actually think your obsession is true with cousin example)
- With absent insight/delusional beliefs (psychotic belief that is not real in world)
- 1:1 gender
- Men > forbidden thoughts & order
- Women > cleaning
- Panic attacks and Suicidal thoughts common
- A mental disorder marked by ongoing obsessions and compulsions lasting more than 1 hour per day (obsessive-compulsive personality disorder = personality disorder marked by rigidity, perfectionism, and strong need for control)
Observations
- Take various forms
- Wishes
- Impulses
- Images
- Ideas
- Doubts
- Dirt/contamination
- Sexuality
- Violence
- Orderliness
- Religion
Compulsions
- Performing behaviors reduces anxiety
- ONLY FOR A SHORT TIME!
- Develop into rituals
- Cleaning
- Checking
- Order
- Counting, touching
- According to psychiatric perspective, doing cocaine vs. washing hands are different because they have different neurochemical response) (compulsion reduces cortisol, removing stress, while drugs add positive sensations, so not the same)
- OCD cycle: repetitive, unwanted, intrusive thoughts are actually NORMAL
- But, see them as dangerous
- Attempt to “neutralize”thoughts w/ actions
- People with OCD:
- High standards of conduct and morality
- Believe thoughts = to actions & can harm (people with OCD think things and view it equivalent to engaging in behavior)
- Ex: person feels happy and relieved when called down for dinner, they turn light switch off, but associate their happiness and relief with turning switch off, rather than being called down for dinner
22
Q
Hoarding - Identify and Distinguish Symptom Presentation Gist
A
- Persistent difficulty parting w/possessions, regardless of value
- Results in accumulation of possessions that congest and clutter active living areas
- People with money have even more possessions; they buy extra houses and hoard in there
- Specify
- With good or fair insight
- With poor insight
- With absent insight/delusional beliefs (insight = understand something is wrong; delusional = you think something bad will actually happen if you don’t do it)
- Begins middle adolescence, young adulthood
- Severity increases with age
- Inconsistent gender findings
- 3 of 4 comorbid with depression or anxiety
- Animal hoarding is worse! They create their own waste, have value, difficult to care for
- Poor Executive Control (executive functioning is very important; depending on level of executive control people develop as children can affect doing well in school, relationships, success; people with hoarding have poor external control)
- Diminished nonverbal attention
- Distract more easily (ex: to do well in class, have to focus, study, and know you have to avoid doing things you actually want to do for some time; hoarders have difficult time)
- Greater variability in reaction time
- Greater impulsivity (hoarders struggle with impulse control)
- Poor memory
- Poor decision making
- Abnormal Frontal Lobe functioning
- Orbitofrontal Cortex (overactivity)
- Ventromedial PFC
- Anterior cingulate cortex
23
Q
Body Dysmorphic - Identify and Distinguish Symptom Presentation Gist
A
- Preoccupation w/ one or more perceived defects in physical appearance (why not weight? Because when we find something wrong with weight, we express it through eating differently, and brain is affected)
- Repetitive behaviors/mental acts in response to appearance concerns
- Clinical distress
- Specify:
- With good or fair insight
- With poor insight
- With absent insight/delusional beliefs
- Begins young to middle adolescence
- > abuse, bullied, as child
- 1:1, gender
- High rates of suicide and depression
- There are common things that become obsessed: nose, wrinkles, hair, skin discoloration, bloating
- What do they do? Look in mirror, feel faces/body routinely with hands, excessive time spent grooming, skin-picking, doing different cosmetic things
- A disorder marked by excessive preoccupation with some perceived body flaw
- Overactive Left Hemisphere
- Attention to details amplified
- Family Environment
- Emphasize perfection & imperfections (family pushes for beauty, and it can trigger/make it worse)
-Direction of Cause Problem (can go both ways; it can be that your born with it, but it’s also possible that environment has caused it; different for different people)
- Left Half of Brain: (activated when looking at super detailed face)
- Logical
- Realistic
- Objective
- Analytic
- Right Half of Brain: (activated when looking at non-detailed face)
- Creative
- Emotional
- Intuitive
- Imagination
-This tells us that they really do see something, because brain activity isn’t changing, it’s just they see something we don’t, which makes it worse
24
Q
Somatic Symptom DO - Identify and Distinguish Symptom Presentation Gist
A
-One or more somatic symptoms that distress or disrupt daily life
- Excessive thoughts, feelings, or behavior related to the somatic symptoms
- Disproportionate / persistent thoughts about symptoms
- Persistent high level of anxiety about symptoms
- Excessive time and energy devoted to symptoms
-> 6 months
- Functional versus Presenting
- Under diagnosed in elderly
- People with depression tend to somatize
-Somatic - feel something; a pain is there; illness - cognitive! No actual physical pain; actually feels a pain; illness anxiety: just worried about having something; leg might hurt one day, the other leg next day
Shared with Conversion DO:
- Somatization
- Communicating distress through physical symptoms
- Somatic Symptom & Related DOs
- Struggle that appears biological → actually psychosocially caused (ex: back hurts, goes to doctor and they find nothing, so the pain is not physically caused)
- And/Or, struggle that is excessive given biological cause (could have some organic dysfunction) (ex: walking to class, stub toe, unable to walk to class, and miss class; doctor says no real problem, just bruising, but he says he hasn’t been able to walk)
- DO NOT consciously want or purposely produce symptoms; it’s an unconscious response to stress
- Suffer actual changes in physical functioning
- Can be undetected organic cause
-Psychophysiological disorders - real thing going on with body, and are affected by stress (things like high blood pressure) (STOPS SHARING WITH CONVERSION DO)
- Communication of Distress through the Body
- Learn Illness beliefs → physical (not psychological) explanations of struggle
- Somatosensory awareness
- More attention devoted to body
- Mind-body Connection
- A mental disorder in which a person experiences physical symptoms that may or may not have a discoverable physical cause, as well as distress
25
Illness Anxiety DO - Identify and Distinguish Symptom Presentation Gist
- Preoccupation with having or acquiring a serious illness
- Somatic (body) symptoms are not present
- High level of anxiety about health
- Excessive health-related behaviors or maladaptive avoidance
- Illness preoccupation > 6 months
- Specify
- Care-seeking type (can cause “boy who cried wolf” when something is actually wrong)
- Care-avoidant type (think something is so wrong, that going to doctor will confirm fear, which would be unbearable, and this causes same problem; person won’t get treated when something is actually wrong)
- Somatic: actually feels a pain; illness anxiety: just worried about having something; leg might hurt one day, the other leg next day
- A somatic symptom disorder marked by excessive preoccupation with fear of having a disease
26
Conversion - Identify and Distinguish Symptom Presentation Gist
- Functional Symptom DO
- One or more symptoms of altered voluntary motor or sensory function (motor = can’t move arm or leg; senses = blind, can’t hear, can’t feel touch)
- No evidence of neurological / medical cause
- Clinical distress
- Example: Glove Anesthesia (person will come in saying they lost feeling in one or both hands; suspicious because there are three main nerves in arm, and people usually only experience damage with one nerve (in pinky or in forefingers), not in whole arm)
- Appears Suddenly (often)
- Associated with
- Childhood abuse
- High suggestibility (personality characteristic about how likely you are to go along with other people; gullible)
- La Belle Indifference (unconsciously knowing that they can still see, so they are less freaked out
- Motor ability:
- Difficulty walking
- Difficulty swallowing
- Fainting
- Convulsions
- Senses:
- Blindness
- Deafness
- Loss of touch
-A somatic symptom disorder marked by odd pseudoneurological symptoms that have no discoverable medical cause
Shared with Somatic Symptom DO:
- Somatization
- Communicating distress through physical symptoms
- Somatic Symptom & Related DOs
- Struggle that appears biological → actually psychosocially caused (ex: back hurts, goes to doctor and they find nothing, so the pain is not physically caused)
- And/Or, struggle that is excessive given biological cause (could have some organic dysfunction) (ex: walking to class, stub toe, unable to walk to class, and miss class; doctor says no real problem, just bruising, but he says he hasn’t been able to walk)
- DO NOT consciously want or purposely produce symptoms; it’s an unconscious response to stress
- Suffer actual changes in physical functioning
- Can be undetected organic cause
-Psychophysiological disorders - real thing going on with body, and are affected by stress (things like high blood pressure) for
27
Factitious - Identify and Distinguish Symptom Presentation Gist
- Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception
- Presents to others as ill, impaired, or injured
-Deception is obvious even without external rewards present (sometimes for psychosocial benefits)
- Subtype: Malingering
- Symptoms reported for personal gain
- Money, time off work, escape punishment
-A mental disorder marked by deliberate production of physical or psychological symptoms to assume the sick role
28
Factitious Imposed on Another - Identify and Distinguish Symptom Presentation Gist
- Munchausen Syndrome by proxy
- Refers to adults who deliberately induce illness or pain into a child and then present the child for medical care
- Parent is usually the perpetrator and often denies knowing the origin of the child’s problem
- Child generally improves once separated from parent
- Most victims are younger than 4 years old, and most perpetrators are mothers
- A main motive = attention and sympathy the parent receives from others
- Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception
- The individual presents another individual (victim) to others as ill, impaired, or injured
- The deceptive behavior is evident even in the absence of obvious external rewards
- The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder
- Note: The perpetrator, not the victim, received this diagnosis
- Specify if there is a single episode or recurrent episodes of falsification of illness and/or induction of injury
- Used to be called “factitious disorder by proxy”
29
Major Depression - Identify and Distinguish Symptom Presentation Gist
- Begins puberty, peaks in late 20’s when often diagnosed
- 2:1, women
- 80% recover in a year
- Recurrence common
- Comorbidity
- Substance Use
- OCD
- Eating DO’s
- Borderline Personality DO
- 5 or more in 2-week period, a change from previous functioning
- Depressed mood most of the day, nearly every day
- Diminished interest or pleasure in all or almost all activities
- Significant weight loss, or decrease or increase in appetite
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive guilt
- Diminished ability to think or concentrate nearly every day (can interfere with work, relationships, school work)
- Recurrent thoughts of death, recurrent suicidal ideation
- Significant distress
- A mental disorder often marked by multiple major depressive episodes
Many Varieties of Major Depressive DO
- Specify
- Mild
- Moderate
- Severe
- With psychotic features
- In partial remission
- In full remission
- Unspecified
- Specify
- W/ anxious distress
- W/ mixed features
- W/ melancholic features
- W/ atypical features
- W/ mood-congruent psychotic features
- W/ mood-incongruent psychotic features
- W/ catatonia (body becomes rigid and can’t move)
- W/ peripartum onset (during pregnancy)
- W/ seasonal pattern (fall/winter - when it gets bad)
30
Persistent Depression - Identify and Distinguish Symptom Presentation Gist
- Dysthymia
* -Depressed mood for most of day, for at least 2 years
- 2 or more
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
- Clinical distress
- A depressive disorder involving a chronic feeling of depression for at least 2 years
- Specify
- Early onset (< 21)
- Late onset
- Specify
- Mild
- Moderate
- Severe
- Comorbidity
- Substance use
- Personality disorders
31
Bipolar I - Identify and Distinguish Symptom Presentation Gist
- Full manic episodes alternate w/ major depressive episodes
- Most common form of Bipolar DO
- 3:1 (more depressive episodes)
- 1:1 gender
- High suicide risk
- A mental disorder marked by one or more manic episodes
Bipolar Disorder in General:
- A full manic episode
- For at least one week
- In extreme cases, symptoms are psychotic
-Less severe symptoms → Hypomanic episode
- Mania: five areas of functioning affected
- Emotional symptoms
- Active, powerful emotions
- Motivational symptoms
- Need for constant excitement, involvement, companionship
- Behavioral symptoms
- Very active –move quickly; talk loudly or rapidly
- Cognitive symptoms
- Show poor judgment or planning
- Physical symptoms
- High energy level –w/ little rest
32
Bipolar II - Identify and Distinguish Symptom Presentation Gist
- Hypomanic episodes alternate w/ major depressive episodes (not full-blown mania like in Bipolar I)
- A mental disorder marked by episodes of hypomania that alternate with episodes of major depression
Bipolar Disorder in General:
- A full manic episode
- For at least one week
- In extreme cases, symptoms are psychotic
-Less severe symptoms → Hypomanic episode
- Mania: five areas of functioning affected
- Emotional symptoms
- Active, powerful emotions
- Motivational symptoms
- Need for constant excitement, involvement, companionship
- Behavioral symptoms
- Very active –move quickly; talk loudly or rapidly
- Cognitive symptoms
- Show poor judgment or planning
- Physical symptoms
- High energy level –w/ little rest
33
Cyclothymic - Identify and Distinguish Symptom Presentation Gist
- Hypomanic episodes alternate w/ mild depressive symptoms
- For two or more years, with periods of normal mood
- May become Bipolar I or II disorder
- Rapid cycling
- 4+ episodes in 1-year period
- Seasonal
- A mental disorder marked by fluctuating symptoms of hypomania and depression for at least 2 years
34
Bulimia - Identify and Distinguish Symptom Presentation Gist
-An eating disorder marked by binge eating, inappropriate methods to prevent weight gain, and self-evaluation greatly influenced by body shape and weight
- Recurrent binge eating
- Eating (w/in 2 hours) more than most would or could eat
- Lack of control over eating (what, or how much)
- Recurrent compensatory behaviors to prevent weight gain
- Purging Type
- Self-induced vomiting
- Laxatives
- Diuretics
- Non Purging Type
- Fasting
- Excessive exercise
- Occurs 1/week for 3 months
- Over Self-evaluation of body shape & weight
- Specify
- Mild: 1-3 / week
- Moderate: 4-7 / week
- Severe: 8-13 / week
- Extreme: 14 / week
-10 : 1, women
Bulimia Nervosa: Binges
- Common to experiment with
- Binge habits often carried out in secret
- Preceded by tension / powerlessness
- Massive amounts of food
- 1,000 -10,000 calories
- Very rapidly àlittle chewing
- Sweet, high-calorie foods with soft texture
- Often very pleasurable
- Followed by
- Self-blame
- Guilt & depression
- Fear of weight gain
Bulimia Nervosa: Compensatory Behaviors
- Compensatory behaviors to “undo” calories
- (1) Vomiting
- Only prevents half the calories
- Affects ability to feel satiated
- Greater hunger & bingeing
- (2) Laxatives and Diuretics
- Mostly fails to reduce calories absorbed
- (1) More other-oriented Experience & Concerns
- (2) Less w/ amenorrhea
- (3) Lower frustration tolerance
- (4) Poorer coping skills
35
Anorexia - Identify and Distinguish Symptom Presentation Gist
-An eating disorder marked by refusal to maintain a minimum, normal body weight, intense fear of gaining weight, and disturbance in perception of body shape and weight
- Core Symptoms
- Refusal to maintain > 85% of normal weight
- Intense fear of becoming overweight
- Distorted view of weight & shape
- Specify
- Mild, Moderate, Severe, Extreme
- Specify
- Restricting Type
- Dieting, fasting, excessive exercise
- Binge-eating/Purging Type
- Vomiting & laxatives
- Bulimia vs. Anorexia Nervosa → difference is in weight, not in binging and purging
- Begins mid to late adolescence
- 10 : 1, women
- Goal: become thin
- Motive: fear
- Giving in to desire to eat & becoming obese
- Losing control of body size & shape
- Preoccupied with food
- Reading about food & planning meals
- The “typical”case:
- Normal to slightly overweight woman dieting
- Stressful event
- Separation of parents
- Move away from home
- Experience of personal failure
- Most recover (somewhat) now
- ~ 5% die
- Medical complications, suicide risk very high
- Associated with (comorbid with):
- Depression
- Anxiety
- Low self-esteem
- Insomnia or other sleep disturbances
- Substance abuse
- Obsessive-compulsive patterns
- Perfectionism
- Everything in body is going to wear down and create dysfunction
- Distorted body image thinking
- Low opinion of body shape
- Overestimate actual proportions
- Adjustable lens assessment technique
- Maladaptive attitudes & misperceptions
- “I must be perfect in every way”
- “I will be a better person if I deprive myself”
- “I can avoid guilt by not eating
36
How does Roger’s humanistic perspective understand the cause and treatment of anxiety?
-Lack of “unconditional positive regard” in childhood leads to “conditions of worth” → I am good IF I do or don’t do “x”
- The less overlap between self-image and ideal-self = bad
- Self-image is different to ideal self
- Here self-actualization will be difficult
- More overlap between self-image and ideal-self = good
- Self-image is similar to ideal self
- This person can self-actualize
- Person-Centered Approach (growth promoting climate) - triangular shape
- Congruence (authenticity and realness) at top
- Unconditional positive regard (non-judgemental respect) to right
- Empathy (process of understanding) to left
37
How are the Amygdala and GABA associated with anxiety.
- Amygdala:
- Anxiety response
- Septal-hippocampal system
- Memory association triggers anxiety
- In normal fear reactions:
- Key neurons fire → excitability
- Brain then tries to reduce excitability
- GABA released to inhibit neuron firing
- Gad linked to:
- Too few GABA receptors
- Ineffective GABA receptors
- Benzodiazepines (valium, xanax) enhance GABA -- increase GABA to reduce cortisol (anxiety)
38
What is the most common antianxiety drug? How does it work? What is its biggest side effect?
- Benzodiazepines (late 1950)
- Provide temporary, modest relief
- Rebound anxiety with withdrawal and cessation of use
- Physical dependence is possible
- Mix badly with certain other drugs (especially alcohol)
- Biggest side-effect - drowsiness, sleepiness
- Early 1950s = barbiturates (hypnotics)
- More recently = antidepressant and antipsychotic drugs
39
3 cognitive new wave explanations for anxiety described in lecture.
- 1. Intolerance of Uncertainty
- 2. Avoidance Theory
- 3. Meta-Worry
40
Intolerance of Uncertainty
- We don’t know what’s going to happen next; think of the worst; how tolerant are we about not knowing what will happen next; most of don’t think about horrible things like dying tomorrow because sun sent out huge radiation ray, and it’s heading towards us
- One of three cognitive new wave explanations for anxiety
41
Avoidance Theory
- Worried cognitively and have bodily responses; some of us are really aware of our bodily responses (ex: sweating), so we retreat into our mind to avoid feeling it in our bodies; ex: on way to school, twisted ankle, feel it right now, and then you feel phone vibrate and see it’s a text from boyfriend breaking up with you, so you don’t really feel pain in ankle for at least a little bit of time
- One of three cognitive new wave explanations for anxiety
42
Meta-Worry
- Grounded in Buddhism; “duka-duka” = the suffering of suffering; worried about your worry; associated with stigma; ex: of partner breaking up with you, and it’s two months later, and you’ve been upset about it all that time. You start to think about friend who just got broken up with and she’s already dating someone else, so you start to think and worry that something is wrong with you
- One of three cognitive new wave explanations for anxiety
43
What are the 2 components of social anxiety that treatment focuses on?
- Fear about one or more social situations person is exposed to (person develops idea that something is wrong with them, like feeling unpopular, go into social encounter thinking that, heart rate goes up, sweating, go to encounter person/people, everyone is noticing everything that’s wrong with them, sweating even more, and after, think of all indicators that people were finding everything wrong with them, and this creates a horrible model for the next time)
- Fear you will show anxiety & be judged in social situations
- Social situations avoided or *endured*
- Fear out of proportion to threat
- > 6 months
- Clinical distress
- Often kept secret, highly disruptive
- 3:2, women; Poverty: 50% more likely
- Often begins in childhood
- Child: More fear, specific situations
- Adult: Less fear, broad situations
-Help by giving anti-anxiety medication and social skills training to help (need both, either one alone is not very helpful)
44
What is biofeedback? How is it helpful to treat GAD?
-Biofeedback - a procedure that allows a person to monitor internal physiological responses and learn to control or modify these responses over time
- Relaxation Training
- Biofeedback
- How autonomic response system reacts; help control responses
- We hook you up to a computer screen because you can see when you start to think about certain thoughts have a response on your autonomic systems (heart rate, breathing, etc.); alternately, you can see that when you change thoughts, your autonomic response system goes down; can help you learn to control your own body and reaction to certain thought processes
- Ex: when thinking about partner, x makes me anxious, y makes me feel calm);
-Part of biological perspective
- You learn to control your own body
- Biofeedback measures heart rate
- Heart rate → biofeedback device → audiovisual display → person’s mind
45
What is the biological challenge? Why is it used to treat panic? How is it used to treat panic?
- Induce physical sensations → causes panic (make you work out a little bit)
- E.g., Jump up & down
- Teaches relaxation
- Teaches appraisal
-Why? Doesn’t eliminate panic attacks, but helps them control a complete, full-blown attack from happening
46
What is “preparedness”?
- “Preparedness”: an evolutionary explanation (of why people have specific phobias)
- We’re afraid of things that can potentially kill us/hurt us; biologically, genetically prepared to be afraid of certain things because they were dangerous in the past, they survived because of fear and avoidance of snakes; passed down to you; ex: grandma and grandpa afraid of snakes, avoided them, and survived to have kids, while other couple didn’t make it because not afraid and died by getting close to one
47
How does stimulus generalization of specific phobias help explain GAD?
- GAD caused by stimulus generalization
- Responses to one stimulus are also elicited by similar stimuli
- Conditioning and modeling:
- Once fears are acquired → avoid object → fear enhanced and maintained
- GAD caused by stimulus generalization
- Responses to one stimulus are also elicited by similar stimuli
48
Based on the lecture, what 2 common structures of the brain are OCD, Hoarding, & Body Dysmorphic associated with?
- 1. Frontal Lobe (abnormal functioning)
- Orbitofrontal cortex (overactive)
- Processes sensing “data” into thoughts and action
- Ventromedial PFC
- Anterior cingulate cortex
- 2. Overactive Left Hemisphere
- Attention to details amplified
49
The difference between obsessions and compulsions? Their relationship to each other?
- Obsessions:
- Persistent thoughts, urges, or images that are intrusive (ex: thinking cousin is going to get killed, die if I don’t keep my house very clean by vacuuming 12 times a day) (impulsive thought?)
- Takes various forms:
- Wishes
- Impulses
- Images
- Ideas
- Doubts
- Common obsessions:
- Dirt/contamination
- Sexuality
- Violence
- Orderliness
- Religion
- Compulsions:
- Repetitive behaviors or mental acts performed by rules (this is behavioral; repeated, ritualistic behaviors; set of behaviors done in specific order that helps reduce distress)
- Performing behaviors reduces anxiety
- Only for a short time
- Develop into rituals
- Common compulsions:
- Checking
- Cleaning
- Order
- Counting, touching
- According to psychiatric perspective, doing cocaine vs. washing hands are different because they have different neurochemical response) (compulsion reduces cortisol, removing stress, while drugs add positive sensations, so not the same)
- Relationship to each other?
- Time consuming ( > 1 hour / day) or cause clinical distress
-Begins in adolescence / young adulthood, gradually worsens (7, 8, or 9, and slowly gets worse)
- Specify:
- With good or fair insight (understand something is wrong with cousin example)
- With poor insight (actually think your obsession is true with cousin example)
- With absent insight/delusional beliefs (psychotic belief that is not real in world)
- 1:1 gender
- Men > forbidden thoughts & order
- Women > cleaning
-Panic attacks and Suicidal thoughts common
50
What aspect of neurofunctioning is most strongly linked to Hoarding?
- Poor Executive Control (executive functioning is very important; depending on level of executive control people develop as children can affect doing well in school, relationships, success; people with hoarding have poor external control)
- Diminished nonverbal attention
- Distract more easily (ex: to do well in class, have to focus, study, and know you have to avoid doing things you actually want to do for some time; hoarders have difficult time)
- Greater variability in reaction time
- Greater impulsivity (hoarders struggle with impulse control)
- Poor memory
- Poor decision making
- Abnormal Frontal Lobe functioning
- Orbitofrontal Cortex (overactivity)
- Ventromedial PFC
- Anterior cingulate cortex
51
4 general symptoms associated with Stress DOs?
- 9 or more of 14 possible symptoms, e.g.,:
- (1) Intrusion symptoms
- Recurrent & Intrusive memories/dreams
- Flashbacks
- Distress at cues
- (2) Dissociative symptoms
- Distorted cognitions about cause or consequences of event → self blame (just-world hypothesis → bad things only happen to bad people, so if I’m hurt, it’s because I did something bad)
- Altered sense of reality
- Inability to remember event
- (3) AvoidanceSymptoms (internal or external)
- External = avoid situation that caused it OR
- Internal = avoid things that even just remind me of it (ex: avoiding school because assault happened on way to school)
- (4) Arousal Symptoms
- Sleep disturbance
- Angry outbursts
- Hypervigilance (super aware of what’s happening around you)
- Problems w/ concentration
- Exaggerated startle response
52
What hormone seems most implicated in stress DOs?
-Cortisol
53
The common reasons why some people develop a Stress DO when exposed to stress and others do not?
- (1) Biological processes
- Some of us don’t have a lot of cortisol (a stress hormone); some of us have chill hippocampus, while others do not; amygdala (?)
- (2) Personalities
- Maddi’s Hardiness - Look for good things in the bad that happened; good takeaway; ex: advocating for social changes, share experiences, etc.) → Transformational Coping and Positive Appraisals
- (3) Childhood experiences
- Ex: divorce; some kids take personal blame, but divorce doesn’t have to be bad and create harm in kid’s life as long as it’s done in a healthy way; hiding conflict and showing only happy faces is bad, because then when you get divorced, kid doesn’t understand why and thinks it’s them; of course, screaming and yelling is not good
-(4) Social support systems
- (5) Cultural backgrounds
- Hispanic, Latin/a Americans higher in PTSD because of importance of family?
- (6) Severity of the traumas
- Ex: some people go through hurricane only had to replace a window, while for another, their whole house was destroyed; when it comes to abuse, assault, how often, community response
- Intensity, duration, frequency
54
What is EMDR? What it is used to treat most often?
- Eye movement desensitization & reprocessing (EMDR) - Follow wand, tell story of trauma, tell it over and over, and some people get better; just feel less overwhelmed, telling it over and over
- Taken back to where happened, help them endure it, and hopefully learn to accept it, and be okay
- Type of behavioral exposure technique
-Used to treat Stress Dos most often
55
What is Psychological Debriefing? What does the evidence say about the effectiveness of Psychological Debriefing?
- Preventative intervention after community trauma (have psychologist on scene, and help people learn ways to cope and talk it so, so they don’t have PTSD)
- Mixed evidence for effectiveness (some people experienced it worse, so when everyone shares story, people feel they should suffer from this because other people are struggling)
56
What is the main difference between Somatic Symptom DO and Illness Anxiety DO?
- In somatic symptom DO → Somatic (body) symptoms are present; communicate distress through physical symptoms
- In illenss anxiety DO → somatic (body) symptoms are not present
57
What are the 2 main categories of symptom dysfunction associated with Conversion DO?
- Motor Function
- Difficulty walking
- Difficulty swallowing
- Fainting
- Convulsions
- Can’t move arm or leg
- Sensory Function
- Blindness
- Deafness
- Loss of touch
58
What personality characteristic is commonly associated with Conversion DO? What is la belle indifference?
- Personality characteristics =High suggestibility (personality characteristic about how likely you are to go along with other people; gullible)
- La Belle Indifference - unconsciously knowing that they can still see, so they are less freaked out
59
The 3 core brain connections to Somatoform DOs based on lecture?
- (1) Overactive amygdala and limbic system
- Connected to experiencing physical sensations that are not genuine
- (2) Dysfunction in frontal lobe and right hemisphere (for hoarding = left hemisphere)
- Connected to attention deficits in somatization
- Many somatic complaints on left side of body
- (3) Decreased blood flow to to prefrontal cortex
- Connected to motor and sensory reports in Conversion DO
60
The 3 behavioral treatments for somatizing disorders?
- (1) Contingency Management–change reward structures
- Ex: can’t walk allows you to miss work → find a ways where you can still go to work, and see if you’re still unable to walk; usually works
- (2) Exposure–think about trauma that triggered symptoms
- Locate a particular environmental trigger
- (3) Confrontation–force client out of sick role
- Ex: Will Ferell stabbing himself in leg with steak knife, which forced him to walk
61
For Amnesia DO, what is the difference between localized & generalized? What is specification w/ fugue?
- Localized: all events occurring within a limited period
- Ex: going away for Thanksgiving, come back, and somebody asks what you did, but you can’t remember it at all
-Generalized: extending back in time; loss of identity
- Specification Fugue
- With dissociative fugue: travel or wandering (often get generalized amnesia and move without saying anything to anyone; fleeing unconsciously)
62
What are the 3 ways in which DID personalities differ from one another?
- (1) Identifying Features
- Dress differently
- Brush hair differently
- Act different
- (2) Abilities and Preferences
- Could be male, but expresses female personalities
- Differences in sexual orientations
- Different skills -really good at basketball with one identity, but can’t even dribble with other personality)
- (3) Physiology
- When hooked up to MRI, can see cognitive differences, suggesting they do experience themselves differently
- Can change eye color
63
DID is often associated with what historical vulnerability? What disorder is DID most often comorbid with?
- History of severe abuse (especially when young; DID often begins in childhood, just so you know)
- Ex: have little girl personality, because they tend to be taken care of, but change to grown, aggressive male who is violent and not vulnerable in environment little girl would be vulnerable in
- 5-7 comorbid DOs! But most often with:
- Borderline Personality DOs (strong emotions, but just don’t know how to manage them, which leads you to split)
64
Evidence for the Sociocognitive Explanation for Dissociative Identity Disorder?
- DID is not a genuine DO, but is instead caused by the media and therapist (encourage them to express)
- (1) Evidence of Media Influence
- Cultural differences in DID presentation (in India, people change personalities overnight (displayed in movies this way); in U.S., people change throughout day)
- Rapid increase from 80’s after movies/novels
- (2) Evidence of Therapist Influence
- Clients already in therapy for other DOs (client already attending therapy, and after being there for a while, they become diagnosed with DID, so it is suggested that therapists encourage their clients to elicit DID)
- False Memory Syndrome
- Hypnosis used to Assess DID (therapist uses hypnosis and drugs, and rewards client for eliciting different personalities)
- DID clients are Fantasy prone
- Clients rewarded for enacting identities
65
What are the common steps to treating DID?
- (1) Recover Memories
- Hypnosis
- Barbiturates
- Pentothal (truth serum)
- Want to help them relax
- (2) Therapist bonds w/ each personality
- Creates safe and supportive environment, so they feel comfortable talking about everything
- (3) Client recognizes & accepts other personalities
- (4) Client Integrates individual personalities
- (5) Fusion into singular personality
- Wants us to know information from image on slide too?
66
What new child mood disorder was created for the DSM-V and why was it added?
- Disruptive Mood Dysregulation DO (DMDD)
- Between ages 6-18
- Extreme Temper Tantrums (verbally/behaviorally) (but if doing them a lot, not responding to ways that will stop it, and it’s extreme, then might be diagnosed with it)
- 3 or more per week
- Replaced diagnosing kids with schizophrenia (because too young, and schizophrenia is a life disorder forever)
-Important: Not all kids who have been getting diagnosed with bipolar disorder have bipolar disorder
67
What are the 3 brain circuit locations most connected to Major Depression?
- Hippocampus
- Amygdala
- Brodmann Area 25 (this component is where most core moods get regulated, and where we see dysfunction of serotonin)
68
5 sociocultural reasons explained in lecture why women have higher rates of depression than men?
- (1) Artifact theory: women and men are equally prone to depression, but clinicians often fail to detect depression in men
- Ex: female client comes in, she expresses depressive symptoms, they diagnose them with depression; male client comes in, he expresses same symptoms, but therapist asks about alcohol abuse, and diagnoses him with alcohol abuse disorder
-(2) Life stress theory: women in most societies experience more stress than men
- (3) Body dissatisfaction theory: women in most societies are taught to seek unreasonable goals that are unhealthy
- Women feel they’re only worthy if they look a certain way, and when they don’t, they feel bad
- (4) Lack-of-control theory: women feel less control than men over their lives
- Women hold less power, but men are able to yield choice war, and depression is associated with hopelessness, and women do have less control than males do
- (5) Rumination theory: people who ruminate when sad are more likely to become depressed & stay depressed longer
- Amanda Rose: studied what men and women do when they hang out; girls/women are at much higher likelihood to co-ruminate, and when they do so, they report feeling closer, but it makes us feel bad because we confirm that life is crappy; men do not co-ruminate, so they don’t get depressed
69
What are the 3 common drug groups historically used to treat Depression? What is the dietary problem with MAO inhibitors?
- 1. Monoamine oxidase inhibitors (MAO Inhibitors)
- First used as TB treatment
- Made patients happy
- Slows down production of MAO
- MAO breaks down Norepinephrine
- MAO inhibitors stop breakdown
- Increase in Norepinephrine activity
- ~50% get better
- High blood pressure if eat tyramine
- 2. Tricyclics
- Accidental, studying Schizophrenia treatments
- E.g., Imipramine
- 10 days -3 weeks before improvement
- Increased Serotonin & NE effectiveness
- 2/3’s improve
- More than MAO’s & no diet restrictions
- Relapse common
- > 5 months after improvement “continuation therapy”
- > 3 years after improvement “maintenance therapy”
- 3. Selective Serotonin Uptake Inhibitors (SSRI’s)
- Increase serotonin activity specifically
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
- Effectiveness and Speed of action similar to Tricyclics
- Harder to overdose
- No dietary restrictions (than MAOs)
- Fewer side effects (than tricyclics)
-Dietary problem with MAO inhibitors = High blood pressure if eat tyramine (ex: banana, grilled cheese, wine)
70
How quickly do SSRIs work for mood DOs? What is the most common problematic side effect of SSRIs?
- 10 days -3 weeks before improvement (similar to tricyclics)
- Sexual dysfunction
- Dry mouth
71
What is treatment-resistant depression?
- Failure to respond to 2 types of antidepressants
- 10-30% of diagnosed clients
- Severe Depression
- Hospitalization
- Residential Care
- Suicide & Lose of Life
72
4 specialized treatments used to treat treatment-resistant depression?
- 1. Ketamine
- Just approved to treat depression
- Helpful within an hour
- Desire to kill oneself decreases to almost nothing
- Increased spine number
- Increased number of “mushroom” or mature spines
- In order to get approved, it has to be administered by doctor
- Every time you go, have to pay for medication and meeting with doctor
- High expense; cost is 1000s of times higher than price available on the street
- 2. MDMA (Ecstasy)
- If you take ecstasy, even a single strong dose of it, you destroy your brain’s ability to produce serotonin
- Fraudulent! Gave them LSD, not MDMA
- Ecstasy doesn’t destroy brain’s ability to produce serotonin
- So we’re probably going to get ecstasy approved
- 3. Deep Brain Stimulation
- Works in ⅔ of people who were resistant to other children
- Risk is really high
- Feel it instantaneously
- 4. Electroconvulsive Therapy (ECT)
- Exploring treatment for Epilepsy
- Fast and Effective
- Contemporary Use
- Given muscle relaxants
- 6-12 sessions over 2-3 weeks
- Unilateral or bilateral
- Memory Loss
- Often recent, Often temporary (ex: of his friend who had it done, and forgot about her kids for a couple of months)
- Frightening, but often works
73
What is mania?
-State of breathless euphoria or frenzied energy (why diagnose it? It can result in risky behavior, such as gambling, unsafe sexual behaviors, driving recklessly, substance use)
- A full manic episode
- For at least one week
- In extreme cases, symptoms are psychotic
-Less severe symptoms → Hypomanic episode
- Mania: five areas of functioning affected
- 1. Emotional symptoms
- Active, powerful emotions
- 2. Motivational symptoms
- Need for constant excitement, involvement, companionship
- 3. Behavioral symptoms
- Very active –move quickly; talk loudly or rapidly
- 4. Cognitive symptoms
- Show poor judgment or planning
- 5. Physical symptoms
- High energy level –w/ little rest
74
How does the permissive theory of neurotransmitters explain the cause of Bipolar versus Depression?
- Depression
- Low S + Low NE
- Mania
- Low S + High NE
- If bipolar, probably have a mix of low serotonin and high epinephrine
-(TYPICAL: Medium S + Medium NE)
75
What are the two most common drug therapies for Bipolar DO?
- (1) Mood Stabilizers: Lithium
- Very effective for mania
- 2/3’s improve
- Less helpful for depression
- Correct dosage hard
- Too low = no effect
- Too high = lithium intoxication (death)
- Little lithium, no affect → little more, no affect → little more, death; small window
- (2) Second Generation Antipsychotics often very helpful!
- E.g., Abilify
- Little success until last quarter of 20th century
- Psychotherapy alone ineffective
- Antidepressant drugs ineffective
- Often increases severity of manic episodes
76
When does psychotherapy tend to work for Bipolar DO?
Combination Psychotherapy:
- Mood stabilizer w/ Therapy
- Medication management
- Interpersonal therapy
- CBT
- Effectiveness
- Reduce hospitalization
- Improves social functioning
- Enhances job maintenance
- *Mania is a seductive symptom!
- Psychotherapy alone = ineffective
77
According to the lecture, what are the 5 steps in the assessment of suicide risk?
- (1) How pervasive and intense is the mood?
- (2) How strong is the desire?
- (3) Does the person have a plan to carry it out?
- (4) Are resources available to carry out the plan?
- If person doesn’t have resources, less to worry about
-(5) Does the person have attachment relationships?
- SIGNS of Suicide:
- Sleep disturbance
- Isolation
- Giving away possessions
- No interest in anything
- Seeing no future
78
Difference between purging and nonpurging types of eating DOs?
- Restricting Type
- Dieting, fasting, excessive exercise
- Binge-eating/Purging Type
- Vomiting & laxatives
- Bulimia vs. Anorexia Nervosa → difference is in weight, not in binging and purging (anorexia = overly thin)
79
What is a binge episode?
- Common to experiment with
- Binge habits often carried out in secret
- Preceded by tension / powerlessness
- Massive amounts of food
- 1,000 -10,000 calories
- Very rapidly àlittle chewing
- Sweet, high-calorie foods with soft texture
- Often very pleasurable
- Followed by
- Self-blame
- Guilt & depression
- Fear of weight gain
-Eating an amount of food in a limited amount of time that is much larger than most people would eat in that circumstance
80
What are the most common compensatory behaviors associated with Bulimia?
- Compensatory behaviors to “undo” calories
- (1) Vomiting
- Only prevents half the calories
- Affects ability to feel satiated
- Greater hunger & bingeing
- (2) Laxatives and Diuretics
- Mostly fails to reduce calories absorbed
81
What are the common differences in people who suffer with Bulimia versus people who suffer with Anorexia?
- Similarities:
- Begin after dieting
- Fear of becoming obese
- Drive to become thin
- Preoccupation w/ food, weight, appearance
- Feelings of anxiety, depression, obsessiveness, perfectionism
- Increased risk of suicide attempts
- Substance abuse
- Distorted body perception
- Disturbed attitudes toward eating
- Differences:
- For Bulimia Nervosa
- (1) More other-oriented Experience & Concerns
- (2) Less w/ amenorrhea
- (3) Lower frustration tolerance
- (4) Poorer coping skills
-Difference is in weight, not in binging and purging
82
How are mood DOs and eating DOs related?
- Mood disorders set the stage (low serotonin)
- Don’t enjoy food, so it’s connected to anorexia
-Can cause eating disorders
83
What groups of women are more likely to suffer from eating DOs?
-Models, actors, dancers
- College athletes
- 9% full criteria for eating disorder
- 50% or more have symptoms
-Higher SES & European American
- Family cultures
- History of emphasizing thinness
- Mothers who
- Diet
- Perfectionistic (obsessing over physical appearance)
84
What are the two stages in treating Anorexia?
- (1) Increase weight (put them in hospital setting and force them to eat - ex. tube)
- (2) Improve psychology (want to have a good therapeutic relationship, which can be difficult because forcing them to eat is uncomfortable, so first have to improve relationship with client first few months with therapist, or with completely new therapist)
- Treatment Context
- Residential Hospital
- Day Hospital
- Out-patient
- Force tube and intravenous feedings
- Distrust
- Power struggle
- Behavioral weight-restoration
- Contingency → Reward based (behave, get a bit better, and you get a reward; ex. Get to see someone you want, smoke a cigarette, etc.)
- We want to focus on prevention!
85
3 phases of the Maudsley approach for Anorexia?
- Phase 1: Weight restoration
- Family meal
- Model for parents uncritical stance
- After hospital setting; gain weight
- Highly monitor what/how person is eating; therapist goes to their house and observes them
- Phase 2: Return control to sufferer
- Goal: achieve healthy weight
- Address parenting concerns
- Give them back their control, so they can do it themselves
- Phase 3: Healthy Adolescent Identity
- Increase Autonomy
- Negotiate parental boundaries
86
3 phases of in Interpersonal Therapy. How does it compare to CBT as an effective treatment for Bulimia?
- Phase 1: Identify interpersonal problems
- Role disputes (ex: one person wants to be in a relationship/intimate and other doesn’t)
- Role transitions (ex: parents want kid to grow up, but kid doesn’t want to; or the opposite)
- Interpersonal deficits
- Unresolved grief (ex: deaths)
- Phase 2 (pretty humanistic)
- Patient-led change (what do you think you/we should do to resolve disagreements)
- Therapist strongly encourages change
- Phase 3
- Maintenance (if, then planning; before, used to stop at phase 2 because people got better, but then people developed bulimia again, so this phase was added)
- Relapse prevention
-Bulimia isn’t a food disorder, but instead, a social/relational disorder that expresses itself through food; the focus is about relationships and ignore food problems
- CBT versus IPT:
- CBT faster improvement
- CBT overall a bit better, MAYBE
- IPT sticks better and grows more (because learning skills relationally that’ll help resolve future problems that contribute to eating disorder)
87
What are the most commonly used depressants?
- Alcohol:
- A problematic pattern of alcohol use leading to clinical distress w/ 2 or more of the following in a 12 month period:
- Alcohol is taken in larger amounts or longer than intended
- Persistent desire to control alcohol use
- Time spent to obtain, use, or recover from alcohol
- Craving use of alcohol
- Use causes failure to fulfill work, school, or home duties
- Continued use despite social problems caused by it
- Use in hazardous situations (driving; operation certain/heavy machinery; sexual activities; pregnancy; using other drugs)
- Use despite physical / psychological problems caused by alcohol
- When is it too much?
- Think of context (ex: different for 40-year-old parent vs. college student)
- Think of 4 D’s
- Tolerance
- A need for increased amounts to achieve desired effect
- Diminished effect with continued use of same amount
- Sedative-Hypnotic Drugs:
- Barbiturates and Benzodiazepines
- Pill or capsule form
- Reduce excitement (like alcohol) by enhancing GABA
- At low doses
- Calming or sedative effect
- At high doses
- Sleep inducers or hypnotics
- Ativan, Halcion, Klonopin, Rohypnol, Valium, Xanax
- Opioids:
- Administered:
- Smoked
- Inhaled
- Injected under skin: “skin popped”
- Injected into bloodstream: “mainlined”
- Initial spasm: “rush”
- Hours of pleasure:“high” or “nod”
- Depress the CNS
- Bind to receptors that receive endorphins*
- Pleasurable / Calming
- Reduce pain & tension
- Also common effects:
- Nausea
- Constipation
88
What neurotransmitters do heroin and alcohol mimic or enhance?
- Helps GABA (an inhibitory messenger) shut down neurons and relax the drinker
- Enhances GABA
-Impairs judgment & impulse control, slows reaction time
89
Why is overdosing with heroin so common? What can happen during overdose?
- Because a person builds tolerance quickly and experience withdrawal
- Anxiety and restlessness
- Twitching, aches, fever, vomiting, diarrhea, and weight loss
During overdose:
- Easy because of tolerance
- Stop breathing (slow down nervous system, because it’s a depressant, so you slow down and eventually stop breathing)
- Death common during sleep
90
What is the most commonly used stimulant?
- Cocaine
- Amphetamines
- Caffeine********
- 80% consume daily
- Coffee, tea, energy drinks, supplements
- Reaches peak concentration in an hour
-Nicotine
91
What neurotransmitters do cocaine and meth most directly influence?
-Dopamine (prevents reabsorption)
92
What neurotransmitter does LSD most directly influence?
- Serotonin
- Binds to serotonin receptors (enhances their activity in a big way; when getting a lot of serotonin in brain, difficult to process sensory information from outside world)
93
Difference between triggers and self-medication as hypotheses for substance use? What is the evidence for each?
- Self-medication hypothesis:
- Operant conditioning
- Reduce tension
- Seek more powerful drugs
- 1 in 4 with diagnosed DO use
- Triggers (certain environmental things happen that cause you to do a drug):
- Classical conditioning
- Poor evidence
94
What two things are most responsible for the supposed “gateway effect” of cannabis?
- (1) Predisposition to use drugs
- If do MJ and decide to do other drugs, it is not because of MJ; you had internal characteristics that were predisposed to use other drugs
- (2) Opportunity
- Marijuana 1st because easy access and cheap
95
3 ingredients of severe addiction?
-(1) History of Childhood Trauma / Abuse (ACEs)
- (2) History of Family w/ Addiction
- Genetic Predisposition
- Family Environment
- Stress
- Modeling (coping with substance use)
- (3) Opportunity
- SES and Drug Culture
- What drugs are available to you; what’s common in your community; what’s the price of the drug
96
Association between these personality traits and addiction → Impulsivity, external locus of control, neuroticism
- Research does not support it, but positive correlations between addiction and:
- PLY disorders
- PLY Characteristics
- (1) External local of control (think things happen to you that you don’t have control over in life)
- (2) Impulsivity
- (3) Negative Affect (neuroticism)
- This is all about addictive personality DO; these three personality traits are found in people who battle addiction; these characteristics work together to help create addition (?)
- Thrill Seeking
- Emotion Dysregulation
- Low Self-Esteem
- Non-conformity
