Abnormal Psychology: Models of Abnormality

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model

a perspective used to explain events;
each one does the following:
1. delineates basic assumptions
2. gives order to the field of study
3. sets guidelines

Do models evolve over time?

yes

Current Models (5)

1. Biological
2. Psychodynamic
3. Cognitive-Behavioral
4. Humanistic-existential
5. Socio-cultural

Biological Models (brain makeup and how information is communicated)

1. brain is made of approximately 100 billion neurons and thousands of billions of support cells (glia - glial cells)
2. Information communicated in the brain through electrical impulses

Synaptic Transmission (4 steps)

1. An electrical impulse reaches the neuron's ending
2. This stimulates the release of a neurotransmitter
3. The neurotransmitter travels across the synapse (space between neurons) and comes in contact with other neuron's receptors
4. This stimulates electrical impulses in this neuron

synapse

space between neurons

Key Neurotransmitters (5)

1. Serotonin
2. Norepinephrine
3. Dopamine
4. GABA
5. Glutamate
SNDGG (Send Gigi)

Serotonin

NT - mood, impulse control

Norepinephrine

NT - mood, response to drugs

Dopamine

NT - pleasure/pain; implicated in schizophrenia

GABA

NT - stress response, anxiety; inhibitory

Glutamate

NT - epilepsy; excitatory

Sources of Biological Abnormalities (2)

1. Genetics (evolutionary perspective)
2. Viral infections (EX: influenza during pregnancy and schizophrenia)

Biological Treatments (4)

1. Psychotropic medications
2. Electroconvulsive therapy
3. Psychosurgery
4. Experimental techniques

psychotropic medications (5)

biological treatment; medications are effective; have a wide range of intense side effects; compliance difficulties; cocktails (mixing kinds)
1. Antidepressants
2. Anxiolytics
3. Antipsychotics
4. Mood Stabilizers
5. Stimulants

Antidepressants (4)

1. Monoamine oxidase inhibitors (MAOIs)
2. Tricyclics (TCAs)
3. Selective serotonin reuptake inhibitors (SSRIs)
4. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SSTM ("System" of antidepressants)

MAOIs

(antidepressants) monoamine oxidase inhibitors; last line of treatment because of lethal interactions with other medications and food; discovered in the 1950s

TCAs

(antidepressants) tricyclics; very effective, but have lots of side effects (EX: dry mouth, blurry vision, drowsiness, anxiety, sexual dysfunction); can also be used to overdose;

EX: imimpramine- Tofranil

SSRIs

(antidepressants) selective serotonin reuptake inhibitors; also effective for anxiety and eating disorders; fewer side effects than TCAs and less potential for overdose; yet some important side effects (sexual dysfunction);

EX: fluoxetine (Prozac); sertraline (Zoloft), paroxetine (Paxil)

SNRIs

(antidepressants) serotonin-norepinephrine reuptake inhibitors; also used for anxiety, ADHD, pain; very similar to SSRIs, but important adrenergic side effects (EX: blood pressure needs to be periodically monitored)

EX: duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq)

Anxiolytics (2)

psychotropic medication
1. Barbiturates
2. Benzodiazepine (benzos)

Barbiturates

(anxiolytics) first synthesized in 1864 by Adolf von Bayer; very powerful relaxants and hypnotic; potential for lethal overdose; no longer used

EX: phenobarbital

Benzodiazepine (benzos)

much safer than barbiturates, though they can still produce dependence and withdrawal; mostly prescribed for short-term relief of anxiety

EX: alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan)

Antipsychotics (2)

1. First generation (typical)
2. Second generation (atypical)

First generation (typical)

antipsychotics; discovered int he 50s; effective but have severe side effects (extrapyramidal, effects on motor control- Parkinson's-type movements; weight gain; lowered white cell count)

EX: haldoperidol (Haldol)

Second generation (atypical)

antipsychotics; less likely to cause extrapyramidal effects; also discovered in the 50s but not popular until the 70s

EX: clozapine (Clozaril), olzanzapine (Zyprexa), quetapina (Seroquel), risperidone (Risperidal)

Mood Stabilizers (2)

1. Antoconvulsants
2. Lithium

Anticonvulsants

mood stabilizer; first used to treat epilepsy; effective but have a wide range of side effects (weight gain, lowered white cell count)

EX: valporic acid (Depakene), divalproex sodium (Depakote), lamotrigine (Lamictal)

Lithium

mood stabilizer; very effective, but blood levels need to be monitored regularly

What are stimulants used to treat?

Attention Deficits Hyperactive Disorder (ADHD); suppress appetite; long term effects not yet known (as with most drugs)

EX: amphetamine salts (Adderall), methylphenidactive (Ritalin)

What is Atmoxetine (Strattera)?

not a stimulant, but rather a selective norepinephrine reuptake inhibitor also used to treat ADHD

ECT

biological treatment; Electroconvulsive Therapy;
1. brain seizure induced by passing electrical current through the brain (65-140 voltz)
2. 6-12 sessions
3. Patients are anesthetized or given muscle relaxants
4. high response rate, but high relapse rate; memory loss

Psychosurgery

biological treatment; modern technologies are derived from lobotomy (1930s): surgeons would cut connections between the frontal lobes and lower regions of the brain

today, techniques are more precise (but still considered experimental and last line of treatment)

Experimental Techniques (3)

1. Transcranial magnetic stimulation (TMS)
2. Deep brain stimulation
3. Vagus nerve stimulation

TMS

experimental techniques, transcranial magnetic stimulation; expose patients to high-intensity magnetic pulses focused on particular brain structures in order to stimulate activity

Deep brain stimulation

experimental technique; surgically plant electrodes in specific areas of the brain that deliver stimulation via a pulse generator

Vagus nerve stimulation

experimental technique; attach electrodes to vagus nerve and deliver stimulation through a pulse generator; stimulation travels to certain brain areas (parasympathetic control of the heart)

Psychodynamic Models

people's behavior (whether normal or abnormal is determined largely by underlying psychological forces of which s/he is not consciously aware

Deterministic

psychodynamic models; no behavior is "accidental" - there is always a "why" (a reason)

Sigmund Freud

Viennese neurologist; interested in research but needed to make additional income so he started seeing patients
1. Worked with French physician Josef Breuer - conducted hypnosis on women with hysterical symptoms
2. Anna O- a patient who started to describe traumatic events under hypnosis (expression of those repressed memories seemed to enhance the effectiveness of the treatment
3. "the talking cure"

Freud's Topographic Model (of personality structure)

iceberg analogy: (id, ego, superego- all in constant struggle with one another - expressed as symptoms)
1. tip is the CONSCIOUS (contract with the outside world) - EGO
2. PRECONSCIOUS (material just beneath the surface of awareness)- EGO (reality principle, secondary process thinking- reality testing)
3. UNCONSCIOUS (difficult to retrieve material- well below the surface of awareness); ID (pleasure principles, primary process thinking, wish fulfillment) and SUPEREGO (social component, moral imperatives) -superego spans all parts

Where does all psychic energy originate according to Freud?

the unconscious

id

instinctual needs, drives, and impulses (anxiety, sexual, anger; pleasure principle); unconscious, pleasure principle, primary process thinking; biological component (the instincts Eros and Thanatos are associated with the unconscious mind and the id)

ego

develops mechanisms to defend against unacceptable impulses and uncontrollable anxiety (reality principle); conscious and preconscious

superego

rules and norms incorporated from our parents and society; conscience

Defense Mechanisms (creator and levels)

George Vaillant (1977) categorized defenses according to psychoanalytic development level
Level 1: pathological defenses
Level 2: immature defenses
Level 3: neurotic defenses
Level 4: mature defenses
(PINM)

Level 1: Pathological Defenses (6)

1. Delusional projection
2. Conversion
3. Denial
4. Distortion
5. Splitting
6. Extreme projection

Delusional projection (level 1)

frank delusions about external reality

Conversion (level 1)

expression of intrapsychic conflict as physical symptoms

Denial (level 1)

refusal to accept external reality

Distortion (level 1)

gross reshaping of external reality to meet inernal needs

Splitting (level 1)

negative and positive impulses are split off and not integrated

Extreme projection (level 1)

blatant denial of a deficiency

Level 2: Immature Defenses (7)

1. Acting out
2. Fantasy
3. Idealization
4. Passive aggression
5. Projection
6. Projective identification
7. Somatization

Acting out (level 2)

direct expression of unconscious wish or impulse in action without conscious awareness

Fantasy (level 2)

tendency to retreat inwards to resolve inner and outer conflicts

Idealization (level 2)

perceiving another person as having more positive qualities than they actually do

Passive aggression (level 2)

aggression towards others expressed indirectly

Projection (level 2)

attributing one's thoughts, emotions, behaviors, to others

Projective identification (level 2)

the object of projection invokes in that person the thoughts, feelings, or behaviors (projected behaviors) to others

Somatization (level 2)

transformation of negative feelings towards others into negative feelings about the self, pain, illness, anxiety

Level 3: Neurotic Defenses (11)

1. Displacement
2. Dissociation
3. Hypochondriasis
4. Intellectualization
5. Isolation
6. Rationalization
7. Reaction formation
8. Regression
9. Repression
10. Undoing
11. Withdrawal

Displacement (level 3)

shifting of sexual or aggressive impulses to a more acceptable or less threatening object

Dissociation (level 3)

temporary drastic modification of one's identity

Hypochondriasis (level 3)

excessive preoccupation about having or contracting an illness

Intellectualization (level 3)

replacement of emotional reactions in favor of overly logical responses

Isolation (level 3)

separation of feelings from ideas and events

Rationalization (level 3)

creation of acceptable excuses for feeling, thoughts, and behaviors that are unacceptable

Reaction formation (level 3)

converting unconscious wishes and impulses perceived to be dangerous as their opposites

Regression (level 3)

temporary reversion of the ego to an earlier stage of development

Repression (level 3)

attempting to prevent unacceptable desires from entering consciousness

Undoing (level 3)

trying to undo an unacceptable thought, feeling, or behavior by engaging in a behavior

Withdrawal (level 3)

removing oneself from events, stimuli, etc. in order to avoid remembering painful thoughts and feelings

Level 4: Mature Defenses (7)

1. Altruism
2. Anticipation
3. Humor
4. Identification
5. Introjection
6. Sublmiation
7. Thought of suppression

Altruism (level 4)

service to others to bring personal satisfaction

Anticipation (level 4)

realistic planning for futuristic discomfort

Humor (level 4)

overt expression of ideas and feelings that gives pleasure to others; the thoughts retain a portion of the original distress

Identification (level 4)

modeling of oneself upon others

Introjection (level 4)

identifying with some idea or object so deeply that it becomes one's identity

Sumblimation (level 4)

transformation of negative emotions or instincts into positive ones

Thought suppression (level 4)

pushing thoughts into the preconscious

Mapping Defense to Psychopathology (3)

1. Pathological: psychotic disorders
2. Immature: psychotic and personality disorders
3. Neurotic: mood and anxiety disorders

Freud's Developmental Stages (5)

1. Oral (0-18m, focus on mouth; id dominates; learn delayed gratification)
2. Anal (18m-3y toilet training, conflict between id and ego regarding waste elimination; autonomy)
3. Phallic (3-5y conflict between id and ego regarding wanting attention of one parent; Oedipus/Electra complex)
4. Latency (5-12y, consolidation of previous stages; identity formation)
5. Genital (12y+ further consolidation, symbolism; goals)

OAPLG (Oh, a plug)

What happens when conflict is not resolved according to Freud?

if conflict is not resolved -> fixation -> psychopathology

Useful Psychodynamic Terms (3)

1. Transference
2. Countertransference
3. Repetition compulsion

Transference

redirection towards the therapist of feelings associated with important figures in the patient's life

Countertransference

reactions that the patient evokes in the therapist

Repetition compulsion

putting oneself in situations when an undesired event is likely to happen again

Psychodynamic Treatment

1. Free association
2. Interpretation of resistance, transference, and dreams (resistance to Freud- patients blocking memories from consciousness; current conceptualization- treatment interfering behaviors by the patient)
3. Catharsis
4. Working through
(Psychodynamically-oriented therapy: once/twice a week, interactive;
Psychoanalysis: 3-4 times/week, patients lies down on the couch, therapist does very little talking)

Behavioral Models (3)

1. Classical conditioning
2. Operant conditioning
3. Modeling and observational learning

Classical Conditioning

(behavioral model); Pavlov's dogs
1. Unconditioned stimulus (food) leads to -> unconditioned response (salivate)
2. Conditioned stimulus (bell) paired with the unconditioned stimulus (food) leads to -> conditioned response (salivate when hear bell)

Extinction

produce the conditioned stimulus (bell) without the unconditioned stimulus (food) and the association between conditioned stimulus and conditioned response (salivation) will become extinguished

new accounts of exposure -> inhibitory learning

John Watson's Little Albert Experiment

US: loud noise -> UR: startle
CS: white rat paired with noise ->
CR: startle at the sight of the rat

Fear generalized to many other white furry things (rabbits, Santa hats)

Operant Conditioning

(behavioral models); B.F. Skinner showed that behaviors that are reinforced are strengthened over time; behaviors that are punished are weakened

Operant Conditioning and Little Albert

1. Little Albert would avoid furry things to reduce anxiety
2. Thus, avoidance behavior was reinforced
3. Avoidant behavior increases
4. Because he avoids white furry things, he also avoids the opportunity for the association between furry things and loud noises to be extinguished
5. Exposure to the unconditioned stimulus in the absence of the conditioned stimulus is at the core of behavioral treatments for anxiety

Mowrer's Two-stage Fear Conditioning

1. Classical conditioning leads to fear
2. Operant conditioning maintains it

+avoidance of experience makes unable to extinguish the association

What is at the core of behavioral treatments for anxiety?

exposure to the conditioned stimulus in the absence of the conditioned response

Modeling (new behaviors)

learning new behaviors by imitating behaviors of others

Observational learning (rewards/punishments)

observe rewards and punishments others receive for behaviors and act accordingly (EX: children can learn to be afraid of things their parents fear by observing their reactions)

Behavioral Treatments (Exposure)

primarily to treat anxiety disorders
1. Patient and therapist generate a hierarchy of feared situations
2. Therapist exposes client to feared situations gradually, starting with the least feared and moving toward the most feared
3. Systematic desensitization when patient is instructed to relax during emotional arousal

What is exposure used to treat?

primarily anxiety disorders

Cognitive Models

individuals engage in automatic thoughts that are based on cognitive distortions; such thoughts perpetuate viscous cycles of depression, anxiety, eating disorders, etc.
(EX: "I'm never going to finish that paper")

Aaron Beck and Cognitive Models

an American psychiatrist; widely regarded as the father of cognitive therapy, and his pioneering theories are widely used in the treatment of clinical depression. Beck also developed self-report measures of depression and anxiety including Beck Depression Inventory (BDI),[1][2] Beck Hopelessness Scale,[3] Beck Scale for Suicidal Ideation (BSS), Beck Anxiety Inventory (BAI), and Beck Youth Inventories.

Cognitive Distortions (10)

1. All-or-Nothing Thinking
2. Overgeneralization
3. Mental Filters
4. Disqualifying the Positive
5. Jumping to Conclusions
6. Magnification/Catastrophizing or Minimization
7. Emotional Reasoning
8. "Should" Statements
9. Labeling and Mislabeling
10. Personalization

All-or-Nothing Thinking

cognitive distortion; you see things in black and white categories; if your performance falls short of perfect, you see yourself as a total failure

Overgeneralization

cognitive distortion; you see a single negative event as a never-ending pattern

Mental Filters

cognitive distortion; you pick out a single negative detail and dwell on it exclusively, so that your vision of all reality becomes darkened (drop of ink in water)

Disqualifying the Positive

cognitive distortion; you reject positive experiences by insisting they "don't count" for some reason or other; in this way you can maintain a negative belief that is contradicted by your everyday experiences

Jumping to Conclusions

cognitive distortion; you make a negative interpretation even though there are no definite facts that convincingly support your conclusion

Magnification/Catastrophizing or Minimization

cognitive distortion; you exaggerate the importance of things (such as your failures or someone else's achievement) or you inappropriately shrink things until they appear tiny (your own desirable qualities)

Emotional Reasoning

cognitive distortion; you assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true."

"Should" Statements

cognitive distortion; you try to motivate yourself with "shoulds" and "shouldn'ts" as if you had to be punished before you could be expected to do anything

Labeling and Mislabeling

cognitive distortion; an extreme form of overgeneralization; instead of describing your error, you attach a negative label to yoursel ("I'm a loser"); mislabeling involves describing an event with language that is highly colored and emotionally loaded

Personalization

cognitive distortion; you see yourself as the cause of some negative external event for which, in fact, you were not primarily responsible

Cognitive Therapy

help patients to:
1.identify irrational and maladaptive thoughts
2. critically examine their validity and usefulness
3. replace them with more adaptive thoughts

The Thought Record

cognitive therapy; Feeling, Situation, Thought, Alternative Perspective

Third-Wave CBT

more recent CBT approaches that include the following processes:
1. Emotion regulation skills (techniques to manage difficult and painful emotions)
2. Mindfulness (ability to remain in contact in the present, non-judgmentally, even if we are experiencing unpleasant emotions/thoughts/physical sensations)
3. Radical acceptance (learning to embrace our feelings, thoughts, and behaviors "as they are")

CBT

Cognitive Behavioral Therapy

Humanistic-Existential Therapies

...

Carl Rogers

Client-centered therapy

Fritz Perls

Gestalt therapy

Irvin Yalom

Existential therapy

Socio-cultural Therapy

abnormal functioning can be understood in the context surrounding a person's life

group therapy, family therapy, marital therapy

For which therapies is empirical support the strongest?

biological, cognitive, and behavioral therapies

Which therapies are time-limited and symptom-focused?

Cognitive and behavioral therapies

Which therapy is the best?

despite their differences, not one therapy is better and it is important to find a therapist treatment that fits one's needs

Describe one difference between psychodynamic and cognitive behavioral therapies?

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