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127 terms

Abnormal Psychology: Models of Abnormality

STUDY
PLAY
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?
???