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Week 1 Introduction to abnormal psychology Introduction and historical overview (Ch. 1) four characteristics of stigma: 1. a label is applied to a group of people that distinguishes them from others 2. label linked to deviant or undesirable attributes by society 3. people with label seen as essentially different from those without the label 4. people with label discriminated against unfairly psychological disorders remain most stigmatised of conditions in the twenty-first century fighting against stigma with strategies: policy and legislative: policy in insurance coverage; discriminatory laws; employment; decriminalisation—people with psychological disorders (e.g. substance abuse) often end up in jail rather than hospitals community: housing options; personal contact; education mental health/profession: mental health evaluations; education and training individual and family: education; support and advocacy groups defining psychological disorder disorder occurs within the individual involves clinically significant difficulties in affect behaviour and cognition involves personal distress of some sort involves dysfunction in processes that support mental functioning not a culturally specific reaction to an event not primarily a result of social deviance or conflict with society personal distress: person’s behaviour may be classified as disordered if it causes person great distress disability: impairment in some important area of life like work or personal relationships violation of social norms: social norms are widely held standards—vary across cultures and ethnic groups dysfunction: harmful dysfunction; a subjective judgment ‘harmful’ objective component ‘dysfunction’ history of psychopathology demonology: doctrine that an evil spirit can dwell within a person and control his or her mind and body exorcism Hippocrates psychological disorders as: mania, melancholia, phrenitis (brain fever) four humours: blood, phlegm, black and yellow bile he moved treatment of psychological disorders from priest to physician; identified that human behaviour is affected by bodily structures or substances—led to contemporary thought Galen, last great physician of classical era dark ages after he died, return to demonology, monks and monasteries nursed psychologically disturbed, lunacy persecution of witches mid 14 century, people hospitalised not thought of as being possessed 13 century, lunacy trials development of asylums 15 century, less hospitals for people with psychological disorders but many hospitals for leprosy, these hospitals converted to mental asylums as leprosy was reduced Bethlehem, bedlam Pinel’s reforms, light and airy rooms replaced dungeons, reserved more humanitarian treatment only for upper classes Dorothea Dix Moral treatments: encouraged people to engage in purposeful activity, patients led lives as close to normal people as possible, took responsibility for themselves, applied to all classes, but abandoned in latter part of 19 century evolution of contemporary thought biological approaches discovering biological origins in general paresis (psychopathology) and syphilis; germ theory; for the first time a causal link was established between infection, damage to certain areas of the brain and a form of psychopathology genetics Galton, nature and nurture, heritability of psychological disorders like schizophrenia, bipolar disorder and depression, created the eugenics movement, 45000 people sterilised in US biological treatments use of ECT electroconvulsive therapy, Cerletti and Bini, to induce seizures to help schizophrenia and depression, still used to deal with depression use of prefrontal lobotomy, removal of tracts connecting frontal lobes to other areas of the brain, Walter Freeman did 2500 lobotomies, too easily done/accessed psychological approaches -Mesmer and Charcot: treated hysteria, which referred to physical incapcities, such as blindness or paralysis for which no physical cause could be found; mesmerised, similar to hypnotism; believed to be altered magnetism, lots of mysterious rituals, talking -Breuer and cathartic method, case of Anna O, reliving an earlier emotional trauma and releasing emotional tension by expressing previously ‘forgotten’ thoughts about the event—catharsis -Freud and psychoanalysis: unconscious conflicts in individual causes psychopathology -structure of the mind: or psyche: id, ego, and superego.; id—energy (libido) for psyche, basic urges, works on pleasure principle, immediate gratification of urges; ego develops from id during second 6 months of life, reality principle mediates between the demands of reality and immediate gratification; superego, conscience, develops from childhood, arises from ego like ego to id; defines mechanisms, how ego protects itself from anxiety psychoanalytic therapy: free association, interpretation and analysis of transference neo-Freudian Jung and analytical psychology, collective unconscious: part of unconscious common to all human beings, archetypes, or basic categories that all human beings use in thinking about the world; Jung’s extraversion v introversion Adler and individual psychology: people as inextricably tied to their society, fulfilment was found in altruism influences on current field of psychopathology: 1. childhood experiences help shape adult personality 2. unconscious influences behaviour 3. causes/purposes of human behaviour not always obvious rise of behaviourism beaviourism: focuses on observable behaviour rather than on consciousness or mental functioning classical, operant conditioning and modelling Thorndike’s law of effect: behaviour that is followed by consequences satisfying organism will be repeated, behaviour followed by noxious/unpleasant consequences will be discouraged behaviour therapy, systematic desensitisation: 1. deep muscle relaxation; 2. gradual exposure to list of feared situations, starting with those that arouse minimal anxiety to those that are most frightening modeling sed as well for behaviour therapy importance of cognition and emotion: cognitive therapy: emphasise how people construe themselves and world is major determinant of psychological disorders by changing cognition, therapists think they can change people’s feelings, behaviours and symptoms Beck’s REBT (rational emotive behaviour therapy) that sustained emotional reactions are caused by internal sentences that people repeat to themselves Diagnosis and assessment (Ch. 3) reliability and validity reliability: consistency of measurement interrater reliability: degree to which two independent observers agree on what they have observed test-retest reliability: extent to which people taking same test twice receive similar scores alternate form reliability: extent to which scores on two forms of test are consistent internal consistency reliability: whether items on a test are related to one another validity: whether a measure does what it is supposed to do content validity: whether a test adequately samples domain of interest—social anxiety test should include items that cover feelings of anxiety in different social situations criterion validity: whether a measure is associated in an expected way with some other measure (criterion) concurrent validity: if both variables measured at the same point in time, resulting validity predictive validity: can measure predict some other variable measured at point in future construct validity: does it measure characteristic or construct not observed simply or overtly DSM-5 diagnostic and statistical manual of mental disorders 1. specific diagnostic criteria—symptoms for a given diagnosis—are spelled out precisely 2. characteristics of each diagnosis described much more extensively: age of onset, course, prevalence, risk……. changes in DSM-5 removal of multiaxial system, in place of three axes, clinicians simply note psychiatric and medical diagnosis changing organisation of disorders by causes to symptoms because knowledge base is not yet strong enough to organise diagnoses around aetiology DSM-4-TR diagnoses clustered into chapters based on similarity of symptoms, but in DSM-5 chapters were reorganised to reflect patterns of comorbidity and shared etiology enhanced sensitivity to developmental nature of psychopathology: childhood diagnoses were considered in separate chapter, but have now been moved into other relevant chapters of DSM-5 to highlight continuity between childhood and adulthood forms of disorder new diagnoses, e.g. disruptive mood dysregulation, to reduce overdiagnosis of bipolar disorder in children; other new: hoarding disorder, binge eating disorder, premenstrual dysphoric disorder, gambling disorder combining diagnoses: some diagnoses from DSM-4-TR combined because not enough evidence for differential etiology, course or treatment response to justify separate diagnostic categories ethnic and cultural considerations in diagnosis: DSM-5 includes a list that cross-references the DSM diagnoses with the International Statistical Classification of Disease and Related Health Problems (ICD) codes appendix devoted developing a cultural informed case formulation; clinicians ar cautioned not to diagnose symptoms unless they are atypical and problematic within a person’s culture; cultures may shape the language used to describe distress DSM-5 includes nine cultural concepts of distress; following are examples of syndromes listed in DSM-5 glossary: Dhat syndrome, Indian, fear of discharging semen; 神經衰弱 neurasthenia, fatigue, dizziness, headaches…; 対人恐怖症 fear that one could offend others through eye contact, blushing… body odour…; ataque de nervios, fear of screaming and shouting uncontrollably (Latino/Latina) not listed in DSM-5: amok, period of brooding and then violent outburst; ghost sickness, preoccupation with death and those who have died (Native American); ひきこもり 自閉症 specific criticisms of the DSM too many diagnoses: now 347 from 297 in DSM-4-TR too many minute distinctions based on small differences in symptoms; side effect of huge number of diagnostic categories is comorbidity, presence of a second diagnosis, people who meet one psychiatric diagnosis, 45% meet criteria for one more psychiatric diagnosis risk factors seem to trigger more than one disorder should we keep finer distinctions or lump? some disorders co-occur more frequently than do others,some disorders co-occur so often that they should be considered different manifestations of one underlying disease process or vulnerability categorical classification versus dimensional classification discrete v continuous categorical system forces clinicians to define one threshold as diagnosable, but many people with sub threshold symptoms of a diagnosis will still receive treatment NOS—not otherwise specified—when person meets many but not all criteria for diagnosis reliability of the DSM in everyday practice—expecting high reliability may be unrealistic as many medical diagnoses do not have great reliability at all how valid are diagnostic categories general criticisms of diagnosing psychological disorders could have a stigmatising effect, though research suggests that people tend to view the behaviours negatively more than the category labels, labels may actually relieve stigma by providing an explanation for the symptomatic behaviour when a diagnostic category is applied we may lose sight fo the uniqueness of that person psychological assessment clinical interviews characteristics: one way a clinical interview is different is the attention the interviewer pays to how the respondent answers or does not answer questions, recognise the importance of establishing rapport, empathise, encourage to elaborate operate on vaguest outlines unstructured interviews are less reliable than structured interviews structured interview: questions are set out in a prescribed fashion for the interviewer eg SCID—structured clinical interview— branching interview, that is, a person’s response to one question determines the next question that is asked clinicians using unstructured diagnostic interviews tend to miss comorbid diagnoses that accompany a primary diagnosis, interrater reliability for structured interviews are quite good assessment of stress stress: subjective experience of distress in response to perceived environmental problems Bedford college life events and difficulties schedule (LEDS), semistructured, interviewer and interviewee work collaboratively to produce a calendar of each of the major events within a given time period; designed to address problems in life stress assessment like need to evaluate importance of any given life event in the context of a person’s life circumstances; excluded life events that might be consequences of symptoms; includes a set of strategies to carefully date when a life stressor occurred self-report stress checklist, not collaborative, quicker way to assess stress typically list different life events and participants are asked to indicate whether or not thees events happened to them in a specified period of time; there is a great variability in how people view these events—one difficulty other problems include difficulties with recall and low test-retest reliability because of bias during responses personality tests psychological tests include personality and intelligence tests self-report personality inventories in a personality inventory, person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her statistical norms for test can then be established—which is called standardisation Minnesota multiphasic personality inventory (MMPI), multiphasic because designed to detect a number of psychological problems MMPI-2 addresses lack of ethnic minorities, sexist wording was eliminated along with outmoded idioms people who endorse a large number of statements in the lie scale might be attempting to present themselves in a good light, high scores on the infrequency scale also discriminate between people trying to fake psychopathology and people who actually have a psychological disorder a person who obtains high scores on the lie or infrequency scale may be viewed with skepticism projective personality tet projective test: psychological assessment tool in which a set of standard stimuli—inkblots or drawings—ambiguous enough to allow variation in responses is presented to the person assumption is that because the stimulus materials are unstructured and ambiguous, the person’s responses will be determined primarily by unconscious processes and will reveal his or her true attitudes, motivations and modes of behaviour—projective hypothesis thematic apperception test: person is shown a series of black-and-white pictures one by one and asked to tell a story related to each; low construct validity, norms based on small and limited sample Rorschach inkblot test: a person is shown 10 inkblots one at a time and asked to tell what the blots look like; Exner’s scoring system, concentrates on perceptual and cognitive patterns in a person’s responses; unclear whether Rorschach provides information that could not be obtained more simply through an interview; appears to have better validity in assessing some issues more than others like schizophrenia, bpd, and dependent personality traits intelligence test IQ test: way of assessing a person’s current mental ability based on assumption that a detailed sample of a person’s current intellectual functioning can predict how well s/he will perform in school, individually administered purposes include: to diagnose learning disorders, identify strengths and weaknesses for academic planning; to assess whether a person has intellectual disability; to identify intellectually gifted children; as part of neuropsychological evaluations to show eg deterioration of mental ability over time 100 is the mean, 15/16 is standard deviation, 65% receive 85-115 IQ tests are highly reliable, good criterion validity, good predictors of educational attainment and occupational success, though lack of causality between education and IQ IQ tests explain only a small part of school performance IQ tests measure only what psychologists consider intelligence stereotype threat, social stigma of poor intellectual performance by some groups actually interferes with performance on these tests awareness of stereotypes develop early (gender race and intellect) behavioural and cognitive assessment identify: aspects of environment that might contribute to symptoms; characteristics of person; frequency and form of problematic behaviours; consequences of problem behaviours direct observation of behaviour: formal behavioural observation, observer divides sequence of behaviour into various parts that make sense within a learning framework; behavioural assessment procedures yield data that could be used to measure effects of treatment self-observation, self-monitoring: observe and track own behaviour and responses ecological momentary assessment (EMA), collection of data in real time as opposed to the more usual methods of having people reflect back over some time period and report on recently experienced thoughts, moods, or stressors; with EMA, a person is signalled (via smartphone) several times a day and asked to enter responses directly into the device reactivity: phenomenon wherein behaviour changes because it is being observed; desirable behaviour such as engaging in social conversation increases in frequency when it is selfmonitored cognitive-style questionnaires Neurobiological assessment brain imaging CT/CAT scan computerised axial tomography assesses structural brain abnormalities, uses radioactivity, magnetic resonance imaging superior to CT scan because it produces pictures of higher quality and does not rely on even the small amount of radiation required by a CT scan functional MRI allows researchers to measure both brain structure and brain function, measures blood flow in the brain, called BOLD signal, blood flow in particular region of brain is proxy for neural activity in that region positron emission tomography, PET scan, allows measurement of both brain structure an brain function although the measurement of brain structure not as precise as with MRI or fMRI, less used because of how invasive it is functional connectivity analysis: aims to identify how different areas of the brain are connected with one another neurotransmitter assessment metabolite, an acid, is produced when a neurotransmitter is deactivated, these by-products of neurotransmitters found in urine blood serum and cerebrospinal fluid, high level of metabolite indicates high level of neurotransmitter and vice versa the problem is that such measures are not direct reflections of levels of neurotransmitters in the brain as metaolites measured could reflect neurotransmitters anywhere in the body, even with CSF fluid however metabolites reflect activity throughout brain and spinal cord, rather than regions directly involved in psychopathology another problem is that they are correlational more experimental data can be obtained from administering drugs that increase or decrease levels of neurotransmitters, consider ethics, also levels of one neurotransmitter influences other neurotransmitter systems many brain abnormalities involve alterations in structure so subtle that they have thus far eluded direct examination, cannot use brain scans to diagnose psychopathology psychopathology so widespread that attributing it to one brain dysfunction is difficult neuropsychological assessment neurologist: specialist in things affecting nervous system neuropsychologist: psychologist who studies how dysfunction of brain affects way we think … neuropsychological tests: used in in conjunction with brain-imaging techniques, to detect brain dysfunction and pinpoint specific areas of behaviour impacted by problems in brain; based on idea that psychological functions rely on different areas of brain Reitan’s modification of a battery of test developed by Halstead tactile performance test—time (timed) tactile performance test—memory speech sounds perception test, measures left-hemisphere function valid for detecting behaviour changes linked to brain dysfunction resulting from a variety of conditions psychophysiological assessment psychophysiology: bodily changes that are associated with psychological events activities of autonomic nervous system used to understand emotion, heart rate, depicted by electrocardiogram EKG skin conductance, for ANS, detected by electrodermal responding—increased sweat-gland activity indicates sympathetic autonomic excitation and taken as measure of emotional arousal electroencephalogram EEG, scalp, record electrical activity in underlying brain area limitations: skin conductance detects more than anxiety; being in a scanner is scary Cultural and ethnic diversity and assessment cultural bias in assessment simply translating words into a different language does not ensure that meaning of those words will be the same across different cultures cultural assumptions may cause clinicians to over- or underestimate psychological problems in other cultures strategies to overcome bias use graduate training programs, education, become informed about culture and its effects on assessment, do not rely on global stereotypes examiner may need to make an extra effort to establish rapport that will result in person’s best performance be tentative structured interviews less likely to overdiagnose people from different cultures