Psychology and Health Care: Understanding Different Models and Approaches to Mental Health, Study notes of Abnormal Psychology

Download Psychology and Health Care: Understanding Different Models and Approaches to Mental Health and more Study notes Abnormal Psychology in PDF only on Docsity! Study guide – Abnormal Psychology Midterm Chapters 1 – 6 Chapter One 1. The role of paradigm/perspectives in psychology and that the way the causes of abnormal are perceived affects the way it is treated. 2. Abnormal behavior can be defined in 4 different ways, distress, impairment, risk to self or others and socially and culturally unacceptable behaviors. Sometimes distress maybe so great that some people cannot get through the daily tasks of life. In many cases, distress leads to a reduction in a person’s ability to function. Impairment involves a reduction in a person’s ability to function at an optimal or even an average level. Risk refers to danger or threat to the well-being of a person. The final criterion for abnormal behavior is behavior that is outside the norms of the social and cultural context within which it takes place. The context within which a behavior takes place is a critical determinant of whether it is regarded as abnormal. a. There is rarely a clear delineation between what is normal and what is abnormal. There is always disagreement about what constitutes a psychological disorder. 3. Biological causes : what is going on in a person’s body that can be attributed to genetic inheritance or disturbances in physical functioning; also can result from disturbances in physical functioning – medical conditions, brain damage or exposure to certain kind of environmental stimuli. Psychological causes: disturbances commonly arise as a result of troubling life experiences – consider a person’s experiences (interpersonal/intrapsychic). Sociocultural causes: the various circles of social influence in the lives of people. immediate circle – people with whom we interact on the most local level; extends to culture within which we live. BIOPSYCHOSOCIAL PERSPECTIVE: the interaction in which biological, psychological and sociocultural factors play a role in the development of the individual. Psychological disorders arise from complex interactions involving all three factors. DIATHESIS STRESS MODEL: people are born with a predisposition that places them at risk for developing a psychological disorder. Presumably this vulnerability is genetic, but when stress is a factor, the person who is vulnerable has greater risk of developing a disorder. 4. Appreciate the stigma associated with having a psychological disorder and seeking professional psychological help as well as the impact of mental illness on the family, community and society. 5. Mystical: regard abnormal behavior as the product of possession by evil or demonic spirits. Scientific: looks for natural causes, such as biological imbalances, faulty learning processes or emotional stressors Humanitarian: view psychological disorders as the result of cruelty, non-acceptance or poor living conditions Medical: trephining (drilling holes in the skull), Spiritual: exorcisms performed 6. Currently, many state hospitals have been built throughout the US. a. De-institutionalization: promoted the release of psychiatric clients into community treatment sites (because of better medication). Many of the programs failed to come through because of inadequate planning and funding. b. Managed care – health insurance not always covering psychological treatment; length of stay and ability to stay affected 7. Medical model: view that abnormal behaviors result from physical problems and should be treated medically Psychoanalytic model: seeks explanations of abnormal behavior in the workings of unconscious psychological processes, had its origins in the controversial techniques of Anton Mesmer hypnotism: treatment for hysteria Humanistic: Scientific: 8. Concordance rate: agreement ratios between people diagnosed as having a particular disorder and their relatives an inherited disorder rwould be expected to have a higher rate between monozygotic (identical) twins and a lower rate among siblings or dizygotic (fraternal) twins a. A more powerful way to determine whether a disorder has genetic basis is the study of families in which an adoption has taken place. Adoptive study: researchers look at children who’s biological parents have diagnosed psychological disorders, but who are adopted by “normal” parents b. Crossfostering study: researches look at children who are adopted by parents with psychological disorders but whose biological parents are psychologically healthy. c. Genetic mapping: a process researchers currently use in studying a variety of diseases thought to have a genetic basis. Rebecca Hasbrouck: Disheveled woman, hair was knotty, clothes were dirty and stained; she needed to “return to the world”. A few years earlier, she was living a comfortable life with a husband and two sons. As she and her family were returning from vacation, a large truck hit their car, causing it to run off the road and flip several times. This accident killed her husband and sons. After returning home from the hospital to her empty house, she was tormented by voices and memories. Her mother was suffering from severe depression as well and could be of no assistance to Rebecca. Her mother told her not to call again because she couldn’t be “burdened” by her. Feeling she had no one to turn to, she set out, looking for her lost family members – lost all contact with her former world and herself. Dr. Tobin recommended that she stay in a hospital during treatment for two weeks. During this time, she attended group therapy, spoke with many doctors about getting her life back on track and at the end, felt like she was “coming back from the grave.” After leaving the hospital, she stayed in a halfway house for a month and then found an apartment close to her sister’s house and she started writing books. Chapter Two 1. Psychiatrists: medical doctors with advanced training in treating people with psychological disorders – licensed to administer medical treatment; psychologists are not Clinical psychologists: individuals trained in either a PhD or a PsyD program; some are trained within the firled of counseling psychology, where the emphasis is on normal adjustment and development rather than on psychological disorders. 2. DSM (Diagnostic and Statistical Manual of Mental Disorders): publication that is periodically revised to reflect the most up-to-date knowledge concerning psychological disorders, published by the American Psychiatric Association. RELIABILITY, VALIDITY a. Five axes of DSM: i. Axis I: Clinical disorders – major clinical disorders, adjustment disorders (emotional reactions, disturbances of conduct, etc.) ii. Axis II: personality disorders and mental retardation iii. Axis III: general medical conditions – because physical problems can be the basis of psychological problems iv. Axis IV: psychosocial and environmental problems – primary support groups: childhood, educational, occupational, economic problems v. Axis V: global assessment of functioning – GAF scale, ranges from 0 – 100 b. Decision tree: a series of simple yes/no questions in the DSM-IV-TR about the clients symptoms that lead to a possible diagnosis – answers are different branches of “tree” c. Mental disorder: “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering, death, pain, disability or an important loss of freedom.” In addition, this syndrome cannot be merely an expectable and culturally sanctioned response to a particular event. d. Syndrome: a collection of symptoms that forms a definable pattern. The disorder is reflected in a behavioral or psychological syndrome. – a collection of observable thoughts and feelings. Thus an isolated behavior or a single thought would not constitute a disorder. e. Differential diagnosis: the process of systematically ruling out alternative diagnoses. This is the final step in the diagnostic process and is done either by questioning the client or reviewing the information already collected. a. Self monitoring: behavioral self report technique in which the client keeps a record of the frequency of specified behaviors – target behaviors. b. Behavioral observation: the clinician observes the individual and records the frequency of specific behaviors, along with any relevant situational factors. 8. Physiological assessment – major forms a. Psychophysiological assessment: provide a wealth of information about the bodily responses of an individual to a given situation. i. Galvanic skin response (GSR) b. Neuropsychological assessment: process of gathering information about a client’s brain functioning on the basis of performance on psychological tests. Ben Robsham: 21 year old, college junior. Sitting in a distant corner of the room, , starting intently at the floor; muttering something. Ben wore a wool knot hat over his are and ears and sleek, black leather gloves. He wasn’t interested in small talk, but rather eager to get right to the point. Conclusion so far: a young man who was experiencing emotion instability and was feeling needy and frightened. He asked whether the police would have access to the testing results, claiming that police officers had been following him for several months, since the day he collided with a police car while riding his bike. The officer had been “quite stern” with him and he was quite troubled about the encounter. When asked why he was wearing his hat and gloves, he answered that it was so he could cover up “identifying characteristics.” Ben expressed concern that he was sounding delusional, and he described an accident in which he sustained minor head injuries including a possible undiagnosed head injury. Family background: he described his childhood years are being troubled both at home and at school. His mother was very overprotective and his father was minimally involved with the rest of the family. He is on the verge of a break with reality and suffering from intense anxiety. Chapter Four Psychoanalytic approach 1. Id: the structure of personality that contains sexual and aggressive instincts; follows the pleasure principle. Ego: center of conscious awareness; function is to give mental powers of judgment, memory, perception and decision making. Governed by reality principle. Superego: controlling the ego’s pursuit of the id’s desires; functions as the conscience 2. Psychosexual stages - Oral (0-18 months): stimulation of mouth and lips a. Oral agressive b. Oral dependent - Anal (18 months – 3 years): stimulation through holding on or expelling feces - Phallic (3-5 years): genital area is focus of child’s sexual feelings - Latency (5-12 years): ineracts with peers the same as parents and other adults do - Genital (12 years – adult): resurfacing of sexual energy prior to puberty c. Fixation, regression Psychoanalytic - Early childhood relationship with parents - Objective relationships – poor attachment - Tranferential issues 3. Levels of Conscious: Conscious, Pre Conscious, Unconscious a. Unconscious – early childhood is rooted in the deepest level of awareness, called Unconscious, and early years played a formative role in personality b. Repression – unconsciously expelling disturbing wishes, thoughts, or experiences from awareness 4. Forms of Anxiety: objective(reality), moral, and neurotic a. Objective (reality) – fear of real-world events, the cause of anxiety is usually easily identifiable, b. Moral – fear of violating our own principles c. Neurotic – unconscious worry that we will lose control of the id’s urges, resulting in punishment for inappropriate behavior 5. Strengths of Psychoanalytic Approach: childhood experiences help shape adult personality, there are unconscious influences on personality, defense mechanisms help to control anxiety, the causes and purposes of human behavior are now always obvious Weaknesses/Criticism: Debate over complexity and relevance of Freudian notions 6. Psychoanalytic – theory relies heavily on concepts of unconscious mind, inhibited sexual impulses, early development, and the use of the “free association” technique and dream analysis a. Psychodynamic – perspective that focuses on unconscious processes and incorporates a wider variety of theoretical perspectives on personality and treatment b. Psychoanalytic treatment – includes free association and dream analysis, to bring repressed, unconscious material into conscious awareness. 7. Identify a. Fixation – arrested development at a particular stage of psychosexual development attributable to excessive or inadequate gratification at that stage b. Regression – back to behavior at an earlier stage or may become stuck, or fixated, at that stage c. Repression – unconsciously expelling disturbing wishes, thoughts, or experiences from awareness d. Primary vs. Secondary Process Thinking – primary: loosely associated, idiosyncratic, and distorted cognitive representation of the world, secondary: the kind of thinking involved in logical and rational problem solving e. Oral character types – regression in adulthood cause excessive reliance on oral sources of gratification (nail biting, cigarette smoking, overeating), usually hostile and have a critical attitude f. Anal character types – regression in adulthood become excessively neat or excessively sloppy g. Defense mechanisms in text p. 106 - 107 h. Pleasure v. reality principles – pleasure: a motivating force oriented toward the immediate and total gratification of sensual needs and desires, reality: motivational force that leads the individual to confront the constraints of the external world i. Reality testing – process through which the psyche gauges the difference between the internal and external world j. Dream analysis – client’s relates the events of a dream to the clinician and free associates to these events k. Free association – client speaks freely, saying whatever comes to mind l. Resistance – unconscious blocking of anxiety-provoking thoughts or feelings m. Transference - the carrying over toward the therapist of the feelings the client had toward parents or other significant people in the client’s life n. Counter transference- redirection of psychotherapist’s feelings toward a client or more generally as a therapist’s emotional entanglement with a client 8. Psychodynamic treatment methods: a. Free association – the client speaks freely in therapy saying whatever comes to mind b. Dream analysis – involves the client relating the events of a dream to the clinician and free associating to these events i. Transference – the client presumably relives conflictual relationships with his or her parents by transferring feelings about them onto the clinician ii. Working through – once conflicting feelings about parents are aroused by evoking transference feelings, the clinician can help the client begin this difficult process iii. Resistance – holding back within the therapy often impedes the progress of therapy 9. Attachment process: early childhood relationship with parents, objective relationships – poor attachment, tranferential issues a. Attachment style: way of relating to a caregiver figure b. Adult Attachment Styles: Secure Adult Attachment – relatively easy to get close to others, Avoidant Adult Attachment, Anxious and ambivalent adult attachment c. Parent Care Giving Style - Warm, responsive – supportive; Cold, rejecting; Ambivalent, inconsistent – sometimes warm sometimes not Sociocultural and Family Systems 1. Sociocultural perspective- emphasize the ways that individuals are influenced by people, social institutions, and social forces in the world around them a. Family perspective – abnormality as caused by disturbances in the patterns of interactions and relationships that exist within the family 2. Discrimination: race, sexual orientation, religion, social class, or age and that stresses associated with such discrimination can cause psychological problems Social Influences: Cultural and societal norms, ex. Social instability and lack of clear cultural norms can cause children to feel like life is unpredictable and to become more prone to developing disorders later in life 3. Assumptions Regarding Causes and Treatment: Problem resides in primary group (FAMILY), not individual (Identified Patient), Individual’s problem are symptoms of dyfunctions within the family, Goal is to change way family members relate to each other • Treatments: Family, Group, Multicultural Approach (three major components: awareness, knowledge, and skills), Milieu (staff and clients in a treatment setting work as a therapeutic community to promote positive functioning in clients) Identify - Family therapy: psychological treatment in which the therapist works with several or all members of the family - How it differs from other forms of therapy: rather than focusing on an individual’s problems or concerns, focus on the ways in which dysfunctional relational patterns mainaint a particular problem or symptom, also use a life-cycle perspective in which they consider the developmental issue of the entire family - Identified patient: person in a dysfunctional family who has been subconsciously selected to act out the inner family’s conflicts in order to keep attention focused on an element that lies outside of the core conflict - Family dynamics: the pattern of interactions among the members of the family 4. Differences between Milieu and Group Therapy: Milieu involves a therapeutic community in which both staff members and clients act as part of a supportive community, Group involves individual clients meeting in a group with one therapist so they can all support each other and share their stories. Behavioral and Cognitive Approach 1. Hypothesis and Assumptions: Behaviorism focuses on the study of observable behavior - The behavioral model views abnormal behavior as learned in the same way as normal behaviors through the mechanisms of: o Classical conditioning o Operant conditioning o Modeling - Behaviors have consequences - Behavior can be changed using the method of SHAPING via successive approximations 2. Classical conditioning - Unconditioned stimulus ---- Unconditioned response - Neutral stimulus ---- No conditioned response - Unconditioned + Neutral stimulus ---- Unconditioned response - Conditioned stimulus ---- Conditioned response Operant Conditioning Behaviors have consequences: o Positive reinforcement : behaviors followed by pleasant stimuli are strengthened o Negative reinforcement : behaviors that terminate a negative stimulus are strengthened o Punishment o Extinction - Social Learning: understanding how people develop psychological disorders through their relationships with others and through observation of other people. - Social Cognition: the factors that influence the way people perceive themselves and others and form judgments about the causes of behavior 2. Behavioral – combination of relaxation training and cognitive intervention 3. Biological – administration of anxiolytic drugs to reduce anxiety. b. OCD i. Eitology 1. Psychoanalytic – Personality Development at the anal stage Compulsive symptoms are a way of undoing anxiety producing symptoms 2. Behavioral – learned behaviors reinforced by fear reductions (negative reinforcement) 3. Biological – focused on activation of the frontal lobes and basal ganglia and genetics ii. Treatment 1. Psychoanalytical – not effective. 2. Cognitive – ERP & thought stopping. ERP – expose person to triggers, and the restrain them from performing compulsion. Thought stopping – yelling stop when there is an obsessive thought. 3. Biological - ? c. Phobias i. Etiology 1. Biological – “Biological preparedness” 2. Psychoanalytical – phobias result from anxiety produced by repressed id impulses. Symbolic displacement from original source of anxiety to phobic object. 3. Cognitive – thought processes result in high levels of anxiety. Cognitive style in which misinterpret stimuli as dangerous. ii. Treatment 1. Psychoanalytical – uncover repressed conflicts using free association and other psychoanalytical techniques 2. Behavioral – a. Sysytematic Desensitization – reduce anxiety to phobic stimuli and situations b. Flooding – exposure to a phobic stimulus at full intensity c. Graduated Exposure d. Thought Stopping 3. Cognitive – focus on altering irrational beliefs. 4. Biological – anxiolytic, MAO, or SSRI. Most drugs have side effects. Anxiolytics can be addictive. d. Panic Attacks i. Etiology 1. Fear – of – fear hypothesis. Real fear does not come from what causes panic attacks, but rather from the fear of having a panic attack. ii. Treatment 1. Biological – Benzodiazepines, Antidepressants, SSRI 2. Psychological – Panic control therapy (Develop awareness of bodily cues associated with panic attacks, and breathing retraining. e. PTSD i. Etiology 1. Biological – nervous system has become primed, more likely tosense danger in the future. ii. Treatment 1. Biological – meds may help, but will not fix. 2. Behavioral – Imaginal flooding and systematic desensitization 3. Cognitive – in vivo therapy combined with relaxation and cognitive restructuring. 4. Factors leading to susceptibility of PTSD – May be a small genetic role. Also, men are more likely to face combat, but women are more likely to develop PTSD. 5. Comorbidity – a person maybe diagnosed with more than one disorder 6. This is not a question…. “The term neurosis is based on the psychoanalytic idea that anxiety is caused by unconscious conflict (neurotic anxiety) and has been replaced by more descriptive terms since the DSM-III including anxiety, dissociative and somatoform disorders.” Barbara Wilder: First impression: convulsing on the floor of the office. Only 22 years old, but the way she carried her body and the look of worry on her face made her appear much older. She began her story by explaining that the past 6 months had been “pure hell”. It all began in a crowded airport when she was flying home for her first visit after starting her new job. She began to feel dizzy, a pain in her chest, hear heart pounded wildly and she broke out in a cold sweat. This worry gradually subsided, but the same thing happened again after 2 weeks in a crowded shopping mall. A physical exam showed no physical abnormalities. She believed they were hiding something from her, so she went from doctor to doctor to find an answer. Her attacks became so severe and intense that she quit her job and eventually stopped leaving her house, for fear that she would have an attack in a public place. She grew up in a dysfunctional family, raised almost exclusively by her mother; her father was almost always drunk when he was home and known for out of town affairs. Her mother was very protective of her, restricting all social activities. Barbara’s maternal grandfather put up with abuse from his wife, and eventually committed suicide leaving a rage- filled note. Barbara was convinced by her mother to attend a community college so she could stay home. After completing college, she got a job and became a very good typist. Her boss transferred to another location out of town and asked Barbara to come with him. She agreed and her mother said she could manage somehow. The most striking feature of her problems were the occurrence of panic attacks. All of them were connected with some kind of emotional conflict in her life and generalized to all places outside of her apartment. Barbara began therapy in her home, and in vivo techniques were introduced in, culminating in a trip to the local shopping center unaccompanied by her therapist. Barbara conquered her fears of leaving home and only relapsed once, after talking to her mother over the phone. Chapter 6 Outline—Somatoform & Dissociative Disorders 1. Somatoform Disorders  Conversion Disorder-the translation of unacceptable drives or troubling conflicts into physical symptoms. “Hysteria” ex-You see your daughter getting raped and then you go blind.  Somatization Disorder-expression of somatic complaints with no known physical basis. Not deliberate.  Pain Disorder-disorder where the only symptom is pain & has no physiological basis.  Hypochondriasis-disease where they misinterpret normal bodily functions as serious illnesses— think they’re always sick  Body Dismorphic Disorder-think they have a major physical defect that causes major distress; obsessed with looking at it and thinking about it Dissociative Disorders  Dissociative Amnesia-the inability to recall important personal info associated with a traumatic event  Dissociative Fugue-when people flee unexpectedly and cannot recall their past; confusion about identity  Depersonalization Disorder-feel one’s body is not connected to one’s mind or that one is not real  Dissociative Identity Disorder (DID)-multiple personality disorder. Presence of alter identities. May result from severe physical or sexual abuse, or a learned social role enactment. 2. Treatment & Theories: Coping with stress, Behavioral Medicine—clients learn to take responsibility for their health, & to terminate unhealthy behaviors. (Somatoform) (Dissociative)-Hypnotherapy-client is hypnotized & encouraged to recall traumatic events, controlling how alters make their appearance 3. skip 4. Problems with diagnosing conversion disorder: conversion symptoms are a physical expression of a psychological disturbance, but the translation from mind to body occurs in a way that defies medical logic. Also, once the symptom is moved from psychological to physical, it no longer poses a threat to their peace of mind. They may dismiss the symptom or dismiss it as minor even though it may be decapitating—“La belle indifference.” 5. Psychological Factors Affecting Medical Conditions—situations in which psychological or behavioral factors have an adverse effect on a medical condition. Ex-Major Depressive Disorder, anxiety that aggravates asthma, hostility, unhealthy diet. Malingering—deliberately faking the symptoms of a physical illness or psychological disorder for an outside reason. Factitious Disorder—people fake symptoms for no particular gain but for the inner need to maintain a sick role Factitious Disorder by Proxy—a person induces physical symptoms in another person who is under their care. 6. Theories:  Primary Gain—avoidance of responsibility when sick  Secondary Gain—sympathy you receive from others  Somatoform disorders are a combination of biological factors, learning experiences, emotional factors, and faulty cognitions. Therefore, childhood events set the stage for symptoms later on.  Approaches to treating somatoform disorders involve exploring the person’s need to play the sick role, evaluating stress in the person’s life, and providing clients with cognitive-behavioral techniques to control their symptoms. This is the most effective way to treat somatoform disorders. Sometimes medication is used 7. dissociation phenomenon 8. DID—person has at least 2 distinct identities, each with its own pattern of thinking, perceiving, behavior, self-image. They have a primary identity associated with their given name—this person is usually passive and dependent, sometimes even depressed. Their alters are usually very different. A change from one alter to another is usually very sudden, triggered by psychological stress. Many people with DID also experience Amnesia, where they have gaps in their memory about some parts of their personal history. Controversy—Diagnostic criteria is too vague so diagnosis is not reliable. Others say DID is a way for people to rationalize their failures and manipulate the sympathy of others. Others question the psychotherapists & if they maintain the symptoms. Others say people fake DID for external gain, like being excused for a crime. Treatment—Hypnotherapy, Sociocognitive Model of DID (clients enact the roles that they feel)., Cognitive-Behavioral therapy—help their sense of self-efficacy thru temporizing-when the client controls the way in which the alters appear. 9. See above 10. Abuse plays a large role in DID. Many people who develop DID were severely abused either physically and or sexually.