Notes

Page 1

The

Psychology of Everyday Life

MULTIPLE

CHOICE QUESTIONS

What

is abnormal 22/9

What would you

consider to be abnormal? - context is important! Can't consider something to be

abnormal without seeing the whole picture.

Characteristic

of abnormal functions:

Deviance

-

violations of what is considered the 'norm' in society. Must remember norms

change throughout time.

Distress

- experienced by the person or family.

Dysfunction

-

perceptual or cognitive distortion.

Danger

- becoming a danger to others or to self.

Dr. Samuel

Cartwright (early 1800s) research on slaves demonstrates how abnormalities' can

be marked upon certain individuals due to their culture - culturally biased. He

claimed they had a mental illness due to them fleeing from slavery

(drapetomania) or if they refused to work and destroyed the property of the

owners (dysathesia aethiopia). Additionally, homosexuality was also considered

a mental disorder up until the 1970s.

However, it is

very difficult to define 'abnormal behaviour' - abnormalities change as time

and society changes.

Meaning

of Mental Illness 29/9

The

Biological Paradigm

Assumes that

psychopathology is caused by an organic defect. Looks at the role of behaviour

genetics and biochemistry in the nervous system in explaining behaviour.

Biological

Model: one of the earliest models to attribute mental

illness to physical causes and has been strong since the 1950s. Lead to the

development of effective psychotropic drugs - research on these medications are

gaining importance. Saw all mental problems as a disease e.g. alcoholism is a

disease. Psychological processes have biological causes.

Behaviour

Genetics: there are individual difference in behaviours that

are attributable in part to differences in genetic makeup. Inherited genes are

genotypes and observable characteristics are phenotype. Monozygotic twins share

diagnosis. Reciprocal gene-environment interactions: genes may predispose

people to create certain environments.

Biochemistry

in the nervous system: GABA, dopamine, norepinephrine and

serotonin are neurotransmitters which are implicated in various disorders.

Mainly serotonin - low levels = eating disorders, depression, alcoholism,

suicide and aggression. In 1997, first artificial human chromosome was created.

If all genes get mapped, then gene therapy may replace many traditional

therapies.

The

Psychodynamic Model

Freud developed

psychoanalysis and dedicated decades in the theory and treatment of mental

problems. Libido: sensual energy which fuels the id, ego and superego. Id:

operated in accordance with the pleasure principle and uses primary process

thinking e.g. wish fulfilment. Ego: operates in accordance with the

reality principle and uses secondary process thinking. The ego develops defence

mechanisms (i.e. repression) to control unacceptable id impulses and avoid or

reduce anxiety. Superego: grows from the ego and interjects our parents'

values through its two components - the conscience and the ego ideal. The psychosexual

stages are oral, anal, phallic, latency and genital.

The model has a

significant impact on the understanding and treatment of abnormal functioning.

It has helped understand that abnormal functioning may be rooted in the same

processes that underlie normal functioning. However, has little research to

support.

Other

psychologists give other explanations:

Jung -

analytical psychology: self-realisation and collective unconscious. Personality

types.

Erikson - stages

of human development. Ego psychologist believe the ego is more independent and

powerful than Freud recognised.

The

Behavioural Model

Assumes abnormal

behaviour is learnt the same way other behaviour is learnt. First clinical

perspective developed in psychological laboratory.

Classical

Conditioning: process of learning by temporal

association. Before conditioning: the unconditioned stimulus elicits the

unconditioned response; During conditioning: a neutral stimulus becomes through

association the conditioned stimulus, which elicits he conditioned response.

Pavlov's apparatus.

Operant

Conditioning: process of learning through

reinforcement. The law of effect states that responses that have satisfying

consequences are strengthened and are likely to be repeated. Shaping is the use

of rewards for successive approximations to the desired behaviour.

Modelling:

process of acquiring responses through observation and imitation. Language,

gestures and food tastes are learned by this process.

This model is a

powerful force in the clinical field. However, treatments easier than causes;

actual behaviour does not always follow basic principles.

The

Cognitive Model

Cognition encompasses the mental processes of

perceiving, recognizing, conceiving, judging and reasoning. Cognitive processes

are seen to be at the center of behavior, thought, and emotions. Emphasis

on this model is growing and much research carried out.

Upsetting thoughts, or irrational thoughts, can lead

one to act and react in ways that contribute to unhappiness - automatic

thoughts can lead to abnormal thinking (illogical thinking processes include

selective perceptions, magnification and overgeneralization).

The cognitive approach may not help with all

disorders, but it has been shown to be effective with depression, anxiety and

sexual disorders.

The model has been criticized for the narrowness of

scope.

The

Humanistic-Existential Model

Unconditional positive regard leads to unconditional

self-regard. Conditions of worth are the standards by which people judge

themselves, the standards to which they must conform if they are to be

acceptable. Conditions of worth lead to self-deception (leads to

dysfunction - hiding from life's responsibilities and choices), which inhibits

self-actualization.

Abdication of responsibility leads to emptiness and in

authenticity, with prevailing emotions of anxiety, frustration, alienation, and

depression.

The model focuses on broad human issues. Humanistic-existential

therapists view patients as people whose special potential has yet to be

fulfilled, and whose behaviour can be influenced by their innate goodness (it

focuses on optimism).

These theories are not very adaptable to research.

The

Sociocultural Model

Sociologists linked forms of abnormal behaviour to

social classes, and anthropologists found that patterns of abnormal behaviour

varied among cultures. Epidemiological studies identify the prevalence and

incidence of specific disorders. Societies undergoing major change usually show a rise

in mental disorders.

Abnormality rate

is 3x higher in lower socioeconomic groups than higher classes. Prejudice and discrimination based on race, sex, or

age make physical and psychological health and life satisfaction harder to

achieve.

At least 2x as many women as men are diagnosed with

anxiety and depression.

The model added

an imp dimension to understanding abnormal functioning. However, research is at

times inaccurate or difficult to interpret (studies failed to support model's

key predictions). Model can't predict psychopathology in specific individuals.

Relationships

with the models

No model is

superior to another (all relevant). Predisposing factors occur long before a disorder appears; precipitating

factors trigger the disorder; maintaining factors keep it going.

Imp to remember:

Diathesis + Stress -----> Dev. of disorder

Predisposition

or vulnerability Environmental

stressor The

stronger the

(Inherited

predisposition to (Parental

trauma, CSA, CPA, diathesis,

the less

develop the

disorder) family

conflict, sign. life changes) stress

needed.

Common methods of assessment:

Interview procedures

(Structure unstructured); Questionnaires; Performance Tests (projective tests,

self report, psychophysiological, neuro, intell); Observational

Methods(naturalistic, structured, self monitoring);

Measuring Families.

Errors

in thinking: Fundamental attribution error: the tendency of people, when explaining

the behaviour of others, to generally underestimate the influence of situations

and overestimate the influence of personality traits. Human mind makes many

errors resulting in inaccurate clinical judgment.

Mistakes include confirmatory

bias, first impressions, illusory correlation and availability bias,

among others.

Creating

Belonging 6/10

Love

and attachment

These are two necessary

components of flourishing relationships, but are not sufficient. This must be

accompanied by purposeful positive relationship behaviours. Attachment acts as an internal working model of self

and others to adult. Children integrate perceptions of their social competence,

appeal, and lovability (self model) with their expectations regarding

the accessibility, responsiveness, and consistency of caregivers (other

model). These models are relatively stable over developmental periods because

they are self-reinforcing.

Children

Bowlby's

research in infant attachment saw how infants can have different forms of

attachment with their primary caregiver (linked to functional behaviour and

emotional experiences of children):

1. Maladaptive:

chaotic, unplanned attempts to meet a child's needs

2. Adaptive:

responsive to a child's behavioural cues e.g. smiling

Parental behaviors lead to the development of an

“attachment system” that regulates the proximity-seeking behaviors connecting

infants and caregivers in physical and emotional space. The

primary function is the

provision of protection and emotional security (Lopez, 2003). Bowlby

realised insecure attachment is a sign to numerous developmental struggles.

Strange Situation Test coined by Ainsworth

exposes a child to a novel situation with his/her caregiver. The

behavioural responses indicate whether the child has a secure attachment or

not:

Secure:

balance between exploration

of the environment and contact with the caregiver.

Insecure-Avoidant:

avoid the caregiver when

reintroduced

Insecure-Resistant/Ambivalent:

demonstrate hostility toward

the caregiver while simultaneously wanted to be held and comforted.

Adults

In romantic

relationships Hazan and Shaver (1987) found the three categories: secure,

avoidant and anxious. Bartholomew and Horowitz (1991) made the avoidant

category into two parts: dismissive and fearful.

Neurobiological of

attachment

Taylor et al.(2002) a nurturing relationship between a

child and a caregiver promotes the development of regulatory activity, in this

case in the hypothalamic-pituitary-adrenocortical (HPA) system (which is

activated via hormone secretion). Schore, 1994; Taylor et al., 2002

interpersonal connections stimulate the brain activity that helps to create the

regulatory systems that leads to the development of empathy, enjoyment of

positive interactions, and management of the stress associated with negative

interactions.

Love

and marriage

Equity Theory (Walster,

Walster & Berscheird, 1978) - first research in this area

In any close

relationship you want to get out what you put in. If you feel it's not balance

you end it. Calculate the costs and benefits of the interpersonal resources

(goods, information, love, money, services, status).

More biological

research into this topic: Oxytocin i.e. cuddle hormone (released during touch

and social contact). Increases during pregnancy and surges during childbirth

and just after. Mums look at pictures of their offspring, brain regions

responsible for negative emotions and social comparison deactivate (Bartels

& Zeki, 2004).

Happiness

Lucas spent

15yrs studying 24000 couples rating their happiness on a scale of 1-10.

Pre-marriage: 7.28, Wedding day: 7.56, 2yrs later: 7.28. Rather consistent

throughout the lifespan (including in remarriage). However, many marriages end

in divorce due to problems. People think love is something you shouldn't have

to work at and relationships can evolve.

Love

There are

varieties of love (Singer, 1984, 87)

1. Eros - search

for the beautiful

2. Philia - the

affection in friendship

3. Nomos -

submission and obedience to the divine

4. Agape -

bestowal of love by the divine

Passionate and

companionate aspects of love

Romantic love is a complex emotion that may be best parsed

into:

Passionate love: Passionate love (the intense arousal

that fuels a romantic union) involves a state of absorption between two people

that often is accompanied by moods ranging from ecstasy to anguish.

Companionate love: The companionate form (the

soothing, steady warmth that sustains a relationship) of romantic love is

manifested in a strong bond and an intertwining of lives that brings about

feelings of comfort and peace.

(Berscheid & Walster, 1978; Hatfield, 1988).

Study found that both forms are equally alive - but

passionate love was the strongest predictor of marital satisfaction.

Triangular theory of

love (Sternberg, 1986)

Theorised love

is a mix of passion (physical attractiveness and romantic drives), intimacy

(feelings of closeness and connectedness) and commitment (involving decision to

initiate and sustain a relationship). Each mix in the triangle would generate

different outcomes.

Decide the way

our love should be through seeing parents relationships, films - expectations.

Love develop throughout our lives. Sternberg, upon interviewing a large sample of couples, found at least

26 “love stories” (e.g. a fantasy story, a horror story) that are largely

unconscious views of romance and relationships that guide our interpersonal

choices. (repeat with the same

sorts of people: certain characteristic and aspects in common with past

partners).

Gottman

discovered a magic ratio to keep marriage together. 5:1 - five positive to 1

negative to maintain a healthy relationship. Small gestures seemed to be a very

good thing when making a good relationship. Along with: look at each other,

pays attention, "stop, look and listen" and partner more important

than TV.

Criticism,

contempt can be very destructive to relationships, leads to defensiveness and ends in withdrawal.

Gable, Reis,

Impett and Asher (2004) asked what do you do when things go right? In their research for responses from partner getting a

raise active/constructive responses by partners were found to be the most

beneficial.

Other aspects

were: active-destructive (are they going to expect more from you now), passive-constructive

(thats nice dear) and passive-destructive (it rained here all day).

Understanding

Distress in Children 13/10

Most children

experience at least some emotional and behavioural problems in the normal

course of development: i.e. worrying, bed-wetting, nightmares, temper tantrums

and restlessness are common. 17-22% adolescents experience a mental disorder.

Child and adult disorders differ significantly.

Gender

differences in mental disorders - more boys than girls, however, more women are

affected than men. Although, developmental disorders e.g. motor or social

skills can persist into adulthood.

Anxiety

Disorders

Almost half of

all children have fears: social phobia usually involves becoming upset in the

presence of strangers and withdraw from these situations. Generalised anxiety disorder are children who are very self

conscious and worry excessively.

Common fears:

0-6 months: loss

of support, loud noises, certain smells, hunger

7-12 months:

strangers, heights, sudden unexpected and looming objects

1 year:

separation from parent, falling into toilet, being injured, and strangers

2 years: loud

noises, animals, darkness, separation from parent, changes in personal

environment, strange peers, parents moods

3 years: masks,

animals, separation from parent

4 years:

separation from parent, animals, dark noises

5 years:

animals, 'bad people', darkness, separation from parent, bodily harm

6 years:

supernatural beings, bodily injuries, thunder, darkness, being alone,

separation

7-8 years:

supernatural beings, darkness, media events, being alone, bodily injury

9-12 years:

tests in school, school performance, bodily injury, physical appearance,

thunder and lightning, death, darkness

Teens: social

performance, sexuality

Can see that

some common fear stay throughout some stages, some are no longer fears and new

ones arise. Fears are caused by: classically conditioned fear responses,

excessive repression, relationship confusion and self-fragmentation or

physiological abnormalities.

Separation

anxiety disorder is marked by excessive anxiety (even

panic) when child is separated from a parent. More common amongst boys. School

phobia may be a form of separation anxiety disorder but may be caused by other

fears / depression.

Depression

Symptoms of

childhood depression include: persistent crying, negative self-concept,

decreased activity, social withdrawal and suicidal thoughts. Depression can be

caused by loss, learned helplessness, negative cognitive bias, low

norepinephrine activity, negative life event (i.e. sexual abuse), major change,

rejection and ongoing abuse. No sex differences, but by 16 the rate for girls

doubles. High rates of mental health problems and depression among parents of

depressed children.

Cognitive-behavioural

therapy, social skills training and family therapy are all good ways in

treating childhood depression. No support for antidepressants for treatment.

Disruptive

behaviour disorders

2 types in this

category: oppositional defiant disorder and conduct disorder. Behavioural

disorders derive from genetic and biological factors, antisocial traits, drug

abuse, poverty and family dysfunction.

Oppositional

defiant disorder: argue repeatedly with adults, lose

tempers, swear, feel great anger and resentment, blame others for their own

mistakes.

Conduct

disorder: more severe; violate others' basic rights by cruel

and criminal behaviour. Usually begins before 10 yrs (6-16% boys and 9% girls).

Often emerge in an atmosphere of family hostility and conflict, and family interventions

are the most effective approaches to treating conduct disorder. More effective

when under 13yrs (more offensive occur, therefore harder to treat).

Community-based residential programs, school-based interventions,

skill-training techniques, institutionalization in juvenile training centres

have had limited effectiveness. Drug therapy has also been recommended.

Moffitt claims

there are two types of CD: life-course-persistent (more common in boys than

girls) and adolescence-limited. Psychopathology, lower levels of education,

partner and child abuse and violent behaviour are problems encountered in

persistent CD in early adulthood. Many aspects can cause CD

Nature plays a

part in this disorder: genetic factors - twin and adoption studies suggest

40-50% of antisocial behaviour is heritable.

Nurture with

nature also plays a role - abuse as a child and low MAOA activity most likely

to develop CD.

Neurobiological

factors - poor verbal skills, difficulty with executive functioning, low IQ,

lower levels of resting skin conductance and HR.

Psychological

factors - deficient moral development (remorse), modelling and reinforcement of

aggressive behaviour, harsh and inconsistent parenting, lack of parental

monitoring, cognitive bias.

Peer influence -

acceptance of rejection by peers, affiliation with deviant peers.

Socio-cultural

factors - poverty, urban environment.

Interventions

Head start

started the early interventions in 1965 - aimed at African American in poor,

inner city areas.

Designed to aid

parents and help their children achieve academically. All involved long term

follow up. The demonstrated good academic performance and dramatic decrease in

delinquency.

Attention-Deficit

Hyperactivity Disorder (ADHD)

Attend poorly to

tasks or are overactive and impulsive. The diagnosis may be ADHD, predominantly

inattentive type; ADHD, predominantly hyperactive-impulsive type

(hyperactivity); or ADHD, combined type.

The symptoms are

usually highly visible at home, school and work and in social situations - less

apparent in a novel setting or a one-to-one situation or when child receives

frequent reinforcement or strict control. 3-5% of children; 80% boys.

Hinshaw et al. (2006) large, ethnically diverse study

of girls

Combined type had: more disruptive behaviors than

inattentive type, more comorbid diagnoses of conduct disorder or oppositional

defiant disorder than girls without ADHD, viewed more negatively by peers than inattentive type

or girls w/out ADHD

Inattentive type:

viewed more negatively by

peers than girls w/out ADHD

Girls with ADHD more likely to: be anxious and

depressed, exhibit neurological deficits (e.g., poor planning, problem-solving),

have symptoms of

eating disorder and substance abuse by adolescence.

Researchers

suggest biological dysfunction create ADHD:

Genetic

factors: heritability estimates 70 to 80% - twin studies,

two dopamine genes (DRD4 and DAT1), either gene associated with increased risk

only when prenatal maternal nicotine or alcohol are present.

Neurobiological

factors: dopaminergic areas smaller in children with ADHD

(frontal lobes, caudate nucleus, globus pallidus), poor performance on tests of

frontal lobe function.

Perinatal

and prenatal factors: low birth weight, maternal tobacco and

alcohol use.

Environmental

toxins: food additives can have a small impact on

hyperactivity behaviour, nicotine from maternal smoking (may damage

dopaminergic system resulting in behavioural disinhibition).

Others suggest

nurture and psychological factors:

Parent-child

relationship: parents give more commands and have

more negative interaction

Family

factors: interact with genetic and neurobiological factors,

contribute to or maintain ADHD behaviours but do not cause them.

There are a

variety of treatments of ADHD: psychological (parent training, change in

classroom management, behaviour monitoring and reinforcement of appropriate behaviour);

supportive classroom structure (brief assignments, immediate feedback,

task-focused, breaks for exercise).

Elimination

disorders

Enuresis

(involuntary urination) may be nocturnal or less commonly diurnal. 7% boys age

5 to 3% age 10 and 3% girls at age 5 to 2% girls age 10. May continue through

infancy or resume as a reaction to

stress. Psychodynamic theorists see it as a symbol of other conflicts: anxiety

or hostility aroused by disturbed family interactions (sexual abuse) or just

failure of toilet training. Treatment as based on behavioural principles - been

successful.

Encopresis

(involuntary or inappropriate defecating) is less common that enuresis. Starts

at 4yrs and affects 1% of 5 yr olds - more boys than girls. Occurs mainly

during the day. This elimination disorder seen more serious as it causes more

shame and embarrassment. Treatment is either behavioural and/or medical and

family therapy is also good (helps with the shame).

Disorders

of learning, coordination and communication

More common in

boys than girls - adolescents with such problems are at increased risk of

severe depression and suicide. Learning disorders include dyslexia, expressive

language disorder (limited vocab or have trouble acquiring new words, 3-10%

children) and dyscalculia. Dyspraxia affects 6% of children between 5-11 yrs.

Children with a mixed receptive/expressive language

disorder have such difficulty comprehending and expressing language that it

interferes with academic achievement or daily activities; up to 3% of

schoolchildren have this problem.

About 1% of children (75% boys) stutter, or display a

disturbance in the normal fluency and timing of their speech. Researchers have

linked these disorders with genetic defects, birth injuries, lead poisoning,

inappropriate diet, sensory dysfunction and poor teaching.

Autistic

Spectrum disorder

Characterised by extreme unresponsiveness to others,

poor communication skills, uninterested and bizarre responses to the

environment (appears before 3 yrs). DSM-IV groups autistic and several other

disorders as pervasive developmental disorders, but all commonly called autism.

A common speech problem is echolalia (echoing a phrase

said by others either immediately or days after it being heard) and sometimes

pronominal reversal is common (You instead of I). May use metaphorical language

or neologisms. Some have difficulty naming objects (nominal aphasia). Incorrect

speech inflections and improper facial expressions and gestures are common. Difficulty

understanding speech and speaking simultaneously. Ritualistic and repetitive

behaviours. Engage in self-stimulatory and self-injurious behaviours.

Affects 2 - 5 of every 10 000 children (80% boys). Two

in three remain severely impaired into adulthood whereas one in six makes a fair adjustment. Higher IQ and better language skills have

more promising futures (Aspergers Syndrome: less severe form, language and

intelligence intact, poor social relationships and rigid, stereotyped

behaviours, recently recognised more in adult population).

Genetic factors: twin studies demonstrated 60 - 91% concordance

rates. Genetic flaw (deletion on chromosome 16 - still not fully supported).

Neurobiological factors: brain size (adults and children with autism have larger

brains), pruning of neurons may not be occurring; the frontal, temporal and

cerebellar areas are overgrown - linked with language, social and emotional

functions.

Treatments for individuals with autism: intensive

operant conditioning, parent training and education, pivotal response treatment

(focus on increasing child's motivation and responsiveness rather than discrete

behaviours), joint attention intervention and symbolic play used to improve

attention and expressive skills, medication most commonly used (haloperidol -

antipsychotic, reduces aggression and stereotypes motor behaviour, however,

however, not improve language and interpersonal relationships).

Mood

disorders 20/10

Normal sadness

is experienced by all of us, its seldom so severe that it significantly alters

daily functioning.

Two main types:

Unipolar depression and Bipolar depression

Unipolar

depression

Worldwide: 15%

will experience a severe episode at sometime in their lives. This statistic is

increasing as it may be due to the lifestyle we are living now which are not

good for our mental health or that we can recognise and diagnose easier in this

society.

Twice more women

experience this but milder (women more likely to go to their GP for help than

men). No difference between boys and girls - however, dramatic increases in

younger ages. Graph shows this.

Between ages of

30-65 white americans have higher rates than afro-americans or

hispanic-americans. 2/3 recover in 6 months but it is likely to reoccur again -

disorder keeps coming back.

Symptoms:

Intense sadness, dejection, feeling empty, experiencing little pleasure, loss

of humour, crying spells, sometimes angry and anxious, loss of motivation, loss

of sex drive, paralysis of will, lack of energy, lethargic, self blame,

feelings of hopelessness.

However, perform

as well as non depressed but will think they have done worse (negative self

perceptions which can make the depression worse), poor memory (not engaging in

the way they are living-focus on negativity), headaches, indigestion,

constipation (due to seratonin), dizziness,

pain. Appetite and sleep disturbance common.

7-15% commit

suicide (1% of non depressed). Shows this is a serious disorder.

Diagnosis:

DSM-V a major depressive is severely disabling, lasts at least two weeks and

has at least 5 of the symptoms of depression.

Must rule out

any other drugs as drugs depress the brain: brain stops producing other

chemicals if you take certain drugs

Must rule out

other medical conditions: can leave you severely depressed if you have a

terminal diagnosis or chronic disorders.

Must rule out

grief: grief lasts a very long time, if someone is depressed as a result of

grief they must get the support. Grief can mimic depression.

A small

percentage of depressives have psychotic symptoms (reality distortions,

delusions or hallucinations).

A diagnosis of major depressive disorder, single

episode indicates the patient’s first depressive episode (with no mania). If

the episode is not the first then it is the recurrent.

Seasonal Affective Disorder (SAD) - is when someone is

depressed in winter. Due to the lack vitamin D from the sunlight.

Catatonic depression - motor immobility/excessive

motor activity.

Postpartum depression - it occurs within 4 weeks of

giving birth. Over expectations of mother.

Melancholic depression - if person is totally

unaffected by pleasurable events, suffers significant motor disturbances,

experience loss of sleep and appetite and feels excessive guilt.

Dysthymia

depression - fewer than 5 symptoms for at least two years (recovery rate is low

- 40%)

Depressive

disorder not otherwise specified (NOS) is anything that doesn't quite meet the

previous criteria.

Life Events can

have a big impact. Depressives have experienced a greater number of stressful

events just prior to the episode. More likely to become depressed as stressors

multiply. If you have good social support you are able to handle all these

events however if isolated it just becomes worse. At least 30% do not report

negative event prior to onset. Interaction of internal and situational

components impact.

There are a few explanations

for this. Psychodynamic theorists vary in their emphasis on hostility turned

inward, oral fixation, anal and phallic problems and loss of self esteem.

Harlow's

monkeys showed absolute despair caused by isolation and separation from their

mother at a very young age - very similar to Bowlby's attachment theory.

Losing a parent

before 6 years is also associated with higher depression rates - however, it

depends very much on your caregiver after. If they are supportive and respond

to all your needs, depression is very unlikely to occur.

Lewinsohn

found that lower performance of positive behaviours (i.e. not bothering to do

certain things that seem pleasurable) leads to decreased rewards. Therefore,

you feel depressed you are not getting the rewards and therefore don't bother

doing positive things - feed into each other.

Beck's

cognitive view suggests that negative thinking (cognitive triad and errors in

thinking) lies at the heart of unipolar depression and results in negative

behaviours and attitudes. Beck believes that the emotional, motivational,

behavioural and somatic aspects of depression all follow from cognitive

processed.

The cognitive

triad consists of negative interpretation of one's experience, oneself and

one's future. Errors in thinking include

random inference, selective abstraction, overgeneralization, magnification and

minimization and personalisation.

Cognitive

therapy is very successful in this.

Seligman

found

learned helplessness is seen in those who are depressed - where they see

negative events as permanent and they are unable to change it or blame

themselves for it.

As many as 20%

of close relatives of a depressed person are depressed compared to 5% in the

general population (environmental factor). Twin studies: if one monozygotic

twin is depressed, 43% of other twins; if dizygotic then 20%. Current theories

propose a deficiency of either norepinephrine (catecholamin theory) or

serotonin (idoleamine theory) or both.

Antidepressant

drugs: before 1950s amphetamines were prescribed (didn't

alleviate the depression).

Monoamine

oxidase (MAO) inhibitors and tricyclics were discovered.

MAO

inhibitors: Nordil, Marplan and Parnate now used -

prevent the destruction of norepinephrine/serotonin. One problem of MAO

inhibitors is that enzyme MAO is essential for certain bodily funtions

(controlling blood pressure) therefore MAO inhibitors block MAO production in

the liver and intestine and allow tyramine to accumulate. Therefore patients

taking MAO inhibitors must stay away from certain food containing tyramine -

cheese, bananas and some wines. Most effective for depressed patients who: over

eat, over sleep or have intense anxiety.

Tricyclic

antidepressants: Tofranil, Elavil, Aventryl and Sinequan

- effective with unipolar patterns and are more commonly used than MAO

inhibitors. Studies show that 40-50% chance of relapse within 6-12 months -

drops to 20% if drugs are taken for several months after the disappearance of

depressive symptoms. Alleviate depression by acting on reuptake mechanisms and

after several days alter the sensitivity of norepineohrine and serotonin

receptors. Are used more than MAO inhibitors as they are less dangerous and

more effective - only create dry mouth, dizziness and blurred vision. Most

effective with: slowing of movements, loss of appetite and insomnia.

Second

generation antidepressants alter the sensitivity of norepinephrine and

serotonin receptors: Selective serotonin reuptake inhibitors (SSRI's) alter

serotonin activity only. These drugs produce less side effects (but may produce

nausea and headaches).

ECT is more

effective than MAO and tricyclic (but relapse is as likely). ECT is reserved

for severe depression that does not respond to other treatment or is associated

with high suicide risk.

Behavioural

therapy is useful but less effective, psychodynamic are even less effective. Most

effective is the combination of cognitive therapy (ITP) with drug therapy.

Bipolar

disorder

Manic episodes:

exaggerated feelings of joy but also anger and sadness. Manic people seek

constant excitement, involvement and companionship. Their behaviour is

described as hyperactive, loud, fast and flamboyant. Display poor judgement and

planning and may hae grandiose self-esteem, they may have so much trouble

keeping their thoughts on track that they become incoherent - easily distracted

by random stimuli and get very little sleep (yet full of energy).

DSM-V – a manic episode is an abnormally elevated, expansive

or irritable mood accompanied by at least three other symptoms for at least one

week.

Hypomania is less severe and has a shorter duration

and less symptoms.

Bipolar I: depressive and manic episodes usually

alternate but some people experience mixed episodes of both manic and

depressive symptoms in the same day. Manic

episodes alternate with major depressive episodes.

Bipolar II:

hypomanic episodes alternate with major depressive episodes. If a patient

experiences four or more episodes of mood disturbance within a year, the

disorder is classified as rapid cycling. If the patients mood vary with the

seasons, disorder is classified as seasonal.

0.4-1.3% of

adults suffer from a bipolar disorder in any given year - bipolar I is more

common. Equally common between the sexes and usually begin between the ages of

15 and 44 years. Common in all socioeconomic classes and ethnic groups.

60 % begin with

a manic or hypomanic episode. In the typical untreated case, manic and

depressive episodes last for several months with intervening periods of normal

mood lasting two or more years. 0.4% affected with cyclothymic disorder, marked

by period of hypomania and mild depressive symptoms.

Explanations:

The psychodynamic view is that depressed reactions are

introjection of a loss object and manic reactions flow from the denial of the

loss of a loved one; this view is not supported by research.

The theory that mania is related to an oversupply of

norepinephrine is supported by research with reserpine and by the effectiveness

of lithium, which reduces norepinephrine activity.

Mania, like depression, is

associated with a low level of serotonin, which is shown by spinal fluid levels

of 5-HIAA (the serotonin metabolite) and by the fact that lithium increases

brain serotonin activity.

A “permissive theory” suggests that low serotonin

activity sets the stage for a mood disorder and norepinephrine activity defines

the particular form it takes. Another possibility is defective transportation of

sodium ions at certain neuron membranes; this hypothesis is derived from the

effectiveness of lithium.

Another possibility is genetics: close relatives of a person with a bipolar disorder

have up to a 25% chance of developing the same disorder, compared to 1% in the

general population. Twin studies show a 70% chance in identical twins (20% in

dizygotic twin). Genetic linkage studies (Israeli, Belgian & Italian

families) found link between bipolar and red-green color blindness and to a

medical abnormality called G6PD deficiency (transmitted by X chromosome).

Suicide: suicide is NOT a DSM-V mental disorder but at least

half of all suicides are associated with mental disorders, especially mood

disorders, alcohol dependence and schizophrenia.

Researchers find more undesirable events in the recent

lives of suicide attempters (loss of loved one, divorce, breakup, rejection and

loss of job). Women who experience

considerable role conflict in their profession display a high suicide rate.

Four long-term stresses that are factors in suicide are

serious illness, an abusive environment, occupational stress and role conflict.

A painful or disabling

illness is often linked to suicide, especially now that physicians’ ability to

sustain life exceeds their ability to maintain its quality; some people argue

for the right to commit suicide in these circumstances.

Factors:

Mood and thought changes (sadness, anxiety, anger and shame). Alcohol use is

common (20% of suicides are legally intoxicated at time of death). Mental

disorders (mood disorder, substance abuse and schizophrenia. Another factor is

modelling, i.e. copying celebrities, colleagues and friends who have committed

suicide.

Males

commit suicide 3 times more than females (gender differences). Additionally age

differences, older white men have the highest rate, however, the rate of young

people is increasing. Suicide is universal but there are there are distinct

patterns - Catholics have a higher rate than

protestants and Japanese people higher rate than Americans. However,

these rates are catching up.

Nonfatal

suicide attempts - most do not come to the attention of professionals: young

people and females with psychiatric conditions do.

Most

suiciders not previously attempted (18-38% have). Approx. 10% of attempters

eventually succeed.

Children:

rare but increasing rates. Boys are 3 times more likely than girls (usually

drug overdose). Half of children live with one parent (however, the reasons may

be due to bullying and poverty, not the one parent household), 25% have made a

previous attempt. Often

preceded by running away, temper tantrums, self-deprecation, loneliness etc.

Adolescents:

third leading cause of death in US. Boys account for 83% of the age group. One

third of all teenagers have considered suicide. Most common is drug overdose.

Most suicide attempts occur at home or after school - may be due to bullying.

About half are linked to clinical depression. More incomplete attempts among teenagers than in the

older groups however, up to 40% try again and 14% will eventually succeed. Adolescents

react to events more sensitively, angrily, dramatically and impulsively than

others, and 93% of adolescents know someone who has attempted suicide.

Elderly:

in Western societies old

people are more likely to commit suicide than people in other age groups. Some investigators believe that suicide is a leading

cause of death among the elderly. Factors in suicide among the elderly include

illness, loss of close friends and relatives, loss of control over one’s life,

loss of societal status, increased hopelessness , loneliness & depression. Treatment

for attempts is medical care. Many survivors do not become involved in therapy.

Most therapy is outpatient

(behaviour therapy fastest improvement but insight therapy also helps) because

hospital admission

often increases suicide risk.

Extended inpatient treatment is more effective for schizophrenic and the severe

mood disordered.

Anxiety

Diorders 3/11

Fear:

state of tension or alarm in response to a serious threat

Anxiety:

response to an unspecified threat

Both these have

the same clinical features.

Anxiety becomes a disorder when it is continuous &

disabling and is too severe, too frequent, too long-lasting and too readily

triggered. In US 15% suffer one of the six DSM-V anxiety disorders

Physical

symptoms: faster breathing, tense muscles, rapid heart rate and nausea

(Historically named neuroses). Inability to concentrate and distorted word

perceptions.

Trait anxiety:

ones general level of anxiety

State anxiety:

varies due to the situation

Phobic

disorders

A persistent

unreasonable fear of a specific object, activity or situation - coping

stratergy is to avoid the fear.

Phobias tend to vary by age; elderly -fear of crowds,

or injury. Fear of snakes, heights and

storms is more common among young adults.

Classical conditioning or observational learning

(observing how others react to stimuli) along with genetic predispositions or

cognitive factors cause phobias.

Generalized

anxiety disorders (GADs)

Free floating anxiety or chronic & persistent

anxiety.

Most commonly appear in childhood

- Symptoms: muscular tension,

autonomic hyperactivity, vigilance and scanning.

Majority of people with this

disorder develop other disorders e.g. depression

Explanation

of phobia / GADs

•

Sociocultural:

Societal pressures

•

Psychoanalytical:

ego defense mechanisms

•

Humanism:

Harsh self-standards

•

Behavioral:

classical conditioning for phobias, operant for avoidance

•

Biological:

genetic basis for phobia + benzodiazepines work to reduce anxiety GAD’s is associated with the anxiety feedback system

involving GABA (Gamma- Aminobutryic Acid) and GABA receptors, and arousal

styles run in families.

Panic disorders

Panic attacks are periodic, discrete bouts of panic

that occur abruptly & reach a peak within 10 minutes - also very

unpredictable and can happen with no apparent cause

Symptoms: palpitations, tingling in hands & feet,

shortness of breath, sweating, temperature changes, trembling, chest pains,

choking sensations, faintness, dizziness and a sense of unreality.

Panic disorders requires a certain level of physical

or cognitive maturity

Explanations:

Biological: Norepinephrine levels are high in these

patients, drugs that reduce these levels helps symptoms.

Norepinephrine activity,

especially in locus coeruleus, is irregular in panic attack people. Yohimbine,

which alters n. in l.c. can trigger panic attacks even in those with no

history. Blood pressure

medicine, Clonidine affects n. activity and reduces panic symptoms.

Cognitive- Biological: Sensitive to physical

sensations then worry about losing control, fear the worst, hyperventilate in

stressful situations = panic attack. People with medical disorders may be

incorrectly diagnosed as having panic attacks.

Obsessive-Compulsive

2 per cent

suffer from this disorder. No sex differences. Begins usually from adolescence

or early adulthood. May also involve depression or alcohol abuse.

Obsession:

Thoughts or wishes (sometimes repeated fantasies). May involve past or future. Cross-culturally,

dirt or contamination, themes, violence and aggression, orderliness, religion

and sexuality.

Compulsions:

Compelled to perform

behaviors. Compulsive rituals are detailed & elaborate.

Common compulsions:

cleaning, checking, symmetry, order, balance, touching, verbal utterances,

counting and eating.

Relationship with both: 70% of patients have both. Compulsions

often yielding to obsessive doubts, ideas or urges. Less commonly, compulsions

are used to control obsessions.

Explanations: Obsessive-Compulsion is not well understood.

Psychoanalytic: anal stage imp.

Cognitive-Behavioral: repetitive behaviors develop via

operant and reduce anxiety.

Biological: antidepressant may help reduce symptoms.

Serotonin may be involved because clomipramine, which

increases serotonin activity, reduces obsessive and compulsive symptoms.

Abnormal functioning in the orbital region of the

frontal cortex and the caudate nuclei (parts of the basal ganglia) may be

involved; these control the conversion

of sensory input into cognitions and actions.

Symptoms may arise/ subside after damage to the

orbital region or the caudate nuclei (eg, an obsessive compulsive patient who

shot himself in the head experienced dramatic decrease in symptoms).

PET scans reveal rapid glucose metabolism in these

areas among o-c patients. Serotonin is active in these areas of the brain.

Stress disorders

Stress: is experienced when one appraises the stressor

as exceeding one’s coping abilities, ie, the demand is seen as greater than

one’s personal resources.

Physical reaction to stress: Reticular

Activating System (RAS) part of brain (core of brain stem) that focuses

attention, when in crisis focuses on potential danger so feedback loop may be

created. HPA

axis Connects nervous system (hypothalamus) to endocrine (hormonal: Pituitary

and Adrenal) system. THREAT = adrenal glands release adrenaline (activates the

sympathetic NS). Diverts energy to muscles and AWAY from long term body

maintenance. Increased adrenaline interferes with clear judgements results in

seeing everything as a THREAT rather than as a challenge to be sorted – narrow

focus (RAS).

If stress

continues cortisol is released - depressed immunity for up to 8hrs. Sustained

cortisol release damages learning and memory as it prevents new memories being

made.

DHEA Dehydroepiandrosterone

(precursor to testosterone and estrogen).

Slows ageing and prevents some chronic health conditions peaks in 20-30 years

of age then declines. DHEA and Cortisol have an inverse relationship – as one

increases, the other decreases. The ratio

(higher DHEA) indicates health or illness

Vulnerability to stress: temperament, confident and

self-esteem, coping skills and style and social support.

Adjustment

disorder

Marked distress that is in excess of what would be

expected, to one or more stressors that have occurred in the previous three

months. Does not include bereavement – separate category in

DSM-IV. There is a reduction in the distress when the stressful circumstances

dissipate or the person learns to live with the new circumstances.

The duration of symptoms is

usually less than 6 months

Disorder involves: depression, anxiety, sleep

disturbances, deterioration in performance, social withdrawal, conduct

disturbances.

Post

Traumatic Stress disorder (PTSD)

The stressor is an intensely traumatic event, which is

much more disturbing than most common human experiences.

The stress reaction can

occur immediately or within 3 months of the trauma (acute), or more than 6

months afterwards (delayed).

Symptoms: Tendency to re-experience events- flashbacks.

Painful or intrusive

recollections, dreams – nightmares. Excessive autonomic arousal, hyperalertness. Difficulty

in concentration – completing tasks, Depression, anxiety, restlessness,

irritability, impulsiveness, Abuse of alcohol/ drugs, Performance and social deterioration,

Denial eg, complete or

partial amnesia.

Risk factors:

Pre- existing emotional and behavioural difficulties

eg, depression, alcohol abuse.

Stage of development – sense of identity.

Symptoms of dissociation during the trauma ie shut out

reality of danger:

Puts

oneself in danger during trauma

Feelings

of unreality and disorientation

Calmness

and lack of emotional reaction

Vulnerability:

•

Feelings

of lack of control, vulnerability

•

Discovery

of aspects of the self that one was not aware existed, both emotional and

behavioral.

•

Part

one plays in trauma – causal or victim.

•

Severity,

duration, and proximity of exposure.

Another side:

20% of all Israel's long term patients in mental hospital were concentration

camp survivors - see how trauma plays a role on mental health.

¼ of the 1.5

million combat soliders who returned to USA from Vietnam were arrested within

two years of their return (Williams, 1983)

The USA has the

highest rate of rape of any industrialized nation – 4 x higher than Germany; 12

x higher than England and 20 x higher than Japan (Comer, 2007)

Major Claude

Robert Eatherly (pilot who dropped bomb on Hiroshima & Nagasaki in 1945)

attempted suicide twice and hospitalised for mhp (Hirsch et al, 1974).

All these events

create stress and lead to problems i.e. mental health, behaviour and even

death.

After September

11th - New Yorkers were twice as likely to be clinically depressed, 40%

reported extreme nervousness at sound of sirens and of airplanes (more than

twice national average).

Dissociative

disorder

Disturbance or alterations in the functions of

identity, memory and consciousness; compartmentalisation of experiences,

identity, memory, perceptions, behaviour.

Severs connection between ideas and emotions, a

process that occurs when attention is divided between two or more tasks, when

involved in fantasy, imagination, acting & hypnosis. Becomes pathological

when one loses control of the process in the face of trauma. Extensive, but

selective, memory loss in the absence of organic change, not forgetfulness. Usually

precipitated by a physical accident or emotional traumatic event.

Types:

Localized Amnesia: The individual fails to recall events that occurred

during a particular period of time (e.g. the first few hours after a profoundly

disturbing event).

Selective Amnesia: The person can recall some, but not all, of the events

during a particular period of time.

Generalized Amnesia: A recall failure that encompasses the person’s entire

life. This type occurs rarely.

Continuous Amnesia: The inability to recall events subsequent to a

specific time, up to and including the present.

Systematized Amnesia: The loss of memory for categories of information e.g.

memories of a particular person.

Dissociative Fugue: Unexpected travel away

from home or work, assumption of a new identity and inability to recall

previous identity. Purposeful, unlike the

wandering of Dissociative Amnesia. Usually brief with complete recovery and need to re-occur. Frequently no

recollection of the events on recovery with distress.

Dissociative identity

disorder: Assumption of alternate personalities Each one has its own memories, values, behaviours,

gender, age, etc. Often not aware of each

other, or there is one-sided awareness. Ability to spontaneously go into a trance.

Emergence of new

personalities begins in childhood in response to severe emotional – physical –

sexual abuse. Means of protecting oneself from the experience by creating

another self to handle the stressor. Attempt to hide the personalities or only gradually and later in life

become aware of them.

Depersonalisation: Change of self-perception. Sense of reality temporarily lost or changed. Feeling that not in control of what one is doing,

saying or feeling. Rapid onset, impairment of

social / occupational functioning and gradual cessation, or persistent sense of

depersonalisation.

Distressing

Bodies and Eating 10/11

Eating

disorders: A disease with no identifiable organic cause – an inherently

feminine condition, developing from women’s irrational and perverse nature.

Diagnoses of

anorexia has risen - Western obsession with thinness and fear of 'fat'. There's

been a growing rate of eating disorders in South East Asia and other highly

industrialised, non-Western societies.

Media growth

could influence this: Ideal female body shapes have become thinner - shows the

'ideal body' - Groesz, Levine & Mumen (2002) reviewed the impact of the

media across 25 separate studies. Exposure to media portrayals of slender

ideals led to body dissatisfaction.

Stice, Schupak,

Neuberg, Shaw & Stein (1994) found a direct link between media exposure and

eating disorder symptomatology.

Diagnosis:

Body

image distortion - overvaluation of thinness. A reduction of food intake,

avoidance of fatty foods, extensive exercise, self-induced vomiting, laxative

or diuretic abuse. Co-morbidity with depression is v. high (bio-chemical

changes and intense feelings of guilt and shame) (Fairburn, 1997). Co-morbidity

with personality disorders and depression.

Women who have a

high level of eating disorders criticise their body more than low scoring women

with eating disorders:

Bulimia

Nervosa: recurrent episodes of binge eating - eat large

quantities in a discrete period of time (e.g. two hours) - usually 2000-2400

calories and occurs at least twice a week. Using inappropriate techniques to

prevent weight gain - laxatives, vomiting, enemas or diuretic products.

Important to note, half of

those diagnosed with anorexia go onto develop bulimia.

Self-evaluation

is influenced by body shape and weight. The disturbance does not occur

exclusively during periods of anorexia nervosa.

Impulsivity,

sexual maturity, lack of self-control influence this behaviour.

The most frequent eating disorder diagnoses were

eating disorder not otherwise specified and binge eating in a US outpatient

psychiatric sample of 2500; Zimmerman, Francione-Witt, Chelminski, Young & Tortolani (2008).

Risk factors:

Body image distortion and body

dissatisfaction (BID) (Steiger, 1988; Heilburn & Friedberg, 1990).

Cognitive

distortion (since 1970’s - seen as core pathology - fear of becoming fat).

'Weight related

self-schemata’ (Vitouesk & Hollon, 1990).

Perfectionist

thinking

Worry of being

out of control

Low self-esteem

Usually white

middle classed and high achievers at more risk (Lawerence, 1992).

Good girl

syndrome (Breunberg, 1990)

Depression,

anxiety, personality disorder or substance abuse

Cognitive

factors: Core self-beliefs are negative. Eating behaviours

are a form of dissociation or avoidance of underlying emotional distress

channelled into weight concern.

Perfectionism/cognitive rigidity, experiential and

emotional avoidance, pro-anorectic beliefs and the response of close others to

the condition, as well as thoughts relating to the importance of control are

all found in patient groups (Cooper, Wells & Todd, 2005; Schmidt &

Treasure, 2006).

Binge eating factors:

i) thoughts reflecting cognitive and emotional

avoidance (positive beliefs about eating),

ii) negative beliefs about weight and shape,

iii) permissive thoughts (negative self statements and

all or nothing (dichotomous) thinking,

iv.) thoughts of no control (Cooper, Wells & Todd,

2005).

Emotions: develop eating difficulties do so as a result of being

unable to express their emotions, or as a way to divorce themselves from

stressful emotions (Copper, Wells & Todd, 2004).

Anger is believed to be threatening, so is directed

away from the self (which it is initially directed at) onto the body (Fox &

Harrison, 2008), leading to extreme body dissatisfaction.

Some research suggests that individuals diagnosed with

an eating disorder experience difficulty in recognising their own and others’

emotional states, which some have argued to be as a result of an emotionally

impoverished early environment (Fox, 2009). Defensive strategy.

Family

Influence: overprotectiveness and lack of conflict

resolution and rigidity (Minuchin, 1978). Anorexic member of the family

deflects attention away from underlying family conflict.

Fathers (Jones, Leung & Harris, 2006):

More negative recollections

of paternal rearing behaviours. Three core beliefs in particular (abandonment,

defectiveness/shame and vulnerability to harm) were found to mediate the

influence of aspects of paternal rearing behaviours. Parental rejection

influences too.

Gender: self more attached to appearance for women. Boskind-Lodahl

(1976): Femininity theory – Femininity/passivity, approval, dependency

(especially on men).

Identity:

refusing sexual maturation (childhood sexual abuse). Supressing the adult

female body. Refusal of

femininity ‘highly emotional, sexual, vulnerable and out of control’. (Malson

& Ussher, 2006a). Outcome: abused anorexics are vulnerable

to selectively processing material symbolically related to body image

Mothers of

individuals diagnosed with eating disorders are more likely themselves to be

problem eaters and have other forms of distress (Hodes, Timimi & Robinson,

1997). Ogden & Stewart (2000) found

that the daughters were more likely to report eating restraints and body

dissatisfaction if the mother reported lower belief in their own and their

daughter’s autonomy.

Disidentification

from the maternal body symbolizes freedom from reproductive destiny rather than

powerlessness (Bordo, 1993).

Sexual

orientation and eating - increasing amount of gay men not lesbians - centrality

of male desire (Siever, 1994). The thin body as heterosexually attractive and

passively feminine - sharp increase in young gay men and eating problems.

Treatment: Most of those with eating disorders (> 90 %) are

NOT in treatment. Treatment often takes place in a hospital. Bulimia can be

treated with antidepressant drugs (involving the serotonin system). No drugs

are currently available for the treatment of anorexia nervosa.

Psychological Therapy: short-term increases in body

weight (family therapy too).

Operant conditioning of eating can also lead to

short-term weight gains.

Long-term maintenance not yet achieved by any

treatment.

Cognitive behaviour therapy for Bulimia patients.

Substance

Abuse 17/11

Addiction

involves behavioural (psychologically dependant - will continue to take it

despite medical and social consequences, behave as if the effects are needed to

live out the daily routine) and physical (tolerance and withdrawal) processes.

Substance abuse

is characterized by: Failure to fulfil major obligations, exposure to physical

dangers (e.g. driving under the influence), legal problems and persistent

social or interpersonal problems.

DSM criteria:

Must have 3 out of 7 to be classified as substance dependence;

Tolerance;

Withdrawal; Substance is often taken in larger amounts or over a longer period

than was intended; Persistent desire or unsuccessful efforts to cut down or

control substance; Great deal of time is spent in activities necessary to

obtain the substance, use the substance or recover from its effects; Important

social, occupations or recreational activities given up or reduced due to

substance abuse; and the substance us is continued despite knowledge of having

a persi