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Abnormal IB Psychology
Transcript of Abnormal IB Psychology
Abnormal psychology focuses on diagnosing, explaining and treating humans suffering from psychological disorders. This option begins with a consideration of normal and abnormal behaviour. An understanding of issues related to diagnosis provides a framework for the subsequent study of disorders and therapeutic approaches.
Although there are numerous psychological disorders this option focuses on the following three groups of disorders:
• anxiety (for example, agoraphobia)
• affective (for example, depression)
• eating (for example, anorexia).
General framework (applicable to all topics in the option)
To what extent do biological, cognitive and sociocultural factors influence abnormal behaviour?
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour.
Examine the concepts of normality and abnormality.
Concepts and diagnosis
Discuss validity and reliability of diagnosis.
Discuss cultural and ethical considerations in diagnosis (for example, cultural variation, stigmatization).
Definition depends on value judgements
-normal falls within the bell curve
Rosenham & Seligman: 7 criteria for diagnosing abnormal
1. suffering- does the person experience distress and discomfort
2. maladaptiveness- behavior that makes it harder
3. irrationality- unable to communicate in reasonable manner
4. unpredictability- act in ways that are unexpected
5. vividness- unconventionality, experience things different than most
6. observer discomfort- person acting in a way that is difficult to watch
7. violation of moral or ideal standards- person habitually break the accepted ethical and moral standards of the culture
-realistic self-esteem and acceptance
-voluntary control of behavior
-true perception of the world
-sustaining relationships and giving affection
-self-direction and productivity
Describe symptoms and prevalence of one disorder from two of the following groups:
Analyse etiologies (in terms of biological, cognitive and/or sociocultural factors) of one disorder from two of the following groups:
Discuss cultural and gender variations in prevalence of disorders.
Diagnosis: culture complicates thinking about normality and abnormality, but a diagnosis without it is incomplete
Classifying within culture
CCMD-3 (Chinese classification of mental disorders)
ICD-10 (WHO International Classification of Disease)
Examine biomedical, individual and group approaches to treatment.
Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.
Discuss the use of eclectic approaches to treatment.
Discuss the relationship between etiology and therapeutic approach in relation to one disorder.
Diagnosis/categorization of mental illnesses can be very subjective…
Homosexuality until 1973
Body Dysmorphic Disorder
-While in the DSM-IV, is not recognized by HMO’s
Koro – Southeast Asia
-Men can develop a fear that one’s penis will withdraw into one’s abdomen, causing death
Winigo – Algonquin Indian hunters
-Intense fear of being turned into a cannibal by supernatural monster
Rosenhan (1973) study
Mentally healthy confederates were admitted with schizophrenia into psychiatric hospitals
They then behaved normally in the hospitals, but their normal behavior was interpreted as pathological based on previous diagnosis
Official categorization of psych disorders in U.S.
5-Axis model adopted in 1980
Clinical disorders (e.g., mood & anxiety disorders)
Personality disorders (e.g., narcissism, antisocial) & mental retardation
Medical (physical) conditions influencing Axis 1 & 2 disorders
Psychosocial & environmental stress influencing Axis 1 & 2 disorders
Global Assessment of Functioning score: highest level of functioning patient has achieved in work, relationships, and activities
fear of places which may cause a panic attack
Recurrent, intrusive thoughts
Recurrent urges to perform ritualistic actions
Emotional disturbances that interfere with normal life functioning
Major Depressive Disorder
At least 2 weeks of depressed mood/loss of interest along with several other symptoms, including…
Significant weight loss (but not through a diet)
Insomnia or hypersomnia
Restlessness or sluggishness
Indecisiveness, lack of concentration
Thoughts of death or suicide
Intense fear of gaining weight – constant desire to keep losing weight
A group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions and inappropriate emotions and actions
False beliefs that are symptoms of schizophrenia and other serious psychological disorders
Hallucinations: False perceptions that are symptoms of schizophrenia and other serious psychological disorders
Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002).
Catatonic: Bizarre, immobile, or relentless motor behaviors
Paranoid: Hallucinations (voices), delusions of persecution and/or grandeur (Jesus), suspicion Intellect and affect are usually normal
Disorganized: Personality deterioration, bizarre behavior (public urination), disorganized speech Or flat, inappropriate affect (laughter)
Undifferentiated: no specific category is appropriate
Types of Schizophrenia
Genetics- risk increases if relatives diagnosed
Brain function-parts of brain operate differently
Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain.
Prenatal virus-flu midway through
Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed
biomedical therapies (for example, drug therapy)
individual psychological therapies (for example, systematic desensitization, cognitive restructuring therapy)
group psychological therapies (for example, encounter groups, family therapy, community-based therapy).
Therapeutic approaches to treating disorders may be broadly organized into three groups:
Symptoms include: Sleep difficulties, withdrawal, Loss of appetite, Listlessness
What western disease does that sound like?
Hispanics have a “fright illness” where the soul leaves the body during a stressful event
Generalized anxiety disorder
Post-traumatic stress disorder
Major Depressive Disorder
Medical Model- illness can be identified, treated and prevented. Better to regard someone as suffering from mental illness. Based on clinical and medical conditions, psychological stressors and extent in which medical condition interferes with daily life.
How to diagnose?
Interviews, problems: patient may experience anxiety or preoccupation; information exchange may be blocked or there is a lack of respect; clinician's style, degree of experience and orientation will affect interview.
direct observation of individual's behavior
CAT and PET scans (schizophrenia and Alzheimers)
psychological testing: personality and IQ tests
A-Affective symptoms: emotional elements, including fear, sadness, anger
B-Behavioral symptoms: observational behaviors, such as crying, physical withdrawal and pacing
C-Cognitive symptoms: ways of thinking, including permission, personalization and self image
S-Somatic symptoms: physical symptoms, including facial twitching, stomach cramping and amenorrhoea
For it to be valid- classify a real pattern of symptoms which lead to effective treatment
-identification is dependent on psychiatrists.
Extent to which Diagnosis is accurate
-see Rosenhan study in your book (page 142)
identity important due to stigmatization
-suffering from Schizophrenia, not schizophrenic
self-fulfilling prophecy- people with labels begin to act and think as they are expected to. The diagnosis changes their behavior and thoughts.
high when psychiatrists agree on a patient's diagnosis when using the same diagnostic system (inter-rater reliability)
Effect of client race and depression on evaluations by European American Therapists
Jenkins-Hall and Sacco (1991)
Therapists watched a video of a clinical interview to evaluate the femaile patient, 4 conditions present representing race and depression. African American woman was rated with more negative terms than the European American woman. Symptoms same.
Confirmation bias- clinicians have expectations about the person who consults them. If the patient is there in the first place of course there is something wrong with them.
-Rosenhan's study backs this up.
Culture-bound syndromes- culture specific abnormalities
-Shenjing shuairuo accounts for more than half of psychotic outpatients in China. It is not in the DSM-IV
does meet criteria in DSM-IV for combination of mood disorder and an anxiety disorder
reporting bias-low hospital numbers don't reflect prevalence rates due to cultural beliefs about mental illness.
Depression takes affective (emotional) form in individualistic cultures
In collectivist societies symptoms are somatic (headaches)
culture blindness- problem of identifying symptoms if they are not the same as clinician diagnosing
Avoiding cultural bias during diagnosis
clinicians should learn about culture
evaluations of bilingual patients should be done in both languages
procedures should be modified to make sure person understands the requirements.
refers to identification of the symptoms
why people suffer from the disorders
Prevalance rate: measure of total number of casesin a given population
Lifetime prevalance (LTP) % of populaton that will experience the disorder at some time of their life
Onset age: average age in which the diosrder will appear
One of the most common disorders
Fatigue-loss of energy almost every day
Feelings of worthlessness, guilt almost every day
Impaired concentration, indecisiveness
Insomnia or hypersomnia
Significant weight loss or gain (more than 5% of your body weight)
Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others.)
Psychomotor agitation or retardation (restlessness or being slowed down)
Recurring thoughts of death or suicide (not just fearing death)
Other LOA affecting depression:
Asymmetry of the brain
Lack of proper exercise
One’s effort-driven rewards system is under-stimulated
Reformulated helplessness theory-negative attribution style
Being a female
View of self
Spirits and other culturally based community causes
Discrimination and prejudice
Grieving a loss
Lack of social support
Causes of Affective Disorder:
1. deficiency of norepinephrine-
both types of drugs used to treat depression - the tricyclics and the monoamineoxidase inhibitors (MAOIs) - tend to increase the amount of norepinephrine available in the central nervous system, although they work in somewhat different ways
The MAOIs block the action of monoamine oxidase, thereby preventing norepinephrine from being destroyed and increasing the amount available for transmission
2. Neuroendocrine Abnormalities
Patients produce large amounts of cortisol, and they are unable to cut down these excessive cortisol production when given dexamethasone.
3. Genetic Factors
About 20 percent of the parents of patients with affective illness also have affective disorders, the rate in brothers and sisters and children is even higher - possibly as high as 30 percent.
The rate tends to be higher in the female relatives.
For identical twins the rate is around 50 - 60 percent.
4. Environmental and social factors
An inherited lack of emotional resilience may be the predisposing factor - the necessary but not sufficient cause - in the development of affective disorders.
Trigger can be physical (illness) or social (stress)
The model described concerning the interaction between social and biological factors has not been proved, but it is widely accepted by many physicians.
Biological Treatment of Depresson:
Herbal treatment (St. John’s wart)
Transcranial magnetic stimulation
Suggest that depressed cognitions, cognitive distortions and irrational beliefs produce the disturbances of mood.
Cognitive style theory (Ellis, 1962): psychological disturbances often come from irrational and illogical thinking, people draw faulty inferences about meaning of an event.
Beck (1976) distortion theory of depression
-based on schema processing where schemas about self interfere with information processing
-depressive patients exhibited a negative cognitive triad
- overgeneralization based on negative events
-non-logical inference about the self
-dichotomous thinking-black and white thinking and selective recall of negative consequences
Beck says negative cognitive schemas are activated by stressful events. Becomes a cycle.
Prospective study: a study in which participants are chosen on a basis of a variable and then followed to see what happens long term (see Alloy study)
Brown and Harris (1978) Social origins of depression in women: 29 out of 32 that became depressed experienced severe life event
-78% who did experience life event didn’t become depressed
Vulnerability model of depression: based on factors that could increase likelihood of depression
Diathesis-stress model (interactionist approach) depression may be result of hereditary predisposition, with precipitating events in the environment
WHO cross culture depression (1983) common symptoms in 4 countries (Iran, Japan, Canada, Switzerland)
-Loss of enjoyment
-Lack of energy
-Loss of interest
-Inability to concentrate
-Ideas of insufficiency
Cross cultural studies identify core of symptoms, but depression is not the same worldwide.
Bio LOA and PTSD
Cognitive LOA and PTSD: focus on how cognitions can make a difference
Sociocultural LOA: majority of research in PTSD
Treatment of Phobias
Link to core LOA
More than 30 days, develops in response to specific stressor, intrusive memories of event, emotional withdrawal, heightened autonomic arousal-leads to insomnia, hyper vigilance, loss of control over anger and aggression
Anhedonia-inability to feel positive emotions
- Triggers: loss of loved one (1/3), rape victims (50%), wounded veterans (20%), personal attack (3%)
- Started studying post Vietnam. 9/11 surges research again
-Twin research shows genetic predisposition (Hauff & Vaglum, 1994)
-Noradrenaline increases causing people to express more emotions
oGeracioti (2001) PTSD patients have higher levels of noradrenaline
-Patients feel they have lack of control, experience guild after the trauma
-Brewin (1997) flashbacks occur because of cue dependent memory
-Rizzo developed flooding- over exposure to stressful events. Stress events fades due to habituation
-If a patient sees the event differently they are more likely to recover (vets that feel they have a purpose, abuse victims know it’s not their fault)
-Research suggests that experiences with racism and oppression are predisposing factors
-Roysicar (2000) Hispanics 27.6%, Black 20.6%, 13% white
-Social learning theory may play a role-observing domestic violence
Culture: non western survivors exhibit body memory symptoms- dizziness experienced by woman which was forced to drink mass amounts of alcohol then raped.
rates vary widely in different countries, from 0.2% in Northern Ireland to approximately 8.8% in the United States. Specific phobias often begin in childhood, often around the age of seven years.
Some sources estimate that one year prevalence of agoraphobia is approximately 1.6%, while lifetime prevalence is approximately 3.6%. Rates do not vary as dramatically between countries as those of other types of phobia.
In the United States, one year prevalence is approximately 0.8%. Agoraphobia typically appears at approximately 20 years of age
Women are two to four times more likely to develop agoraphobia
Abdominal distress (diarrhea, nausea, constipation)
Chest pain or discomfort
Chills or hot flashes
Fear of dying
Fear of losing control or going crazy
Feeling faint, dizzy, lightheaded, unsteady
Feeling of choking
Feeling of unreality or of being detached from oneself
Numbness or tingling sensations
Palpitations, pounding heart, racing heartbeat
Shortness of breath, feeling smothered
Trembling or shaking
1. Patient Education (cognitive)
2. Behavior modification therapy (sociocultural)
3. Medication (biological approach)
(1) is exposed to a situation that causes anxiety or panic and then
(2) learns to "ride out" the distress until the anxiety or attack passes. The duration of exposure gradually increases with each session. This treatment works best if the patient is not taking tranquilizers because tranquilizers can prevent the experience of anxiety.
Some antidepressant drugs
MAO inhibitors such as phenelzine reduce the degradation of norepinephrine and serotonin
Cognitive: Thought processes result in high levels of anxiety
Biological: genes and autonomic nervous system liability
Socio-cultural: Agoraphobia is a fear of an open, social setting
unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions).
Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety
Standardized rating scales such as Yale–Brown Obsessive Compulsive Scale can be used to assess the severity of OCD symptoms
comorbid disorder: can be diagnosed with- major depressive disorder, GAD, body dysmorphic disorder, eating disorders, social anxiety disorder, among others
-seratonin understimulated- evidence through anti-depressants (SSRIs) showing success with treatment.
-genetic mutation with hSERT as evidenced with twin studies
-brain scans show brain functions differently in patients suffering from OCD
Treatment includes a number of behavioral principles, and thus has been called “cognitive-behavioral”
People with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result
To avoid such negative outcomes, they attempt to neutralize their thoughts with actions (or other thoughts)
Neutralizing thoughts/actions may include:
Thinking “good” thoughts
If everyone has intrusive thoughts, why do only some people develop OCD?
People with OCD:
Are more depressed than others
Have higher standards of morality and conduct
Believe thoughts = actions and are capable of bringing harm
Believe that they can and should have perfect control over their thoughts and behaviors
lacks evidence and studies supporting.
Most likely environmental triggers influence (stress, family situations, home environment, accidents that occur within your life, etc.
Binge and purge
-Twin studies found MZ twins have higher rate (self reporting not always accurate)-Increased serotonin levels stimulate the medial hypothalamus and decrease food intake-Carraso (2000) found lower serotonin levels
The body-image distortion hypothesis-many suffer form the delusion that they are fat
-Degree of distortion varies with contextual factors
-In US undergraduate male/female asked to pick body most like themselves. Men chose similar shapes while women chose ideal
Cognitive disinhibition- dichotomous thinking (all or none). Bulimics follow strict dieting rules, when they break the rules they binge eat.-Thoughts about eating (cognitions)
-Act to release all dietary restrictions (dishibition)
-Polivy and Herman (1985) dieters and non-dieters take part in taste test. 1st given chocolate milkshake, after taste test three types of ice cream. Told they could eat as much as they like. Dieters ate significant amount more than non-dieters
Cognitive patterns of thought are descriptive not explanatory
-Body figure ideas have changed over the years
-Comparing self to others affects self-esteem
Many disorders begin when women who are not overweight believe they need to diet
-Women much more likely to be susceptible to thinness propaganda. Distorted ideas lead children to be satisfied with own shape.
An emotional disorder in which bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting.
characterized by an unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image.
Genetic: twin studies show risk
Younger generations develop eating disorders when raised in families in which weight is an excessive concern
lower levels of serotonin
societal pressure to be thin
Body dismorphic-person sees themselves as larger than they actually are
Often the person can't control an aspect of their life that is causing anxiety sot they turn to controling food intake
Abuse victims need to change the way they think about abuse and see it isn't their fault
Biopsychosocial approach (multifaceted) believe to be most effective
Biomedical approaches based on bio factors being involved with disorder (neurotransmitters and hormones)
Drugs should help but come with side effects; drugs and doses have to be individualized
Individual therapies-one on one with client. Most include cognitive therapy. Meet the need of the client
Group therapy- group of clients meet with one or more therapists
-Sharing experiences with similar patients can be part of healing process
-Less expensive- support for client, diminish therapist, realize not alone
Disadvantages: some don’t want to disclose to group, confidentiality hard to protect, group dynamics
Culture in treatment: therapy success depends on culture, i.e. group therapy doesn’t work in Arab cultures.
Indigenous healing practices with Western psychotherapy can be successful
-Heavy reliance on family and community, incorporation of traditional, spiritual and religious beliefs
Chinese Taoist cognitive psychotherapy-focus on Taoist principles restraining selfishness, learning how to be content and learning to let go
-Reduce long-term anxiety disorders more effective vs. meds
Community psychologists-include psychological health of community
-Miller (2000) ecological model- emphasizes relationships between people and setting they live in
Eclectic approach-incorporates principles or techniques from various systems or theories
-Uses strengths of each to tailor therapy sessions
-A severely depressed patient doesn’t have time for cognitive sessions
Measuring the effectiveness of therapy
Criterion to consider when evaluating:
1. For how long must a person show a relief from his or her symptoms to be categorized as a treatment success?
2. Is a total absence of symptoms the only criterion that should be used?
3. Should only observable behavioral change be used to access success?
4. Is it possible to gather quantitative data on the effectiveness of therapy or only qualitative data?
Outcome studies-to study effectiveness, focuses on the result-did patients show an improvement or not? All types of treatments are to some extent effective
All therapies have in common: warm interpersonal relationship, reassurance and support, the opportunity for the individual to gain insight into his or her experience
-Bennun and Schindler (1988) found that the best indicator of success in therapy is how favorably clients rated their therapist during the initial session. Those who liked their therapists reported more improvement.
Biomedical approaches to the treatment of depression-based on assumption that if the problem is based on biological malfunctioning
Antidepressant drugs used to elevate mood. SSRIs (selective serotonin re-uptake inhibitors), which increase the levels of serotonin by preventing reuptake.
Prozac most common.
Evaluation of drug therapy
-Some reports say antidepressants help 60-80% of patients, could be ineffective in long term
Kirsch and Sapirstein (1998) found Prozac only 25% more effective than placebo.
-Reduce hospital inpatient stays
Large money market for SSRIs. UK spends 291 million pounds a year on them.
Blumenthal (1999) found exercise just as effective as SSRIs.
Placebos show just as much improvement-not sure why.
Elkin (1989) NIMH study that had 28 clinicians and 280 patients diagnosed with major depression, randomly assigned treatment (antidepressant drug, interpersonal therapy, cognitive –behavioral therapy or another form and a control group with placebo). Double blind procedure.
-Results: over 50 percent of patients recovered in each of the CBT and IPT groups as well as drug groups. Only 29% recovered in placebo group. All treatments have the same effect.
Beck’s cognitive restructuring (basis for many CBT):
• Identify negative, self-critical thoughts that occur automatically
• Note the connection between negative thought and depression
• Examine each negative thought and decide whether it can be supported
• Replace distorted negative thoughts with realistic interpretations of each situation
Based on schemas, negative self-schemas bias a person’s thinking
-Form of psychotherapy used in treatments with adults and children. Focuses on current issues and symptoms
-12-20 weekly sessions
Beck argues that are patterns of faulty thinking
1. Arbitrary inference: drawing wrong conclusion about oneself. Rains on a day you plan a picnic-of course it does that’s just your luck.
2. Selective abstraction: drawing conclusions by focusing a single part of a whole. Even the you have an A in the class you can’t get over the C you got on a test.
3. Overgeneralization: applying a single incident to all similar incidents-if you are in a fight with your friends it means you are bad at relationships.
4. Exaggeration: overestimating the significance of negative events. Run out of breath while exercising means you have heart problems.
5. Personalization: assuming that others’ behavior is done with the intention of hurting or humiliating you. If someone doesn’t say hi to you in the hall you assume they are angry with you.
6. Dichotomous thinking: an all or nothing approach to viewing the world. You love me or hate me.
CBT therapist helps clients find new ways to deal with problems and get them back into the habit of doing things they love.
Cognitive Therapy effective in treating depression
Treatment effective, also effective in combo with SSRIs.
Criticisms for focusing on symptoms rather than causes, provide clients with strategies they are less manipulative than other treatments.
Most is couples therapy due to link between marital problems and depression. Teaches more effective communication and problem solving techniques, increase positive interactions and reduce negative interactions.
Toseland and Siporin (1986) found group treatment as effective as individual treatment in 75% of studies and more effective in 25% of studies.
More cost effective
Same disadvantages to group therapy apply as before: group cohesion, exclusion, confidentiality, and relationship with therapist.
Biomedical, individual and group approaches to treatment of PTSD
Antidepressants and tranquilizers most common to treat PTSD
Valium and Xanax, benzodiazepine group to modulate GABA, as well as antidepressants.
Foa (1986) expert on treatment using CBT. Give patients information about PTSD then expose them to traumatic events.
1. Create a safe environment that shows trauma can’t cause harm.
2. Show that remembering the trauma is not equivalent to experiencing it again.
3. Show that anxiety is alleviated over time.
4. Acknowledge the experiencing PTSD symptoms do not lead to a loss of control.
Weine (1998) working with Bosnian refugees developed testimonial psychotherapy
-Testimonial therapy is the creation of oral history archive to use the survivor’s memories, which give purpose and meaning to experience. Considers how experience affected how they feel about their lives today.
-PTSD symptom scale translated to Bosnian. All testimonies in Bosnian, translated to English, translated back to Bosnian and then corrected. Back translation to help reduce reliability errors with translation. Final document is given back to survivor to verify and sign.
No empirical research to evaluate effectiveness of treatment of PTSD.
Biomedical, individual and group approaches to treatment of bulimia
McGilley and Pryor (1998) good results with controlled trials of SSRI (Prozac). Higher doses of drugs resulted in less binge eating and vomiting.
It’s estimated 90% of those that suffer from eating disorders don’t seek treatment (Bulimics are in denial about having an eating disorder).
CBT most common form of treatment for eating disorders.
-Addresses obsession with body weight, dichotomous thinking and negative self-image as well as the behavioral components (binge/purge).
-Control eating but avoid dieting
Group therapy growing in use and is effective.
-Family systems model: individual’s dysfunctional behavior based on larger family dysfunctional behavior. So family needs to be restructured.
-Problems with group therapy:
• Gain negative ideas from each other
• Adopt pessimistic attitude about treatment
• Reinforce idea that eating disorder normal
• Competition to gain attention
• Members become co-therapists leading to resentment from other members
Prevalence rate: measure of total number of cases in a given population.
Lifetime prevalence rate (LTP) % of population that will experience the disorder at some time of their life.
Onset age: average age in which the disorder will appear.