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Psych 95


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What distinguishes OCD from more harmless recurring thoughts?
1) Obsessions are distressing and unwelcome and intrude on consciousness.

2) Obsessions arise from within, not from external situation

3) Obsessions very difficult to control.
What is the family resemblance approach?
Assessing abnormality based on the match btw an individual's characteristics and the seven elements of abnormality:
- suffering
- maladaptiveness
- irrationality
- unpredictability/loss of control
- vividness
- observer discomfort
- violation of moral and ideal standards
What is considered reliable?
Test must generate same findings with repeated use.
What is dependent variable?
What experimentor measures.
What is the independent variable?
What the experimenter controls. Hypothesized cause.
What is scientific experimentation? What are the pros and cons?
Obtain information about causal effects.

- nonrandom assignmnet
- experimenter bias creates self-fulling prophesies
- subject bias: placebo effect
- demand characteristics give clues to subjects as to what to expect
What is an operational definition?
Set of clear-cut, measurable criteria.
What is valid?
Must actually meaure what it is intended to measure.
What are projective tests?
Psychological tests that utilize ambiguous stimuli, such as Rorschach tests.
What are clinical case histories? What are their pros and cons?
Relies on individual case histories as a source of hypothesis.

Pros: Source of hypotheses.

1) selectivity of memory
2) lack of repeatability, often "one of a kind"
3) lack of generality, specific to person
4) insufficient evidence for causality
What are the reasons for diagnosis?
- Communication shorthand
- Etiology
- Treatment possibilities
- Aid to scientific investigations
- Enabling third-party payments
What are the difficulties to diagnosis?
- context (like study where normal people admitted to psychiatric hospital)
- expectation (reverse pseudopatients)
- source credibility (man on tape)
- cultural contexts and influences: culturally-specific disorders (like penis retraction)
What are the factors in psychological assessment?
- reliable & valid
- physical examination
- clinical interview (structured/unstructured)
- observation (behavioral/psychophysiological)
What are the axes in Multiaxial Classification?
1: Clinical Syndromes: paranoid schizophrenia, major depression, anxiety disorders.

2: Personality Disorders

3: General medical Conditions

4: Psychosocial and Environmental Problems: sources of difficulty during past year (retirement)

5: Global Assessment of Functioning: social relations with family and friends, occupational functioning, use of leisure time.
Who was Charcot? What did he do?
French director of Parisian insane asylum. Used hypnosis to distinguish btw symptons that had organic cause and symptoms that were hysterical in nature.
What is animalism?
Belief that there are remarkable similarities between animals and mad people. Like animals, mad people cannot control themselves, are cpable of sudden violence, could live in subhuman conditions.

Used to justify horrible treatment of insane. Believed fear would restore reason.
Who was Breuer? What did he do?
Viennese internist. Came up with catharsis. Induced patients to talk about problems and fantasies under hypnosis. Would become emotional, undergo catharsis, and emerge from hypnosis feeling much better.
How does DID develop?
1) Traumatic emotional problem btw 4-6 ys. Copes with trauma by creating another distinct identity to take brunt of problem.
2) Individual highly susceptible to self-hypnosis.
3) Individual finds out that creating another distinct identity by self-hypnosis relieves her of emotional burder, so in future confronts emotional problems by creating new personalities to take brunt of it.
What would psychoanalysists have to say about Somatoform Disorders?
1) Individual made anxious by some unacceptable idea, and conversion is defense against this anxiety.

2) Psychic energy from anxiety has to go somewhere--so debilitates physical organ.

3) Somatic loss symbolizes underlying conflict.
What is mesmerism?
Mesmer. Flow of universal magnetic fluid. Wooden tub with magnetized iron filings. Patients had convulsions when touched with iron wand. Power of suggestion.
What is the communicative view to somatoform disorders?
Person who cannot communicate distressing emotions (not just anxiety) to others, so expresses them with physical loss.
What is animism?
Belief that everyone and everything has a "soul". Widespread in pre-modern societies. Mental disturbances often ascribed to animistic causes. Evil spirits. Trephining.
What is Factitious Disorder/Munchhausen Syndrome?
Presents with physical symptoms that are DELIBERATELY CREATED.
Goal: Medical attention.
Tipoff: Loud and demanding, v. familiar with medical terms, request invasive procedures.
Most worked in health care fields, deprived backgrounds, early hospitalization.
Know they're faking, but don't know why.
That is difference with malingering.
Munchhausen by proxy: recreate in child.
Describe the doubts about DID.
1) Cognitive & Behavioral thinkers are unwilling to accept idea of unconscious and repression. Doubt whether DID really exists at all.

2) Lawyers and courts dismiss it as excuse.

3) Linked to false memory controversy.

4) DID can be faked--malingering.
General Adaptation Syndrome
1. Alarm reaction: Physiological arousal, "fight or flee"

2. Resistance/Adaptation: Defense and adaptation are sustained and optimal. While body spends energy to cope with stressor, immune system begins to weaken.

3. Exhaustion: Body gives up as physical energy is deleted, immune system is suppressed, attention, thinking, coping efforts weaken or fail.
Under what conditions does dissociative amnesia appear?
In war
In men
In young people
What is dissociative fugue?
Someone suddenly takes off from home/work, can't remember past identity.
Running away from something--war, natural disaster, crisis.
Recovery usually rapid, especially with cues.
How does dissociative amnesia differ from organic amnesia?
Dissociative troubled by stress; not nec. case in organic.
Organic amnesia can remember distant past well, whereas dissociative cannot recall basic autobiographical info.
Organic forgets all knowledge, dissociative remembers general but not personal knowledge.
Organic can have anterograde amnesia; not with dissociative.
Dissociative amnesia can reverse abruptly.
What is post-traumatic amnesia?
Memory loss for events after a traumatic episode.
What is global/generalized amnesia?
All details of personal life vanish
How does one diagnose Hypochondriasis?
1) Medical condition must be ruled out
2) Related mental disorders must be ruled out
3) Patient must not be experiencing psychosis
What is Pain Disorder?
Like Conversion disorder, but with pain.
1) Symptoms
2) No medical reason
3) Patient indifferent
4) Precipitated by event.
What is the difference between efficacy studies and effectiveness studies?
Efficacy: controlled laboratory studies of therapy

Effectivenesss: studies of psychotherapy as it is actually done in the real world
What is Somatization Disorder (Briquet's Syndrome)?
Person has at least 8 physical complaints before age 30. Long medical history.
Pain in at least 4 areas.
Cannot be fully explained by physical causes, but also not under voluntary control.
Patients don't think they have a psychological disorder.
Usually occurs on right (nonverbal) side of body.
What is Conversion disorder?
1) Lost physical functioning. Often looks neurological (blindness, paralysis)
2) But nothing wrong with person medically
3) Involuntary control
4) Patient indifference to paralysis
5) Psychological: preceded by event; paralysis is symbolic
What are somatoform disorders?
Characterized by a loss of physical functioning not due to any physical disorder but apparently resulting from psychological conflict.
How is OCD treated?
Response prevention
Anxiety in the Elderly
Like depression, the rate of anxiety seems to decline with age.

Mental health benefits of good physical health.

Drugs: must be careful of interaction with other medication.
Psychological influences on Asthma
Emotional factors -- family-related emotional distress among children.
What is the cognitive-behavioral theory of OCD?
1) we all have unwanted and repetitive thoughts

2) the more stressed we are, the more frequent and intense are these thoughts

3) the more depressed " "
What is systematic desensitization?
1) Therapy trains the phobic patient in deep muscle relaxation. (Relaxation and fear are incompatible responses.)

2) With the aid of the therapist, patient constructs hierarchy of frightening situations.

3) Removces fear of phobic object by gradual counterconditioning. Causing a response that is incompatible with fear to occur at the same time as the feared CS.
Why do people develop phobias of some objects but not others?
Prepared classical conditioning: Certain evolutionarily dangerous objects are prepared to become phobic objects when paried with trauma, but thers are not and require more extensive and traumatic conditioning to become phobic objects.

Modeling behavior of parents. (Rhesus monkeys)
What are the criteria for Post-Traumatic Stress Disorder (PTSD)?
1) person relieves trauma repeatedly

2) person becomes numb to the world, avoids stimuli that remind him of trauma

3) person experiences symptoms of anxiety and arousal that were not present before the trauma, including sleeping, over-alterness, trouble concentrating, exagerrated startle

4) person is unable to remember important part of traumatic event

5) person feels detached, dissociated from others

6) symptoms last for more than a month.
Psychological influences on Immunological diseases
Depression impairs Natural Killer (NK) and T-cell counts.
Psychological factors influencing Peptic ulcers
Diathesis: H. Pylori
STRESS: STRESS, high anxiety.

- Stress, bad emotions, increase gastric secretions.
- unpredictability and uncontrollability

Type B Personality
Relaxed, serene, no sense of time urgency.
Coronary Heart Disease (CHD)
Kills more people than any other disease in the Western world.

Due to atherosclerosis, building up of fat on inner walls of coronary arteries.
Allostatic load
Hidden price body pays for complex set of trade-offs among different systems and for the overproduction of stress mediators. Occurs when there is frequent stress or body cannot dampen stress. May lead to disease.

High for someone who has a job that has little decision latitude but high demands.
Single, ideal setpoint for each bodily state, such as blood pressure or ACTH level, so get stable, internal balance.

Different homeostasi for diff activities.
What is cortisol? What does it do?
"Fight or flee" stress hormone.

If stressors persist and cortisol continues to be released, has negative effects. Deficient problem solving, susceptibility to disease, stunted growth.
What is the psychodymanic theory of OCD?
Obsessive thought is defense against anxiety produced by repressed, even more unwelcome/unconscious thought.
Elements of Fear
1) cognitive - discernment of an immediate threat to life or limb

2) somatic - body's emergency reaction to danger

3) emotional - dread/terror

4) behavioral - freezing, fleeing, fighting.
Escape responding
Harmful event occurs, subject leaves scene. Escape danger.
What are different treatment methods of PTSD?
Exposure therapy: extinction procedure in which individual repeated exposed to feared stimulus. Most successful.

SIT: anxiety management skills, including deep muscle relaxation, thought-stopping.
What is exposure treatment/flooding/reality testing?
Phobic patient imagines phobic situation or stays in presence for long time without attempting to escape. (Claustrophobic patient put in closet for four hours).
What is the neuroscience view of OCD?
OCD has been known to develop right after brain trauma. "Soft signs" of brain damage. Comorbid with neurological disorders like epilepsy. Too much glucose.

Evolutionary theory.
What are the symptoms of a panic attack?
1) Emotionally, individual overwhelmed with intense apprehension & terror.

2) Physically, panic attack consists of acute emergency reaction.

3) Cognitively, indvidual thinks might have heart attack and die, go crazy, or lose control.

Begins abruptly, peaks within 10 minutes, subsides gradually.
What is applied tension?
Best for blood phobias. Patient TENSES muscles, then exposed to blood. Because blood phobic patients experience DROP in blood pressure, opposite experience of other phobias.
What is Social Phobia?
When is the onset?
Who is most susceptible?
Fear of being observed, afraid they will humiliate themselves and end up having a panic attack. Recognize that the fear is unreasonable, but still avoid social situations that provoke anxiety.

Begin adolescence-25ys.
More women than men, more poor people.

Japanese TKS--fear of offending or embarrassing others by blushing, breaking wind, staring, having deformity. More males than females.
What is retrograde amnesia?
More localized that globalized amnesia; all events immediately before some trauma are forgotten.

i.e. car accident victim might forget anything that happened in the 24 hrs before accident.
What are dissociative disorders?
Profound and lasting disturbance of memory. Two or more mental processes co-exist without becoming connected or influencing each other.
What is dissociative amnesia?
1) Difficult in accessing personal, autobiographical information.
2) Memory loss is too large to explain by normal forgetfulness
3) Content usually traumatic
4) Potentially reversible.
"Recovered memories" are resolved dissociative amnesia.
What is modeling? (Treatment for phobia.)
Patient with phobia watches someone who does not have phobia perform the behavior tha the phobic patient is unable to do himself. Therapist then involves patient in exercises.
How can one treat GAD?
Anti-anxiety drugs

Cognitive-behavioral techniques.
What is panic disorder?
Recurrent panic attacks that come out of nowhere.
What is selective or categorical amnesia?
Only memorys of events related to a particular theme vanish.
What is anterograde amnesia?
Difficulty remembering new material. Rarest kind. Almost always has organic cause, like a stroke.
What is Body Dysmorphic Disorder (BDD)?
Person exaggerates slight bodily defect into perception of wholesale ugliness, which comes to dominate his life.
V difficult to treat, lots of anxiety.
What is the behavioral explanation for phobias?
Classical fear being conditioned by a particularly traumatic unconditioned stimulus.
What is depersonalization disorder?
Feels like an automaton or in a movie. Disturbance in perception of self. Feeling outside body.
Not a delusional state, because reality testing OK.
Highly hypnotizable, distortion in shapes.
Comorbid with depression, hypochondriasis, substance abuse.
Psychological influences on Cancer
Lack of meaning in one's life, job instability, and a lack of plans for the future are better predictors of who has lung cancer than is the amount of smoking.

Psychological distress decreases attention to health care.

Spiegel's study: Psychotherapy prolongs survival.
What is Hypochondriasis?
Conviction that one has a serious disease, or the preoccupation with fears about contracting one, in spite of extensive evidence and reassurance to the contrary.
Worry endlessly. "Doctor shop".
Why has DID become so much more common in recent decades?
1) Diagnostic probe for amnesia now common. "Are there large parts of the week that you can't remember?"

2) Very psychodynamic, so eager to diagnose.

3) New and highly visible awareness of child abuse.
What is agoraphobia?
Sometimes occurs with panic disorders. Fear of going out to places of assembly, open spaces, crowds.

Starts with panic attack. Not afraid of marketplace per se, but of having panic attack and being helpless.

Not a true phobia, but a more global anxiety disorder.
What is Dissociative Identity Disorder (DID) or Multiple Personality Disorder (MPD)?
Occurrence of 2+ identities (alters) in same individual. Each has unique memories, behavior patterns, physiological characteristics (menstrual cycle, blood pressure).
Large role of amnesia. State-dependent memory.
Identity of individual fractured.
Usually from severe childhood abuse. Developed to cope with stress.
Highly hypnotizable. Disorder of self-hypnosis.
How is panic disorder treated?
Cognitive: Patients taught to reinterpret their symptoms more realistically.

What is Generalized Anxiety Disorder (GAD)?
Trouble controlling worry and anxiety.

Cognitive: expects something awful but doesn't know what.

Physically: chronic muscle tension

Behaviorally: flails around trying to relieve worries

Common among poorer people, lower educational groups, urban settings.
What is Malingering?
Faking symptoms.
Frequent problem in diagnosing somatoform disorders.
1) Malingering is under patient's direct control.
2) Malingerer has obvious external goal: avoiding draft/prison/work, etc.
What are Psychosomatic Disorders?
Real physical condition precipitated by psychological conditon.
Peptic ulcers.
What is the diathesis-stress model?
"Diathesis" = predisposition, vulnerability to disorder. Acquired abnormalities in brain structure or function, developmental history.

"Stress" = psychological disturbance, trigger. Pre-/postnatal infections or trauma, interpersonal conflict, lack of supportive relationships, poverty.

Emotional responses: anxiety, hostility, anger, depression

Behavioral responses: poor diet, disrupted sleep, substance abuse, aggressiveness, passivity.

Results in DISEASE.
What is the difference between fear and anxiety?
Fear: distress about specific, dangerous objects.

Anxiety: general feeling of unease about some unspecified danger.
How might we study the effectiveness of complex treatments?
1. Total sample studies, including patients from a wide and representative range of modalities of treatment.

2. Longitudinal: before, during, after treatment.

3. 4 perspectives on outcome: patient's self-report, therapist's view, blind diagnosis, full battery of tests

4. Externally valid, with patients choosing the modality they wanted, duration of treatment....
Avoidance responding
Subject will leave before harmful event occurs. A signal will herald the bad event, warn subject to run away.
The adaption of many bodily states simulatenously across many different life circumstances.
What are tehr DSM-IV's criteria for "Psychological Factors Affecting a General Medical Condition"?
1. there is a disorder of known physical pathology present

2. psychologically meaningful events preceded and contributed to the onset or worsening of the disorder.
What is the lifetime prevalence of PTSD?
8%, more women than men.
How can we treat agoraphobia?

What is Secondary Gain?
Deriving benefits from one's environment as a consequence of having abnormal symptoms. Sympathy.

Difference from malingering:
Malingering fakes intitial symptom and may use them to benefit.
Somatoform patient is not faking symptoms but may derive benefit from having them.
What is the cause of agoraphobia?
Feared illness is full-blown panic or panic-like symptoms.

Classical conditioning analysis.
What were the results of the 1995 Consumer Reports psychotherapy survey?
1. Treatment worked very well. Most respondents got a lot better.

2. Long-term therapy produced much more improvement than short-term therapy.

3. No specific modality of psychotherapy did any better than any other for any problem.

4. No one drug is better than any other.
Why might Type A Personality lead to CHD?
Potential for anger -> Hostility

Competitive, Need for Control -> Helplessness

Ambitious -> Frustration

Time urgent -> Prolonged emergency reaction
Why can the results of efficacy and effectiveness studies differ? (Methods)
1. Kinds of problems are different. Patients in efficacy studies only have one disorder, whereas in real world they have many.

2. In efficacy studies, patients randomly assigned to therapist. In real world, self-selecting.

3. Effectiveness therapy is short-term; real-world often goes on for years.

4. Real-world therapy is often eclectic.
What is the difference between possible "internal" and "external" flaws of effectiveness and efficacy studies?
Internal flaws = sampling bias, insufficiently tight control, lack of external control groups....

External flaws = conditions in efficacy studies so alien to real world that are not generalizeable at all.
What is obsessive-compulsive disorder (OCD)?
Obsessions: repetitive thoughts, images, or impulses that invade consciousness. Very difficult to dismiss or control. Patient is aware that thoughts are product of own imagination. Also aware that obsessions are inappropriate, unreasonable, and tries to suppress them with another action.

Compulsions: responses to obsessive thoughts. Rigid rituals or mental acts that person feels driven to perform in response to obsession. Aimed at preventing or reducing distress. However, not connected with reality, and clearly excessive.
What predicts who will suffer from PTSD?
Degree of threat to one's life--people who were surest they would die.

Had psychological disturbances before incident.

Poor, lower educational background.

Genetic predisposition
Type A Personality
1) Exaggerated sense of time urgency
2) Competitiveness and ambition
3) Aggressiveness and hostility

Higher risk for CHD.
Signs that you have a Phobia
1) Persistant fear reaction that is strongly out of proportion to the reality of the danger.

2) Great anxiety and panic produced by actual exposure to the situation.

3) Recognition that the fear is excessive or unreasonable

4) Avoidance of the phobic situation

5) Symptoms that are not due to another disorder.

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