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Unformatted text preview: Chapter 1 Handouts Abnormal Psychology: Past and Present 0. What is abnormal psychology? 0. The field devoted to the scientific study of _______________ to ________ , ________ , ________ , and ________ abnormal patterns of __________ 1. Workers may be: 0. ______________________________ 1. ______________________________ What Is Psychological Abnormality? Although many definitions have been proposed, none is universally accepted Most definitions share some common features... 2. "The Four Ds" 0. ______________________________ 1. ______________________________ 2. ___________________________ 3. ______________________________ Deviance From what? 3. From behaviors, thoughts, and emotions considered normal in a specific place and time and by specific people 5. ______________________________ 4. Stated and unstated rules for proper conduct in a given society or culture 5. Examples? Judgments of deviance also depend on specific circumstances (i.e., _________________) 2. 3. 4. 6. Distress 1. According to many clinical guidelines, behavior must be _______________ before it can be labeled abnormal 7. Not always the case 4. Examples? Dysfunction 2. Abnormal behavior tends to be __________ it interferes with daily functioning 3. __________ has an influence on determinations of dysfunction, as well 4. Dysfunction alone does not necessarily indicate psychological ___________ Danger 5. Abnormal behavior may become dangerous to oneself or others 8. Behavior may be car___________________________________________ 6. Although cited as a feature of psychological abnormality, _______________________ __________________________________ The Elusive Nature of Abnormality 7. Ultimately, a society selects the general criteria for defining abnormality and then uses those criteria to judge particular cases 9. _______________ argues that, because of the influence of society, the whole concept of mental illness is invalid 5. Deviations called "abnormal" are only "___________" 6. Societies use the concept of mental illness to _________________ who threaten social order The Elusive Nature of Abnormality 8. Even if we agree with the concept of abnormality, it is often applied inconsistently 10. Examples: 9. In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and dangerous, these criteria often are vague What Is Treatment? 10. Once abnormality is determined, clinicians attempt to treat it 11. Treatment (or therapy) is a procedure designed to change abnormal behavior into more normal behavior 11. Despite the clarity of the definition, clinical therapy is surrounded by confusion and conflict: 12. Lack of agreement _________________ 13. Lack of agreement about ______________________ 14. Lack of agreement about ______________________ 15. Are clinicians seeking to ___________? ___________________ 16. Are sufferers patients _________________ or ______________________ What Is Treatment? 12. Despite these disagreements, most clinicians agree that large numbers of people need therapy 17. Research indicates that therapy often is helpful How Was Abnormality Viewed and Treated in the Past? 18. In any given year in the US, ___% of adults and ___% of children display serious psychological disturbances and are in need of treatment 19. In addition, most people have difficulty coping at various times in their lives 20. Is this the fault of modern society? 7. Not entirely; historical records demonstrate that every society has witnessed psychological abnormality and had its own form of treatment... 13. Much of today's thinking about abnormal psychology is built on past approaches and ideas, rather than being a rejection of these ideas 14. Theories and themes about abnormal psychology occur again and again; progress has not been a steady movement forward Ancient Views and Treatment 15. Most historians believe that prehistoric societies regarded abnormal behavior as the work of evil spirits 21. May have begun as far back as ____________________ 16. The cure for abnormality was to force the demons from the body through ________ and ________ Greek and Roman Views and Treatments 17. _________ B.C. to A.D. ___________ 18. Many psychological disorders were identified 19. Hippocrates believed that abnormality was a ________________________________________ 22. He looked to an unbalance of the ___________________ 23. His suggested treatment that attempted to "rebalance" Europe in the Middle Ages: Demonology Returns 24. A.D. _______________ ___________________ 25. With the rise of clergy came the _______________ 8. Abnormality was again seen as a conflict between _______________ 9. The incidence of abnormality increased dramatically as outbreaks of mass madness occurred 10. Earlier (largely discarded) treatments such as __________________ reemerged 26. At the close of the Middle Ages, demonology began to lose favor again The Renaissance and the Rise of Asylums 20. A.D. 1400 1700 21. German physician _________________ believed that the mind was as susceptible to sickness as the body 27. Weyer is considered the founder of modern study of __________________ 22. Patient care improved as demonological views declined 23. Shrines devoted to loving care of the mentally ill were established and one, at ___________ became a community mental health program of sorts 24. This time also saw a rise of asylums institutions whose primary purpose was care of the mentally ill 28. The intention was good care, but because of overcrowding they became _______________________ The Nineteenth Century: Reform and Moral Treatment 25. As 1800 approached, asylums were reformed into places of care 29. _________ (France) and ___________(England) advocated moral treatment care that emphasized humane and respectful treatment 11. In the US, Benjamin __________ (father of American psychiatry) and Dorothea _________(Boston schoolteacher) were the primary proponents of moral treatment 30. By the end of the nineteenth century, there was a reversal of the moral treatment movement because of several factors: 12. _________________________________________ 13. _________________________________________ 14. _________________________________________ 31. Longterm hospitalization became the rule once again The Early Twentieth Century: Dual Perspectives 26. As the moral movement was declining in the late 1800s, two opposing perspectives emerged: 32. The Somatogenic Perspective 15. ______________________________________ 33. The Psychogenic Perspective 16. ______________________________________ The Early Twentieth Century: The Somatogenic Perspective 34. Two factors responsible for rebirth of this perspective: 17. Emil _________________ textbook argued that physical factors (like fatigue) are responsible for mental dysfunction 18. Several biological discoveries were made, such as the link between untreated syphilis & general paresis 35. This approach, while creating optimism, lead to few positive results until the 1950s, when a number of effective medications were discovered The Early Twentieth Century: The Psychogenic Perspective Current Trends 27. Have we come a long way? 36. ________ of people interviewed believe that people bring mental health disorders upon themselves 37. ________ consider mental health disorders to be caused by sinful behavior 38. However, the past 50 years have brought major changes in the ways clinicians understand and treat abnormal functioning How Are People with Severe Disturbances Treated? 28. 1950s _________________ discovered 39. _____________________________ 40. _____________________________ 41. _____________________________ 29. These discoveries led to _________________________________ and a rise in outpatient care 42. This change in care was not without problems How Are People with Severe Disturbances Treated? 30. Outpatient care is now the primary mode of treatment 43. When patients need greater care, they are usually given shortterm hospitalizations or outpatient psychotherapy and medication in community settings 19. Unfortunately, there are too few community programs available; only ______________ of those with severe disturbances receive treatment of any kind How Are People with Less Severe Disturbances Treated? 31. Since the 1950s, there has been an increase in outpatient care 44. Although this type of care was once exclusively private psychotherapy, it now includes various settings, as well as specialty care 32. In any given year, __________ adults receive some type of mental health care A Growing Emphasis on Preventing Disorders and Promoting Mental Health 45. The community mental health approach has given rise to the prevention movement 20. Many of today's programs are trying to: 6. Correct the social conditions associated with psychological problems 7. ________________________________________________ and promotion of positive feelings, traits, and abilities 46. Prevention programs have also been energized by the rise of _________________ the study The Growing Influence of Insurance Companies 47. Today the dominant form of insurance coverage is the managed care program a program in which the insurance company determines key care issues 21. Approximately 75% of all privately insured persons in the U.S. are enrolled in managed care programs 22. At issue are the duration of therapy, the push for medication treatment, and the relatively low rates of reimbursement for care What Are Today's Leading Theories and Professions? 48. One important development in the field of abnormal psychology is the growth of theoretical perspectives, including: 23. P__________________ 24. B_________________ 25. B_________________ 26. C_________________ 27. H_________________ 28. S___________________ 49. No single perspective dominates 33. In addition to multiple perspectives, there also are a variety of professionals now available to offer help to people with psychological problems 34. One final development in the study and treatment of mental disorders is a growing appreciation for ___________________ 50. Clinical researchers attempt to examine which concepts and theories best ________ and ________ abnormal behavior, which ________ are most effective, and what kinds of _________ may be required What Do Clinical Researchers Do? 35. ____________________ is the key to accuracy in all fields 51. Particularly important (and challenging) in the field of abnormal psychology 52. Clinical researchers face certain challenges that make their investigations particularly difficult: 29. Measuring unconscious motives 30. Assessing private thoughts 31. Monitoring mood changes 53. Clinical researchers must consider cultural backgrounds, races, and genders of those they study 54. Clinical researchers must follow the _____________ to ensure that their subjects are not harmed 55. Clinical researchers try to discover laws and principles of abnormal psychological functioning: 32. Search for nomothetic understanding 8. _____________________________ 33. Generally do not assess, diagnose, or treat individual clients 34. Use the _____________________ to pinpoint relationships among variables 9. They systematically ____________ and _____________ information through careful _________________ 35. Use three methods of investigation to form and test hypotheses... The Case Study 56. Provides a detailed, interpretative description of a person's life & psychological problems 57. Can serve as a source of new ideas about behavior 36. Freud's theories based entirely on case studies 58. May offer ______________ for a theory 59. May challenge a theory's assumptions 60. May inspire new therapeutic techniques 61. May offer opportunities to study ______________ 62. Has limitations: 37. _____________________________ 38. _____________________________ 10. Has low internal validity 39. _____________________________ 11. Has low external validity 63. These limitations are addressed by the two other methods of investigation... The Correlational Method & The Experimental Method 36. Do not offer richness of detail 37. Do allow researchers to draw broad conclusions 64. Typically involve observing many individuals 65. Researchers apply procedures ______________ 40. Studies can be replicated 66. Researchers use ______________ to analyze results The Correlational Method 38. Correlation is the degree to which events or characteristics vary with each other 67. Measures the strength of a relationship 39. The people chosen for a study are its _______ ____________ 40. The direction of a correlation (relationship) is important 68. Positive correlation = variables change in the _____________________ 69. Negative correlation = variables change in the _____________________ 70. Unrelated = ___________________ 41. ___________________________ 41. The magnitude (strength) of a correlation is also important 71. High magnitude = variables that vary closely together 72. Low magnitude = variables that do not vary as closely together 73. Direction and magnitude of a correlation are often calculated statistically 42. Called the "correlation coefficient" 12. Sign (+ or ) indicates direction 13. Number (from _____________ to ___________________) indicates magnitude 14. 0.00 = no consistent relationship 15. +1.00 = perfect positive correlation 16. 1.00 = perfect negative correlation 74. Most correlations found in psychological research fall far short of "perfect" 42. Correlations can be trusted based on _____________________ 75. How likely is it that the observed correlation occurred by chance? 43. Advantages of correlational studies: 76. __________________________________ 77. __________________________________ 44. Difficulties with correlational studies: 78. Results do not _________ a relationship 45. Two special forms of correlational study: 79. Epidemiological studies 43. Reveal the incidence and prevalence of a disorder in a particular population 17. Incidence = number of new cases in a given period 18. Prevalence = total number of cases in a given period 80. Longitudinal studies 44. Observe one sample of participants on many occasions over a long period The Experimental Method 81. An experiment is a research procedure in which a variable is manipulated, and the manipulation's effect on another variable is observed 45. Manipulated variable = ___________________ 46. Variable being observed = ___________________ 82. Allows researchers to ask questions such as: Does therapy X reduce symptoms of disorder Y? 47. Causal relationships can only be determined through ___________ 83. Statistics and research design are very important variable that may also be affecting the dependent variable 49. Three features are included in experiments to guard against confounds: 19. The control group 20. Random assignment 21. Blind design 46. A ______________ is a group of participants who are not exposed to the independent variable, but whose experience is similar to that of the experimental group 84. By comparing the groups, researchers can better determine the effect of the __________________ 47. Rules of statistical significance are applied 48. Researchers must also watch out for differences in the makeup of the experimental and control groups 48. Researchers must eliminate all confounds those variables other than the independent 85. To do so, researchers use _________________ any one of a number of selection procedures that ensures that every participant in the experiment is as likely to be placed in one group as another 50. Examples: _________________________ 86. A final confound problem is __________ 51. To avoid bias by the participant, experimenters employ a " _________ ," in which participants are kept from knowing which condition of the study (experimental or control) they are in 22. One strategy for this is providing a ___________ something that simulates real therapy but has no key ingredient 52. To avoid bias by the experimenter, experimenters employ a "______________ ," in which both experimenters and participants are kept from knowing which condition of the study participants are in 23. Often used in medication trials Alternative Experimental Designs 49. Clinical researchers often must settle for designs that are less than ideal and include: 87. Quasiexperimental designs 88. Natural experiments 89. Analogue experiments 90. Singlesubject experiments 50. In _________________ , investigators do not randomly assign subjects to groups, but make use of group that already exist 91. Example: children with a history of child abuse 51. To address the problem of confounds, researchers use _________________________ 92. These groups are "matched" to the experimental group based on demographic and other variables 52. In natural experiments, nature manipulates the independent variable and the experimenter observes the effects 93. Example: _____________________________ 94. Cannot be replicated at will 95. Broad generalizations cannot be made 53. Analogue experiments allow investigators to freely manipulate independent variables while avoiding ethical and practical limitations 96. They induce laboratory subjects to behave in ways that seem to resemble real life 53. Example: _________________ 54. In a singlesubject experiment, a single participant is observed both before and after manipulation of an independent variable 97. Example: __________________ design What Are the Limits of Clinical Investigations? 55. Each method addresses some of the problems of studying human behavior but ________________ overcomes them all 56. Best to view each method as part of a team of approaches Chapter 2 Handouts Models of Abnormality 98. In science, the perspectives used to explain phenomena are known as models, or paradigms 54. Each provides _________________________________ that help us explain and interpret observations 55. Helpful because they spell out basic assumptions and set guidelines for investigation 56. They influence what investigators observe, the questions they ask, the information they seek, and their interpretation of that information Models of Abnormality 57. Historically, clinical scientists of a given time and place agreed on a single model of abnormality a model greatly influenced by ___________________ 58. Currently, there are several competing models of abnormality 99. Why? Each model focuses on one aspect of human functioning and no single model can explain all aspects of abnormality The Biological Model 59. Takes a medical perspective 60. Main focus is that psychological abnormality is an illness brought about by _________________________________ 100. Typically focused on the _______________ How Do Biological Theorists Explain Abnormal Behavior? 61. Brain anatomy 101. The brain is composed of ~100 billion nerve cells (called _________ ) and thousands of billions of support cells (called _________ ) 102. Within the brain, large groups of neurons form distinct areas called brain ___________ How Do Biological Theorists Explain Abnormal Behavior? 0. Brain anatomy and abnormal behavior 103. Clinical researchers have found connections between certain psychological disorders and problems in specific brain areas 57. Example: Huntington's disease & basal ganglia (forebrain) 62. Brain chemistry 104. Information spreads throughout the brain in the form of _______________ that travel from one neuron to one or more other neurons 105. An impulse is received at a neuron's ____________, travels down the ____________ , and is transmitted to other neurons through the nerve ____________ 63. Brain chemistry 106. Neurons don't touch; they are separated by a space (the ____________), across which a message moves 107. When an electrical impulse reaches a nerve ending, the nerve ending is stimulated to release a chemical called a ______________ (NT) 58. Some NTs tell receiving neurons to "fire"; other NTs tell receiving neurons to stop firing 64. Brain chemistry and abnormal behavior 108. Researchers have identified dozens of NTs 59. Examples: serotonin, dopamine, and GABA 109. Studies indicate that abnormal activity in certain NTs can lead to specific mental disorders 60. Examples: depression (serotonin and norepinephrine) and anxiety (GABA), schizophrenia (dopamine) 110. Brain chemistry and abnormal behavior 61. Additionally, researchers have learned that mental disorders are sometimes related to abnormal chemical activity in the endocrine system 62. Hormone release, triggered by a variety of factors, propels body organs into action. Abnormal secretions have been linked to psychological disorders 63. Example: cortisol release is related to anxiety and mood disorders 111. Sources of biological abnormalities ____________ 64. Humans have 23 pairs of chromosomes, each with numerous genes that control the characteristics and traits a person inherits 65. Studies suggest that inheritance plays a part in mood disorders, schizophrenia, mental retardation, Alzheimer's disease, and other mental disorders 24. Aren't able (yet) to identify specific genes 25. Don't know the extent to which genetic factors contribute to disorders 26. Seems no SINGLE gene is responsible for ____________________ Sources of biological abnormalities ___________________________ 66. Genes that contribute to mental disorders are viewed as unfortunate occurrences: 27. May be mutations 28. May be inherited after a mutation in the family line 67. Evolutionary theorists argue that we can best understand abnormality by examining the millions of years of human evolution 29. Looking at a combination of adaptive behaviors of the past, genes, and the interaction between genes and current environmental events 30. Example: Fear 65. Sources of biological abnormalities ____________________________ 112. Infection provides another possible source of abnormal brain structure or biochemical dysfunction 68. Example: schizophrenia and prenatal viral exposure 113. Interest in viral explanations of psychological disorders has been growing in the past decade 69. Example: anxiety and mood disorders Biological Treatments 66. Biological practitioners attempt to pinpoint the physical _________ of dysfunction to determine the course of treatment 67. Three types of biological treatment: 114. _____________________________ 115. _____________________________ 116. _____________________________ Biological Treatments 68. Drug therapy: 117. 1950s = advent of psychotropic medications 70. Changed outlook for a number of mental disorders 118. Four groups of drugs: 71. _____________________________ 72. ______________________ 73. _____________________________ 74. _____________________________ 69. Electroconvulsive therapy (ECT): 119. Currently experiencing a revival 120. Used for depression when drugs and other therapies have failed 70. Psychosurgery (or neurosurgery): 121. Historical roots in ______________ 122. 1930s = first lobotomy 123. Much more precise than in the past 124. Considered experimental and used only in extreme cases Assessing the Biological Model 125. Strengths: 75. Enjoys considerable respect in the field 76. Brings great relief 77. Fruitful 31. ____________________ 32. Suggests new avenues of research 126. Weaknesses: 78. Can limit rather than enhance our understanding 79. ________________ 80. Evidence is incomplete or inconclusive 81. Treatments produce significant __________ ___________________ The Psychodynamic Model 127. Oldest and most famous psychological model 128. Based on belief that a person's behavior (whether normal or abnormal) is determined largely by underlying _______________ psychological forces _________________________ 82. Abnormal symptoms are the result of conflict among these forces 129. Father of psychodynamic theory and psychoanalytic therapy: 83. __________________ (18561939) How Did Freud Explain Normal and Abnormal Functioning? Caused by three ______________ forces: 84. 85. 86. 87. Id guided by the ______________ Principle Instinctual needs, drives, & impulses Sexual; fueled by libido (sexual energy) Ego guided by the ______________ Principle Seeks gratification but guides us to know when we can & can't express our wishes Ego defense mechanisms protect us from anxiety Caused by three UNCONSCIOUS forces: 71. 0. 130. 131. Superego guided by the ____________ Principle 33. Conscience; unconsciously adopted from our parents 132. These three parts of the personality are often in conflict 88. A healthy personality is one in which compromise exists among the three forces 89. If the id, ego, and superego are in excessive conflict, the person's behavior may show signs of dysfunction How Did Freud Explain Normal and Abnormal Functioning? 72. Developmental stages adjustment in the id, ego, and superego 90. If successful personal growth 0. 133.Freud proposed that at each stage of development, new events and pressures require 91. If unsuccessful fixation at an early developmental stage, leading to psychological abnormality 34. Because parents are the key figures in early life, they are often seen as the cause of improper development 73. Developmental stages 134. _____________ (0 to 18 months of age) 135. _____________ (18 months to 3 years of age) 136. _____________ (3 to 5 years of age) 137. _____________ (5 to 12 years of age) 138. _____________ (12 years of age to adulthood) How Do Other Psychodynamic Explanations Differ from Freud's? 139. Although current models deviate from Freud's in important ways, each retains the belief that human functioning is shaped by dynamic (interacting) forces: 92. __________________ 35. Emphasize the role of the ego; consider it independent 93. __________________ 36. Emphasize the unified personality over any one component 94. __________________ 37. Emphasize the human need for interpersonal relationships Psychodynamic Therapies 74. Range from Freudian psychoanalysis to more modern therapies 75. All seek to uncover past trauma and inner conflicts 76. Therapist acts as "______________" 77. Utilize various techniques: 140. ____________________________ 141. Therapist interpretation 95. ___________________________ 96. Transference 97. Dream interpretation 142. Catharsis 143. Working through 78. Contemporary trends: 144. _________________ psychodynamic therapies 145. ________________________ psychoanalytic therapy Assessing the Psychodynamic Model 98. Strengths: 38. First to recognize importance of psychological theories & treatment 39. Saw internal conflict as important source of psychological health and abnormality 40. First to apply theory and techniques systematically to treatment monumental impact on the field 146. Weaknesses: 99. Unsupported ideas; __________________ 41. Nonobservable 42. Inaccessible to human subject (unconscious) The Behavioral Model 79. Like the psychodynamic perspective, behaviorism is ______________ and is based on the idea that our actions are determined largely by our life experiences 80. Emphasizes __________________ and environmental factors 81. Focuses on how behavior is acquired (learned) and maintained over time 82. Historical beginnings in laboratories where conditioning studies were conducted 147. Several forms of conditioning: 100. Operant conditioning 101. Modeling 102. Classical conditioning 148. May produce __________________ behavior How Do Behaviorists Explain Abnormal Functioning? 83. Operant conditioning 149. Organism "operates" on environment and produces an effect whenever they do so 84. Modeling 151. Individuals learn behavioral responses by observing and repeating behavior 103. ___________________________________ 85. Classical conditioning 152. Learning by __________________ 104. When two events repeatedly occur close together in time, they become fused in a person's mind; before long, the person responds in the same way to both events 153. Father of classical conditioning: ______________ (18491936) 105. Classic study using dogs & meat powder 86. Classical conditioning 154. If, after conditioning, the CS is repeatedly presented alone, it will eventually stop eliciting the CR 106. This process is called ________________________________ 155. Explains many familiar behaviors (both normal and abnormal) 150.Humans and animals learn to behave in certain ways as a result of receiving rewards Behavioral Therapies 87. Aim is to identify the behaviors that are causing problems and replace them with more appropriate ones 156. May use classical conditioning, operant conditioning, or modeling 88. Therapist is "__________" rather than healer 157. Early life experiences important only in providing clues to current learning 89. Classical conditioning treatments may be used to change abnormal reactions to particular stimuli 158. Example: _______________________ for phobia 107. Stepbystep procedure 43. Learn relaxation skills 44. Develop a fear hierarchy 45. Confront feared situations (covertly or in vivo) Assessing the Behavioral Model 159. Strengths: 108. Powerful force in the field 109. Rooted in ___________ 46. Phenomena can be observed and measured 110. __________________ __________________ 160. Weaknesses: 111. ______________ 112. Unrealistic 113. Downplays role of _________________ 47. New focus on selfefficacy, social cognition, and cognitivebehavioral theories The Cognitive Model 90. Proposes that cognitive processes are at the center of behavior, thought, and emotion 91. Argues that clinicians must ask questions about assumptions, attitudes, and thoughts of a client 161. Concerned with internal processes 162. Presentfocused How Do Cognitive Theorists Explain Abnormal Functioning? 92. Maladaptive ______________ is the cause of maladaptive ______________ 163. Several kinds of faulty thinking: 114. Faulty assumptions and attitudes 115. Illogical thinking processes 116. Example: ___________________ Cognitive Therapies 93. People must be taught a new way of thinking to prevent maladaptive behavior 94. Main model: Beck's Cognitive Therapy 117. The goal of therapy is to help clients ______________ and ______________ their thinking 48. Therapists also guide clients to challenge dysfunctional thoughts, try out new interpretations, and apply new ways of thinking in their daily lives 118. Widely used in treating depression Assessing the Cognitive Model 164. Strengths: 49. Very broad appeal 50. ____________________ 51. Focuses on a uniquely human process 52. Correlation between symptoms and maladaptive cognition 53. Therapies effective in treating several disorders 54. Adapt well to technology 55. ____________________ 165. Weaknesses: 119. __________________ 120. Overemphasis on the present 121. Limited effectiveness 122. Verification of cognition is difficult 56. Precise role is hard to determine The HumanisticExistential Model 95. Combination model 166. The humanist view 123. Emphasis on people as friendly, cooperative, and constructive; focus on drive to selfactualization 167. The existentialist view 124. Emphasis on selfdetermination, choice, and individual responsibility; focus on authenticity Rogers's Humanistic Theory and Therapy 0. Basic human need for ________________________ 125. If received, leads to unconditional selfregard 126. If not, leads to "conditions of worth" 57. Incapable of selfactualization because of distortion don't know what they really need, etc. 168. Rogers's "_________________" therapy 0. Therapist provides unconditional positive regard 58. Both accurate & genuine in reflection (reflective listening) 59. Focus on the "experiencing person" 60. Little research support 96. Humanistic approach 169. Developed by Fritz Perls 170. Goal is to help clients achieve selfrecognition through challenge and frustration 171. Techniques: 127. Skillful frustration 128. Role playing 129. Rules, including "Here and Now" and "I" language Existential Theories and Therapy 1. Psychological dysfunction is caused by selfdeception: people hide from life's responsibilities and fail to recognize that it is up to them to give meaning to their lives 2. Therapy is focused on patient acceptance of personal responsibility and recognition of freedom of action 1. Goals more important than technique 2. Great emphasis placed on clienttherapist relationship Assessing the HumanisticExistential Model Gestalt Theory and Therapy 172. Strengths: 130. Emphasizes the individual 131. Taps into domains missing from other theories 61. ___________________ 132. ___________________ 133. Emphasizes health 173. Weaknesses: 134. ________________ 62. Difficult to research 135. Not much influence 136. Weakened by ____________________ ____________________ 63. Changing somewhat The Sociocultural Model 97. Argues that abnormal behavior is best understood in light of the social and cultural forces that influence an individual 174. Addresses norms and roles in society 98. Influenced by sociology and anthropology 99. Argues that we must examine a person's social surroundings to understand their (abnormal) behavior How Do Sociocultural Theorists Explain Abnormal Functioning? 100. Focus on: 137. 138. 175. Societal labels & roles Diagnostic labels (example: Rosenhan study) Sick role 176. Social networks and support How Do Sociocultural Theorists Explain Abnormal Functioning? 101. Focus on: 177. Family structure and communication 139. ________________________ = abnormal functioning within family leads to abnormal behavior (insane behavior becomes sane in an insane environment) 64. Examples: enmeshed, disengaged structures 102. Focus on: 178. ________________________________ 140. Set of values, attitudes, beliefs, history, and behaviors shared by a group of people and communicated from one generation to the next 141. "Multicultural" psychology is a growing field of study 103. Focus on: 179. Religion and spirituality 142. For most of the twentieth century, clinical scientists viewed religion as a negative factor in mental health, but this alienation now seems to be ending: 65. Researchers have begun to systematically study the influence of religion and spirituality on mental health 66. Many therapists now address spiritual issues when treating religious clients Sociocultural Treatments 180. May include traditional individual therapy 181. Broadened therapy to include: 143. Culturesensitive therapy 144. Group therapy 145. Family therapy 146. Couple therapy 147. Community treatment 67. Includes prevention work Assessing the Sociocultural Model 182. Strengths: 148. Added greatly to ____________________ ____________________ 68. Increased awareness of labeling 149. Clinically successful when other treatments have failed 183. Weaknesses: 150. Research is difficult to interpret 69. Correlation causation 151. Model unable to predict abnormality in ____________________ ____________________ Integration of the Models 184. Each perspective is valuable to understanding abnormal behavior 185. Different perspectives are more appropriate under differing conditions 186. An integrative approach provides a general framework for thinking about abnormal behavior, and also allows for specification of the factors that are especially pertinent to particular disorders 104. Many theorists, clinicians, and practitioners adhere to a ____________________ model 3. Abnormality results from the interaction of genetic, biological, developmental, emotional, behavioral, cognitive, social, and societal influences 3. Also popular: 152. ______________________________ 0. Diathesis = predisposition (bio, psycho, or social) 105. Integrative therapists are often called "_______________" taking the strengths from each model and using them in combination Chapter 3 Handouts Clinical Assessment: How and Why Does the Client Behave Abnormally? 106. What is assessment? 187. _______________________________________ 188. ______________ assessment is used to determine how and why a person is behaving abnormally and how that person may be helped 153. Focus is _____________ on an individual person 154. Also may be used to evaluate treatment progress 107. The specific tools used in an assessment depend on the clinician's theoretical orientation 108. Hundreds of clinical assessment tools have been developed and fall into three categories: 189. Clinical interviews 190. Tests 191. Observations Characteristics of Assessment Tools 109. To be useful, assessment tools must be _________ and have clear _________ and _________ 192. To standardize a technique is to set up common steps to be followed whenever it is administered 193. One must standardize _____________ , ___________ , and _______________ 194. Reliability refers to the _______________ of a test 155. A good test will yield the same results in the same situation 156. Two main types: 70. __________________ reliability 0. To test for this type of reliability, a subject is tested on two different occasions and the scores are correlated the higher the correlation, the greater the test's reliability 71. __________________ reliability 1. Independent judges agree on how to score and interpret a particular test 195. Validity refers to the __________ of a test's results 157. A good test must accurately measure what it is supposed to be measuring 158. Three specific types: 72. ________________ a test appears to measure what it is supposed to measure; does not necessarily indicate true validity 73. ________________ a test accurately predicts future characteristics or behavior 74. ________________ a test's results agree with independent measures assessing similar characteristics or behavior Clinical Interviews 110. Facetoface encounters 196. Often the first contact between a client and a clinician/assessor 111. Used to collect detailed information, especially personal history, about a client 112. Allow the interviewer to focus on whatever topics they consider most important 113. Conducting the interview 197. Focus depends on theoretical orientation 198. Can be either ___________ or ___________ 159. In unstructured interviews, clinicians ask openended questions 160. In structured interviews, clinicians ask prepared questions, often from a published interview schedule 75. May include a mental status exam 114. Limitations: 199. May lack _________________ or accuracy 200. Interviewers may be biased or may make mistakes in judgment 201. Interviews, particularly _______________ ones, may lack reliability Clinical Tests 115. Devices for gathering information about a few aspects of a person's psychological functioning, from which broader information can be inferred 116. More than 500 different tests are in use 202. They fall into six categories ... 203. _________________ tests 161. Require that subjects interpret vague and ambiguous stimuli or follow openended instruction 162. Mainly used by ______________ practitioners 163. Most popular: 76. Rorschach Test 77. Thematic Apperception Test 78. 79. Sentence Completion Test Drawings Clinical Test: SentenceCompletion Test 117. "I wish ___________________________" 118. "My father ________________________" Clinical Test: Drawings 119. DrawaPerson (DAP) test: 204. "Draw a person" 205. "Draw another person of the opposite sex" Clinical Tests 120. Projective tests 206. Strengths and weaknesses: 164. Helpful for providing "supplementary" information 165. Have rarely demonstrated much ________________ 166. May be biased against __________________ Clinical Tests 121. ________________ inventories 207. Designed to measure broad personality characteristics 208. Focus on behaviors, beliefs, and feelings 209. Usually based on selfreported responses 210. Most widely used: Minnesota Multiphasic Personality Inventory 167. For Adults: MMPI (original) or MMPI2 (1989 revision) 168. For Adolescents: MMPIA Clinical Test: MMPI Minnesota Multiphasic Personality Inventory 122. Consists of more than __________________________ that can be answered "true," "false," or "cannot say" 211. Statements describe physical concerns; mood; morale; attitudes toward religion, sex, and social activities; and psychological symptoms 212. Assesses careless responding & lying 169. Comprised of __________ clinical scales: 80. Hypochondriasis (HS) 81. Depression (D) 82. Conversion hysteria (Hy) 83. Psychopathic deviate (PD) 84. Masculinityfemininity (Mf) 170. Scores range from 0 120 85. Above 70 = deviant 86. Graphed to create a "profile" 87. Paranoia (P) 88. Psychasthenia (Pt) 89. Schizophrenia (Sc) 90. Hypomania (Ma) 91. Social introversion (Si) Clinical Tests 123. Personality inventories 213. Strengths and weaknesses: 171. Easier, cheaper, and faster to administer than projective tests 172. ________________ scored and standardized 173. Appear to have greater validity than projective tests 92. Measured traits often cannot be directly examined how can we really know the assessment is correct? 174. Tests fail to allow for __________________ in responses Clinical Tests 124. Response inventories 214. Usually based on selfreported responses 215. Focus on one specific area of functioning 175. Affective inventories (example: Beck Depression Inventory) 176. _________________________________ 177. Cognitive inventories Clinical Tests 125. ____________________ tests 216. Measure physiological response as an indication of psychological problems 178. Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction 217. Most popular is the __________ (lie detector) Clinical Tests 126. Psychophysiological tests 218. Strengths and weaknesses: 179. Require expensive equipment that must be tuned and maintained 180. Can be ___________________________ Clinical Tests 127. ____________________________ tests 219. Neurological tests __________ assess brain function by assessing brain structure and activity 181. Examples: EEG, PET scans, CAT scans, MRI 220. Neuropsychological tests __________ assess brain function by assessing cognitive, perceptual, and motor functioning 182. Most widely used is the ________________________________________ Clinical Tests 128. Neurological and neuropsychological tests 221. Strengths and weaknesses: 183. Can be very accurate 184. At best, though, these tests are general screening devices 93. Best when used in a battery of tests, each targeting a specific skill area 129. _______________________ tests 222. Designed to measure intellectual ability 223. Composed of a series of tests assessing both verbal and nonverbal skills 224. Generate an ______________________ (IQ) 130. Intelligence tests 225. Strengths and weaknesses: 185. Are among the most carefully produced of all clinical tests 186. Highly standardized on large groups of subjects 187. Have very high reliability and validity 188. Because intelligence is an inferred quality, it can only be measured indirectly 131. Intelligence tests 226. Strengths and weaknesses: 189. Performance can be influenced by nonintelligence factors (e.g., ____________ , ____________ , ______________________) 190. Tests may contain _________ in language or tasks Clinical Observations 132. Systematic observation of behavior 133. Several kinds: 227. _______________________ 228. Analog 229. Selfmonitoring 230. Naturalistic and analog observations 191. Naturalistic observations occur in ____________ environments 94. Can occur in homes, schools, institutions (hospitals and prisons), and community settings 95. Tend to focus on parentchild, siblingchild, or teacherchild interactions 96. Observations are generally made by "________________" and reported to a clinician 192. If naturalistic observation is impractical, analog observations are used in __________________ 134. Naturalistic and analog observations 231. Strengths and weaknesses: 193. ___________________________ is a concern 97. Different observers may focus on different aspects of behavior 194. ___________________________ is a concern 98. Risk of "overload," "observer drift," and observer bias 99. ______________________ may also limit validity 100. Observations may lack _____________________ validity Clinical Observations 135. Selfmonitoring 232. People observe themselves and carefully record certain behaviors, feelings, or cognitions as they occur over time Clinical Observations 233. Selfmonitoring 195. Strengths and weaknesses: 101. Useful in assessing infrequent behaviors 102. Useful for observing overly frequent behaviors 103. Provides a means of measuring private thoughts or perceptions 104. Validity is often a problem 105. Clients may not receive proper training and instruction 106. Clients may not record information accurately 107. When people monitor themselves, they often change their behavior Diagnosis: Does the Client's Syndrome Match a Known Disorder? 234. Using all available information, clinicians attempt to paint a "_______________" 196. Influenced by their _________________ 235. Using assessment data and the clinical picture, clinicians attempt to make a ________________ 197. A determination that a person's problems reflect a particular disorder or syndrome 198. Based on an existing _________________ Classification Systems 136. Lists of categories, disorders, and symptom descriptions, with guidelines for assignment 236. Focus on clusters of symptoms (syndromes) 137. In current use in the US: DSMIVTR 237. _________________________________________ (4th edition), Text Revision DSMIVTR 138. Published in 1994, revised slightly in 2000 139. Lists approximately 400 disorders 238. Listed in the inside back flap of your text 140. Describes criteria for diagnoses, key clinical features, and related features which are often but not always present 141. Most widely used classification system in the US 142. _____________ 239. Uses 5 axes (____________________) to develop a full clinical picture 240.People usually receive a diagnosis on either Axis I or Axis II, but they may receive diagnoses on both The DSMIVTR 143. Axis I : 241. Most frequently diagnosed disorders, except personality disorders and mental retardation 144. Axis II 242. Personality disorders and mental retardation 199. Longstanding problems 145. Axis III 243. Relevant general medical conditions 146. Axis IV 244. Psychosocial and environmental problems 147. Axis V 245. Global assessment of psychological, social, and occupational functioning 200. Current functioning and highest functioning in past year 201. 0100 scale Is DSMIVTR an Effective Classification System? 246. Classification systems are judged by _________________________ and ________________________ 247. Here reliability = different diagnosticians agreeing on a diagnosis using the same classification system 202. DSMIVTR has greater reliability than any previous editions 108. Used field trials to increase reliability 203. Reliability is still a concern 148. The validity of a classification system is the accuracy of information that the diagnostic categories provide 248. ____________ validity is of the most use clinically 249. DSMIVTR has greater validity than any previous editions 204. Conducted extensive literature reviews and ran field studies Validity is still a 149. Beyond concerns about reliability and validity, a growing number of theorists believe that two fundamental problems weaken the DSM: 250.Basic assumption that disorders are _____________ different from normal behavior 251. Reliance on _____________ diagnostic categories Can Diagnosis and Labeling Cause Harm? 150. Misdiagnosis always a concern 252. Major issue is reliance on __________________ 151. Also present is the issue of _______________ 253. Diagnosis may be a selffulfilling prophecy 152. Because of these problems, some clinicians would like to cease the practice of diagnosis Treatment: How Might the Client Be Helped? 254. Treatment decisions 205. Begin with assessment information and diagnostic decisions to determine a treatment plan 109. Use a combination of ___________________________ 206. Other factors: 110. ___________________________________________ 111. ___________________________________________ 112. General state of clinical knowledge currently focusing on ___________________________________________ The Effectiveness of Treatment 153. More than 400 forms of therapy in practice, but is therapy effective? 255. Difficult question to answer: 207. How do you define success? 208. How do you measure improvement? 209. How do you compare treatments treatments differ in range and complexity; therapists differ in skill and knowledge; clients differ in severity and motivation... 154. Controlled clinical research and therapy outcome studies typically assess one of the following questions: 155. Is therapy generally effective? 259. Research suggests that therapy is generally more effective than ____________ or _________ 260. In one major study using ____________ , the average person who received treatment was better off than 75% of the untreated subjects 156. Is therapy generally effective? 261. Some clinicians are concerned with a related question: Can therapy can be harmful? 210. Has this potential 256.Is therapy in general effective? 257.Are particular therapies generally effective? 258.Are particular therapies effective for particular problems? 211. Studies report ~5% get worse with treatment 157. Are particular therapies generally effective? 262. Generally, therapyoutcome studies lump all therapies together to consider their general effectiveness 212. One critic has called this the "__________________" 263. It is argued that scientists must look at the effectiveness of ______________ therapies 213. There is a movement ("______________") to look at __________________ among therapies 264. Are particular therapies effective for particular problems? 214. Studies now being conducted to examine effectiveness of specific treatments for specific disorders: 113. " ______ specific treatment, by ______, is the most effective for ______ individual with ______ specific problem, and under ______ set of circumstances?" 215. Recent studies focus on the effectiveness of combined approaches ________________ combined with certain forms of _______________ to treat certain disorders Chapter 4 Handouts Anxiety Disorders Anxiety 158. What distinguishes fear from anxiety? 265. Fear is a state of immediate alarm in response to a _______________________________________ 266. Anxiety is a state of alarm in response to a _______________________________________ 267. Both have the same _______________ features: increase in respiration, perspiration, muscle tension, etc. Anxiety 159. Is the fear/anxiety response useful/adaptive? 268. Yes, when ________________________ is protective 269. However, when it is triggered by "________________" situations, or when it is too severe or longlasting, this response can be disabling 216. Can lead to the development of anxiety disorders Anxiety Disorders 270. Most common mental disorders in the U.S. 217. In any given year, ____% of the adult population in the U.S. experience one or another of the six DSMIV anxiety disorders 114. Only ~20% of these individuals seek treatment 271. Most individuals with one anxiety disorder suffer from a second disorder, as well 272. Anxiety disorders cost $42 billion each year in health care, lost wages, and lost productivity Anxiety Disorders 160. Six disorders: 273. Generalized anxiety disorder (GAD) 274. Phobias 275. Panic disorder 276. Obsessivecompulsive disorder (OCD) 277. Acute stress disorder 278. Posttraumatic stress disorder (PTSD) Generalized Anxiety Disorder (GAD) 279. Characterized by excessive anxiety under most circumstances and worry about practically anything 218. Vague, intense concerns and fearfulness 115. Often called "freefloating" anxiety 116. "Danger" not a factor 280. Symptoms include restlessness, easy fatigue, irritability, muscle tension, and/or sleep disturbance 219. Symptoms last at least six months Generalized Anxiety Disorder (GAD) 161. The disorder is common in Western society 281. Affects ~3% of the population in any given year and ~6% at sometime during their lives 162. Usually first appears in childhood or adolescence 163. Women are diagnosed more than men by 2:1 164. Various theories have been offered to explain the development of the disorder... GAD: The Sociocultural Perspective 220. According to this theory, GAD is most likely to develop in people faced with social conditions that truly are ____________ 117. Research supports this theory (example: Three Mile Island in 1979) 221. One of the most powerful forms of societal stress is _________ 118. Why? Rundown communities, higher crime rates, fewer educational and job opportunities, and greater risk for health problems 119. As would be predicted by the model, there are higher rates of GAD in lower SES groups GAD: The Sociocultural Perspective 165. Since race is closely tied to income and job opportunities in the U.S., it also is tied to the prevalence of GAD 282. In any given year, ~6% of African Americans and 3% Caucasians suffer from GAD 222. African American women have highest rates (6.6%) GAD: The Sociocultural Perspective 166. Although poverty and other social pressures may create a climate for GAD, other factors are clearly at work 283. How do we know this? 223. Most people living in dangerous environments ______________________________________ 284. Other models attempt to explain why some people develop the disorder and others do not... GAD: The Psychodynamic Perspective 285. Freud believed that all children experience anxiety 224. Realistic anxiety when faced with actual danger 225. Neurotic anxiety when prevented from expressing id impulses 226. Moral anxiety when punished for expressing id impulses 286. One can use ego defense mechanisms to control these forms of anxiety, but when they don't work or when anxiety is too high...GAD develops GAD: The Psychodynamic Perspective 167. Today's psychodynamic theorists often disagree with specific aspects of Freud's explanation 168. Researchers have found some support for the psychodynamic perspective: 287. People with GAD are particularly likely to use defense mechanisms (especially repression) 288. Children who were severely punished for expressing id impulses have higher levels of anxiety later in life GAD: The Psychodynamic Perspective 169. Some scientists question the validity of these findings: 289. There are alternative explanations of the data: 227. Discomfort with painful memories or "forgetting" in therapy is not necessarily defensive 290. Some data contradict the model 228. Many (if not most) GAD clients report normal childhood upbringings GAD: The Psychodynamic Perspective 170. Psychodynamic therapies 291. Use same general techniques for treating all dysfunction: 229. Free association 230. Therapist interpretation 292. Specific treatments for GAD: 231. Freudians: focus less on fear and more on control of id 232. Objectrelations therapists: help patients identify and settle early relationship conflicts GAD: The Psychodynamic Perspective 171. Psychodynamic therapies 293. Overall, controlled research has found psychodynamic approaches to be of _________________ help in treating cases of GAD 233. Shortterm dynamic therapy may be beneficial in some cases GAD: The Humanistic Perspective 294. Theorists propose that GAD, like other psychological disorders, arises when people stop looking at themselves honestly and acceptingly 295. This view is best illustrated by Carl Rogers's explanation: 234. Lack of "____________________" in childhood leads to "_______________________" (harsh selfstandards) 235. These threatening selfjudgments break through and cause anxiety, setting the stage for GAD to develop GAD: The Humanistic Perspective 296. Therapy based on this model is "______________" and focuses on creating an accepting environment where clients can "experience" themselves 236. Although case reports have been positive, controlled studies have only sometimes found clientcentered therapy to be more effective than placebo or no therapy 237. Only limited support has been found for Rogers's explanation of causal factors GAD: The Cognitive Perspective 172. Theorists believe that psychological problems are caused by maladaptive and dysfunctional thinking 173. Since GAD is characterized by excessive worry (cognition), this model is a good start... GAD: The Cognitive Perspective 4. Theory: GAD is caused by maladaptive assumptions 238. Albert Ellis identified ________________________: 120. It is necessary for humans to be loved by everyone 121. It is catastrophic when things are not as one want them to be 122. If something is fearful, a person should be terribly concerned and dwell on the possibility that it will occur 123. One should be competent in all domains to be a worthwhile person 239. When these assumptions are applied to everyday life, GAD may develop GAD: The Cognitive Perspective 297. Aaron Beck is another cognitive theorist 240. Those with GAD hold unrealistic silent assumptions that ________________________: 124. Any strange situation is dangerous 125. A situation/person is unsafe until proven safe 298. Research supports the presence of these types of assumptions in GAD, particularly about dangerousness GAD: The Cognitive Perspective 174. What kinds of people are likely to have exaggerated expectations of danger? 299. Those whose lives have been filled with ______________________________________ 241. To avoid being "blindsided," they try to predict events; they look everywhere for danger (and therefore see danger everywhere) 242. Theory still under investigation GAD: The Cognitive Perspective 300. SecondGeneration Cognitive Explanations 243. In recent years, two new promising explanations have emerged: 126. ____________________ theory 2. Developed by Wells; holds that the most problematic assumptions in GAD are the individual's beliefs about worrying itself 127. ____________________ theory 3. Developed by Borkovec; holds that worrying serves a "positive" function for those with GAD by reducing unusually high levels of bodily arousal 244. Both theories have received considerable research support GAD: The Cognitive Perspective 175. Two kinds of cognitive therapy: 301. ____________________________________ 245. Based on the work of Ellis and Beck 302. Helping clients understand the special role that ________________ plays, and changing their views about it GAD: The Cognitive Perspective 176. Cognitive therapies 303. Changing maladaptive assumptions 246. Ellis's rationalemotive therapy (RET) 128. Point out irrational assumptions 129. Suggest more appropriate assumptions GAD: The Cognitive Perspective 177. Cognitive therapies 304. Focusing on worrying 247. Therapists begin with psychoeducation about worrying and GAD 130. Assign selfmonitoring of somatic arousal and cognitive responses 248. As therapy progresses, clients become increasingly skilled at identifying their worrying and its counterproductivity GAD: The Cognitive Perspective 178. Cognitive therapies 305. Focusing on worrying 249. With continued practice, clients are expected to see the world as less threatening; to adopt more constructive ways of coping; and to worry less 250. Research has begun to indicate that a concentrated focus on worrying is a helpful addition to traditional cognitive therapy GAD: The Biological Perspective 179. Theory holds that GAD is caused by biological factors 306. Supported by ____________________________ 251. Blood relatives more likely to have GAD (~15%) than general population (~6%) 252. The closer the relative, the greater the likelihood 131. Issue of ___________________________ The Biological Perspective 180. ___________________________ 307. 1950s Benzodiazepines (Valium, Xanax) found to reduce anxiety 308. Why? 253. Neurons have specific receptors (______________) 254. Benzodiazepine receptors ordinarily receive gammaaminobutyric acid (GABA, a common NT in the brain) 132. GABA is an __________________________; when received, it causes a neuron to stop firing GAD: The Biological Perspective 309. In the normal fear reaction: 255. Key neurons fire more rapidly, creating a general state of excitability experienced as fear or anxiety 256. A feedback system is triggered; brain and body activities work to reduce excitability 133. Some neurons release GABA to inhibit neuron firing, thereby reducing experience of fear or anxiety 257. Problems with the feedback system are believed to cause GAD 134. Possible reasons: ________________, ________________, ________________ GAD: The Biological Perspective 181. Promising (but problematic) explanation 310. Other NTs also bind to GABA receptors 311. Research conducted on lab animals raises question: Is "fear" really fear? 312. Issue of ______________________ 258. Do physiological events CAUSE anxiety? How can we know? What are alternative explanations? GAD: The Biological Perspective 259. Biological treatments 135. Antianxiety drugs 4. Pre1950s: barbiturates (sedativehypnotics) 5. Post1950s: benzodiazepines 6. Provide temporary, modest relief 7. Rebound anxiety with withdrawal and cessation of use 8. Physical dependence is possible 9. Undesirable effects (drowsiness, etc.) 10. Multiply effects of other drugs (especially alcohol) 11. 1980s: buspirone (BuSpar) 12. Different receptors, same effectiveness, fewer problems GAD: The Biological Perspective 182. Biological treatments 313. Relaxation training 260. Theory: Physical relaxation leads to psychological relaxation 261. Research indicates that relaxation training is more effective than placebo or no treatment 262. Best when used in combination with cognitive therapy or biofeedback 314. Biological treatments 263. Biofeedback 136. Therapist uses electrical signals from the body to train people to control physiological processes 137. EMG is the most widely used; provides feedback about muscle tension 264. Found to be most effective when used as an adjunct to other methods for the treatment of certain medical problems (headache, back pain, etc.) Phobias 183. From the Greek word for "fear" 315. Formal names are also often from the Greek (see "A Closer Look, p. 106) 184. Persistent and unreasonable fears of particular objects, activities, or situations 185. Phobic people often avoid the object or thoughts about it Phobias 186. We all have some fears at some points in our lives; this is a normal and common experience 316. How do phobias differ from these "normal" experiences? 0. _____________________________________ 1. Greater desire to avoid the feared object or situation 2. ______________________________________ Phobias 187. Most phobias are categorized as "specific" 317. Also two broader kinds: 265. Social phobia 266. Agoraphobia Specific Phobias 188. Persistent fears of specific objects or situations 189. When exposed to the object or situation, sufferers experience immediate fear 190. Most common: phobias of specific animals or insects, heights, enclosed spaces, thunderstorms, and blood Specific Phobias 4. ~9% of the U.S. population have symptoms in any given year 5. ~12% develop a specific phobia at some point in their lives 5. Many suffer from more than one phobia at a time 6. Women outnumber men 2:1 7. Prevalence differs across racial and ethnic minority groups 8. Vast majority do NOT seek treatment Social Phobias 191. Severe, persistent, and unreasonable fears of social or performance situations in which embarrassment may occur 318. May be ____________ talking, performing, eating, or writing in public GAD: The Biological Perspective 319. May be ____________ general fear of functioning inadequately in front of others 320. In both cases, people rate themselves as performing less adequately than is objectively true Social Phobias 321. Can greatly interfere with functioning 267. Often kept a secret 322. Affect ~7% of U.S. population in any given year 6. ~12% develop a social phobia at some point in their lives 323. Women outnumber men 3:2 324. Often begin in childhood and may persist for many years What Causes Phobias? 192. Each model offers explanations, but evidence tends to support the __________________: 193. Phobias develop through ______________ 325. Once fears are acquired, they are continued because feared objects are avoided 326. Behaviorists propose a classical conditioning model... Classical Conditioning of Phobia What Causes Phobias? 194. Other behavioral explanations 327. Phobias develop through ___________________ 268. Observation and imitation 328. Phobias are maintained through ______________ 329. Phobias may develop into GAD when a person acquires a large number of phobias 269. Process of _______________________: responses to one stimulus are also elicited by similar stimuli What Causes Phobias? 330. Behavioral explanations have received some empirical support: 270. Classical conditioning study involving Little Albert 271. Modeling studies 272. Bandura, confederates, buzz, and shock 331. Research conclusion is that phobias CAN be acquired in these ways but there is no evidence that this is how the disorder is ordinarily acquired What Causes Phobias? 195. A behavioralevolutionary explanation 332. Some phobias are much more common than others; for example: animals, blood, and heights vs meat, grass, and houses What Causes Phobias? 196. A behavioralevolutionary explanation 333. Theorists argue that there is a speciesspecific biological ____________ to develop certain fears 273. Called "____________": humans are more "prepared" to develop phobias around certain objects or situations 274. Unknown if these predispositions are due to evolutionary or environmental factors How Are Phobias Treated? 334. Surveys reveal that ~____% of those with specific phobia and ___% of those with social phobia currently are in treatment 335. Each model offers treatment approaches specific phobias 138. Shown to be ______________________ 139. Fare better in headtohead comparisons than other approaches 140. Include desensitization, flooding, and modeling Treatments for Specific Phobias 336. Systematic desensitization 276. Technique developed by Joseph Wolpe 141. Teach ___________________ 142. Create ___________________ 143. Sufferers learn to relax while facing feared objects 13. Since relaxation is incompatible with fear, the relaxation response is thought to substitute for the fear response 277. Several types: 144. In vivo desensitization (live) 145. Covert desensitization (imaginal) Treatments for Specific Phobias 337. Other behavioral treatments: 278. Flooding 146. Forced nongradual exposure 279. Modeling 147. Therapist confronts the feared object while the fearful person observes 338. Clinical research supports each of these treatments 280. The key to success is ___________________________ with the feared object or situation Treatments for Social Phobias 197. Treatments only recently successful 339. Two components must be addressed: 281. _________________________________ 148. Address fears behaviorally with exposure 282. _________________________________ 149. Social skills and assertiveness trainings have proved helpful Treatments for Social Phobias 275.Behavioral techniques (_________________) are most widely used, especially for 340. Unlike specific phobias, social phobias respond well to medication (particularly _______________ drugs) 341. Several types of psychotherapy have proved at least as effective as medication 283. ______________________________________________ ______________________________________________ 284. One psychological approach is exposure therapy, either in an individual or group setting 285. Cognitive therapies also have been widely used Treatments for Social Phobias 198. Another treatment option is social skills training, a combination of several behavioral techniques to help people improve their social functioning 342. Therapist provides feedback and reinforcement Panic Disorder 343. Panic, an extreme anxiety reaction, can result when a real threat suddenly emerges 344. The experience of "panic attacks," however, is different 286. Panic attacks are ______, _________ _______ of panic that occur _________, _____________, and __________ 287. Sufferers often fear they will die, go crazy, or lose control 288. __________________________________________ Panic Disorder 199. Anyone can experience a panic attack, but some people have panic attacks __________, _____________, and ________________ 345. Diagnosis: Panic disorder 289. Sufferers also experience dysfunctional changes in thinking and behavior as a result of the attacks 150. Example: sufferer worries persistently about having an attack; plans behavior around possibility of future attack Panic Disorder 346. Often (but not always) accompanied by agoraphobia 290. From the Greek "____________________________" 291. Afraid to leave home and travel to locations from which escape might be difficult or help unavailable 292. Intensity may fluctuate 293. There has only recently been a recognition of the link between agoraphobia and panic attacks (or paniclike symptoms) Panic Disorder 347. Two diagnoses: panic disorder with agoraphobia; panic disorder without agoraphobia 294. ~3% of U.S. population affected in a given year 295. ~5% of U.S. population affected at some point in their lives 348. Likely to develop in late adolescence and early adulthood 349. Women are twice as likely as men to be affected 350. Approximately 35% of those with panic disorder are in treatment Panic Disorder: The Biological Perspective 9. In the 1960s, it was recognized that people with panic disorder were not helped by ___________, but were helped by _________________ 351. Researchers worked backward from their understanding of antidepressant drugs Panic Disorder: The Biological Perspective 352. What biological factors contribute to panic disorder? 296. NT at work is _____________________ 151. Irregular in people with panic attacks 152. Research suggests that panic reactions are related to changes in norepinephrine activity in the locus ceruleus 297. Although norepinephrine is clearly linked to panic disorder, what goes wrong isn't exactly understood 153. May be excessive activity, deficient activity, or some other defect 154. Other NTs and brain circuits seem to be involved Panic Disorder: The Biological Perspective 200. It is also unclear why some people have such abnormalities in norepinephrine activity 353. ______________________ is one possible reason 298. If so, prevalence should be (and is) greater among close relatives 155. Among monozygotic (MZ, or identical) twins = ____% 156. Among dizygotic (DZ, or fraternal) twins = ____% 299. Issue is still open to debate Panic Disorder: The Biological Perspective 354. Drug therapies 300. Antidepressants are effective at preventing or reducing panic attacks 157. Function at norepinephrine receptors in the panic brain circuit 158. Bring at least some improvement to 80% of patients with panic disorder 159. ~50% recover markedly or fully 160. Require _____________ of drug therapy; otherwise relapse rates are high 301. Some benzodiazepines (especially Xanax [alprazolam]) also have proved helpful Panic Disorder: The Biological Perspective Panic Disorder: The Cognitive Perspective 201. Cognitive theorists and practitioners recognize that biological factors are only part of the cause of panic attacks events 356. Cognitive treatment is aimed at correcting such misinterpretations Panic Disorder: The Cognitive Perspective 202. Misinterpreting bodily sensations 357. Panicprone people may be overly sensitive to certain __________________________ and may misinterpret them as signs of a medical catastrophe; this leads to panic 358. Why might some people be prone to such misinterpretations? 359. One possibility: Experience more frequent or intense bodily sensations Panic Disorder: The Cognitive Perspective 360. Misinterpreting bodily sensations 302. Panicprone people also have a high degree of "anxiety sensitivity" 161. They focus on bodily sensations much of the time, are unable to assess the sensations logically, and interpret them as potentially harmful Panic Disorder: The Cognitive Perspective 361. Cognitive therapy 303. Attempts to correct people's misinterpretations of their bodily sensations 162. Step 1: Educate clients 163. About panic in general 164. About the causes of bodily sensations 165. About their tendency to misinterpret the sensations 166. Step 2: Teach clients to apply more accurate interpretations (especially when stressed) 167. Step 3: Teach clients skills for coping with anxiety 168. Examples: relaxation, breathing Panic Disorder: The Cognitive Perspective 203. Cognitive therapy 362. May also use "_______________________" procedures to induce panic sensations 304. Induce physical sensations which cause feelings of panic: 169. Jump up and down 170. Run up a flight of steps 305. Practice coping strategies and making more accurate interpretations Panic Disorder: The Cognitive Perspective ObsessiveCompulsive Disorder 204. Made up of two components: 363. Obsessions 355.In their view, full panic reactions are experienced only by people who misinterpret bodily 306. __________________________________________ __________________________________________ 364. Compulsions 307. __________________________________________ __________________________________________ ObsessiveCompulsive Disorder 205. Diagnosis may be called for when symptoms: 365. Feel excessive or unreasonable 366. Cause great distress 367. Consume considerable time 368. Interfere with daily functions ObsessiveCompulsive Disorder 369. Classified as an anxiety disorder because obsessions _________________ anxiety, while compulsions are aimed at ____________________________ anxiety 308. Anxiety rises if obsessions or compulsions are avoided 370. Between 1% and 2% of U.S. population has OCD in a given year; around 3% over a lifetime 371. Ratio of women to men is _______ 372. It is estimated that more than 40% of those with OCD seek treatment What Are the Features of Obsessions and Compulsions? 206. Obsessions 373. Thoughts that feel intrusive and foreign 374. Attempts to ignore or avoid them trigger anxiety What Are the Features of Obsessions and Compulsions? 207. Compulsions 7. "Voluntary" behaviors or mental acts 1. Feel mandatory/unstoppable 8. Person may recognize that behaviors are irrational 2. Believe, though, that catastrophe will occur if they don't perform the compulsive acts 9. Performing behaviors reduces anxiety 3. ________________________________________! 10. Behaviors often develop into _____________ What Are the Features of Obsessions and Compulsions? 208. Compulsions 375. Common forms/themes: 309. Cleaning 310. Checking 311. Order or balance 312. Touching, verbal, and/or counting What Are the Features of Obsessions and Compulsions? 209. Are obsessions and compulsions related? 376. Most (not all) people with OCD experience both 377. Compulsive acts often occur in response to obsessive thoughts 313. Compulsions seem to represent a yielding to obsessions 314. Compulsions also sometimes serve to help control obsessions What Are the Features of Obsessions and Compulsions? 210. Are obsessions and compulsions related? 378. Many with OCD are concerned that they will act on their obsessions 315. Most of these concerns are unfounded 316. Compulsions usually do not lead to violence or "immoral acts" ObsessiveCompulsive Disorder 211. OCD was once among the least understood of the psychological disorders 212. In recent years, however, researchers have begun to learn more about it 213. The most influential explanations are from the psychodynamic, behavioral, cognitive, and biological models... OCD: The Psychodynamic Perspective 379. Anxiety disorders develop when children come to fear their id impulses and use ego defense mechanisms to lessen their anxiety 380. OCD differs from anxiety disorders in that the "battle" is not unconscious; it is played out in explicit thoughts and action 317. Id impulses = obsessive thoughts 318. Ego defenses = counterthoughts or compulsive actions 11. At its core, OCD is related to aggressive impulses and the competing need to control them OCD: The Psychodynamic Perspective 381. The battle between the id and the ego 319. Three ego defenses mechanisms are common: 171. ________________: disown disturbing thoughts 172. _________________: perform acts to "cancel out" thoughts 173. _________________: take on lifestyle in contrast to unacceptable impulses 320. Freud believed that OCD was related to the anal stage of development 174. Period of intense conflict between id and ego 321. Research has not supported this explanation OCD: The Psychodynamic Perspective 214. Psychodynamic therapies 382. Goals are to uncover and overcome underlying conflicts and defenses 383. Main techniques are free association and interpretation 384. Research evidence is poor 322. Some therapists now prefer to treat these patients with shortterm psychodynamic therapies OCD: The Behavioral Perspective 215. Behaviorists concentrate on explaining and treating compulsions rather than obsessions 216. Although the behavioral explanation of OCD has received little support, behavioral treatments for compulsive behaviors have been very successful OCD: The Behavioral Perspective 385. ________________________________ 323. People happen upon compulsions randomly 175. In a fearful situation, they happen to perform a particular act (washing hands) 176. When the threat lifts, they associate the improvement with the random act 324. After repeated associations, they believe the compulsion is changing the situation 177. Bringing luck, warding away evil, etc. 325. The act becomes a key method to avoiding or reducing anxiety OCD: The Behavioral Perspective 217. Key investigator: Stanley Rachman 386. Compulsions do appear to be rewarded by an eventual decrease in anxiety 326. Studies provide no evidence of the learning of compulsions OCD: The Behavioral Perspective 387. Behavioral therapy 327. _______________________________________ (ERP) 178. Clients are repeatedly exposed to anxietyprovoking stimuli and prevented from responding with compulsions 179. Therapists often model the behavior while the client watches 180. _____________________ is an important component 181. Treatment is offered in individual and group settings 182. Treatment provides significant, longlasting improvements for most patients 14. However, as many as 25% fail to improve at all and the approach is of limited help to those with obsessions but no compulsions OCD: The Cognitive Perspective 218. Cognitive theory begins by pointing out that everyone has repetitive, unwanted, and intrusive thoughts 388. People with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result OCD: The Cognitive Perspective 389. Overreacting to unwanted thoughts 328. To avoid such negative outcomes, they attempt to ____________ their thoughts with actions (or other thoughts) 329. Neutralizing thoughts/actions may include: 330. Seeking reassurance 331. Thinking "good" thoughts 332. Washing 333. Checking OCD: The Cognitive Perspective 219. When a neutralizing action reduces anxiety, it is reinforced 390. Client becomes more convinced that the thoughts are dangerous 391. As fear of thoughts increases, the number of thoughts increases OCD: The Cognitive Perspective 220. If everyone has intrusive thoughts, why do only some people develop OCD? 392. People with OCD tend: 334. To be more depressed than others 335. To have higher standards of morality and conduct 336. To believe thoughts are equal to actions and are capable of bringing harm 337. To believe that they can and should have perfect control over their thoughts and behaviors OCD: The Cognitive Perspective 221. Cognitive therapies 393. Focus on the cognitive processes that help to produce and maintain obsessive thoughts and compulsive acts 394. May include: 338. Psychoeducation 339. Habituation training OCD: The Cognitive Perspective 222. CognitiveBehavioral Therapy (CBT) 395. Research suggests that a combination of the cognitive and behavioral models often is more effective than either intervention alone 396. These treatments typically include psychoeducation and exposure and response prevention exercises OCD: The Biological Perspective 397. Two recent lines of research indicate that biological factors play a key role in OCD: 340. NT _________________________ 183. Evidence that serotoninbased antidepressants reduce OCD symptoms 341. _____________________________ 184. OCD linked to orbital region of frontal cortex and caudate nuclei 185. Frontal cortex and caudate nuclei compose brain circuit that converts sensory information into thoughts and actions 186. Either area may be too active, letting through troublesome thoughts and actions OCD: The Biological Perspective 223. Some research provides evidence that these two lines may be connected 398. Serotonin plays a very active role in the operation of the orbital region and the caudate nuclei 342. Low serotonin activity might interfere with the proper functioning of those brain parts OCD: The Biological Perspective 399. Biological therapies 343. Serotoninbased antidepressants 187. Examples: clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox) 188. Bring improvement to 50%80% of those with OCD 189. Relapse occurs if medication is stopped 344. Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective 190. May have same effect on the brain ...
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