Abnormal Psychology Exam 2

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Clinical assessment is the systematic evaluation and measurement of

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psychological, biological and social factors in an individual presenting with a possible psychological disorder.

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Clinical assessments help us

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understand the individual, predict behavior, plan treatment and evaluate treatment outcome

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Diagnosis is the process of determining whether a person's problem(s) meets

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all the criteria for a psychological disorder according to the dsm iv

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Has to impair functionality to be

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a panic disorder

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Reliability is the most important requirement of assessment procedures and is

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the degree to which a measure is consistent(stable over time)

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Consistency across 2 or more raters and assessors is called

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interrater reliability

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Consistency across time is referred to as

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test-retest reliability

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Validity is the

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degree to which a technique measures what it is designed to measure

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comparing the results of one assessment measure with the results of others helps determine

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concurrent or descriptive validity (long v. short version of IQ test)

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Predictive validity is

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how well the assessment predicts what will happen in the future (IQ--> grades in college)

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Whether the test items look reasonable and valid at first glance is called

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face validity

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Standardization is

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process by which a set of standards or norms is established for a technique to ensure its consistency across different measurements.

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The clinical interview is the core of most clinical work and is used primarily to

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gather info about patients past and present behaviors, attitudes, emotions, and a history of the person's problems and life circumstances. the most common.

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To organize info obtained during an interview, many clinicians use a

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mental status test.

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the mental status exam allows the clinician to make a

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preliminary determination of which areas of the patients behaviors and conditions should be assessed in more detail.

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semistructured clinical interviews contain questions that have been carefully phrased and tested to elicit useful info

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in a consistent manner

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Behavioral assessment is using

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direct observation to formally assess an individuals thought, feelings, and overt behaviors in SPECIFIC SITUATIONS OR CONTEXTS

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Behavioral assessments focus on

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here and now. Tends to be direct and minimally inferential.Target behaviors are identified and observed. focus on antecedents

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The purpose of behavioral assessment is to identify

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target behavior and environmental events that may become targets of therapeutic intervention.

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Problem with behavioral assessment is reactivity...

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people know they are being watched, change their behavior.

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Psychological testing must be reliable and valid and cover specific tests designed to determine

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cognitive, emotional, or behavioral responses that may be associated with a specific disroder or personality feature

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Projective tests use methods in which

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ambiguous stimuli are presented to a person who is asked to state what he sees.

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In projective tests, there is

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high degree of inference (bias) in scoring and interpreter.

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Personality inventories are gerneally more empirically based than projective tests but often requrie

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a substantial amount of time to complete.

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intelligence tests were intially developed to predict how well people

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would do in school.

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Neuropsychological tests are used to assess a broad range of a persons skils and abilities in areas such as receptive and expresive language,

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attention and concentration.

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Goal of neuropsycholgical test is to

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understand brain-behavior relations
used to evaluate persons assets and deficits.

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Problems with neuropsychological tests:

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false positives- saying tou have a brain problem when you really do not.

false negatives- saying you do not have a brain problem, but you do. This one is more likely.

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neuroimaging allows a window on brain structure and

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brain function

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Computerized axial tomography

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uses multiple xray exposures of the brain at different angles

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magnetic resonance imaging (MRI)

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has better resolution than CAT scan, strong magnetic field.

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Positron Emission tomography

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helps detect disease before changes in anatomy are apparent with other imaging tests

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The PET procedure involves

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injection of a tracer

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fMRI-functional MRI

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takes only miliseconds allows for examination of immediate responses of the brain to a brief event

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psycophysiological assessment

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methods used to assess brain structure, function, and activity of the nervous system

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EEG

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brain wave activity

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Internal validity refers to the extent to which we are

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confident that the Iv causes the DV to change

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external validity refers to how well the results of the study

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relate to the aspects in the real world

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Increase internal validity by minimizing confounds

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use control groups, use of random assignment

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as internal validity increases,

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external validity decreases

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Statistical significance

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results due to chance

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clinical significance

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results clinically meaningful

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What is anxiety?

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Future-oriented mood state
Characterized by marked negative affect
Somatic symptoms of tension

Apprehension about future danger or misfortune

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What is fear?

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Present-oriented mood state, marked negative affect
immediate fight or flight response to danger or threat
Strong avoidance/escapist tendencies
Abrupt activation of the sympathetic nervous system

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What are the characteristics of Anxiety Disorders?

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Pervasive and persistent symptoms of anxiety and fear

Involve excessive avoidance and escapist tendencies

Causes clinically significant distress and impairment

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Comorbidity?

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Comorbidity is common across the anxiety disorders
About half of patients have 2 or more secondary diagnoses
MAJOR DEPRESSION is the most common secondary diagnosis
Comorbidity suggests common factors across anxiety disorders
Anxiety and depression are closely related

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The roots of anxiety and panic

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Pan—This really ugly guy who was lurking in the woods. They would become so frightened they would die of the sight of him. People do think they are going to die

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What Is a Panic Attack?

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Abrupt experience of intense fear of discomfort
Accompanied by several physical symptoms
DSM-IV Subtypes of Panic Attacks
Situationally bound (cued) panic
Unexpected (uncued) panic (Do not avoid)
Situationally predisposed panic

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The presentaition of panic

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According to the dsm iv, for the attact to be considered a panic attack, it must have four or more of the following symptoms. If one has fewer symptoms but still experiences the sudden onset and brief duration that characterizes a panic attackm then he/she may be having a “limited attack”

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PAnic symptoms:

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Palpitations, pounding heart, or fast heart rate
Sweating
Trembling or shaking
Shortness of breath or smothering sensations (not getting enough air)
Choking feelings (may also feel like a lump in the throat or difficulty swallowing)
Chest pain or discomfort
Nausea and abdominal distress
Dizziness, unsteadiness, light headiness, faintness
Derealization
Fear of going crazy or losing control
Fear of dying
Numbness or tingling sensations (also known as paresthesias, this may be described as pins and needles and may be felt in various parts of the body
Chills or hot flushes

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Facts and Statistics about panic disorder?

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Panic disorder affects—3.5% of population
2/3 with panic disorder are female
Onset is often acute, beginning between ages 25-29

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treatment for panic disorder?

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Cognitive-behavior therapies are highly effective
- No long-term advantage for combined treatments
- Best long-term outcome – Cognitive-behavior therapy alone

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What is cognitive-behavior therapy (CBT)

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CBT is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.
CBT is based on the scientific fact that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel/ act better even if the situation does not change.
It is brief and time-limited PDA=13 sessions
CBT is a collaborative effort between the therapist and the client
CBT is structured and directive (specific techniques/ concepts are taught during each session.) CBT therapist do not tell their clients what to do—rather, they teach their clients how to do.
CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned and can be unlearned.
Homework is a central feature of CBT

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what is specific phobia?

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Extreme and irrational fear of a specific object or situation
Markedly interferes with one’s ability to function
- Recognize fears are unreasonable!
Go to great lengths to avoid phobic objects

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fats about specific phobia

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Affects 11% of the general population
Females are over-represented (female>male)
- Are chronic
- Onset: between 15 and 20 years of age

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Subtypes of Specific Phobia

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Blood-injury-injection phobia –Vasovagal response
Situational phobia –public transportation or enclosed places (e.g. planes)
Natural environment phobia –events occurring in nature (e.g. heights, storms)
- Animal phobia – animals and insects
Other phobias –Do not fit into the other categories (e.g. fear of choking, vomiting
- Separation anxiety disorder – Children’s worry that something will happen to parents

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WARNING SIGNS FOR SPECIFIC PHOBIAS

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 Feelings of panic, dread, horror, or terror in response to thoughts, images, or exposure to a specific object or situation (e.g., snakes, heights, planes)
 Recognition that the fear goes beyond normal boundaries and the actual threat of danger
 Reactions that are automatic and uncontrollable, practically taking over the person’s thoughts
 Rapid heartbeat, shortness of breath, trembling, and an overwhelming desire to flee the situation—all the physical reactions associated with extreme fear
 Extreme measures taken to avoid the feared object or situation

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Causes of Phobias

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-Biological and evolutionary vulnerability, direct conditioning, observational learning, information transmission

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Psychological Treatments of Specific Phobias

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Cognitive-behavior therapies are highly effective
-structured and consistent graduated exposure

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Generalized Anxiety Disorder (GAD)The “Basic” Anxiety Disorder

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Defining Features
- Excessive, uncontrollable, anxious apprehension and worry
- Coupled with strong, persistent anxiety
Somatic symptoms differ from panic (e.g. muscle tension, fatigue, irritability)
- Persists for 6 months or more

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Statistics of GAD

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GAD affects 4% of the general population
Females outnumber males approximately 2:1
Onset is often insidious (gets gradually worse), beginning in early adulthood
- Tendency to be anxious runs in families

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GAD: Features and Treatment

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Persons with GAD --called “autonomic restrictors” =show less responsiveness on most physiological measures (e.g. HR, RR)
High sensitivity to threat in general (often unconscious e.g. Stroop task, slower in naming color with threatening words—unemployment)
Fail to process emotional component---thoughts/images

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Treatment of GAD

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Benzodiazepines – often prescribed
- Psychological interventions –- Cognitive behavioral therapy (e.g. cognitive reconstructing and relaxation techniques

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WARNING SIGNS FOR GENERALIZED ANXIETY DISORDER

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 Continuous worry about major and minor events without just cause
 Headaches and other aches and pains for no apparent reason
 Constant bodily tension, feelings of fatigue, and difficulty relaxing
 Difficulty focusing on one thing or task at a time
 Frequent irritability (i.e., getting crabby or grouchy)
 Trouble falling asleep or staying asleep
 Experience excessive sweatiness or hot flashes
 Feeling of having a lump in throat or feeling the need to vomit when worried

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Social Phobia

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Defining Features
- Extreme and irrational fear/shyness (not just shy!)
Focused on social and/or performance situations
Markedly interferes with one’s ability to function
- May avoid social situations or endure them with distress
Generalized subtype – Anxiety across many social situations
Most common type: public speaking

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Facts and Statistics of Social Phobia

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Affects about 13% of the general population at some point
- Females are slightly more represented than males
- Onset is usually during adolescence
Peak age of onset at about 15 years
Many sufferers are single

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Causes of Social phobia

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Prepared to fear angry, critical, or rejecting people e.g. Lundgh & Oest study: SP were more likely to remember pictures with critical faces; fMRI studies (Stein et al.) show stronger activation in amygdala

Direct conditioning (the school play)

Observational learning (Mother  daughter)

Information transmission (social environment is dangerous  constant evaluation)

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Social Phobia: Treatment

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Psychological Treatment of Social Phobia
Cognitive-behavioral treatment –Exposure, rehearsal, role-play in a group setting
- Cognitive-behavior therapies are highly effective (e.g. Clark et al. 2003, CT>Prozac>PLA short & long-term)
Medication Treatment of Social Phobia
- Beta blockers –Are ineffective
- Tricyclic antidepressants --Reduce social anxiety
- MAO inhibitors – Reduce anxiety
SSRI Paxil – FDA approved for social anxiety disorder

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Relapse rates: of spcial phobia

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High following medication discontinuation

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Obsessive-Compulsive Disorder (OCD

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Intrusive and nonsensical thoughts, images, or urges that one tries to resist or eliminate

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Compulsions

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Thoughts (cognitions) or actions (behaviors) used to suppress thoughts; e.g. checking is a behavioral compulsion
Provide relief

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Thought-action fusion

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e.g. believing that thinking about an abortion is the moral equivalent of having an abortion.

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Facts and Figures of OCD

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Affects about 2.6 % of the population at some point
Most persons with OCD are female
Tends to be chronic
Onset is typically in early adolescence or adulthood
Among anxiety disorder up likelihood for hospitalization

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WARNING SIGNS FOR OBSESSIVE-COMPULSIVE DISORDER

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Feeling of being trapped in a pattern of unwanted and upsetting thoughts
Feeling a need to repeat thoughts/behaviors over and over for no good reason
Upsetting thoughts or images repeatedly enter one’s mind
Feeling an inability to stop thoughts or images
Difficultly stopping oneself from doing things again and again (e.g., counting, checking on things, washing hands, re-arranging objects, doing things until it feels right, collecting useless objects)
Excessive worry that terrible things will happen if not careful
Fear that you will harm someone you care about