1
Q
What are the main responsibilities of a CP?
A
Assessment
Formulation
Intervention
Evaluation
Research
2
Q
What is a projective test?
A
A participant is presented with an ambiguous stimulus and asked to describe or interpret this e.g. the Rorschach Inkblot Test or sentence completion test. These are timed because unconscious responses are desired.
3
Q
What is formulation?
A
Using information from a service user’s assessment to formulate a treatment plan.
Person’s (1989) 6 formulation component:
1. Create a list of problems
2. Identify psychological problems that may be relevant
3. Identify how these psychological mechanisms could cause distress
4. Identify precipitating events
5. Explore how precipitating events may lead to distress
6. Develop a treatment plan
4
Q
What is the difference between formulation and medical diagnostics?
A
Formulation is more specific to the individual client and their needs and considers variations in life experience etc. In more depth than a simple reporting of symptoms required for a diagnosis.
5
Q
What are the six Common Mental Health Conditions? (CMHC)
A
- Depression
- Generalised Anxiety Disorder
- Panic Disorder
- Phobias
- OCD
- CMHC, not otherwise specified (often depressive symptoms doesn’t fit into a criteria CMHC-NOS)
6
Q
Describe GAB and its prevalence
A
GAD requires excessive, chronic worry, not associated with specific external circumstances, additionally, there is often physiological arousal such as restlessness and muscle tension. Symptoms often begin in childhood, with twin heritability between 30-60%. GAD increases the risk of having another MHC by 3. There are roughly twice as many women with GAD than men, this may be related to the societal control of women, and expectations for seeking help. When studies controlled for this, women still had higher levels of anxiety - this may be hormonally mediated.
7
Q
What is prevalence?
A
The proportion of the population who have a specific characteristic in a given time period
8
Q
What is incidence?
A
The number of new cases on disease in a given population in a given year
9
Q
Who suggested that the incidence rate of common mental health disorders has more than doubled 2000 - 2019?
A
Dykxhoorn et al, 2023
Huge longitudinal sample
10
Q
What proportion of adults in England have had a CMHC in the last week?
A
Approx 1/5
11
Q
What did Slee et al, 2020 find?
A
Massive increases in annual incidence rates of GAD and depression. More consistent data collection than other trials, so good conclusions.
12
Q
What is social prescribing?
A
connecting service users to other individuals or services within their communities such as to art classes or exercise schemes.
13
Q
What is the Serotonin Hypothesis of depression?
A
Imbalance, or lack of neurotransmitter activity is responsible for the low mood and other symptoms felt in depressive disorders.
Anti-depressant medications help about 2/3 of people.
Serotonin does enhance the impact of positive rewards on our mood (Michey et al, 2020)
14
Q
Who published a comprehensive review, challenging the Serotonin Hypothesis, suggesting there is insufficient evidence?
A
Moncrieff et al, 2022
e.g. exploring serotonin receptors and degredation (using tryptophan)
Conclusion: may still be relevant in a wider picture of GABAergic and serotonergic activity patterns
15
Q
What is the relevance of biotypes in the treatment of depression?
A
Novel research suggests there are clinically relevant neural bioptypes in depression, which may respond differently to treatments. This may help to subdivide depression into biotypical categories to support treatment (Tozzi et al, 2024).
Highlights the importance to transdiagnostic approaches
16
Q
What is the HITOP?
A
Hierarchical Taxonomy of Psychopathology
A transdiagnostic framework for conceptualising mental health conditions within their symptoms
17
Q
What are five physiological vulnerabilities to depression?
A
Variations to sensorimotor systems
Variations to cognitive systems
Variations to social processing
Arousal and regulatory variations
Positive and negative valence system variations
18
Q
What is the learned helplessness hypothesis?
A
Seligman and Maier (1967)
Based on fear conditioning, this is the theory that when confronted with difficult situations and a lack of control, animals gave up trying to protect themselves, even when the danger was no longer present, and that this helplessness generalised to wider situations.
Later work suggests this is mediated by the activation of the dorsal raphe nucleus 5-HT neurons
19
Q
What are the three dimensions of Anxiety Sensitivity and Panic (McNally, 2002)?
A
Physical concerns: e.g. scary to be out of breath
Mental incapacitation concerns e.g. concerns of being out of control
Social concerns e.g. concerns of being perceived as nervous
20
Q
What is meant by psychoeducation within CMHC interventions?
A
Guiding a person through realising what their own problems were. Ellis believed people have the capacity to change and that these thinking styles have biological bases.
20
Q
What are 3 examples of behavioural therapies which can be used for CMHC?
A
Token economies
Systematic desensitisation
Flooding
21
Q
What is the route to therapeutic changes in REBT?
A
- Diagnosis of ABC analysis (note A is usually recent)
- Psychoeducation and Cognitive Restructuring
- Internalisation of rational beliefs
22
Q
What are the four types of irrational beliefs?
A
- Demandingness
- Awfulising
- Frustration Intolerance
- Global evaluations of human worth (B+W thinking)
23
Q
What are three benefits of transdiagnostic approaches?
A
- allow for patient heterogeneity
- encourage awareness of comorbidity
- minimises the need for arbitrary classifications
24
What are the emotions associated with irrational beliefs in REBT?
- anger often comes from awfulizing/blaming/condemnation
- anxiety comes from concerns about the future
- depression (Beck’s triad)
- guilt comes from the self-condemnation of a wrong-doing
25
What is Socratic Dialogue?
A series of open / semi-open questions to motivate disputation by guiding the client towards self-discovery.
26
What is Didactic dialogue?
When information is given to the therapeutic client, such as mini-lectures and analogies to promote changing thoughts
27
What is elegant disputation?
When the therapist accepts the inference but disputes the irrational conclusions or beliefs that the client holds. This is most promoted by Ellis and may provide more generalisable coping mechanisms than other methods of disputation.
28
What is inelegant disputation?
When the therapist questions the logic or premise of the inference and seeks to empirically test it.
29
What is the fruit basket analogy in REBT?
Does the existence of a single piece of rotten fruit make the entire, otherwise wonderful, fruit basket worthless?
30
What is the watch analogy in REBT?
Just because one person loves an accessory and another hates it, does not mean that that watch is more or less valuable.
31
What is the difference between effectiveness and efficacy?
Efficacy is an assessment of an intervention with optimal samples and conditions, whereas effectiveness refers to its utility in more realistic and contextual situations.
32
What is the difference between case control and cohort studies?
Case-control studies are retrospective, looking back at different groups to calculate an odds ratio, whereas cohort studies are usually prospective.
33
What are three indicators of a successful psychological treatment?
Statistical significance
Effect size
Clinical significance - changes to symptoms, typically of 2 SD or more.
34
Who supported REBT claims that irrational beliefs can change perceived outcomes when confronted with a novel and artificially induced belief about spiders?
Dryden et al, 1989
(are typical IBs more complex?)
35
What is Ellis's Model of Irrational Beliefs?
Demandingness as core with other iBs following from demands.
36
What is Beck's Model of iBs?
Evaluative beliefs produce demandingness, where demands are simply the mediator.
37
What is DiGiuseppe's model of iBs?
Proposed that the different iBs were independent of each other and priority should be decided by the client
38
Hyland et al, 2014 used structural equation modelling of iBs to explore their impact on symptoms of PTSD. Which model did they find most support for?
Model 1 or Beck's model which centralises demandingness.
39
David (2018) ran a meta-analysis on 84 studies exploring the effectiveness of REBT. What did they find?
REBT is a good psychological intervention, but not very different clinically than other interventions.
40
Who wrote a review of current literature regard the effectiveness of EMDR and suggested it can reduce clinical PTSD symptoms in 5 sessions, and can be applied to multicultural patient groups and across non-western cultures?
de Jongh et al 2024
41
Beyond PTSD, where else has EMDR been successfully applied?
Pain, depression, cancer-related distress and dementia-induced distress (Scelles & Bulnes, 2021)
42
What is EBT?
Evidence - based treatments
Umbrella term for treatments with a clear and comprehensive empirical background
43
Harris et al, 2006 conducted an important study testing the core principles of REBT. What did they do and what did they find?
Put participants in real life stressful situations while they held rB or iB. Those with iB reported higher levels of anxiety and greater increases in systolic blood pressure, indicating a physiological response to psychological thoughts
44
What are the three phases for the onset of Sz?
- **PRODROMAL PHASE**: often during childhood, unusual speech, visual world may appear different - unusual perceptual experiences, social withdrawal, avolition (lethargic) - clear deterioration in functioning
- **ACTIVE PHASE**: psychotic disorders, delusions, hallucinations, thought disorder
- **RESIDUAL PHASE:** subsiding of psychotic symptoms, negative symptoms, impaired functioning with obvious flattened affect
45
In 1959 Kurt Schneider proposed the four fundamental symptoms of Sz. What were they?
- *thought broadcasting* - belief that thoughts are being shown to others
- *thought insertion* - belief that thoughts of others are being placed inside the individuals’ head
- *voices commenting* - about the patient, usually in a derogatory manner
- *somatic passivity* - patient believes there are outside physical interventions and they are a passive recipient
46
How much more likely are individuals with Sz to die by suicide than their NT counterparts?
12 times
Saha et al, 2007
47
What is the Social Drift Hypothesis?
Refers to how the disease may hinder social status and cause a class drift.
48
What is EE?
Expressed emotion: overprotective, critical and overbearing expressed emotion.
49
How did high EE families compare to low EE families in the relapse of Sz individuals?
High EE families had a 51% relapse rate within 9 months, compared to low EE families with 13%. This relationship is also mirrored in bipolar affectives.
50
What is the Viral Hypothesis in Sz?
Maternal viral infections during the second trimester of pregnancy has been identified as a risk of Sz, but there is no specific type of viral infection identified.
51
Who suggested that individuals born in urban areas have a higher risk of Sz and why might this be?
Peen & Dekker, 1997
Stressful environments?
52
What is the MZ heritability of Sz?
48%
When comparing brain structure in MZ twins (one with Sz), the Sz twin had a dilated lateral ventricle but not the other. This data raises questions about neural pathology being caused by genetics.
53
What is the relationship between cannabis and Sz?
Cannabis increases the risk of expressing Schizotypical symptoms when individuals carry the valine158 allele of the COMT gene.
54
What is the first-line antipsychotic?
Neuroleptics: they block dopamine receptors so challenge positive symptoms, but may exacerbate negative symptoms.
Could cause permanent side effects such as tardive dyskinesia.
55
What is the dopamine hypothesis in Sz?
Excessive dopamine in the mesolimbic pathway may be responsible for positive symptoms.
Lower dopamine in the mesocortical pathway (between VTA of brainstem to limbic cortex) could cause negative symptoms.
56
Who is a key author for the Dodo Bird effect and what does this mean?
Luborsky et al, 2002
The idea that psychotherapies and psychological interventions have such significant factors in common that their clinical relevance varies very little between interventions
57
According to Brown and Patterson, 2011, what proportion of subjects exposed to in-utero rubella, went on to develop Sz?
20%
58
Who presents a unified Neurodevelopmental and Dopamine Hypothesis of Sz, aiming to explain the E/I patterns underlying the cognitive patterns of Sz?
Howes & Shatalina, 2022
59
Do males or females tend to have an earlier onset of Parkinson's?
Males
60
What are some early signs of Parkinson's?
Changes to sense of smell, handwriting and gait, or a tremor
61
What is the typical neurobiology associated with PD?
Dopamine-producing neurons in the substantia nigra in the basal ganglia, become damaged. The basal ganglia mediates motor function. Voluntary movements become more difficult to initiate. May be related to alpha synuclein in Lewy Bodies in the neurons.
Alpha synuclein is a natural protein present in all individuals, in Parkinson’s it may clot to form toxic Lewy Bodies. It is unclear why this happens.
62
What are the two types of pharmacotherapies administered in PD?
L-DOPA - precursor to dopamine because dopamine cannot cross the BBB. Not very useful in late stage PD because there aren't enough dopamine receptors left
MOA inhibitors - dopamine agonists
63
What are the four cardinal signs of PD?
Tremor
Rigidity
Akinesia (and bradykinesia - difficulty in initiating movement, or slowing of movement once begun)
Postural Instability
64
What are the two types of rigidity in PD?
lead pipe rigidity (plasticine or bendable pipe)
cogwheel (like a ratchet with key parts - start stop movement).
65
What proportion of PD patients also present with mild-moderate depression?
50%
66
RBD is a pre-disease indicator of PD (by 10 years). What is it?
RBD is REM-sleep behavioural disorder where individuals may move or become distressed during sleep. They may act out dreams.
67
At what stage of dopamine degredation, do symptoms of PD become apparent?
80% degredation, or 20% remaining, because there is no more compensatory capacity
68
What is the preprogramming deficit hypothesis of PD?
The suggestion that akinesia occurs because individuals are unable to generate pre-programmed (predictive) actions.
Flowers (1976) claimed PD individuals were unable to make predictive actions in the absence of visual cues.
69
Crawford et al 1989: Study at Royal London Hospital for PD
Suggests the pre-programming hypothesis is incorrect.
Saw PDs could anticipate in count down procedures and make predictive saccades.
However there may be a cognitive cost of prediction.
70
What is the SRT (simple reaction time) deficit in PD and why is it relevant?
It was hypothesized that the PD SRT deficit was a result of attentional resource problems, so they should be less susceptible to interference. This is what studies found, very consistently.
Secondary tasks produced higher levels of interference in healthy elderly controls than PD, supporting theories that akinesia is related to cognitive processes.
This suggests that PD can pre-programme, but their brains may chose not to, to protect resources.
71
What did Goodrich et al, 1989 find about PD?
Simple RT and Choice RT are dissassociable in PD, meaning they have different and distinct neuropsychological mechanisms, and can indicate that since PD struggle with SRT, there is a neuroattentional deficit.
72
What is the substantia nigra?
An area in the basal ganglia, called that, because of the neuromelanin in dopaminergic neurons. During neurodegenerative diseases, this is a particularly vulnerable area.
73
Who suggested that chronic emotional stress can leave individuals susceptible to the dopaminergic loss associated with PD?
Djamshidian & Lees, 2013
74
What can eye-tracking studies suggest about PD?
Anti-saccades are not significantly different between PD and controls, suggesting anti-saccadic pathways are unaffected in PD (Lueck et al, 1990)
PD had longer fixations during reading, which decreased when medicated. (Gibbs et al, 2024)
PD were impaired in emotion recognition in faces, despite no visible saccadic differences (Gibbs et al, 2024)
However naturalistic studies are lacking.
75
What is paradoxical kinesis?
Individuals with PD can sometimes quickly move or reach for something "in the moment" but can really struggle with self-directed or intentional movements.
Suggests there may be two neural signals for internally/externally driven movements.
Siegert et al, 2002
76
What can eye-tracking tell us about Sz?
Probands (patients) demonstrate more antisaccadic distractability than their healthy peers (Crawford et al, 1998).
77
What are the links between clinical psychology and vitamin D? (Rihal et al, 2022)
Potentially above 40% of the world has vitamin D deficiency, and it is vital for healthy neurological functioning.
Vit D is anti-inflammatory in the brain and reduces neuronal oxidative stress. It may facilitate the formation and regulation of serotonin, dopamine and acetylcholine.
It may be linked to symptom severity in depression, autism and Sz.
78
True or false: Sz is associated with healthy synaptic pruning processes?
False: this disrupted synaptic pruning may be associated with reduced grey matter volume in Sz: McCutcheon et al, 2019
79
What part of the brain is associated with semantic meanings, and therefore persecutory delusions in Sz?
Dorsal striatum - typically has high levels of dysregulated activity (McCutcheon et al, 2019)
80
Who suggested that Sz is associated with sleep abnormalities and reduced NREM?
Monti and Monti, 2005
81
What is the corollary discharge theory of Sz?
Self-monitoring mechanisms are faulty which lead to individuals failing to perceive their own speech or movements as their own or self-generated (Stephan et al, )
CD is a basic evolutionary phenomenon seen in many animals.
82
What is some of the underlying neurobiology of AD?
Amyloid beta plaques: amyloid beta folds into oligomers and fibrils which make up plaques, which then weaken synapses and are toxic to the nearby cells. A-beta is present in all brains. Microglia can become activated by a-beta to release pro-inflammatory cytokines which can further destroy synapses.
A protein, known as Tau, stabilises microtubules in axons. In AD, tau can become destabilised and move towards a cell body and can become tangles which kill neurons. Misfolded tau proteins can move between neurons to healthy neurons, causing previously healthy tau proteins to misfold. Certain neurons may be more vulnerable.
83
How can AD be detected?
Lumbar punctures can be used to detect beta-amyloid in the plasma in CSF.
84
What are some of the limitations of neuropsychological cognitive decline tests in AD?
Underestimation of damage in highly educated participants, while an overestimation of damage in those with a low IQ/ limited education (Rentz and Weintraub, 2000).
85
What do aMCI and naMCI stand for?
aMCI = amnesic Mild Cognitive Impairments
naMCI = non-amnesic MCI
86
Describe Case AP11 regarding dementia
Neuropsychological assessments indicated healthy cognition. However, her eye movement errors were 3.5 SD worse than controls. After 12 months there were signs in neuropsychological assessments for dementia.
WM was preserved while IC was not.
**Eye movement data appeared to pick clear signs 18 months prior to neuropsychological assessments.**
Crawford et al, 2016
87
Who suggested that individuals with Sz fail to disengage attention from salient facial features in social situations using eye-tracking?
Green et al, 2008
88
Describe Crawford et al's 2015 paper, questioning whether individuals with AD have deficits in disengagement of attention?
Eye-tracking to measure how far individuals could look away from a central stimulus.
AD and C had the same patterns of activity, demonstrating that AD individuals could disengage.
89
Can individuals with AD suppress inhibition distractors?
No, Crawford et al, 2005 suggested that inhibition signals in AD are strikingly affected. Similarly, these errors in the Anti-Saccade Task were often uncorrected.
90
Can WM and inhibitory control be dissociated in AD?
Yes, there is a double dissociation between the two where some participants had preserved WM but limited IC. Crawford et al, 2016
91
What genetic factors could influence the development of AD?
Amyloid Precursor Protein genes may code for the volume of APP. Also the apoliopoprotein E4 allele, which may hinger the degradation of AB. (Yankner, 1996)
92
What did Wilcockson et al, 2019 find?
AD and aMCI have higher levels of uncorrected anti-saccadic behaviour, whereas naMCI and controls were much better at correcting them.
This is a reliable finding, suggesting a potential diagnostic avenue that is inexpensive, noninvasive and can provide early suggestions of aMCI.
Anti-saccade tasks may provide a biomarker for AD.
93
What is the difference between Dementia with Lewy Bodies and Parkinson's Disease with Dementia?
Despite very large neuropathological overlaps, there are some differences (Troster, 2008).
DLB tends to have poorer visual attention and more significant attention and WM impairments.
Diagnoses are given based on whether motor or dementia symptoms come first.
It is controversial whether or not they are the same disorder.
94
What percentage of children worldwide are diagnosed with autism?
1 - 2%, but this level is increasing as diagnostic processes develop
95
What proportion of autistic children show signs of intellectual disability?
30 - 60%
Shaw et al, 2023
96
What is meant by the adjective "minimally speaking" in autism?
5 or fewer words in expressive vocabulary
97
What is echolalia?
The repetition of words or phrases spoken by someone else. While present in almost all developing children, it may persist in autistic children/adults.
Echolalia may serve communicative functions for the autistic individuals and those around them
98
What is ADOS-2?
Autism Diagnosis Observation Schedule, version 2 is the “gold standard” assessment tool for autism. It forms a semi-structured interview, that can be tailored for adults or children (but for adults, can be condescending). It explores many activities related to autism e.g. language, play etc.
It is very long and expensive to train to use the ADOS-2.
99
Cascade et al, 2008 suggested a proportion of autistic children were prescribed medication as pharmaceutical interventions. What was the proportion?
More than 50%
100
What are behavioural interventions in autism?
**Behavioural interventions** tend to use operant conditioning principles and extrinsic positive reinforcement. They have been used to reduce stimming.
This is highly structured and adult-led.
Discrete trial training = target responses are elicited and reinforced.
101
What are Naturalistic Developmental Behavioural Interventions for autism?
Interventions integrating both developmental and behavioural principles (Schreibman et al, 2015).
Situated in play contexts and scaffolded through adult support.
102
What is the citation suggeesting an autistic child passed away following chelation therapy (flushing out heavy metal "toxins") to remove the autism?
Brown et al, 2006
103
What interventions are most effective for autistic children?
Sandbank et al. (2020) conducted a meta-analysis of interventions for autistic children (<8yrs) across 130 samples and found NDBIs were most supported by quality research and benefitted social communication and language and play. Behavioural interventions are most recommended, but evidence was vastly limited and of poor quality.
104
What are the criticisms of current autism literature?
- studies rarely use RCT
- reliance on caregiver reports, also not blind
- context or temporal boundedness of research
105
What does autism look like in adulthood (4 things)?
1. language difficulties often improve, but social communication difficulties can persist
2. social challenges may lead to mental health difficulties
3. many autistic adults can excel professionally
4. some may require support into adulthood
106
What is meant by the Female Autism Phenotype (FAP)?
Developed in response to an underdiagnosis of autism in women, the FAP suggests autism presents differently in women and girls, due to socially-driven masking.
For instance, special interests may be different in girls and seen as more acceptable e.g. animals or psychology
Hull et al, 2020
107
What is the Extreme Male Brain Theory of Autism?
Baron-Cohen, 2002
Androgens and sex hormones in males lead to a higher likelihood or vulnerability to develop autism
108
Describe and discuss Lovaas, 1987
Suggests autism is a pervasive "disorder" which needs to be fixed.
Small sample and no random allocation.
Intensive vs control interventions, including corporal punishment.
Suggested intensive treatment could "cure" autism.
Failed to consider staff biases, impact of time spent, outcome variables were not comprehensive
109
What is ABA in autism?
Applied Behaviour Analysis is a well-funded behavioural intervention for autism. It is a rewards-based model, promoting behavioural modifications.
110
Describe a study which challenges ABA in autism?
Kupferstein, 2018:
243 autistic adults were recruited online, 62% met the criteria for PTSD relating to ABA therapy.
This is potentially related to forced suppression of emotionally regulatory behaviours and destruction of sense of self.
111
What is BED?
Binge Eating Disorder
112
What is SUD?
Substance Use Disorder
113
What is the difference between the decision to take drugs and a psychopathology?
People have the right to make choices for themselves, even potentially risky ones which can have negative health or social implications.
Psychopathology is characterised by the development of a dependency, a loss of control and marked psychological distress.
114
What are the DSM V criteria for SUD?
Withdrawal, taken for longer than intended, social, psychological and physical consequences, cravings etc.
Behavioural is the only recognised addictive disorder in the DSM.
115
What is the AUDIT?
Self-report SUD measure: Alcohol Use Disorders Identification Test (Saunders et al, 1993). It is a basic screening test of 10 questions with scores ranging 0-40, with scores above 20 indicating specialist support may be necessary due to a dependence.
116
According to Galmiche et al, 2019, what proportion of people will have eating disorders in their lifetimes?
8% of women and 2% of men
117
What are different types of eating disorder? (5 examples)
Anorexia Nervosa
Bulimia Nervosa
BED
Avoidant-restrictive food intake disorder
PICA
118
What are the DSM criteria for BED?
Recurrent episodes of binge eating, without purging, with feelings of a loss of control. Episodes occur more than once a week and there is marked distress.
119
What are the DSM criteria for Bulimia Nervosa?
Recurrent episodes of binge eating with compensatory behaviours to prevent weight gain, e.g. purging.
Body weight and shape are influential on self-evaluation
120
What are the DSM criteria for Anorexia Nervosa?
Two subtypes: restricting or binging/purging.
Intense fear of weight gain.
One key feature is a refusal to maintain a healthy body weight, or less than 85% of a healthy weight. This is a very risky disorder with high levels of mortality.
121
What are some treatments for eating disorders? (3 examples)
Psychoeducation
CBT-ED, typically 16-20 sessions
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
122
What is buprenorphine?
An opioid to reduce pain and stress, it can be used to treat opioid addictions.
123
What is Contingency Management?
A kind of behavioural training for SUD, reinforcing positive behaviour to promote sobriety and externally support individuals to change their behaviours.
123
What are some recommended treatments for addiction (4 examples)?
Medications (e.g. methadone for heroin, opioid substitution therapy)
Talking therapies
Inpatient treatments and detoxification
Psychosocial intervention programmes, such as contingency management.
124
What are individual factors that influence SUD?
Adapted from Dennis and Pryor, 2014:
- personality: impulsivity, sensation seeking
- age - underdeveloped PFC
- life stress
- similar genes relevant to "externalising pathologies" e.g. conduct disorder
125
How much of AUD genes are heritable, according to Kendler et al, 2003?
50 - 60%
126
Heckhausen and Heckhausen 2008, aruged there are two types of behavioural motivators. What are they:
Needs Driven: motivation from internal drives, pushing towards a goal, relying on some deprivation e.g. thirst
Incentive Driven: external motivation - pushing towards a goal, dopaminergic desires, rewards
Their study allowed rats as much food as they’d like, or a food-deprived state. Both ate lots of fatty/salty hamburgers, but those who were hungry ate lots of bland chow, unlike those who were not.
127
What are Approach/Avoidance Theories and how are they relevant in addiction?
Trans-diagnostic theories where this balance may underly our behavioural motivations and addictive pathologies. We have an approach/avoid drive within us which compete for our attention.
128
What is Carver and White's 1994 BIS/BAS
Self-report measure of behaviour to measure approach/avoid balance, known as the Behavioural Activation System and the Behavioural Inhibition System.
Their work supports theories about two conflicting systems.
129
What is the difference between Liking and Wanting in dependency? Berridge and Robinson, 2016
Liking - hedonic value, pleasure, mediated by the endogenous opioid system
Wanting - motivational value, incentive salience, dopaminergic activity in the striatum Dopamine doesn’t explicitly reward, but teaches us there are rewards or associations present.
130
What was Loxton and Dawe's 2001 study, exploring reward sensitivity?
Community sample of teen girls, explored if there were overlaps in alcohol addiction and eating disorders. Suggested that sensitivity to rewards was present in both, and that this sensitivity in one could increase the sensitivity in the other.
131
What are environmental or social cues for eating behaviours and why should the results be interpreted with caution?
Variety of food may increase intake because of sensory specific satiety (Rolls, 1986)
The presence of others and the size of the group may increase the amount a person eats (Ruddock et al, 2021).
However, there are many papers in this field which have had to be redacted for academic misconduct.
132
What is the approach/avoid balance link in addicts trying to quit?
Both are high (Breiner et al, 1999), but approach is cognitively easier so there is a high level of cognitive competition.
133
What is the Incentive Sensitisation Theory of Addiction?
Robinson and Berridge (1993)
There are different pathways for liking and wanting, repeated use of the substance/behaviour, leads to neuroadaptation, or the hypersensitisation of dopaminergic pathways.
This hypersensitisation can last years beyond final drug incidence. This theory can also explain "incubation of drug craving" where cravings peak a month after last usage - makes it a useful theory.
134
What is the Revised Reinforcement Sensitivity Theory?
Gray and McNaughton, 2003:
The idea that there are three systems, always in competition, Fight/Flight/Freeze System, Behavioural Approach and Behavioural Inhibition systems.
Suggests that imbalances here are associated with many mental health conditions, including GAD and SUD.
135
How is the Dual Processes Model relevant to SUD?
Slow thinking is deliberate self-regulation, which can be used to challenge automatic addicted tendencies.
136
Why is Cognitive Training limited in its treatment for SUD?
When moderators and publication biases were controlled for, the interventions were not effective (Aulbach et al, 2019)
137
What are the overlaps with ED and addiction and how is this relationship nuanced?
The prospect of a food addiction is controversial within the field, with some arguing it is not a possible thing to have. It is estimated that 91% of individuals with BED have some level of food addiction.
There are similar risk factors between eating disorders and SUDs, so there is a significant overlap.
However, food is necessary for survival, while drugs are not.
Nevertheless, both can have neural consequences and are used to challenge negative feelings.
138
What is impulsivity?
A trait/disposition associated with a preference for receiving rewards quickly, and an inability to tolerate delay.
Inhibitory control is often mediated by the PFC.
139
What is Bruch's Attachment Model of Anorexia?
Familial experiences and family dynamics always underly the development of the disorder.
140
What is the evidence supporting cognitive approaches to anorexia?
Higher levels of perfectionism in AN
overevaluation of shape or weight (Lampard et al, 2012)
sensitivity to social ranking (Cardi et al, 2014)
emotional dysregulation (Haynos and Fruzetti, 2011).
141
How can predictive coding be applied to AN?
Predictive Coding is a computational model, exploring AN. There are three essential elements Priors (beliefs about the body), Afferent Signals (signals about these beliefs), Precision (predicted accuracy of these beliefs).
When Priors and Afferent Signals are cohesive, and align, we can maintain homeostasis and the brain can accurately predict the body’s state.
In AN, failure to interpret afferent signals, can lead to prediction errors which are very stressful. This can lead an individual to completely ignore internal signals and only listen to priors.
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There is some evidence that individuals with AN struggle with introspection. Give an example:
Reduced ability to perceive heartbeat signals (Pollatos et al, 2008)
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What proportion of people who ever try cocaine go on to become addicts?
30% - importance of individual susceptibilities
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What are neurocognitive factors of addiction?
Darcq and Kieffer (2018) argue for the role of the endogenous opioid system. In particular, the mu-, delta- and kappa-opioid G-coupled Protein receptors (MORs, DORs and KORs).
MOR - target for opiates, liking aspect, euphoria, receptors predominantly found in NA and VTA
KOR - negative effect, dysphoria, hallucinogenic effects
DOR - mood improvements, stimulation, pain relief
Suggests we could tackle drug addiction by utilising the strengths of these approaches.
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Who suggested that women with eating disorders were more than twice as likely to have SUDs?
Munn-Chernoff et al, 2020
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When were psychiatric diagnoses first introduced into the ICD?
1949
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What is the difference between functional and organic psychiatric diagnoses?
Functional = the role of the brain is unknown and the aetiology is contested
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What are some factors influencing the recent re-medicalisation, driven by the public, where individuals seek psychiatric diagnoses?
identity politics
consumerism
biomedicalisation
need to be taken seriously
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What is Romm's Hearing Voices Framework?
It was developed by psychiatrists and involved a shared expression of auditory experiences, rather than a focus on diagnoses. It raised concerns that we don’t have frameworks for support or understanding beyond diagnoses.
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What is the Power Threat Meaning Framework?
An idiosyncratic approach, which puts trauma at the forefront, and explores a person beyond the diagnoses
