1
Q
projective personality tests
A
personality assessment - given ambiguous stimuli & asked to interpret what the stimulus means
- the projective hypothesis: as the stimulus materials are unstructured, the client’s responses will be determined by unconscious processes and will reveal
their true attitudes, motivations, &
behaviours
2
Q
the rorschach inkblot test
A
designed hundreds of inkblots
* Tested them on 400+ subjects
* Claimed that the blots could be
used to diagnose mental illness
* He eventually settled on 15 blots
that gave the best results
* Eliminated 5 more and published
the 10 in a book called
“Psychodiagnostik” in 1921
3
Q
thematic apperception test
A
a projective test for the assessment of children and adults b/c it utilizes images to gather info regarding a person’s feelings, conflicts, & desires
4
Q
Measuring intelligence: the Binet Scales
A
Alfred Binet originally constructed mental tests to help school board predict which children were in need of special schooling.
*An intelligence test, often referred as an IQ
(intelligence quotient) test, is a standardized means of assessing a person’s current mental abilitie
5
Q
The 1905 Simon-Binet Test
A
30 tasks or tests of increasing difficulty
(no measuring unit–just roughly categorized people)
- Idiots (most severe intellectual
impairment)
- Imbeciles (moderate impairment)
- Morons (mildest impairment)
Norms were based on a sample
of only 50 children
6
Q
The Wechsler Adult Intelligence Scale (WAIS)
A
First developed in 1937 b/c of criticisms w/ newer versions of the Binet scales.
- Administered w/ an experienced clinician
- Performance based
- Assesses full IQ and various subscales
- The FSIQ is composed by four scores & a general intelligence index
The four indexes are: Verbal Comprehension Scale, Perceptual Reasoning Scale, Working Memory Scale, and Processing Speed Scale. Every index is composed by two or three subtest that are required to obtain the total IQ score.
7
Q
Verbal Comprehension Scale - Core & Supplemental Subsets
A
Core:
- Similarities (what likeness 2 diff words have)
- Vocabulary (words to define)
- Information (subtest about general knowledge)
Supplemental:
- Comprehension (questions about social situations)
8
Q
Perceptual Reasoning Scale - Core & Supplemental Subsets
A
Core:
- Block design (timed test to copy presented model w/ the use of blocks)
- Matrix reasoning (series of pics, asked to fill in missing detail)
- Visual puzzles
Supplemental:
- Picture completion (points/names missing part of pic)
- Figure weights
9
Q
Working Memory Scale - Core & Supplemental Subsets
A
Core:
- Digit span (series of #s, asked to repeat either in sequence or reverse order)
- Arithmetic (timed oral questioning of arithmetic questions)
Supplemental:
- Letter-number sequencing (given series of letters & digits, report back the stimuli w/ the letters in alphabetical & digits in ascending numerical order)
10
Q
Processing Speed Scale - Core & Supplemental Subsets
A
Core:
- Symbol search (row of symbols & “target” symbol, asked if target symbol is present in each row)
- Coding (timed subtest, asked to write a digit-symbol code)
Supplemental:
- Cancellation (random pictures, mark target symbols given under time pressure)
11
Q
Self-report scales
A
Most common assessment tool
(Come in several formats)
⚬ Self-assessment on a 5-point Likert
scale (Strongly Disagree to Strongly
Agree)
⚬ Trait selection (Yes/No)
⚬ Symptom frequency
*Can be self-administered or administered
in a clinical setting
*Validity and reliability can vary
*Are in-line with current evidence and DSM
criteria
12
Q
Behavioural Cognitive Assessment & Case Formulation
A
Cognitive-behavioural case formulation:
hypothesis that ties together, in a brief narrative or diagram, the mechanisms that cause & maintain all of the patient’s problems, the origins of the mechanisms; & the precipitants that are currently activating the mechanisms to cause the problems.
13
Q
Biological Assessments and Brain Imaging
A
- CT or CAT Scan (Computerized axial tomography): uses X-ray tech to produce detailed images of very thin slices of the inside of the body
- MRI (Magnetic Resonance Imaging): uses strong magnetic fields & radio waves to produce detailed images of the inside of the body; produces higher quality images than a CT & doesn’t rely on radiation
- fMRI (Functional Magnetic Resonance Imaging): Allows for MRI images to be taken so quickly that metabolic changes can be measured, providing a picture of the brain at work rather than of its structure alone
- PET (Positron Emission Tomography): the PET scan uses a radioactive drug (tracer) to show both normal & abnormal metabolic activity
14
Q
DSM Classification System
A
Diagnostic & Statistical Manual (DSM) of the American Psychiatric Association:
- Covers all categories of mental health disorders
- No identification of symptoms
- DSM-III (first to provide clear direction on classification of symptoms)
- Nearly 300 mental disorders listed in the DSM-5-TR in 22 major categories
15
Q
Goals for DSM-5
A
- Address gaps in diagnoses
- Update criteria based on new research knowledge
- Reduce number of Not Otherwise Specified (NOS) classifications b/c too generic
- Add dimensions to categorical system
Categorical (yes/no); Dimensional (add nuance - can scale symptoms) - Streamline and simplify diagnoses (includes combining some disorders into one category); (new conceptualization for existing disorders) - E.g., OCD is no longer an anxiety disorder
16
Q
Controversies & the DSM-5
A
- Pathologizing normal human experience
(E.g., Disruptive Mood Dysregulation Disorder is criticized as “temper tantrum disorder”); Bereavement can no longer exclude Major Depression – may over-diagnose normal grieving - Lack of representation of certain disorders (E.g., internet addiction)
- Some disorders have been eliminated leading to issues in funding and access to resources (E.g., Asperger’s Syndrome – ppl w/ aspergers’ syndrome doesn’t have a diagnosed condition anymore and they’ll no longer provide resources for them because it “doesn’t exist”
- Ties to pharmaceutical companies
17
Q
Culture & Diagnosis
A
- Early editions of DSM were criticized for lack of consideration of culture and ethnicity.
- DSM-IV-TR introduced culture-bound syndromes: (E.g., Culture-bound syndromes eliminated in DSM-5 replaced with “cultural syndromes,” “cultural idioms,” and “cultural explanations”)
- DSM-5 elaborated four specific themes to be considered in making cultural formulation: 1) Cultural identity, 2)
Cultural consideration of distress, 3) Cultural features of vulnerability & resilience, 4) Cultural features of the relationship between clinician & patient
18
Q
theory vs hypothesis
A
Theory: a well-developed set of ideas that aims to explain an observable phenomena
- primary goal of science is to advance theories to account for data, often by proposing cause–effect relationships
Hypothesis: a testable prediction or proposed explanation for an observable phenomenon
19
Q
Qualitative Research
A
quantitative looks at the specific, measurable changes in behaviour. But qualitative looks at what is the impact of a disorder on your daily life, what does it feel like & what is the depth of the experience.
*case studies - study of 1 individual
(case studies are useful for disproving aspects of a theory)
20
Q
nomothetic research
A
- measuring a group of people on a number of variables
- examines the relationship among the variables
- correlational methods are an example of nomothetic research
- variable centered
- research that uses data from a lg # of ppl to identify general trends & make predictions about human behavior; focused on using statistics, the scientific method, & group averages to understand human behavior
21
Q
idiographic research
A
- detailed understanding of the individual
- case studies & qualitative methods are examples of idiographic research
- person centred
- focuses on a complete, in-depth understanding of a single case (e.g. why do I not have any pets?)
22
Q
epidemiological studies
A
examines rates of occurrence of abnormal behavior in the population as a whole & in various subgroups: race, ethnicity, gender, age, or social class.
- provides a general picture of a disorder
23
Q
prevalence, incidence, & risk factors
A
Prevalence: Proportion of a pop. that has the disorder at a given point or period of time – how many ppl?
Incidence: The number of new cases of the disorder that occur in some period, usually a year – incident rate (e.g., 5% of ppl might be diagnosed w/ autism within a given year)
Risk factors: Conditions or variables that, if present, increases the likelihood of developing or worsening the disorder
24
Q
Basic Features of Experimental Study Methods
A
- Researcher typically begins with an experimental hypothesis
- Investigator chooses an independent variable (IV) that can be manipulated (different conditions – often experimental vs. control)
- Participants are assigned to the conditions by random assignment
- Researcher arranges for the measurement of a dependent variable (DV)
- Analyze the data to determine if there has been an experimental effect
25
Statistical significance in Experimental Research (within-group variance, between-group variance)
statistical significance is tested by dividing the between group variance by a
measure of the within-group variance.
When the avg. difference between the two groups is large relative to the
within-group variance, the result is more likely to be statistically significant.
- (you have control & manipulated group, need to look individually within those groups to measure their variance. Then, compare between the two groups to determine whether the manipulated ppl score higher than the ppl within the other group).
26
assessing difference
use tests that allow us to compare the means of groups to see if the differences are statistically significant (meaningful). *Tests of statistical significance.
*p-value tells us how sure we can be that one thing is related to another or how sure we can be that two groups are different (the results are from group differences, not just random chance)
- P-value or Probability Statistic
E.g., happiness and parenting status - can we be sure they’re related?
- Effect size
E.g., parents vs not parents - can we be sure that these two groups are actually different?
27
Effect Size and cohen's d
use Cohen’s d to assess effect size when comparing the means (averages) of two experimental groups (e.g., treatment group vs. control group) or comparing two independent groups (e.g., men vs. women, before vs. after intervention).
- Basically, is there a big enough difference between the two peaks (a big enough impact) to matter
28
single-blind & double-blind procedures
a. when the patient or client is unaware of what group they have been placed in (placebo or treatment)
b. when neither the researchers nor the clients are aware of who has been placed in the treatment or placebo control groups
29
internal validity vs external validity
a. examines whether the study design, conduct, & analysis answer the research questions without bias (E.g., researchers randomize their participants, thus accounting for their biases)
b. can the results be generalized beyond immediate study? (E.g., Groups receiving treatment for depression were all white ppl w/ high paying jobs – can't really take the results & attribute them to students in uni)
30
confounders & analogue experiments
a. something that affects the result of a scientific experiment in a way that makes it less clear that one thing causes another
(E.g., passage of time could change scores on a stress scale; changes may not be due to the treatment)
b. the use of a related phenomenon (an analogue) in the lab behaviour is rendered temporarily abnormal through experimental manipulations (E.g., ppl have difficulty w/ memory during/following a panic attack; how do we actually study that - induce one & ask to do a memory task at diff times then compare to control group)
31
meta analysis + limitations
review of many studies in order to determine the effects of treatment
- Examine published studies, combine the results into a common format & then determine the extent of improvement (effect size).
limitations: complicated process that requires decisions at each of numerous phases, results are difficult to interpret, need to take into account moderator variables
32
illness vs no-illness
Illness: (you're having serious impacts in your daily life due to chronic anxiety) you meet the criteria for a diagnosis even if you don’t want it
No illness: (You feel anxious sometimes – doesn't mean you have anxiety disorder) no diagnosis because you don't need one
33
diagnosing a mental illness (intensity, duration, frequency)
Intensity: you could have only a discomfort w/ something or you could have a major intense reaction to it.
Duration & frequency: you could have these upset feelings after an upsetting life circumstance & they could be really intense for a bit but is it lasting awhile and is it very frequent?
*Your mental health condition needs to meet all the criteria; otherwise it could simply be attributed to something else that is distressing.
34
anxiety disorders
Anxiety disorders are diff from ‘everyday anxiety’ in that the anxiety is disproportionate to the situation that elicited the anxious response (concerned about smtg that might happen in the future. The disorder comes in when there's smtg that's ambiguous or not even in the environment. But it also has to be chronic, cause significant distress for yourself or others, & disproportionate to the situation).
35
components of anxiety
Physiological: heightened level of arousal and physiological activation (e.g., ↑ heart rate, shortness of breath, dry mouth
Cognitive: subjective perception of anxious arousal & associated cognitive processes
(e.g., worry & ruminations )
Behavioural: clinicians often add this component (e.g., ‘safety’ behaviours avoidance)
36
prevalence of anxiety disorders
- the most common psychological disorders
- 16% of women; 9% of men suffered from anxiety disorders in the preceding year
- the highest one-year prevalence rates (i.e., almost 1 in 5) were found in women 15 to 24 years of age.
- more common in women than in men across all age groups
37
separation anxiety
experience of excessive fear or anxiety concerning separation from those to whom they're attached.
- children 6-12 month + toddlers prevalence in US is ~4%
- school-aged girls have higher prevalence rates than school-aged boys
- adolescents - 12 month prevalence rate in US is 1.6%
- adults - 12 month prevalence is the US ranges from 0.9% - 1.9%
38
specific phobias
unwarranted fears caused by the presence or anticipation of a specific object/situation
- the fear & avoidance is out of proportion to the actual danger & is recognized by the sufferer as groundless
- the person suffers intense distress & social or occupational impairment b/c of the anxiety.
* Affects more women than men 2:1
- tend to be long-lasting (mean duration of 20 years)
- only 8% of ppl w/ a specific phobia
received treatment
39
subtypes of phobias
- Blood-Injection-Injury
⚬ getting shot, donating blood, going
to the doctor or dentist*, getting a
needle
- Situations
⚬ enclosed spaces, elevators, planes
- Animals
⚬ insects, dogs, snakes
- Natural Environments
⚬ storms, water, heights
- Other
⚬ choking, vomiting, clowns
- most common specific phobia subtypes in
order were:
1. animal phobias (insects, snakes, & birds)
2. heights
3. being in closed spaces
4. flying
5. being in or on water
6. going to the dentist
7. seeing blood or getting an injection
8. storms, thunder, or lightning
40
social anxiety disorder
fearful or anxious about or avoidant of social interactions & situations that involve the possibility of being negatively evaluated by others.
* meeting unfamiliar people, situations where they may be observed eating or drinking, performing in front of others.
* Concerns that blushing, shaking, sweating will be observed by others
*Three types:
* Speaking or performing in public (e.g., piano recital)
* Social interactions (e.g., asking a store clerk for help)
* Being observed in public (e.g., sitting on a bus in rush hour)
41
prevalence of social anxiety disorder
- onset takes place during adolescence,
though can occur in children.
- prevalence of SAD was higher among ppl
who had never married or were divorced, had not completed secondary education, had lower income or were unemployed, reported lacking adequate social support, reported low quality of life, or had a chronic physical condition
42
Specific phobias & SAD: behavioural theories
theories about how someone develops phobias or social anxiety considers that the disorders are ‘learned’
* Avoidance conditioning
* Modeling
* Prepared learning
* Social Skills Deficits
43
avoidance conditioning, modelling, & prepared learning
Avoidance conditioning: reactions are
learned avoidance responses that develop:
* via classical conditioning - neutral stimulus; (CS) is paired w/ frightening event
* via operant conditioning - fear is maintained; when person learns to reduce conditioned fear by escaping from or avoiding the CS
Modelling: person can learn fear through
imitating the reaction of others (vicarious
learning).
Prepared Learning: some fears may reflect
classical conditioning, but only to stimuli to
which an organism is physiologically prepared to be sensitive -> ppl fear spiders, snakes, & heights but not lambs
44
Social Skills Deficits in Social Anxiety Disorder
- inappropriate behaviour or a lack of social skills is the cause of social anxiety.
- the individual has not learned how to act so that they feel comfortable w/ others or the person repeatedly commits faux pas, is awkward & socially inept, & is often criticized by social companions.
- socially anxious ppl often rated as being
low in social skills.
- timing & placement of socially anxious
responses in a social interaction, such as saying thank you at the right time & place, are impaired.
45
Specific Phobias and SAD: cognitive theories
Ppl’s thought processes can serve as a
diathesis & thoughts can maintain a phobia
or anxiety. Ppl who experience phobias or social anxiety are more likely to:
* attend to negative stimuli;
* interpret ambiguous info as
threatening; &
* believe that negative events are more
likely than positive ones to re-occur.
Cognitive-behavioural models link SAD to
certain cognitive characteristics:
* Attentional bias to focus on negative social info
* Perfectionistic standards for accepted social performances
* High degree of public self-consciousness
Ppl w/ SAD have a tendency to interpret
ambiguous social situations as negative & a
reflection of their personal shortcomings, they also have a memory bias linked to this
interpretation bias
46
Cognitive Theories of SAD
- Post-event processing (PEP) of negative social experiences
- A form of rumination about previous experiences &
responses to these situations, especially experiences
involving other ppl that didn't turn out well.
- David Moscovitch (a prof and researcher here at UW) concluded that the fundamental core thematic fear in social phobia is “the self is deficient.”
- The key situational triggers are situations & circumstances that will publicly reveal the self as inadequate.
47
Specific Phobias and SAD: biological theories
Predisposing Biological Factors:
- greater activity in two areas associated w/ negative
emotional responses: the amygdala & the insula
Autonomic Nervous System - stability-lability:
- labile, or jumpy, individuals have autonomic systems that are readily aroused by a wide range of stimuli; involved in fear & in phobic behaviour
- autonomic lability is to some degree genetically
determined
- heredity may have a significant role in the
development of phobias
48
Specific Phobias and SAD: genetic factors
Jerome Kagan has focused on the trait of
behavioural inhibition or shyness.
- some infants as young as 4 months become agitated & cry when they're shown toys or other stimuli. This behaviour pattern, which may be inherited, may set the stage for the later
development of phobias.
49
Specific Phobias and SAD: psychoanalytic theory
Phobias are a defense against the anxiety produced
by repressed id impulses.
Anxiety is displaced from the feared id impulse &
moved to an object or situation that has some
symbolic connection to it.
These objects or situations then become the phobic
stimuli.
By avoiding them the person is able to avoid dealing
w/ repressed conflicts.
50
Panic disorder
In a panic attack, a person suffers a sudden & often inexplicable attack of alarming symptoms:
* Rapid or laboured breathing, heart palpitations, nausea & chest pain;
* Feelings of choking & smothering;
* Dizziness, sweating, & trembling;
* Intense apprehension, terror, & feelings of impending doom.
Person may also experience:
* Depersonalization (a feeling of being outside one’s body).
* Derealization (a feeling of the world’s not being real, as well as fears of losing control, of going crazy, or even of dying).
Panic attacks may:
* Occur frequently
* Be situationally predisposed
* Be uncued
* Occur in seemingly benign states,
⚬ Relaxation or sleep, and in unexpected situations
51
prevalence of Panic Disorder among Canadians
- women are more affected than men - 2:1
- prevalence is low before 14, rates increase in adolescence, peak during adulthood, & decline in older adults.
- panic attacks were related to poor overall functioning, suicidal ideation, psychological distress, activity restriction, chronic physical conditions, & self-rated physical & mental health
52
Panic Disorder with or without Agoraphobia
Panic disorder is diagnosed as with or without agoraphobia
- Def of Agoraphobia: a cluster of fears centering on public places & being unable to escape or find help should one become incapacitated.
- Diagnosis requires anxiety in at least 2 of 5 situations: public transportation, open spaces, enclosed spaces, lines/crowds, being out of the house alone
- Many ppl w/ agoraphobia are unable to leave the house or do so only w/ great distress
- Ppl who have panic disorder typically avoid the situations in which a panic attack could be dangerous or embarrassing.
53
Generalized Anxiety Disorder (GAD)
- Ppl w/ GAD are persistently anxious & overly concerned about minor items.
- Chronic, uncontrollable worries about everything (Seems like everything causes anxiety, very hard to pinpoint a specific cause).
- Most frequent worries concern their health & the hassles of daily life.
- Other features of GAD: difficulty concentrating, tiring easily, restlessness, irritability, high level of muscle tension
- Ppl w/ GAD don't typically seek psychological treatment. (Getting help is a stimulus that makes them feel anxious, they don't see the relief in that).
- typically begins in mid-teens; stressful life events play role in onset.
- 12-month prevalence - 0.9% among adolescents & 2.9% among adults in the general community of the United States.
54
systematic densistization
create an anxiety hierarchy rating of fears. Relax & then start w/ the smallest fear & work up to conquering the greatest fears.
- clinical and experimental evidence indicates that this technique is effective in eliminating, or at least reducing, phobias.
55
In Vivo & Virtual Reality
- In vivo exposure outperformed other modes of exposure (e.g., imaginal exposure & virtual reality) at post-treatment (but not at follow-up).
- In vivo exposure is associated w/ a high dropout rate & low treatment acceptance.
- VR exposure found to be just as effective
- VR exposure therapy has a powerful real-life impact & yields stable outcomes comparable to other treatment interventions.
- VR exposure treatment has comparatively better efficacy for the fear of flying.
- there is a move by some researchers from VR exposure to augmented reality (AR) exposure.
56
Blood & Injection Phobias
- relaxation tends to make matters worse for ppl w/ blood-and-injection phobias.
- after the initial fright, accompanied by dramatic increases in heart rate & blood pressure, they'll often experience a sudden drop in blood pressure & heart rate & faint.
- clients are now encouraged to tense rather than relax their muscles when confronting the situation
57
Social skills training for SAD
Learning social skills can help ppl w/ Social Anxiety Disorder who may not know what to do or say in social situations.
- Some CBT therapists encourage clients to role-play interpersonal encounters in the consulting room or in therapy groups & several studies attest to the long-term effectiveness of this approach
58
Behavioural therapy for GAD
(difficult to find specific causes of the anxiety suffered by clients w/ GAD)
- tend to prescribe more generalized treatment (intensive relaxation training), in hope that if clients learn to relax when beginning to feel tense, their anxiety will be kept from spiraling out of control.
- clients are taught to relax away low-level tensions, to respond to incipient anxiety w/ relaxation rather than alarm -> quite effective in alleviating GAD
59
Cognitive treatment of phobias
Cognitive treatments for specific phobias have been viewed w/ skepticism b/c of a central defining characteristic of phobias:
- the phobic fear is recognized by the individual as excessive or unreasonable.
- if the person already acknowledges that the fear is of something harmless, what use can it be to alter the person’s thoughts about it?
- there is no evidence that the elimination of irrational beliefs alone, w/out exposure to the fearsome situations, reduces phobic avoidance
60
Exposure-based treatments for Panic Disorders
A well-validated exposure-based therapy developed by Barlow is called panic-control therapy.
- Panic-control therapy has three principal components:
(1) relaxation training
(2) a combination of Ellis-and-Beck-type CBT interventions, including cognitive restructuring
(3) exposure to the internal cues that trigger panic (which is termed – interoceptive exposure)
61
psychoanalytic approaches to anxiety treatment
Psychoanalytic therapies attempt to uncover the repressed conflicts believed to underlie the extreme fear & avoidance characteristic of these disorders.
Because the phobia itself was regarded as symptomatic of underlying conflicts, it is usually not dealt w/ directly.
Direct attempts to reduce phobic avoidance were contraindicated because the phobia is assumed to protect the person from repressed conflicts that are too painful to confront.
Many analytically oriented clinicians recognize the importance of exposure to what is feared, although they often regard any subsequent improvement as merely symptomatic & not as a resolution of the underlying conflict that was assumed to have produced the phobia
62
symptoms of depression
Mood disturbances:
* emotional state marked by great sadness
* feelings of worthlessness and guilt
Cognitive or ‘thinking’ disturbance:
* Self-criticism, self-blame
* indecisiveness, slowed thinking, thoughts of
death or suicide
Physiological (somatic) and behavioural
disturbance:
* loss of sleep, appetite, and sexual desire
* loss of interest and pleasure in usual
activities
Symptoms vary between cultures
Children: somatic symptoms are most common
early signs
63
symptoms of mania
An emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans
May be characterized by
* euphoric mood,
* excessively talkative,
* difficult to interrupt,
* shifting from topic to topic,
* need for activity,
* grandiose thinking,
* little need for sleep,
* poor planning
64
PREMENSTRUAL
DYSPHORIC DISORDER
Mood lability, irritability, dysphoria, &
anxiety symptoms that occur repeatedly
during the premenstrual phase & remit
around the onset of menses or shortly
thereafter.
Symptoms include:
* mood lability, irritability, anger, depressed mood, hopelessness, anxiety, tension, feelings of overwhelm, insomnia or hypersomnia, changes in appetite etc.
The prevalence of premenstrual dysphoric disorder symptoms in adolescent girls may be higher than that observed in adult women
65
postpartum or peripartum onset depression
Major depression during pregnancy or in the
first 4 weeks following childbirth
- about 50% of episodes begin before
delivery
- can include feelings of anxiety, guilt,
agitation, weepiness, difficulty bonding w/ or caring for baby, & even panic attacks
- can appear w/ or w/out psychotic features
- in Canada, almost one-quarter of mothers who recently gave birth reported feelings consistent w/ either post-partum depression or an anxiety disorder
66
seasonal affective disorder
- no longer a discrete diagnosis - it’s a
specifier of major depressive disorder.
- full remittance is necessary during other seasons, & the pattern must continue for at least 2 years
- is not restricted to winter. SAD can coincide w/ diff seasons
- highest rates of SAD can be found among people who live in the Canadian Arctic (up to 18% of
population)
67
Bipolar disorder
Bipolar 1 - involves recurring mood episodes
(manic, depressive, and hypomanic), but the occurrence of at least one manic episode is necessary for diagnosis.
- peak age at onset is between 20-30 years, but occurs throughout the life cycle.
- mean age at onset is 22 years & slightly
younger for women (21.5 years) than for men
(23.0 years)
Bipolar 2 - characterized by recurring mood episodes consisting of one or more major depressive episodes & at least one hypomanic episode
- average age at onset is mid-20s
68
persistent mood disorders
*symptoms for at least 2 years & are not severe enough to warrant a diagnosis of Major Depressive Disorder (MDD) or manic episode.
Cyclothymic disorder:
- numerous & alternating periods of hypomania & depression
- symptoms at least half the time w/ no more than two consecutive, symptom-free months
Persistent Depressive disorder
- mild to moderate depressed moods most of the day nearly every day for at least two years
- at least two of the other symptoms of MDD
Double Depression
- people w/ persistent depressive disorder may also experience episodes of MDD
69
psychoanalytic theory of depression
Freud theorized that the potential for depression begins in early childhood during the oral period.
- children’s needs are insufficiently or oversufficiently met causing fixation in this stage.
- depression comes about through rejection & dependency
*Very little empirical support for this theory.
70
beck's theory of depression
Thinking is biased toward negative interpretations
Negative triad
- negative views of the self, the world, & the future
Principal Cognitive Biases
- Arbitrary inference
- Selective abstraction
- Overgeneralization
- Magnification & minimization
71
Beck Depression Inventory (BDI II)
Scale used in the assessment of major depressive disorder
- self-report scale of 23 items rated on a 3-point scale.
- classifies individuals as having low, moderate, or significant depression based on scale total.
72
Learned helplessness, attribution & learned helplessness, learned hopelessness
Learned Helplessness:
- individual’s passivity & sense of being unable to act & control own life is acquired through unpleasant experiences and traumas that were unsuccessfully controlled.
Attribution & Learned Helplessness:
- revised theory is the concept of attribution
- global attributions
- attributions to stable factors
- attributions to internal characteristics
Learned Hopelessness:
- advantage of theory is that it can deal the comorbidity of depression & anxiety disorders
73
interpersonal theory of depression
Sparse social networks that provide little support
- decreases an individual’s ability to handle negative life events
- increases their vulnerability to depression
Depressed people also elicit negative reactions from others & are low in social skills.
They also constantly seek the reassurance of others.
74
biological theories
Heritability estimate = 35%
- relatives of unipolar probands are at an increased risk for unipolar depression
- serotonin transporter gene-linked promoter region (5-HTTLPR) is being considered
- drug actions suggest that depression & mania are related to serotonin, norepinephrine, & dopamine.
- anti-depressants & mood stabilizer (anti-manic) medications may work by changing the responsiveness of receptors (which may be too insensitive in people w/ depression & too sensitive in people w/ mania) for these neurotransmitters.
Neuroendocrine System
- HPA axis may play a role in depression.
- limbic area of brain (closely linked to emotion) affects the hypothalamus which in turn controls endrocine glands (release of hormones)
- increased levels of cortisol in depressed patients
Disorders of thyroid function are often seen in bipolar patients.
- thyroid hormones can induce mania.
Right hemisphere dysfunction
- sense of indifference or flatness
75
therapies for mood disorders
Psychological Therapies
- Psychodynamic Therapies
- Cognitive & Behaviour Therapies
- Mindfulness-Based Cognitive Therapy
- Psychological Treatment for Bipolar Disorder
Biological Therapies
- Electroconvulsive therapy (ECT)
- Drug therapy
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Suicide
- suicide is more about struggling to live, than wanting to die
- suicide was the 9th leading cause of death in Canada in 2005
- suicide is the 2nd cause of death (after accidents) in youth ages 15 to 24
Women have higher rates of suicide attempts but lower rates of suicide as compared to men,
- gender paradox of suicidal behaviour
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terminology
A person died by suicide
- commit is harmful, judgmental, & stigmatizing language
Suicidal ideation
- thoughts and intentions of killing oneself
Suicide attempts
- self-injury behaviours intended to cause death but that do not lead to death - we do not say "successful" or "failed"
Suicide gestures
- self-injury in which there is no intent to die
Suicide
- behaviours intended to cause death & death occurs
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risk factors & suicide
Predisposing factors (make a person vulnerable to suicidal behaviour):
- psychological disorder, abuse, early loss
Precipitating factors (create a crisis):
- end of a relationship, job loss, rejection, pressure to succeed
Contributing factors (increase exposure to predisposing or precipitating factors)
- physical illness, sexual identity issues, isolation).
Protective factors (decrease risk of suicidal behaviour)
- personal resilience, adaptive coping skills, positive future expectations, and perceived social support.
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How do I know if someone is at risk? (IS PATH WARM)
I - Ideation
S - Substance abuse
P - Purposelessness
A - Anxiety
T - Trapped
H - Hopelessness
W - Withdrawal
A - Anger
R - Recklessness
M - Mood changes
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how can I help someone?
- Take all threats or attempts seriously.
- Be aware & learn warning signs of suicide.
- Be direct & ask if the person is thinking of suicide. If yes, ask if they have a plan.
- Be non-judgmental & empathic.
- Do not minimize the feelings expressed by the person.
- Do not try to debate with the person or talk them out of their thoughts of suicide.
- Reach out for appropriate support.
- In an acute crisis take them to an emergency room or walk in clinic or call a mobile crisis service.
- Do not leave them alone until help is provided.
- If safe to do so, remove any obvious means (e.g. firearms, drugs or sharp objects) from the area
- Or remove the person from the situation.
*Do not promise to keep thoughts of suicide a secret
