User:Atcovi/Psychopathology/Chapter 3

Introductions

• Paradigm = Philosophical/theoretical framework of a "school of thought". These paradigms explained basic concepts, such as "the earth is flat", and proving these paradigms wrong opened up a huge amount of potential work to be done in the scientific community.

For a preview, the brain is made up of over a billion nerve cells (neurons) and has billions of 'support cells' (glia). Glial cells provide support/protection for the neurons and maintain homeostasis. Message is felt on dendrites --> [travels to] axon --> synapses --> [stimulation leads to] release of neurotransmitters into the synaptic space --> [received on] dendrites of receiving neuron.

Below, we will review the type of models:

The Biological Model

1. The Biological Model - Mental illnesses/displacement of thoughts, emotions, and behavior are because of abnormalities in brain function or brain anatomy/chemistry.

How do they explain abnormal behavior?

• Through deficiencies/overproduction of certain neurotransmitters... for example, low serotonin = depression, too much dopamine = schizophrenia, high epinephrine/low GABA = anxiety.
• Abnormal production of hormones can also lead to mental disorders, particularly cortisol.
• Brain structure & brain circuits: Issues with certain brain structures (cerebrum and its parts for example) could cause mental issues as well. Brain circuits are the opposite... focus on the functionality of brain circuits. For example, the "fear circuit" (axons of one neuron from one structure extend to other structures in the fear circuit... abnormality in this has been seen in patients with PTSD).

Genes

Background

Genes are parts of DNA that have specific duties (for example, making proteins). We have 23 pairs of chromosomes, filled to the brim with hella' genes that control our personalities/traits that we get from our parents. For genes to play a role in our behavior, they need to affect our anatomy (through our neurobiological/neuroendocrine systems). Mental disorders CANNOT be pointed at just one gene, but multiple genes (polygenicity). To see how these genes are 'activated'. This is the field of epigenetics.

Epigenetics

• DNA methylation: an epigenetic mechanism that alters the functionality of a specific gene. This is where a methyl group is added to a DNA molecule, subsequently affecting gene function and expression. DNA methylation is similar to a padlock on a door, it regulates gene expression and gene function --> [influences] human behavior.

Evolution

Although sketchy (not precise at times and hard to research), evolutionary theorists put out gene contributions (random, positive mutations) to survival. Good genes are passed on. (slide 28)

Treatments

• Psychotropic medications: Drugs that alter brain chemistry and reduce symptoms of mental abnormalness.
• Brain stimulation: Methods that stimulate the brain to improve psychological mood. Includes ECT (see below), TMS, and VNS [used vs. depression]. See slide 33.
• Electroconvulsive therapy (ECT): Brain seizure is artifically trigged when a current is set through the patient's forehead via electrodes.
• Drug therapy: 1950s emerged: antianxiety drugs, antidepressant drugs, antibipolar drugs, antipsychotic drugs.
• Psychosurgery: Deep brain stimulation (DBS), treats Parkinson's and dystonia.

Direct-to-consumer (DTC) drug advertisement: Hella money into drug industry, in the US and NZ, more drug education and involvement of patients, but drug prices increase, patients may feel misinformed (or misinformation is easier to spread), and doctors may be pressured to prescribe bad DTC-advertised drugs.

Strengths & Weaknesses

Strengths

• Respect is high, treatment is legit, and constant legit info is coming at all times

Weaknesses

• Non-biological factors matter (like the environment when it comes to interacting with genes), and side effects could be an issue.

The Psychodynamic Model

Founder: Freud (1856-1939), developed theory of psychoanalysis.

A person's behavior comes by unconscious and underlying psychological impulses. Abnormal symptoms are the consequences of conflicting urges.

So what's the explanation behind his model?

These are the forces that shape personality:

1. Id: Force that is instinctual, powered by libido (sexual energy). Sexual force.
2. Ego: The rational guy, this dude makes sense! Guides our impulses. This originally was the "id", but realized that life wasn't worth it. EGO DEFENSE MECHANISM.
3. Superego: Morality principle

Instincts, rationality, and morality shape our personality. Balance and working amongst each other fashionably? You healthy Conflict? Dysfunction.

- Check slide 39. Sublimation is solving the desire with a good solution (I want to have sex with that girl vs. You can't have sex with her vs. Look, have sex with your wife).

Each stage of development (listed in slide 41), either success was achieved or not. If success was achieved, then personal growth is the reward. If not? Fixation takes place (id, ego, or superego don't mature and are 'held back' at a certain stage).

Self theory vs. object-relations theory

Both say that human functioning is shaped by interactive psych forces:

• Self theory: "Belief in that our underlying motivation is to strengthen a 'unified personality'"
• Object relations theory: Humans are social beings and want relationships.

Therapy time!

Therapy sessions consist of the guider (therapist) trying to uncover and reason with past traumas/underlying conflicts/issues between the three components of persona the client may have. This includes:

• Free association: Client says anything that pops up into their mind in a discussion.
• Therapist interpretation: Listen, assess, and come up with conclusions and throw in their subjective 2 cents when the time is appropriate. There could be resistance (by the patient), transference (acceptance), and dream interpretation ("royal road to the unconscious").
• Catharsis: Re-live the past moments so we can figure out the issues/provide soultions.
• Working through: Patient & therapist will just work it out, whenver need be, for a good couple of years.

Demands for psychotherapies have increased, so there are two ways to go about with this. Short-term psychodynamic therapies exist (patient only focuses on one problem) and relational psychoanalytic therapy exists (therapists are involved in the patient's life).

Strengths & Weaknesses

Strengths

• Did a good job in emphasizing psychological theories and systematic treatment for mentally ill functioning.
• Grouped abnormal functioning with normal functioning ('normalized' it).
• Could prove useful for folks with long-term disorders.

Weaknesses

• Not very scientifically based.
• You can't observe or measure objectively.
• "Unconscious", so we can't really access it...

Cognitive-Behavioral Model (CBT)

Emphasis on behavior & cognition, and their effects on emotions. Origin in research vs. origin in clinical work (like psychodynamic).

• Behavioral dimension, which are sought to be replaced by better behaviors/habits, such as classical/operant conditiong & modeling (Bandura Doll Torture experiment).
• Cognitive dimension sort of re-wires the way you think and act. Therapists can guide their patients to looking at life in different lens and to not have illogical assumptions or poor attitudes. Ellis and Aaron Beck are credited with this shift in dimension. Examples of maladaptive ways of thinking are "all or nothing", "emotional reasons", "self-labels", "taking things personal", and "thinking positive thoughts are useless". An example of this is cognitive processing therapy (working beliefs out) and exposure therapy (social anxiety disorder is an example).

You got new approaches coming along, such as acceptance and commitment therapy (ACT) and mindfulness.

Strengths and Weaknesses

Strengths

• Powerful in clinical field, clinically useful, can access easily and report, empirical studies.
• Effective therapies.

Weaknesses

• Not enough focus on past experiences and can be limited.

Humanistic-Existential Model

Focus on broader dimensions of human existence.

• Humanistic: Focus on people as cooperative and friendly. Path to self-actualization through positives and negatives of one's persona.
• Existentialist: Focus on authenticity in one's life. Do not believe humans are naturally positive. More focus on 'reality' than 'positive vibes' (humanism). Abnormality comes from "self-deception".

Religious/spiritual views have been integreting with this model in recent times.

Abnormality arises from someone using 'self-deception' to shy away from their wordly duties. They feel like society is taking a 'jab' at them with these responsibilities, and the client forgets that they have a choice in the matter. Existential therapy is where the therapist implements 'shared learning' and tracking 'growth', which eases the clients into accepting their worldy responsibilities.

Carl Rogers

The pioneer of humanistic theory. He believed that:

• Humans need unconditional positive regard. If they get this early on, they will develop "unconditional self-regard".
• Client-centered therapy: supportive climate, unconditional positive regard is given, this is real (genuine).

These approaches don't have a whole lot of scientific backing, but they get the job done!

Gestalt therapy

...by Frederick Perls in the 1950s. The aim is to guide patients towards 'self-recognition' and 'self-acceptance' through challenges. Coping with these challenges include skillful frustration, roleplaying, and language shifts ("here and now", "I").

Strengths and Weaknesses

Strengths

• We get into the other fields that we've felt were ignored in the other models
• Emphasis on the individual, health and implements an optimistic mindset

Weaknesses

• Abstract, hard to research, and isn't very scientific.

Sociocultural Model

How are we going to assess the things that cause abnormal behavior in somebody? We look at the person's social and cultural environment. Two major perspectives when looking into this:

Family-social perspective

Family-social perspective: Emphasis on forces that directly affect an individual as they grow up, including family relations, social interactions, and whatever community events they participate in. Attention is set on these 3 factors:

1. Social labels and roles
2. Social networks - how does one interact with other people?
3. Family structure, plays into the family systems theory = a family talking with each other in consistent and unique ways.

Some people behave in different ways, depending on who they are with. For example, someone that is emeshed is too involved and struggle with independence later on in life... while someone that is disengaged has strict boundaries and have trouble in group functioning/receiving support later on.

Family-social treatments: Abnormalities are treated well within family settings. Examples are family therapy, couple therapy, group therapy, and community treatment. Intervention is of the three:

1. primary (prevention)
2. secondary (identifying the problems)
3. tertiary (treatment for said problems)

Multicultural perspective

Multicultural perspective: Understand one's behavior and the appropriate treatment for it based on their culture. Intersectionality is a multicultural outlook where multiple 'identites' are merged together to really look at their experiences, view on life, and their ability to function.

Abnormal functioning in minority groups could be spurred from racism and discrimination.

Multicultural treatments: It's tough because the statistics show that minorities are more likely to skip out on therapy. But research has shown that greater cultural awareness/sensitivity and including cultural morals improve therapy. This is separated into culture-sensitive therapies and gender-sensitive therapies.

Strengths and Weaknesses

Strengths

• We understand abnormality better and have an emphasis on clinical/social roles

Weaknesses

• Research is hard to be objective

Mindtech Therapy

• Mobile computing has given us more options when dealing with mental health care, including mental health apps & wearable therapy (JITAI).

Developmental Psychopathology Perspective

Abnormal behavior theories could originate from multiple causes (biopsychosocial theories).

Developmental psychopathology perspective: an integrative framework to reason out how variables and principles from the models above can come together and sufficiently explain adaptive and maladaptive behaviors.

Perspectives are divided into:

• Equifinality: Several developmental routes, such as bad genetics or want for approval of others, can lead to the same abnomrality (conduct disorder).
• Multifinality: Same developmental routes could lead to different outcomes (conduct disorder or being well adjusted to society).