Vygotsky's Theories
The work of Lev Vygotsky focuses on how culture, the values , beliefs, customs, and skills of social group is transmitted to the next generation. According to Vygotsky’s, Social interaction in particular cooperative dialogues with more knowledgeable members of society. It is necessary for children to acquire the ways of thinking and behaving that make up a community's culture ( Rowe and Wertsch, 2002). Vygotsky's theories stress the fundamental role of social interaction in the development of cognition (Vygotsky, 1978; Wertsch, 1985), as he believed strongly that community plays a central role in the process of "making meaning. Vygotsky's theory suggests that development depends on interaction with people and the tools that the culture provides to help form their own view of the world. There are three ways a cultural tool can be passed from one individual to another. The first one is imitative learning, where one person tries to imitate or copy another. The second way is by instructed learning which involves remembering the instructions of the teacher and then using these instructions to self-regulate. The final way that cultural tools are passed to others is through collaborative learning, which involves a group of peers who strive to understand each other and work together to learn a specific skill.
Vygotsky theory combines the social environment and cognition. Children will acquire the ways of thinking and behaving that make up a culture by interacting with a more knowledgeable person, and believed that social interaction will lead to ongoing changes in a child's thought and behavior. Theses thoughts and behaviors would vary between cultures (Berk, 1994).
Vygotsky places considerably more emphasis on social factors contributing to cognitive development (Piaget is criticized for underestimating this). Vygotsky states cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge. In contrast Piaget maintains that cognitive development stems largely from independent explorations in which children construct knowledge of their own. For Vygotsky, the environment in which children grow up will influence how they think and what they think about. Vygotsky places more and different, emphasis on the role of language in cognitive development (again Piaget is criticized for lack of emphasis on this). For Vygotsky, cognitive development results from an internalization of language.
Sociocultural Model
Sociology: Human relationships & social groups
Anthropology: Human cultures & institutions; cultural context that influence people
Questions:
What are the norms of society?
What roles does the person play in the social environment?
What family structure is the person a part of?
What is the social network of support?
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Developmental Cognitive Neuroscience
Biological psychology, behavioral neuroscience, biopsychology, and psychobiology are all terms encompassing the application of biology, particularly neurobiology, to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals. Biological psychology investigates at the level of nerves, neurotransmitters, brain circuitry and the basic biological processes that underlie normal and abnormal behavior. Most research in behavioral neuroscience involves non-human animal models which have implications for understanding human pathology and contribute to evidence-based practice.
Cognitive-Behavioral The way you construe the world has bearing on how you are affected by events in the world. Your thoughts influence your behavior.
Attributions: Inferences we make about causes of events
Beliefs we hold about our abilities (self-efficacy)
Beliefs we hold about the behaviors of others
Cognitive Treatments
CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings
See how inner beliefs are affecting behavior and conflict in one’s life
Overgeneralizations, all-or-none thinking
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Behavioral Terms Behavioral
Reinforcement
Positive OR Negative
Most effective: Intermittent Reinforcement
Punishment
Shaping
Generalization
Extinction
Behavioral Treatments
Functional Assessment
Look at environment and see how person is functioning in the environment. Change environment, change person
References
(Berk, 1994).
Rowe and Wertsch, 2002
Vygotsky, 1978; Wertsch, 1985
Esther Barros-Garcia
On Wed, Sep 17, 2014 at 10:11 AM, Esther Barros-Garcia <ebarrosg@my.smccd.edu> wrote:
Vygotsky's Theories
The work of Lev Vygotsky and other developmental psychologists has become the foundation of much research and theory in developmental cognition over the past several decades, particularly of what has become known as social development theory. Vygotsky's theories stress the fundamental role of social interaction in the development of cognition (Vygotsky, 1978; Wertsch, 1985), as he believed strongly that community plays a central role in the process of "making meaning.
Basically Vygotsky's theory suggests that development depends on interaction with people and the tools that the culture provides to help form their own view of the world. There are three ways a cultural tool can be passed from one individual to another. The first one is imitative learning, where one person tries to imitate or copy another. The second way is by instructed learning which involves remembering the instructions of the teacher and then using these instructions to self-regulate. The final way that cultural tools are passed to others is through collaborative learning, which involves a group of peers who strive to understand each other and work together to learn a specific skill (Tomasello, et al., 1993).
His theory combines the social environment and cognition. Children will acquire the ways of thinking and behaving that make up a culture by interacting with a more knowledgeable person. Vygotsky believed that social interaction will lead to ongoing changes in a child's thought and behavior. Theses thoughts and behaviors would vary between cultures (Berk, 1994).
Hence Vygotsky assumes cognitive development varies across cultures, whereas Piaget states cognitive development is mostly universal across cultures.
2: Vygotsky places considerably more emphasis on social factors contributing to cognitive development (Piaget is criticized for underestimating this).
(i) Vygotsky states cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge. In contrast Piaget maintains that cognitive development stems largely from independent explorations in which children construct knowledge of their own.
(ii) For Vygotsky, the environment in which children grow up will influence how they think and what they think about.
3: Vygotsky places more (and different) emphasis on the role of language in cognitive development (again Piaget is criticized for lack of emphasis on this). For Vygotsky, cognitive development results from an internalization of language.
4: According to Piaget, language depends on thought for its development (i.e. thought comes before language). For Vygotsky, thought and language are initially separate systems from the beginning of life, merging at around three years of age, producing verbal thought (inner speech).
Sociocultural
Sociocultural Model
Sociology: Human relationships & social groups
Anthropology: Human cultures & institutions; cultural context that influence people
Questions:
What are the norms of society?
What roles does the person play in the social environment?
What family structure is the person a part of?
What is the social network of support?
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Therapy:
Family Systems
Individual, Group, Couple Therapy
Developmental Cognitive Neuroscience
Biological psychology, behavioral neuroscience, biopsychology, and psychobiology are all terms encompassing the application of biology, particularly neurobiology, to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals. Biological psychology investigates at the level of nerves, neurotransmitters, brain circuitry and the basic biological processes that underlie normal and abnormal behavior. Most research in behavioral neuroscience involves non-human animal models which have implications for understanding human pathology and contribute to evidence-based practice.
Cognitive (Cognitive-Behavioral)
The way you construe the world has bearing on how you are affected by events in the world.
Your thoughts influence your behavior.
Attributions: Inferences we make about causes of events
Beliefs we hold about our abilities (self-efficacy)
Beliefs we hold about the behaviors of others
Cognitive Treatments
CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings
See how inner beliefs are affecting behavior and conflict in one’s life
Overgeneralizations, all-or-none thinking
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
References
Vygotsky, 1978; Wertsch, 1985),
Esther Barros-Garcia
On Tue, Sep 16, 2014 at 4:49 PM, Esther Barros-Garcia <ebarrosg@my.smccd.edu> wrote:
In 1963, Stanley Milgram, a Yale psychologist, conducted an experiment on obedience. Milgram describe several experiments which establish to prove his point that people follow instructions without questioning the authority figure. In order to demonstrate that participants carried out orders without question, Milgram shows: “When the very first experiments were carried out, Yale undergraduates were used as subjects, and about sixty percent of them were fully obedient (696)”. The participants obey the authority under the complex circumstances. A lab director, a perceived authority figure, ordered participants to administer increasingly painful shocks to “subjects”, who were all strangers, which escalated to a lethal voltage. The participants were unaware that the shocks were not real and that “the subjects” were actually actors hired to pretend to be shocked. The majority of participants were willing to administer deadly shocks and only a minority refused to obey when asked by the lab director. In this controversial study, the participants were able to act without guilt because the lab director, the perceived authority figure, could be blamed for the harmful consequences of their actions.
People follow instructions without questioning the morality of the orders. “The point of the experiment is to see how far a person will proceed in concrete and measurable situation, in which he is ordered to inflict increasing pain on a protesting victim (694)”.This experiment powerfully demonstrates real-world behavior; people may act in ways that may be labeled as immoral if executed on an individual basis. However, these same actions may seem acceptable if they can be justified as “just following orders.” For example, many former Nazi officers used the defense of “just following orders” when tried for war crimes against the Jewish people, yet this defense rarely proved successful. Milgram’s experiment suggests that the desire to obey perceived authority strongly influences social behavior. It indicates that most people are unable to withstand social pressure and only a few successfully resist conformity when confronted with a perceived authority. Interesting future research might explore finding out what helped individuals resist harming others even when pressured by a perceived authority.
At present, Religious obedience is that general submission which religious vow to God, and voluntarily promised to their superiors. The person allowing him to be governed throughout his life by others for the sake of God, religious have taken a far greater part than formerly in civil and public life, personally fulfilling all the conditions required of citizens, in order to exercise their right of voting and other functions compatible with their profession. No political system rejects the votes of persons in dependent positions, and all freely permits the use of any legitimate influence, which corrects to some extent the vicious tendency of equalitarianism. The moral significance religious is bound morally to obey on all occasions. A member of a religious order has often compared to a dead body, but in truth, the religious vow by vanity and self-love and all their fatal opposition to the Divine will kill nothing. If superiors and subjects have sometimes failed to understand the practice of religious obedience, if direction has sometimes been indiscreet, human institution is not free from these accidental imperfections. The expression "blind obedience” (the catholic encyclopedia on CD-ROM ) signifies a keen appreciation of the rights of authority, the reasonableness of submission, and blindness only to such selfish or worldly considerations as would lessen regard for authority.
This article demonstrate that the problem of obedience is part psychological, social, and learned. The behaviors of these individuals in the study are patterns of society. The essence of obedience for some people seems to be that they feel no responsibility for their actions that the authority gives to the person in the study. The breaking up of society into people carrying out narrow and specific jobs takes away the human quality, says Milgram. The importance of this lesson is that ordinary people simply doing their jobs and can become agents in terrible destruction. People’s willingness to go almost any length to please the authority figure is demanding explanations.
References
In 1963, Stanley Milgram, a Yale psychologist
Esther Barros-Garcia
On Tue, Sep 16, 2014 at 4:02 PM, Esther Barros-Garcia <ebarrosg@my.smccd.edu> wrote:
THEORETICAL ORIENTATIONS/PERSPECTIVES
BIOLOGICAL
Genetic inheritance physiological changes exposure to toxic substances.
Main Tenets of this Perspective: A theoretical perspective in which it is assumed that disturbances in emotions, behavior, and cognitive processes are caused by abnormalities in the functioning of the body.
Biological Causes: domain includes genetic and environmental influences on physical functioning. People with psychological disorders may inherit a predisposition to developing behavioral disturbances. Of particular interest are inherited factors that alter the functioning of the nervous system. There are also physiological changes that affect behavior, which other conditions in the body cause, such as brain damage or exposure to harmful environmental stimuli, For example, a thyroid abnormality can cause a person’s moods to fluctuate widely. Brain damage resulting from a head trauma can result in aberrant thought patterns. Toxic substances or allergens in the environment can also cause a person to experience disturbing emotional changes and behavior.
Biological Perspective: Family inheritance studies provide strong evidence in favor of genetic explanations of antisocial personality disorder, the personality trait of psychopathy, an antisocial behavior with heritability estimates as high as 80% to explain this genetic variation, their attention is focused on genes related to the activity of serotonin and dopamine. One of particular is monoamine oxidase A, an enzyme coded by the MAOA gene. A mutation in this gene results in abnormally high levels of dopamine, serotonin, and norepinephrine. High levels of these neurotransmitters are linked to greater impulsivity. Researchers also believe that dependence of the mother during pregnancy can lead to epigenetic influences through DNA methylation. Malnutrition in early life may serve as another risk factor for the development of antisocial personality disorder.
In a study of children tested form age 3 to 17, those who experienced poor nutrition at age 3 showed more aggressiveness and motor activity as they grew up. By age 17 they had a higher likelihood of conduct disorder, a precursor to antisocial personality disorder (Liu, Raine, Venables, & Mednick, 2004)
Biological Treatments Medication /Neurotransmitters/Herbal Supplements
Other Medical Methods as Fit ECT Psychosurgery
How might this perspective view a disorder (e.g., depression)?
PSYCHOANALYTIC / PSYCHODYNAMIC
Emphasizes unconscious determinates of behavior. Of all the psychological approaches it gives greatest emphasis to the role of processes beneath the surface of awareness as influences on abnormality.
Classic Theorist:
Psychodynamic Treatments INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
Free Association
Hypnosis
Dream Analysis
How might this perspective view a disorder (e.g., depression)?
BEHAVIORAL
The theoretical perspective in which it is assumed that abnormality is caused by faulty learning experiences.
Classic Theorist:
Main Tenets:
Behavioral Treatments
Functional Assessment Look at environment and see how person is functioning in the environment.Systematic Desensitization Progressively pairing an incompatible response (relaxation) with a subject of fear Sequential therapy spanning many sessions
Exposure Therapy (In Vivo)
Expose individual to subject of fear in safe situation with therapist involved
How might this perspective view a disorder (e.g., depression)?
COGNITIVE:
It is assumed that abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.
Main Tenets:
Cognitive Treatments CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings. See how inner beliefs are affecting behavior and contribute to conflict in one’s life
Overgeneralizations
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Challenge distortions & Reframe CBT
Common cognitive distortions:
All-or-none-thinking
“Ugly or good looking”
“You trust someone or you don’t”
“If I can’t get an A, I’m not studying”
“That was a waste of time”
“If I can’t do it well, I’m not doing it at all”
“She is perfect”
“They completely messed up”
CBT Challenge your belief system!
Common cognitive distortions:
Overgeneralization (inaccurate use of always & never)
“I never do this right”
“She always yells at me”
Discounting the Positive
“He was just being nice. He felt sorry for me.”
Jumping to Conclusions
“I know I’m not going to pass, so I’m not going to try.”
How might this perspective view a disorder (e.g., depression)?
HUMANISTIC-EXISTENTIAL:
Psychological disorders as the result of cruelty, stress, or poor living conditions. The need to understand themselves and the world and toderive great enrichment form their experiences by fulfilling their unique individual potential.
Main Tenets:
TX Strategies:
Humanistic Model Existential-Humanistic Theory
Existentialism
Here and Now
Freedom
Responsibility
Existential Anxiety
Meaning
Rollo May
Irvin Yalom
Humanism
Here and Now
Human Potential
Self-Actualization
Self-Transcendence
Carl Rogers
Abraham Maslow
Person-Centered Therapy
Actualizing Tendency:
Developing all of your capacities
Potential
Self:
We see ourselves as a unique phenomenon
Person-Centered Therapy
Self-Actualizing Tendency:
Meeting your potential as your unique self…who are YOU?
Organismic Valuing & Conditions of Worth
Positive Regard
Being true to your self…
Unconditional Positive Regard
Humanistic Treatments
Individual Therapy
Group Therapy I.I.H.S. (International Institute for Humanistic Studies:
www.human-studies.org
How might this perspective view a disorder (e.g., depression)?
DIATHESIS-STRESS
The proposal that people are born with a predisposition (or diathesis) that places them at risk for developing a psychological sisorder if exposed to certain exptemely stressful life experiences.
Diathesis-Stress Theory
An “Interactionist” Approach
Genetic Vulnerability + Stress = Illness
Biological Factors: Genetic Predisposition/Congenital Birth Issue/Virus or Illness during Pregnancy
Stressful Events: Trauma (Abuse, Accident, Injury) Loss (Death, Early Attachment)
Stressors: drug use, exposure to toxins
MODEL Main Proposal:
BIO-PSYCHO-SOCIAL: A model in which the interaction of biological, psychological, and sociocultural factors is seen as influencing the development of the individual.
Psychosocial Rehabilitation
Biological Supports
Medication: Approaching chemical needs with Chemical Treatments
Psychological Supports
Therapeutic Interventions
Social Supports (Sociological) Social Skills, Cultural Supports
Psychodynamic Treatments
INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
Free Association
Hypnosis
Dream Analysis
INTRO, HISTORY, ASSESSMENT, DIAGNOSIS
INTRODUCTION
Normal: Typical standard pattern, average.
Abnormal: Away from the norm.
Abnormal behaviors are not always bizarre; no clear distinction can be drawn between normal and abnormal behaviors. No geniuses are particularly prone to insanity. Most psychological disorders are treatable.
Para-normal:
THE 4 D’S:
DEVIANCE: Deviation from the norm.Departing from usual standards.
DYSFUNCTION: How is the person functioning in daily life? Hygiene, Employment, Relationships More objective.
DISTRESS: How does the individual feel? What is the level of suffering experienced? More subjective
DANGER:Is the individual a danger to self?
Is the individual a danger to others?
Is the individual gravely disabled?
5150: Involuntary 72-hour hold
PSYCHOLOGIST PhD can do assessment, research, and therapy
PSYCHIATRIST MD licensed by state to practice medicine
LCSW: SOCIAL WORKER
Licensed Clinical Social Worker
Master’s in Social Work & License
MFT: Marriage & Family Therapist
Master’s in Counseling & License
HISTORY
5150:
Trepanation (Def / Purpose):
Trephination (also known as trepanning or burr holing) is a surgical intervention where a hole is drilled, incised or scraped into the skull using simple surgical tools. In drilling into the skull and removing a piece of the bone, the dura mater is exposed without damage to the underlying blood-vessels, meninges and brain. Trephination has been used to treat health problems associated with intracranial diseases, epileptic seizures, migraines and mental disorders by relieving pressure. There is also evidence it was used as a primitive form of emergency surgery to remove shattered pieces of bone from fractured skulls after receiving a head wound, and cleaning out the pools of blood that would form underneath the skull.
Hippocrates & 4 Humors:
Lobotomy:
Today, the word “lobotomy” is rarely mentioned. If it is, it’s usually the butt of a joke.But in the 20th century, a lobotomy became a legitimate alternative treatment for serious mental illness, such as schizophrenia and severe depression. Physicians even used it to treat chronic or severe pain and backaches. (As you’ll learn below, in some cases, there was no compelling reason for the surgery at all.) There’s a surprising history of the lobotomy for its use in mental health.
A lobotomy wasn’t some primitive procedure of the early 1900s. In fact, an article in Wired magazine states that lobotomies were performed “well into the 1980s” in the “United States, Britain, Scandinavia and several western European countries.”
ECT (Electroconvulsive Tx)
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
ECT is much safer today and is given to people while they're under general anesthesia. Although ECT still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
Deinstitutionalization:
Deinstitutionalization is becoming more and more of a popular choice of mental hospitals because pharmacotherapy can supply the needs of the patients in most cases by taking a drug to solve a problem that should be faced more directly.The early focus was on moving individuals out of state public mental hospitals and from 1955 to 1980, the resident population in those facilities fell from 559,000 to 154,000; the number of patients in mental hospitals decreased significantly. Then, in the 1990’s whole institutions began to close in significant numbers. However, this also led to many mentally unstable people out on the streets where they would be receiving no treatment.
In Your Own Words
Removing patients from hospitals and into normal living conditions, caused by successful use of medication but has resulted in a high rate of homelessness for people with mental disorders.
The policy when the hospital has to send some patients home after their treatments, even if the patient might become homeless, or they don't have family that can give them the proper care.
Removal of patients, even those still in chronic states, to take in more patients and decrease overcrowding, with the hopes that the patients could survive on their own and keep up with their medical agendas alone.
Releasing mental patients from the hospitals and back into the public.
Examples/Functions
Patients may have a hard time assimilating into everyday life, especially if their families are not helping to support them. It may be difficult finding a job,
causing homelessness to be a potential issue of deinstitutionalization in the cases where medication is at a price unattainable to the released patients and/or they are unable to adapt from a controlled environment to an uncontrolled environment.
Patients who are successfully deinstitutionalized may be able to maintain relatively normal lifestyles as they continue therapy and treatment for their condition.
Allowing patients with psychological disorders to be placed, ideally, in the hands of a relative to resume treatment outside of a mental hospital.
Current Issues in Care:
ASSESSMENT TESTS
OBJECTIVE SELF-REPORT: (Briefly define and give examples)
PROJECTIVE TESTS: (Briefly define and give examples)
Mental Status Exam:
MRI: (Magnetic Resonance Imaging)
fMRI:
MRI that now captures functional pictures of the brain
Can see changes from one moment to the next
Replacing PET scans
See immediate response
SOME IMPORTANT INTERVIEW TOPICS: 1. 2. 3.
DSM Diagnostic and Statistical Manual of Mental Disorders
Kraeplin:
DSM Classification History
Emil Kraeplin (1856-1926)
Endogenous: Caused from within--internal
Exogenous: External Cause
DSM Classification
DSM is published by: American Psychiatric Association
Primary Purpose of the DSM: Facilitate Communication Provide Shorthand Information
Diagnostic Tool Focuses on MANIFEST symptoms (Not dependent on your theoretical background)
DSM Classification
Limitations: What is in DSM is what has sufficient data and research to justify the inclusion. If it is not in there, it doesn’t mean it is not important, means not enough justifiable data
DSM Classification History
Emil Kraeplin (1856-1926)
Classified disorders into 13 categories
Grouped things together that he thought had a common etiology
Created descriptive categories based on symptom similarity
The system we use today is a DIRECT relation to his system
DSM Classification History PRIMARY PURPOSE: To standardize data collection
To Facilitate Communication among Clinicians
Strongly influenced by Psychodynamic Approach
Very little empirical data available
Listed 60 disorders (diagnostic make-up represented a CONSENSUS of disorders that were being noticed by psychiatrists in the 50s and 60s
Disorders were considered to be reactions to real or imagined trauma
DSM Classification History
DSM I: 1952: Labeled things as REACTION
DSM II: 1968
Didn’t label everything a reaction (major departure from DSM I)
BOTH distinguished between psychosis (break from reality—hallucinations, delusions, illogical thinking) and neurosis (most commonly depression and anxiety)
DSM Classification History
DSM III: 1980
Partially to revise out the psychodynamic over-influence
THE MEDICAL MODEL becomes the primary approach
DSM becomes “ATHEORETICAL” in that it had no preferred etiology for the disorders
Spitzer gets homosexuality out of the DSM
DSM Classification History
DSM IV: 1994 (TR in 2000)
Minor revisions in codes to be more compatible with ICD-(International Classification of Diseases)
18 Major Categories with many disorders
Based upon a comprehensive review of literature
New categories included only if enough data
DSM Classification History
DSM IV: 1994 (TR in 2000)
Minor Revision
Multi-Axial Diagnostic System
5 Axes seeking essential factors necessary for a comprehensive diagnosis
Specific to DSM IV (started with DSM III
Axes: Define & give example:
Axis I: General Clinical Disorders.
Major depression disorder
Generalized anxiety disorder.
Axis II: Personality Disorders Mental Retardation.
Dependant Personality DX
Panic Disorder
AXIS III: General Medical Conditions
Broken Hip
Hypertension
Diabetes
AXIS IV: Multi-Axial Diagnosis
Resent Job Loss
Obese
AXIS V: Psychosocial Stressors
46 scles from 1 to 100 (number 46)
GAF and severity scales
Axis V: GAF (Global Assessment of Functioning)
Scale of 1-100
DSM Classification History
DSM 5: Published May, 2013
Removal of Multi-Axial System
Looking at Basic Nomenclature Issues
E.G., Some disorders added, condensed, removed Neuroscience and Genetics Research
Lifespan Approach
DSM as a “living document” (DSM 5.1, etc.)
Cross Cultural & Gender Issues
Cohesion with ICD-9, 10 & 11 (11 out 2014)
Removal of NOS – now “Unspecified” or “Other Specified”
TREATMENT STRATEGIES
BIOLOGICAL: TX:
Biological Treatments Medication Neurotransmitters Herbal Supplements
Other Medical Methods as Fit
ECT
Psychosurgery
PSYCHODYNAMIC: TREATMENT
INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
Free Association
Hypnosis
Dream Analysis
BEHAVIORAL: TX:
Functional Assessment
Systematic Desensitization Functional Assessment
Look at environment and see how person is functioning in the environment.
Systematic Desensitization
Progressively pairing an incompatible response (relaxation) with a subject of fear
Sequential therapy spanning many sessions
Exposure Therapy (In Vivo)
Expose individual to subject of fear in safe situation with therapist involved
COGNITIVE-BEHAVIORAL TX:
COGNITIVE:
It is assumed that abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.
Main Tenets:
Cognitive Treatments CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings. See how inner beliefs are affecting behavior and contribute to conflict in one’s life
Overgeneralizations
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Challenge distortions & Reframe CBT
Common cognitive distortions:
All-or-none-thinking
“Ugly or good looking”
“You trust someone or you don’t”
“If I can’t get an A, I’m not studying”
“That was a waste of time”
“If I can’t do it well, I’m not doing it at all”
“She is perfect”
“They completely messed up”
CBT Challenge your belief system!
Common cognitive distortions:
Overgeneralization (inaccurate use of always & never)
“I never do this right”
“She always yells at me”
Discounting the Positive
“He was just being nice. He felt sorry for me.”
Jumping to Conclusions
“I know I’m not going to pass, so I’m not going to try.”
How might this perspective view a disorder (e.g., depression)?
Brain Hemispheres
Left Hemisphere:
Words
Right Hemisphere: Images Dialectical Behavioral Therapy (DBT)
Dialectical—tension between acceptance and change /Problem-solving skills & Coping Skills
Weekly psychotherapy/ Weekly 2.5 hours skills-training group/Phone consultations with primary therapist
Weekly consultation of team members/6 hours/week therapist time (direct & indirect)
DBT Objectives
Decreasing suicidal behaviors/Decreasing therapy-interfering behaviors
Nonattendance
Noncollaboration
Noncompliance
Increasing Quality of Life improving behaviors
Increase behavioral skills
Mindfulness skills
Interpersonal effectiveness
DBT Modules
Mindfulness
Emotional Regulation
Distress Tolerance
Interpersonal Effectiveness
HUMANISTIC Person-Centered/UPR
Exam I is worth 50 points. Completing the review sheet posted above by filling in the spaces with pertinent defining information & related examples will help you greatly with your exam preparation. In addition, reviewing and creating responses to the following questions will help you in preparing for any written responses.
Humanistic Treatments:
Individual Therapy
Group Therapy I.I.H.S. (International Institute for Humanistic Studies:
www.human-studies.org)
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Therapy:
Family Systems
Individual, Group, Couple Therapy I.I.H.S. (International Institute for Humanistic Studies:
www.human-studies.org
How do you define abnormal? What is the purpose of defining abnormal? List and describe the 4 Ds and discuss these criteria may assist you in your definition? Explain the ways these 4 criteria may be useful to keep in mind during an assessment. Use examples to support your discussion.
Discuss the history of the treatment of mental illness up until deinstitutionalization in the 1960s. Discuss the implications of deinstitutionalization upon mental health treatment and the creation of Community Based Organizations. Discuss what you feel is necessary for effective mental health treatment.
Discuss the use of trepanation in the history of treatment of mental illness and describe for what reasons it was likely used. Describe the treatment of lobotomy and describe how it is similar to and different from the use of trepanation as a former method of treatment.
List each of the 5 DSM axes and describe what each axis represents (use an example to support your definition of each). Imagine you are a professional psychotherapist. What assessment techniques might you have utilize in coming up with your diagnosis? Select 2 and describe with detailed examples.
Using depression as an example, describe how depression might be viewed from each of the following therapeutic models: Biological, Psychodynamic, Cognitive-Behavioral, Humanistic-Existential. Describe the possible etiology and potential treatment for depression from each of the 4 listed models.
Differentiate the Behavioral treatment method of Systematic Desensitization with the Cognitive treatment method of Cognitive Behavioral Therapy (CBT). Discuss the purpose and method of each. Describe the ways in which each are utilized to help an individual achieve improved mental health. Use examples.
Discuss the history and evolution of the DSM. Describe some of the major changes that have occurred moving from DSM-IV to DSM-5. Discuss the removal of the axes in particular. In doing so, describe the axes and what was listed on each axis. Describe how you might list a diagnosis in the model of DSM-5 as well.
Theoretical Orientations
Biological
Psychodynamic
Behavioral
Cognitive (Cognitive-Behavioral)
Humanistic (Existential-Humanistic)
Sociocultural
Interactionist:
Biopsychosocial & Diathesis Stress
Biological
Physical Processes as Key to Behavior
“BioMedical” Perspective
Emphasizes Genetic Contributions
Genetic Predispositions
Heredity
Factors within the Nervous System
Hormones, Neurotransmitters
Physical Trauma, Illness
Biological Treatments
Medication
Neurotransmitters
Herbal Supplements
Other Medical Methods as Fit
Surgery to remove tumor if tumor is the organic problem
ECT
Psychosurgery
Psychodynamic Model
Psyche= Soul/Mind
Dynamic= Inherently conflicted organisms
Based on the concept of the Unconscious
Emphasis on Early Childhood
Inner Conflict of the Unconscious:
Ego & Defense Mechanisms
Repression
Denial
Projection
Psychodynamic
Psychoanalytic
Psychodynamic: Id, Ego, Superego
Unconscious
Emphasis on Early Childhood Experiences
Formative Years
Attachment Styles
Secure, Insecure, Anxious, Avoidant
Psychodynamic Treatments
INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
(Now some shorter-term models, but classically long-term)
Free Association
Hypnosis
Dream Analysis
Behavioral Model
Based upon Skinner’s Operant Conditioning
An Individual Operates on the Environment
Concentrates on the behaviors or responses an individual makes to the environment
Do not look at the psyche, look at the organism
Look at what is happening in your life NOW
Deal with the behavior and alter the environment in order to change the behavior.
Behavioral Terms Behavioral
Reinforcement
Positive OR Negative
Most effective: Intermittent Reinforcement
Punishment
Shaping
Pairing
Generalization
Extinction
Behavioral Treatments
Functional Assessment
Look at environment and see how person is functioning in the environment.
Change environment, change person
Systematic Desensitization
Progressively pairing an incompatible response (relaxation) with a subject of fear
A sequential therapy spanning many sessions
Exposure Therapy (In Vivo)
Exposing individual to subject of fear in a safe situation with therapist involved
Cognitive (Cognitive-Behavioral)
The way you construe the world has bearing on how you are affected by events in the world.
Your thoughts influence your behavior.
Attributions:
Inferences we make about causes of events
Beliefs we hold about our abilities (self-efficacy)
Beliefs we hold about the behaviors of others
Cognitive Treatments
CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings
See how inner beliefs are affecting behavior and conflict in one’s life
Overgeneralizations, all-or-none thinking
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Humanistic Existential-Humanistic)
Existential-Humanistic Theory
Existentialism
Here and Now
Freedom
Responsibility
Existential Anxiety
Meaning
Rollo May
Irvin Yalom
Humanism
Here and Now
Human Potential
Self-Actualization
Self-Transcendence
Carl Rogers
Abraham Maslow
Humanistic Treatments
Individual Therapy
Group Therapy I.I.H.S. (International Institute for Humanistic Studies: www.human-studies.org)
Sociocultural
Sociocultural Model
Sociology: Human relationships & social groups
Anthropology: Human cultures & institutions; cultural context that influence people
Questions:
What are the norms of society?
What roles does the person play in the social environment?
What family structure is the person a part of?
What is the social network of support?
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Therapy:
Family Systems
Individual, Group, Couple Therapy
Biopsychosocial & Diathesis Stress
Psychosocial Rehabilitation
Biological Supports
Medication: Approaching chemical needs with Chemical Treatments
Psychological Supports
Therapeutic Interventions
Social Supports (Sociological)
Social Skills, Cultural Supports
Diathesis-Stress Theory
An “Interactionist” Approach
Genetic Vulnerability + Stress = Illness
Biological Factors:
Genetic Predisposition
Congenital Birth Issue
Virus or Illness during Pregnancy
Brain cell loss due to stress or disease
Stressful Events:
Trauma (Abuse, Accident, Injury)
Loss (Death, Early Attachment)
Any number of stressors: drug use,
exposure to toxins
Causes of Stress:
Nature and Nurture
Physical Illness
Chronic Pain
Genetic Make-up & Heritability
Birth Trauma, Illness
Attachment Styles
Drug Use
Marriage / Divorce
Final Exams
Poverty
Stress Changes the Brain
Stressors experienced over a period of time and severity—whether biological or environmental—create a chronic stress response in the brain.
The work of Lev Vygotsky focuses on how culture, the values , beliefs, customs, and skills of social group is transmitted to the next generation. According to Vygotsky’s, Social interaction in particular cooperative dialogues with more knowledgeable members of society. It is necessary for children to acquire the ways of thinking and behaving that make up a community's culture ( Rowe and Wertsch, 2002). Vygotsky's theories stress the fundamental role of social interaction in the development of cognition (Vygotsky, 1978; Wertsch, 1985), as he believed strongly that community plays a central role in the process of "making meaning. Vygotsky's theory suggests that development depends on interaction with people and the tools that the culture provides to help form their own view of the world. There are three ways a cultural tool can be passed from one individual to another. The first one is imitative learning, where one person tries to imitate or copy another. The second way is by instructed learning which involves remembering the instructions of the teacher and then using these instructions to self-regulate. The final way that cultural tools are passed to others is through collaborative learning, which involves a group of peers who strive to understand each other and work together to learn a specific skill.
Vygotsky theory combines the social environment and cognition. Children will acquire the ways of thinking and behaving that make up a culture by interacting with a more knowledgeable person, and believed that social interaction will lead to ongoing changes in a child's thought and behavior. Theses thoughts and behaviors would vary between cultures (Berk, 1994).
Vygotsky places considerably more emphasis on social factors contributing to cognitive development (Piaget is criticized for underestimating this). Vygotsky states cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge. In contrast Piaget maintains that cognitive development stems largely from independent explorations in which children construct knowledge of their own. For Vygotsky, the environment in which children grow up will influence how they think and what they think about. Vygotsky places more and different, emphasis on the role of language in cognitive development (again Piaget is criticized for lack of emphasis on this). For Vygotsky, cognitive development results from an internalization of language.
Sociocultural Model
Sociology: Human relationships & social groups
Anthropology: Human cultures & institutions; cultural context that influence people
Questions:
What are the norms of society?
What roles does the person play in the social environment?
What family structure is the person a part of?
What is the social network of support?
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Developmental Cognitive Neuroscience
Biological psychology, behavioral neuroscience, biopsychology, and psychobiology are all terms encompassing the application of biology, particularly neurobiology, to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals. Biological psychology investigates at the level of nerves, neurotransmitters, brain circuitry and the basic biological processes that underlie normal and abnormal behavior. Most research in behavioral neuroscience involves non-human animal models which have implications for understanding human pathology and contribute to evidence-based practice.
Cognitive-Behavioral The way you construe the world has bearing on how you are affected by events in the world. Your thoughts influence your behavior.
Attributions: Inferences we make about causes of events
Beliefs we hold about our abilities (self-efficacy)
Beliefs we hold about the behaviors of others
Cognitive Treatments
CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings
See how inner beliefs are affecting behavior and conflict in one’s life
Overgeneralizations, all-or-none thinking
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Behavioral Terms Behavioral
Reinforcement
Positive OR Negative
Most effective: Intermittent Reinforcement
Punishment
Shaping
Generalization
Extinction
Behavioral Treatments
Functional Assessment
Look at environment and see how person is functioning in the environment. Change environment, change person
References
(Berk, 1994).
Rowe and Wertsch, 2002
Vygotsky, 1978; Wertsch, 1985
Esther Barros-Garcia
On Wed, Sep 17, 2014 at 10:11 AM, Esther Barros-Garcia <ebarrosg@my.smccd.edu> wrote:
Vygotsky's Theories
The work of Lev Vygotsky and other developmental psychologists has become the foundation of much research and theory in developmental cognition over the past several decades, particularly of what has become known as social development theory. Vygotsky's theories stress the fundamental role of social interaction in the development of cognition (Vygotsky, 1978; Wertsch, 1985), as he believed strongly that community plays a central role in the process of "making meaning.
Basically Vygotsky's theory suggests that development depends on interaction with people and the tools that the culture provides to help form their own view of the world. There are three ways a cultural tool can be passed from one individual to another. The first one is imitative learning, where one person tries to imitate or copy another. The second way is by instructed learning which involves remembering the instructions of the teacher and then using these instructions to self-regulate. The final way that cultural tools are passed to others is through collaborative learning, which involves a group of peers who strive to understand each other and work together to learn a specific skill (Tomasello, et al., 1993).
His theory combines the social environment and cognition. Children will acquire the ways of thinking and behaving that make up a culture by interacting with a more knowledgeable person. Vygotsky believed that social interaction will lead to ongoing changes in a child's thought and behavior. Theses thoughts and behaviors would vary between cultures (Berk, 1994).
Hence Vygotsky assumes cognitive development varies across cultures, whereas Piaget states cognitive development is mostly universal across cultures.
2: Vygotsky places considerably more emphasis on social factors contributing to cognitive development (Piaget is criticized for underestimating this).
(i) Vygotsky states cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge. In contrast Piaget maintains that cognitive development stems largely from independent explorations in which children construct knowledge of their own.
(ii) For Vygotsky, the environment in which children grow up will influence how they think and what they think about.
3: Vygotsky places more (and different) emphasis on the role of language in cognitive development (again Piaget is criticized for lack of emphasis on this). For Vygotsky, cognitive development results from an internalization of language.
4: According to Piaget, language depends on thought for its development (i.e. thought comes before language). For Vygotsky, thought and language are initially separate systems from the beginning of life, merging at around three years of age, producing verbal thought (inner speech).
Sociocultural
Sociocultural Model
Sociology: Human relationships & social groups
Anthropology: Human cultures & institutions; cultural context that influence people
Questions:
What are the norms of society?
What roles does the person play in the social environment?
What family structure is the person a part of?
What is the social network of support?
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Therapy:
Family Systems
Individual, Group, Couple Therapy
Developmental Cognitive Neuroscience
Biological psychology, behavioral neuroscience, biopsychology, and psychobiology are all terms encompassing the application of biology, particularly neurobiology, to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals. Biological psychology investigates at the level of nerves, neurotransmitters, brain circuitry and the basic biological processes that underlie normal and abnormal behavior. Most research in behavioral neuroscience involves non-human animal models which have implications for understanding human pathology and contribute to evidence-based practice.
Cognitive (Cognitive-Behavioral)
The way you construe the world has bearing on how you are affected by events in the world.
Your thoughts influence your behavior.
Attributions: Inferences we make about causes of events
Beliefs we hold about our abilities (self-efficacy)
Beliefs we hold about the behaviors of others
Cognitive Treatments
CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings
See how inner beliefs are affecting behavior and conflict in one’s life
Overgeneralizations, all-or-none thinking
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
References
Vygotsky, 1978; Wertsch, 1985),
Esther Barros-Garcia
On Tue, Sep 16, 2014 at 4:49 PM, Esther Barros-Garcia <ebarrosg@my.smccd.edu> wrote:
In 1963, Stanley Milgram, a Yale psychologist, conducted an experiment on obedience. Milgram describe several experiments which establish to prove his point that people follow instructions without questioning the authority figure. In order to demonstrate that participants carried out orders without question, Milgram shows: “When the very first experiments were carried out, Yale undergraduates were used as subjects, and about sixty percent of them were fully obedient (696)”. The participants obey the authority under the complex circumstances. A lab director, a perceived authority figure, ordered participants to administer increasingly painful shocks to “subjects”, who were all strangers, which escalated to a lethal voltage. The participants were unaware that the shocks were not real and that “the subjects” were actually actors hired to pretend to be shocked. The majority of participants were willing to administer deadly shocks and only a minority refused to obey when asked by the lab director. In this controversial study, the participants were able to act without guilt because the lab director, the perceived authority figure, could be blamed for the harmful consequences of their actions.
People follow instructions without questioning the morality of the orders. “The point of the experiment is to see how far a person will proceed in concrete and measurable situation, in which he is ordered to inflict increasing pain on a protesting victim (694)”.This experiment powerfully demonstrates real-world behavior; people may act in ways that may be labeled as immoral if executed on an individual basis. However, these same actions may seem acceptable if they can be justified as “just following orders.” For example, many former Nazi officers used the defense of “just following orders” when tried for war crimes against the Jewish people, yet this defense rarely proved successful. Milgram’s experiment suggests that the desire to obey perceived authority strongly influences social behavior. It indicates that most people are unable to withstand social pressure and only a few successfully resist conformity when confronted with a perceived authority. Interesting future research might explore finding out what helped individuals resist harming others even when pressured by a perceived authority.
At present, Religious obedience is that general submission which religious vow to God, and voluntarily promised to their superiors. The person allowing him to be governed throughout his life by others for the sake of God, religious have taken a far greater part than formerly in civil and public life, personally fulfilling all the conditions required of citizens, in order to exercise their right of voting and other functions compatible with their profession. No political system rejects the votes of persons in dependent positions, and all freely permits the use of any legitimate influence, which corrects to some extent the vicious tendency of equalitarianism. The moral significance religious is bound morally to obey on all occasions. A member of a religious order has often compared to a dead body, but in truth, the religious vow by vanity and self-love and all their fatal opposition to the Divine will kill nothing. If superiors and subjects have sometimes failed to understand the practice of religious obedience, if direction has sometimes been indiscreet, human institution is not free from these accidental imperfections. The expression "blind obedience” (the catholic encyclopedia on CD-ROM ) signifies a keen appreciation of the rights of authority, the reasonableness of submission, and blindness only to such selfish or worldly considerations as would lessen regard for authority.
This article demonstrate that the problem of obedience is part psychological, social, and learned. The behaviors of these individuals in the study are patterns of society. The essence of obedience for some people seems to be that they feel no responsibility for their actions that the authority gives to the person in the study. The breaking up of society into people carrying out narrow and specific jobs takes away the human quality, says Milgram. The importance of this lesson is that ordinary people simply doing their jobs and can become agents in terrible destruction. People’s willingness to go almost any length to please the authority figure is demanding explanations.
References
In 1963, Stanley Milgram, a Yale psychologist
Esther Barros-Garcia
On Tue, Sep 16, 2014 at 4:02 PM, Esther Barros-Garcia <ebarrosg@my.smccd.edu> wrote:
THEORETICAL ORIENTATIONS/PERSPECTIVES
BIOLOGICAL
Genetic inheritance physiological changes exposure to toxic substances.
Main Tenets of this Perspective: A theoretical perspective in which it is assumed that disturbances in emotions, behavior, and cognitive processes are caused by abnormalities in the functioning of the body.
Biological Causes: domain includes genetic and environmental influences on physical functioning. People with psychological disorders may inherit a predisposition to developing behavioral disturbances. Of particular interest are inherited factors that alter the functioning of the nervous system. There are also physiological changes that affect behavior, which other conditions in the body cause, such as brain damage or exposure to harmful environmental stimuli, For example, a thyroid abnormality can cause a person’s moods to fluctuate widely. Brain damage resulting from a head trauma can result in aberrant thought patterns. Toxic substances or allergens in the environment can also cause a person to experience disturbing emotional changes and behavior.
Biological Perspective: Family inheritance studies provide strong evidence in favor of genetic explanations of antisocial personality disorder, the personality trait of psychopathy, an antisocial behavior with heritability estimates as high as 80% to explain this genetic variation, their attention is focused on genes related to the activity of serotonin and dopamine. One of particular is monoamine oxidase A, an enzyme coded by the MAOA gene. A mutation in this gene results in abnormally high levels of dopamine, serotonin, and norepinephrine. High levels of these neurotransmitters are linked to greater impulsivity. Researchers also believe that dependence of the mother during pregnancy can lead to epigenetic influences through DNA methylation. Malnutrition in early life may serve as another risk factor for the development of antisocial personality disorder.
In a study of children tested form age 3 to 17, those who experienced poor nutrition at age 3 showed more aggressiveness and motor activity as they grew up. By age 17 they had a higher likelihood of conduct disorder, a precursor to antisocial personality disorder (Liu, Raine, Venables, & Mednick, 2004)
Biological Treatments Medication /Neurotransmitters/Herbal Supplements
Other Medical Methods as Fit ECT Psychosurgery
How might this perspective view a disorder (e.g., depression)?
PSYCHOANALYTIC / PSYCHODYNAMIC
Emphasizes unconscious determinates of behavior. Of all the psychological approaches it gives greatest emphasis to the role of processes beneath the surface of awareness as influences on abnormality.
Classic Theorist:
Psychodynamic Treatments INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
Free Association
Hypnosis
Dream Analysis
How might this perspective view a disorder (e.g., depression)?
BEHAVIORAL
The theoretical perspective in which it is assumed that abnormality is caused by faulty learning experiences.
Classic Theorist:
Main Tenets:
Behavioral Treatments
Functional Assessment Look at environment and see how person is functioning in the environment.Systematic Desensitization Progressively pairing an incompatible response (relaxation) with a subject of fear Sequential therapy spanning many sessions
Exposure Therapy (In Vivo)
Expose individual to subject of fear in safe situation with therapist involved
How might this perspective view a disorder (e.g., depression)?
COGNITIVE:
It is assumed that abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.
Main Tenets:
Cognitive Treatments CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings. See how inner beliefs are affecting behavior and contribute to conflict in one’s life
Overgeneralizations
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Challenge distortions & Reframe CBT
Common cognitive distortions:
All-or-none-thinking
“Ugly or good looking”
“You trust someone or you don’t”
“If I can’t get an A, I’m not studying”
“That was a waste of time”
“If I can’t do it well, I’m not doing it at all”
“She is perfect”
“They completely messed up”
CBT Challenge your belief system!
Common cognitive distortions:
Overgeneralization (inaccurate use of always & never)
“I never do this right”
“She always yells at me”
Discounting the Positive
“He was just being nice. He felt sorry for me.”
Jumping to Conclusions
“I know I’m not going to pass, so I’m not going to try.”
How might this perspective view a disorder (e.g., depression)?
HUMANISTIC-EXISTENTIAL:
Psychological disorders as the result of cruelty, stress, or poor living conditions. The need to understand themselves and the world and toderive great enrichment form their experiences by fulfilling their unique individual potential.
Main Tenets:
TX Strategies:
Humanistic Model Existential-Humanistic Theory
Existentialism
Here and Now
Freedom
Responsibility
Existential Anxiety
Meaning
Rollo May
Irvin Yalom
Humanism
Here and Now
Human Potential
Self-Actualization
Self-Transcendence
Carl Rogers
Abraham Maslow
Person-Centered Therapy
Actualizing Tendency:
Developing all of your capacities
Potential
Self:
We see ourselves as a unique phenomenon
Person-Centered Therapy
Self-Actualizing Tendency:
Meeting your potential as your unique self…who are YOU?
Organismic Valuing & Conditions of Worth
Positive Regard
Being true to your self…
Unconditional Positive Regard
Humanistic Treatments
Individual Therapy
Group Therapy I.I.H.S. (International Institute for Humanistic Studies:
www.human-studies.org
How might this perspective view a disorder (e.g., depression)?
DIATHESIS-STRESS
The proposal that people are born with a predisposition (or diathesis) that places them at risk for developing a psychological sisorder if exposed to certain exptemely stressful life experiences.
Diathesis-Stress Theory
An “Interactionist” Approach
Genetic Vulnerability + Stress = Illness
Biological Factors: Genetic Predisposition/Congenital Birth Issue/Virus or Illness during Pregnancy
Stressful Events: Trauma (Abuse, Accident, Injury) Loss (Death, Early Attachment)
Stressors: drug use, exposure to toxins
MODEL Main Proposal:
BIO-PSYCHO-SOCIAL: A model in which the interaction of biological, psychological, and sociocultural factors is seen as influencing the development of the individual.
Psychosocial Rehabilitation
Biological Supports
Medication: Approaching chemical needs with Chemical Treatments
Psychological Supports
Therapeutic Interventions
Social Supports (Sociological) Social Skills, Cultural Supports
Psychodynamic Treatments
INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
Free Association
Hypnosis
Dream Analysis
INTRO, HISTORY, ASSESSMENT, DIAGNOSIS
INTRODUCTION
Normal: Typical standard pattern, average.
Abnormal: Away from the norm.
Abnormal behaviors are not always bizarre; no clear distinction can be drawn between normal and abnormal behaviors. No geniuses are particularly prone to insanity. Most psychological disorders are treatable.
Para-normal:
THE 4 D’S:
DEVIANCE: Deviation from the norm.Departing from usual standards.
DYSFUNCTION: How is the person functioning in daily life? Hygiene, Employment, Relationships More objective.
DISTRESS: How does the individual feel? What is the level of suffering experienced? More subjective
DANGER:Is the individual a danger to self?
Is the individual a danger to others?
Is the individual gravely disabled?
5150: Involuntary 72-hour hold
PSYCHOLOGIST PhD can do assessment, research, and therapy
PSYCHIATRIST MD licensed by state to practice medicine
LCSW: SOCIAL WORKER
Licensed Clinical Social Worker
Master’s in Social Work & License
MFT: Marriage & Family Therapist
Master’s in Counseling & License
HISTORY
5150:
Trepanation (Def / Purpose):
Trephination (also known as trepanning or burr holing) is a surgical intervention where a hole is drilled, incised or scraped into the skull using simple surgical tools. In drilling into the skull and removing a piece of the bone, the dura mater is exposed without damage to the underlying blood-vessels, meninges and brain. Trephination has been used to treat health problems associated with intracranial diseases, epileptic seizures, migraines and mental disorders by relieving pressure. There is also evidence it was used as a primitive form of emergency surgery to remove shattered pieces of bone from fractured skulls after receiving a head wound, and cleaning out the pools of blood that would form underneath the skull.
Hippocrates & 4 Humors:
Lobotomy:
Today, the word “lobotomy” is rarely mentioned. If it is, it’s usually the butt of a joke.But in the 20th century, a lobotomy became a legitimate alternative treatment for serious mental illness, such as schizophrenia and severe depression. Physicians even used it to treat chronic or severe pain and backaches. (As you’ll learn below, in some cases, there was no compelling reason for the surgery at all.) There’s a surprising history of the lobotomy for its use in mental health.
A lobotomy wasn’t some primitive procedure of the early 1900s. In fact, an article in Wired magazine states that lobotomies were performed “well into the 1980s” in the “United States, Britain, Scandinavia and several western European countries.”
ECT (Electroconvulsive Tx)
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
ECT is much safer today and is given to people while they're under general anesthesia. Although ECT still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
Deinstitutionalization:
Deinstitutionalization is becoming more and more of a popular choice of mental hospitals because pharmacotherapy can supply the needs of the patients in most cases by taking a drug to solve a problem that should be faced more directly.The early focus was on moving individuals out of state public mental hospitals and from 1955 to 1980, the resident population in those facilities fell from 559,000 to 154,000; the number of patients in mental hospitals decreased significantly. Then, in the 1990’s whole institutions began to close in significant numbers. However, this also led to many mentally unstable people out on the streets where they would be receiving no treatment.
In Your Own Words
Removing patients from hospitals and into normal living conditions, caused by successful use of medication but has resulted in a high rate of homelessness for people with mental disorders.
The policy when the hospital has to send some patients home after their treatments, even if the patient might become homeless, or they don't have family that can give them the proper care.
Removal of patients, even those still in chronic states, to take in more patients and decrease overcrowding, with the hopes that the patients could survive on their own and keep up with their medical agendas alone.
Releasing mental patients from the hospitals and back into the public.
Examples/Functions
Patients may have a hard time assimilating into everyday life, especially if their families are not helping to support them. It may be difficult finding a job,
causing homelessness to be a potential issue of deinstitutionalization in the cases where medication is at a price unattainable to the released patients and/or they are unable to adapt from a controlled environment to an uncontrolled environment.
Patients who are successfully deinstitutionalized may be able to maintain relatively normal lifestyles as they continue therapy and treatment for their condition.
Allowing patients with psychological disorders to be placed, ideally, in the hands of a relative to resume treatment outside of a mental hospital.
Current Issues in Care:
ASSESSMENT TESTS
OBJECTIVE SELF-REPORT: (Briefly define and give examples)
PROJECTIVE TESTS: (Briefly define and give examples)
Mental Status Exam:
MRI: (Magnetic Resonance Imaging)
fMRI:
MRI that now captures functional pictures of the brain
Can see changes from one moment to the next
Replacing PET scans
See immediate response
SOME IMPORTANT INTERVIEW TOPICS: 1. 2. 3.
DSM Diagnostic and Statistical Manual of Mental Disorders
Kraeplin:
DSM Classification History
Emil Kraeplin (1856-1926)
Endogenous: Caused from within--internal
Exogenous: External Cause
DSM Classification
DSM is published by: American Psychiatric Association
Primary Purpose of the DSM: Facilitate Communication Provide Shorthand Information
Diagnostic Tool Focuses on MANIFEST symptoms (Not dependent on your theoretical background)
DSM Classification
Limitations: What is in DSM is what has sufficient data and research to justify the inclusion. If it is not in there, it doesn’t mean it is not important, means not enough justifiable data
DSM Classification History
Emil Kraeplin (1856-1926)
Classified disorders into 13 categories
Grouped things together that he thought had a common etiology
Created descriptive categories based on symptom similarity
The system we use today is a DIRECT relation to his system
DSM Classification History PRIMARY PURPOSE: To standardize data collection
To Facilitate Communication among Clinicians
Strongly influenced by Psychodynamic Approach
Very little empirical data available
Listed 60 disorders (diagnostic make-up represented a CONSENSUS of disorders that were being noticed by psychiatrists in the 50s and 60s
Disorders were considered to be reactions to real or imagined trauma
DSM Classification History
DSM I: 1952: Labeled things as REACTION
DSM II: 1968
Didn’t label everything a reaction (major departure from DSM I)
BOTH distinguished between psychosis (break from reality—hallucinations, delusions, illogical thinking) and neurosis (most commonly depression and anxiety)
DSM Classification History
DSM III: 1980
Partially to revise out the psychodynamic over-influence
THE MEDICAL MODEL becomes the primary approach
DSM becomes “ATHEORETICAL” in that it had no preferred etiology for the disorders
Spitzer gets homosexuality out of the DSM
DSM Classification History
DSM IV: 1994 (TR in 2000)
Minor revisions in codes to be more compatible with ICD-(International Classification of Diseases)
18 Major Categories with many disorders
Based upon a comprehensive review of literature
New categories included only if enough data
DSM Classification History
DSM IV: 1994 (TR in 2000)
Minor Revision
Multi-Axial Diagnostic System
5 Axes seeking essential factors necessary for a comprehensive diagnosis
Specific to DSM IV (started with DSM III
Axes: Define & give example:
Axis I: General Clinical Disorders.
Major depression disorder
Generalized anxiety disorder.
Axis II: Personality Disorders Mental Retardation.
Dependant Personality DX
Panic Disorder
AXIS III: General Medical Conditions
Broken Hip
Hypertension
Diabetes
AXIS IV: Multi-Axial Diagnosis
Resent Job Loss
Obese
AXIS V: Psychosocial Stressors
46 scles from 1 to 100 (number 46)
GAF and severity scales
Axis V: GAF (Global Assessment of Functioning)
Scale of 1-100
DSM Classification History
DSM 5: Published May, 2013
Removal of Multi-Axial System
Looking at Basic Nomenclature Issues
E.G., Some disorders added, condensed, removed Neuroscience and Genetics Research
Lifespan Approach
DSM as a “living document” (DSM 5.1, etc.)
Cross Cultural & Gender Issues
Cohesion with ICD-9, 10 & 11 (11 out 2014)
Removal of NOS – now “Unspecified” or “Other Specified”
TREATMENT STRATEGIES
BIOLOGICAL: TX:
Biological Treatments Medication Neurotransmitters Herbal Supplements
Other Medical Methods as Fit
ECT
Psychosurgery
PSYCHODYNAMIC: TREATMENT
INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
Free Association
Hypnosis
Dream Analysis
BEHAVIORAL: TX:
Functional Assessment
Systematic Desensitization Functional Assessment
Look at environment and see how person is functioning in the environment.
Systematic Desensitization
Progressively pairing an incompatible response (relaxation) with a subject of fear
Sequential therapy spanning many sessions
Exposure Therapy (In Vivo)
Expose individual to subject of fear in safe situation with therapist involved
COGNITIVE-BEHAVIORAL TX:
COGNITIVE:
It is assumed that abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.
Main Tenets:
Cognitive Treatments CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings. See how inner beliefs are affecting behavior and contribute to conflict in one’s life
Overgeneralizations
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Challenge distortions & Reframe CBT
Common cognitive distortions:
All-or-none-thinking
“Ugly or good looking”
“You trust someone or you don’t”
“If I can’t get an A, I’m not studying”
“That was a waste of time”
“If I can’t do it well, I’m not doing it at all”
“She is perfect”
“They completely messed up”
CBT Challenge your belief system!
Common cognitive distortions:
Overgeneralization (inaccurate use of always & never)
“I never do this right”
“She always yells at me”
Discounting the Positive
“He was just being nice. He felt sorry for me.”
Jumping to Conclusions
“I know I’m not going to pass, so I’m not going to try.”
How might this perspective view a disorder (e.g., depression)?
Brain Hemispheres
Left Hemisphere:
Words
Right Hemisphere: Images Dialectical Behavioral Therapy (DBT)
Dialectical—tension between acceptance and change /Problem-solving skills & Coping Skills
Weekly psychotherapy/ Weekly 2.5 hours skills-training group/Phone consultations with primary therapist
Weekly consultation of team members/6 hours/week therapist time (direct & indirect)
DBT Objectives
Decreasing suicidal behaviors/Decreasing therapy-interfering behaviors
Nonattendance
Noncollaboration
Noncompliance
Increasing Quality of Life improving behaviors
Increase behavioral skills
Mindfulness skills
Interpersonal effectiveness
DBT Modules
Mindfulness
Emotional Regulation
Distress Tolerance
Interpersonal Effectiveness
HUMANISTIC Person-Centered/UPR
Exam I is worth 50 points. Completing the review sheet posted above by filling in the spaces with pertinent defining information & related examples will help you greatly with your exam preparation. In addition, reviewing and creating responses to the following questions will help you in preparing for any written responses.
Humanistic Treatments:
Individual Therapy
Group Therapy I.I.H.S. (International Institute for Humanistic Studies:
www.human-studies.org)
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Therapy:
Family Systems
Individual, Group, Couple Therapy I.I.H.S. (International Institute for Humanistic Studies:
www.human-studies.org
How do you define abnormal? What is the purpose of defining abnormal? List and describe the 4 Ds and discuss these criteria may assist you in your definition? Explain the ways these 4 criteria may be useful to keep in mind during an assessment. Use examples to support your discussion.
Discuss the history of the treatment of mental illness up until deinstitutionalization in the 1960s. Discuss the implications of deinstitutionalization upon mental health treatment and the creation of Community Based Organizations. Discuss what you feel is necessary for effective mental health treatment.
Discuss the use of trepanation in the history of treatment of mental illness and describe for what reasons it was likely used. Describe the treatment of lobotomy and describe how it is similar to and different from the use of trepanation as a former method of treatment.
List each of the 5 DSM axes and describe what each axis represents (use an example to support your definition of each). Imagine you are a professional psychotherapist. What assessment techniques might you have utilize in coming up with your diagnosis? Select 2 and describe with detailed examples.
Using depression as an example, describe how depression might be viewed from each of the following therapeutic models: Biological, Psychodynamic, Cognitive-Behavioral, Humanistic-Existential. Describe the possible etiology and potential treatment for depression from each of the 4 listed models.
Differentiate the Behavioral treatment method of Systematic Desensitization with the Cognitive treatment method of Cognitive Behavioral Therapy (CBT). Discuss the purpose and method of each. Describe the ways in which each are utilized to help an individual achieve improved mental health. Use examples.
Discuss the history and evolution of the DSM. Describe some of the major changes that have occurred moving from DSM-IV to DSM-5. Discuss the removal of the axes in particular. In doing so, describe the axes and what was listed on each axis. Describe how you might list a diagnosis in the model of DSM-5 as well.
Theoretical Orientations
Biological
Psychodynamic
Behavioral
Cognitive (Cognitive-Behavioral)
Humanistic (Existential-Humanistic)
Sociocultural
Interactionist:
Biopsychosocial & Diathesis Stress
Biological
Physical Processes as Key to Behavior
“BioMedical” Perspective
Emphasizes Genetic Contributions
Genetic Predispositions
Heredity
Factors within the Nervous System
Hormones, Neurotransmitters
Physical Trauma, Illness
Biological Treatments
Medication
Neurotransmitters
Herbal Supplements
Other Medical Methods as Fit
Surgery to remove tumor if tumor is the organic problem
ECT
Psychosurgery
Psychodynamic Model
Psyche= Soul/Mind
Dynamic= Inherently conflicted organisms
Based on the concept of the Unconscious
Emphasis on Early Childhood
Inner Conflict of the Unconscious:
Ego & Defense Mechanisms
Repression
Denial
Projection
Psychodynamic
Psychoanalytic
Psychodynamic: Id, Ego, Superego
Unconscious
Emphasis on Early Childhood Experiences
Formative Years
Attachment Styles
Secure, Insecure, Anxious, Avoidant
Psychodynamic Treatments
INTRAPSYCHIC METHODS
Methods used to access the unconscious conflicts in the psyche
Intensive Therapy: “Talk Therapy”
(Now some shorter-term models, but classically long-term)
Free Association
Hypnosis
Dream Analysis
Behavioral Model
Based upon Skinner’s Operant Conditioning
An Individual Operates on the Environment
Concentrates on the behaviors or responses an individual makes to the environment
Do not look at the psyche, look at the organism
Look at what is happening in your life NOW
Deal with the behavior and alter the environment in order to change the behavior.
Behavioral Terms Behavioral
Reinforcement
Positive OR Negative
Most effective: Intermittent Reinforcement
Punishment
Shaping
Pairing
Generalization
Extinction
Behavioral Treatments
Functional Assessment
Look at environment and see how person is functioning in the environment.
Change environment, change person
Systematic Desensitization
Progressively pairing an incompatible response (relaxation) with a subject of fear
A sequential therapy spanning many sessions
Exposure Therapy (In Vivo)
Exposing individual to subject of fear in a safe situation with therapist involved
Cognitive (Cognitive-Behavioral)
The way you construe the world has bearing on how you are affected by events in the world.
Your thoughts influence your behavior.
Attributions:
Inferences we make about causes of events
Beliefs we hold about our abilities (self-efficacy)
Beliefs we hold about the behaviors of others
Cognitive Treatments
CBT: Cognitive Behavioral Therapy
Uncover internal thoughts, beliefs, feelings
See how inner beliefs are affecting behavior and conflict in one’s life
Overgeneralizations, all-or-none thinking
Negative Thinking
Illogical Thought Patterns
Inflexible Standards of Perfection
Become aware of “automatic” self-talk
Humanistic Existential-Humanistic)
Existential-Humanistic Theory
Existentialism
Here and Now
Freedom
Responsibility
Existential Anxiety
Meaning
Rollo May
Irvin Yalom
Humanism
Here and Now
Human Potential
Self-Actualization
Self-Transcendence
Carl Rogers
Abraham Maslow
Humanistic Treatments
Individual Therapy
Group Therapy I.I.H.S. (International Institute for Humanistic Studies: www.human-studies.org)
Sociocultural
Sociocultural Model
Sociology: Human relationships & social groups
Anthropology: Human cultures & institutions; cultural context that influence people
Questions:
What are the norms of society?
What roles does the person play in the social environment?
What family structure is the person a part of?
What is the social network of support?
Sociocultural Treatments
Examine a person’s social surroundings
Explanations focus on:
Family structure and communications
Social Networks
Societal Conditions
Societal labels and roles
Therapy:
Family Systems
Individual, Group, Couple Therapy
Biopsychosocial & Diathesis Stress
Psychosocial Rehabilitation
Biological Supports
Medication: Approaching chemical needs with Chemical Treatments
Psychological Supports
Therapeutic Interventions
Social Supports (Sociological)
Social Skills, Cultural Supports
Diathesis-Stress Theory
An “Interactionist” Approach
Genetic Vulnerability + Stress = Illness
Biological Factors:
Genetic Predisposition
Congenital Birth Issue
Virus or Illness during Pregnancy
Brain cell loss due to stress or disease
Stressful Events:
Trauma (Abuse, Accident, Injury)
Loss (Death, Early Attachment)
Any number of stressors: drug use,
exposure to toxins
Causes of Stress:
Nature and Nurture
Physical Illness
Chronic Pain
Genetic Make-up & Heritability
Birth Trauma, Illness
Attachment Styles
Drug Use
Marriage / Divorce
Final Exams
Poverty
Stress Changes the Brain
Stressors experienced over a period of time and severity—whether biological or environmental—create a chronic stress response in the brain.
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