Psychopathology Final

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Psychopathology Final
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  1. Anxiety Disorder
    more than a normal amount of reaction; more intense, more persistent and maladaptive

    -must cause sig distress, hurts socially & academically
  2. What is Anxiety
    The real or percieved normal reaction to threat

    -normal to have anxiety
  3. Triple Response Model Components
    • Cognitive
    • Motor Variables
    • Physiological
  4. Triple Response Model:
    Cognitive
    Fear related thoughts.

    ex. easter bunny = scary, breaking into house and may steal you
  5. Triple Response Model:
    Motor Variables
    "fight or flight" when youre scared you either run or stay and fight or freeze ("play dead")
  6. Triple Response Model:
    Physiological
    activation of the sympthathetic nervous system.

    ie. sweating, increase in heart ratem blood pressure, shake, plams & feet get colder(blood rushes toward center), dry mouth, butterflies
  7. Cognitive-Behavioral Theory: Pathways to fear
    • -Genetic predisposition (Seligman)
    • -Respondent Conditioning (Watson)
    • -2-factor theory (Mowrer)
    • -Social Learning (Rachman)
    • -Information Transmission (Rachman)
    • -Maladaptive thoughts (Beck)
  8. Cognitive-Behavioral Theory: Pathways to fear

    Respondent Conditioning
    • How fears are developed in the first place
    • ex. little albert
  9. Cognitive-Behavioral Theory: Pathways to fear:

    2-Factor Theory
    • How fears are maintained.
    • ex. operant conditioning. Fearful behaviors are rienforced
  10. Cognitive-Behavioral Theory: Pathways to fear:
    Social Learning
    Watching and learning fear through social modeling
  11. Cognitive-Behavioral Theory: Pathways to fear:
    Information Transmission
    • Other people telling you to be scared.
    • ex. a snake head shaped like a diamond is poisonious
  12. Cognitive-Behavioral Theory: Pathways to fear:
    Maladaptive Thoughts
    Cognitive Theories. Thoughts make the anxiety more extreme. Distorted anxiety can lead to more intense anxiety.
  13. What are Panic Attacks?
    NOT a disorder.

    • Discrete period of intense fear/discomfort when 4+ of these occured w/in 10 minutes:
    • increased heart rate, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, feeling dizzy, de-realization, fear of dying, fear of losing control, numbness, chills or hot flashes
    • *Physiological symptoms taking over your body
  14. Panic Disorder
    • -recurrect UNEXPECTED panic attacks.
    • -one of the attacks followed by one month of one of these...concern about additional attacks, worry about attacks implications, sig. change in behavior
    • -with or w/o agoraphobia
  15. Agoraphobia
    • NOT a disorder, but a specific phobia
    • -anxiety about places in general from which escape may be difficult. (ie. crowds, lines, bridges)
    • -situations are avoided or endued with distress(or dont go)
    • **you can diagnose agoraphobia w/o history of panic disorder
  16. Specific Phobia
    • -fear cued by specific object or situation
    • -exposure provokes anxiety--may lead to a situational panic attack.
    • -person recognizes fear is excessive(except children)
    • -phobic situation is avoided (or endured w.stress)
    • -causes impairment
    • -for children it must last at least 6 months(no time length for adults)
    • -specific types: animal, natural environment, blood-injection-injury, situational, other
  17. Post-Traumatic Stress Disorder
    • Exposed to traumatic event that:
    • -involved threat to physical integrity
    • -involved intense fear, helplessness, horror
    • *event is reexperienfced in at least one way:
    • -recurrect recollections (play)
    • -dreams(may be nonspecific)
    • -feeling like its recurring
    • -intense psychological distress
    • -physiological reactivity to cues(sand reminds of iraq)
    • *persistent avoidance of thoughts, places, diminished interest in acitivities, cant recall parts of event, feeling of detachment, flat affect, sense of foreshortened future
    • *in kids must last 1 month
  18. Acute Stress Disorder
    • similar to ptsd
    • symptoms must last between 2 days & 4 weeks
  19. Obessive-Complusive Disorder (OCD)
    • Obsesions:
    • persistent intrusive thoughts/images,worries, attempts to ignore or suppress, not believed that thoughts were put in by someone elses idea
    • *and/or compulsions:
    • repetitive behavior or mental acts that the person feels driven to do, behavior or mental acts are unrealistic attempts to reduce distress
    • *recognize the excessiveness (in children)
    • *causes impairment

    **dont need obsessions & compulsions (only one)
  20. Generalized Anxiety Disorder
    • *excessive anxiety and worry occuring more days than not about severl events for 6+months
    • *1+the folling(children), 3+(adults)
    • restlessness,easily fatigued, diff concentrating, irritability, muscle tension, sleep disturbance
    • *causes impairment
  21. Social Anxiety Disorder (social phobia)
    • fear of acting in an embarrassing way during a social or performance istuation in which person is exposed to unfamilliar people or scruitiny by others
    • exposure provokes anxiety - may lead to situational panic attack, person recognizes that the fear is excessive, social situations avoided
    • *causes impairment
  22. Seperation anxiety Disorder
    • excessive anxiety about seperation from home or caregivers
    • *distress about seperation, worry about people, worry about event that may lead to seperation, reluctance to go to school, reluctance to be w/o major caregiver, reluctance to sleep w/o caregivers, nightmares about seperation, physical symptoms about seperation
    • 4+weeks (onsent before 18)
    • causes impairment
  23. selective mutism
    • failure to speak in specific social situations
    • causes impairment(achievement or social
    • 1+month
    • not due to lack of knowledge or comfort w/ language
  24. school refusal (school phobia)
    • NOT a dsm diagnosis
    • multiple functions
  25. K-SADS
    Schedule for affective disorders and schizophrenia for school-age children

    assessment of anxiety
  26. ADIS
    Anxiety Disorders Interview Schedule

    Assessment of anxiety
  27. RCMAS
    Revised children's manifest anxiety scale

    self report questionnaire for anxiety
  28. MASC
    • Multidimensional Anxiety Scale fo Children
    • -self report questionnaire for anxiety
    • -areas of assessment: physical symptoms, harm avoidance, social anxiety, seperation/panic
  29. Behavior avoidance test
    • observational assessment for anxiety
    • -confront feared object/situation for up to 5 mins
    • -measures time or distance
    • -use a fear thermometer
    • -exposes child to feared object
  30. Anxiety Self-Monitoring
    • Daily Diary
    • -time; situation; what did you do; thoughts; how afraid (0-10)
    • -must sell child on diary (explain purpose and possible reward program)
    • -write down every anxious thought
  31. is it healthy for parents to encourage their kids to ignore anxiety?
    NO
  32. TF-CBT
    • Trauma Focused-Cogntive Behavioral Therapy
    • **WELL ESTABLISHED**
    • -treatment for anxiety disorders
  33. School-based CBT
    • **PROB EFFICACIOUS**
    • -treatment for anxiety disorders
  34. treatment for OCD
    • NO well established treatments
    • *prob efficacious:
    • -CBT(exposure based)
    • -CBT(exposure based w/ SSRI-sertraline)
  35. Treatments for phobic & most anxiety disorders
    • *no well established
    • *prob efficacious
    • -CBT(individual, group, group w/ parents)
    • -social effectiveness training for social phobia
  36. Barrett et al. (1996)
    • -79 children w/ anxiety disorders
    • -ages 7-14
    • -12 sessions w/ manual based treatment

    • *RESULTS:
    • -lowest % that still met criterian for anxiety disorder at the end of treatment was CBT+family, then CBT, then waitlist/control
  37. Barrett et al. (2001) 6 year follow up
    • -only 14 % had an axiety disorder
    • -no difference between CBT group & CBT+family group
    • -waitlist got treatment after completion of study so no stats on that
    • *could suggest thta parents are necessary to include
  38. Barrett et al. (2004)
    • -77 children w. OCD
    • -ages 7-17 years
    • *results:
    • -none of the children got better w/o some type of intervention
    • -CBT-individ & CBT-group both had a small number of participants that still had disorder at post-treatment (less than 20% for both)
  39. Barrett et al. (2005) 1.5 year follow-up
    • CBT-individ: 30% still had OCD
    • CBT-group: 16% still had OCD
    • *Groups help to see diff forms of ocd & ways to cope & can help them manage theirs later. Helps promote generalization
  40. basic "core four" components of modular cognitive-behavioral therapy for childhood anxiety disorders
    • **all kids get these in some form
    • -create a fear ladder(fear heirarchy)
    • -learning about anxiety(education)
    • -exposure(practice)
    • -maintenance (relapse prevention) <-good for group therapy to generalize
    • *cherry picks which components each kid gets, depending on what the anxiety is for.
  41. Fear Ladders "fear thermometer"
    • about 10 situations (only ideas)
    • -child & therapist decide together)
    • -Subjective Units of Distress (SUDs)*
    • -from 0-10 how anxious would it make you feel to do these activities
  42. SUDs
    Subjective Units of Distress

    *aka fear ladder
  43. children & parents learning about anxiety
    • -parts: feelings, thoughts actions
    • -everyone has it
    • -anxiety=alarm w/ stages (1"yellow light"=warning danger might be coming. 2"red light"=warning danger is here)
    • -some anxiety is good (protects us)
    • -some anxiety is bad (false alarm)
    • -goal is to manage false alarms
    • -can test to see if your fears are false alarms w. practice
    • -practice can be gradual(start at bottom of ladder)
    • *never make clients do something you cant do
  44. systematic desensitization
    • *moving up the ladder to progressively more anxious behavior
    • -in vivo (real life) exposure
    • -imaginal (talk therapy)
    • -virtual reality (cant expose, so you put a virtual reality mask on to experience it)
  45. Participant Modeling
    when you watch others get exposed to what makes you anxious
  46. Flooding
    • when you are exposed to top level of your fear ladder right away.
    • -expose someone until they calm down
    • *not typically used
  47. Panic disorder - exposure method
    introceptive exposure: have the person purposefully have the symptoms of a panic attack (breath out of a straw, spin in a chair dizzy)
  48. agoraphobia - exposure method
    go to the places
  49. specific phobia - exposure method
    expose them to the object or situation
  50. ptsd - exposure method
    expose them to related stimuli
  51. GAD (general anxiety disorder) - exposure method
    "worry chair" - have scheduled times of the day where you are able to worry & you are forced to worry only during that time
  52. Maintenance & relapse prevention for anxiety disorder
    • -praise accomplishments in therapy
    • -make connections between gains & practice
    • -emphasize the need for continued exposure in everyday life
    • -discuss lapse & relapse (just bc you have a slip doesnt mean all is lost. Have a plan for how to handle when you slip)
    • -gradually decrease sessions
  53. cognitive restucturing
    • -probability overestimation (thinking it will happen more than it would)
    • -catastophic thinking (thinking that something that happens is worse than the others)
  54. parents role in decreasing anxiety
    • -active ignoring to decrease attention for fearful behavior
    • -increase praise for brave behavior
    • -rewards to increase motivation
    • -t.o. when disruptive behaviors interfere
  55. STOP
    name brand version of CBT for children:

    • Scared? (identify feeling scared)
    • Thoughts (identify anxious thoughts)
    • Other (generate other thoughts)
    • Praise (self-praise)
  56. FEAR
    name brand version of CBT for children:

    • Feeling frightened? (recognize fear)
    • Expecting bad things to happen (recognize the fearful self-talk)
    • Attitudes/Actions that will help (develop & use coping skills)
    • Results & Rewards (self-Evaluation & self-reward)
  57. Relaxation training:
    • -deep breathing (belly breaths)
    • -Progressive Muscle Relaxation (PMR): tighten & relax each muscle in body
    • -imagery (imagine calm scenarios)
    • -biofeedback (can see how much the sun is & how much more relaxed they are
    • -hand warming exercise (imagine hands are tucked in a warm place)
  58. Treatment for Adults w/ specific phobia
    • WELL ESTABLISHED
    • *exposure therapies
  59. Treatment for Adults w/ generalized anxiety disorder
    • WELL ESTABLISHED
    • *cognitive & behavioral therapies
  60. Treatment for Adults w/ Social Anxiety Disoerder & public speaking
    • WELL ESTABLISHED
    • *cognitive & behavioral therapies
  61. WELL ESTABLISHED Treatment for Adults w/ ocd
    • -exposure & response prevention (prob effic in kids)
    • -cognitive therapy
  62. Treatment for Adults w/ Panid Disorder
    • WELL ESTABLISHED
    • *cognitive behavioral therapy

    • PROB EFFICIACIOUS
    • *Applied relaxation
    • *psychoanalytic treatment
  63. Treatment for Adults w/ PTSD
    • WELL ESTABLISHED
    • *prolonged exposure
    • *cognitive processing therapy
    • *eye movement desensitization & reprocessing (purple hat theory) rapid eye movement while imagining fear

    • PROB EFFICACIOUS
    • *Stress Innoculation Therapy (CBT)

    • NO RESEARCH SUPPORT
    • *psychological debriefing
  64. Acceptance Commitment Therapy (ACT)
    • -behavioral therapy
    • -CBT (actively talk back to anxious thoughts)
    • -act (do active things in your life)
  65. Freud's view on human nature
    • -negative
    • -sinners
    • -psychopathology
  66. seligman's view on human nature
    • -positive
    • -moraility
    • -alturism
    • -positive psychology
  67. what does the "experience machine" tell us?
    • that if we could be happy all of the time, most of us wouldnt want it. down time helps us appriciate the good times.
    • -theres room in our life for sadness and depression
  68. where does happiness come from?
    • -pleasures (tv, spa, chocolate)
    • -gratifications (playing a sport, reading a book, volunteering)
  69. Unipolar Depressive Disorders
    • -major depression
    • -dysthymic disorder
    • -depressive - NOS
  70. Bipolar disorders
    • -bipolar I
    • -bipolar II
    • -Cyclothymic
    • -bipolar - NOS
  71. Mood Disorders
    • -Unipolar Depressive Disorders
    • -Bipolar Disorders
    • -Mood Disorder -NOS
  72. Major Depressive Episode
    • 5 symptoms present in same 2 week period and are diff from previous fuctioning:
    • -depressed all day
    • -disinterest in activites
    • -weight loss
    • -insomnia or hypersomnia
    • -psychomotor agitation
    • -loss of energy
    • -guilt
    • -inability to concentrate
    • -suicidal ideation
  73. major depressive disorder
    • *single episode (mild, moderate, severe)
    • -one major episode, no manic/hypomanic/mixed episodes

    • *recurrent (mild, moderate, severe)
    • -2+ major depressive episodes, no manic/hypomanic/mixed episodes
  74. Dysthymic Disorder
    *milder than major depressive disorder but lasts longer

    • *depressed mood for most of day for at least 2 years (youth=1year)
    • *while depressed 2+: poor appitite, insomnia,low energy, low self-esteem, poor concentration, feelings of hopelessness
    • *neevr w/o symptoms for 2 straight months
    • *less than 21 years-old = early onset
  75. depressive disorder -NOS
    • *"minor depressive disorder ": fewer than the 5 required symptoms
    • *"recurrent brief depressive disorder" : episodes lasting 2 days up to 2 weeks...once a month for 12 months
  76. Hankin et al. (1998) prevalence of major depressive disorder by Gender
    • pretty even until age 15 (more females)
    • -10% of females have it by age 18
    • -females are more likely to have it
  77. Bertelsen et al (1977) concordance rates for twins w/ mood disorders
    • if a monozygotic twin has M.D. than its very likely the other will
    • *genes play a big role
  78. Norepinephrine for mood disorder
    • not enough=depressed
    • too much=mania
  79. serotonin for mood disorders
    reduction can trigger a fall in norepinephrine levels
  80. biological research on mood disorders
    • -mostly done w. adults
    • -directionality: correlational study, depressed behavior caused the changes in neurotransmitters
  81. behavioral theories of depression
    • *lack of positive rienforcement (not valued by family or peers and lack the social skills to obtain social positive rienforcement)
    • *learned helplessness (repeated experiences with uncontrollable events, depressive attributional stule:stable, internal, global)
    • *modeling (depressed caregivers have depressed children)
  82. depression in caregivers
    • depressed parents tend to be:
    • -less positive affect, war & praising
    • -controlling, impatient & irritable
    • -use coercive discipline techniques
  83. Seiner & gelfand (1995) on depressed mothers
    • non-depressed mothers kept a "still face"
    • -children physically withdrew from mothers
    • *observable impact of nonwarmth on children
  84. cognitive theory: Beck
    • -dismiss positive events
    • -remember negative events more readily
    • -negative automatic thoughts about: self, future & world
    • -self-fulfilling prophecy: how you think about yourself can lead you to have this occur
  85. Beck's cognitive distortions
    • -all-or-nothing thinking
    • -overgeneralization
    • -mental filter
    • -discounting positives
    • -jumping to conclusions
    • -minimization or magnification
    • -emotional reasoning
    • -"should" statements
    • -labeling
    • -personalization/blame
  86. cognitive modeling
    • what you say in front of(and to) your children can become their thoughts
    • *how kids learn cognitive distortions
    • *never, ever or always can lead to cognitive distortions
  87. EBT's for depression in youth
    • WELL ESTABLISHED:
    • CBT, group CBT, group CBT for children +parent, terpersonal psychotherapy

    • PROB EFFICACIOUS:
    • -self control therapy (school-based cbt, social skills training)
    • -penn prevention program (cbt model, social problem solving
    • -behavior therapy
    • -coping with depression (CWD-A)
    • -CBT for adolescents, & + family, group CBT+parents
    • -interpersonal Therapy (IPT-A)
  88. Cognitive-Behavioral Therapy
    • -Cognitive component :recognizes distoritions & modifies distortions w/ rational responses
    • -behavioral component :weekly activity schedule (behavioral activation- good to have things to look forward to), social skills training
  89. Increasing optimism by ABCDE
    • Adversity (when bad things happend)
    • Belief (negative beliefs)
    • Consequences (emotions)
    • Disputation (knowing how to make it better)
    • Energization (positive & focused)
  90. Learning Disputation
    • "im the worst student in this class"
    • *find evidence
    • *consider more causes
    • *decatastophize: even if you are, is it the end of the world?
    • *consider usefulness: how is it a bad thing?
  91. Daily mood record components
    date |situation| thought| belief (0-100)| Distortion| Rational Response


    *if you go dark & negative you need to talk those feelings out and have rational responses
  92. Treating depressed children: ACTION
    • Always find something to do to feel better
    • Catch the positive
    • Think about it as a problem to be solved
    • Inspect the situation
    • Open yourself to the positive
    • Never get stuck in the negative much
  93. Interpersonal Therapy
    • -Grief (helf mourn & reestablish interests)
    • -interpersonal disputes (make a plan & change communication)
    • -role transitions (understand gained/lost & learn new skills)
    • -interpersonal deficits (reduce isolation & improve social skills)
    • -single-parent families (understand feelings & define roles/expectations)
  94. humaistic approach for depression
    • client centered, not eddective of a stand alone treatment but is good combined w/ many things
    • *therapeutic alliance: the more the client feels, the more successful treatment will be.(evidence based)
    • *supportive therapy
    • *reflective listening
  95. Treatment for Adolescents with Depression Study (TADS)
    • -439 adolescents, ages 12-17
    • -diagnosed with MDD
    • -12 weeks of treatment

    • RESULTS:
    • teens responded to medicine
  96. Robert Leahy on Pain
    • *pain points to meaning(important part of life, tells us whats important in our lives)
    • *pain tells tou what you value
    • *pain helps you overcome adversity(motivate to make changes)
    • *too much medicine doesnt give you a chance to feel pain
    • *pills dont teach skills* cant change the way you act or react to a situation
  97. cognitive therapy & neurotransmitters
    • peoples neurotransmitters in brain change after getting cognitive therapy the same way meds would.
    • *med are easiest & quickest , but short lived
    • *cognitive therapy changes for a more sig way & longer lasting
  98. concordance rates in bipolar disorder
    more genetically based than the others
  99. manic episode
    • a period of abnormally and persistently elevated, expansive or irritable mood lasting 1+ week & 3 symptoms:
    • -inflated self-esteem, decreased need for sleep, more talkative, racing thoughts, sitractibility, increased goal directed activity, excessive involvement in activities that have painful consequesnces
  100. mixed episodes
    simultaneously major depressive & manic episodes
  101. hypomanic episode
    • -similar to manic episode but only 4+days & no sig impairment
    • -unequivocal change in functioning
  102. bipolar I
    presence/ history of at least 1 manic or mixed episode
  103. bipolar II
    presence/history of 1+ major depressive episode & 1+ hypomanic episode & no manic or mixed episodes
  104. cyclothymic disorder
    1 year of the presence of numerous periods w/ hypomanic symptoms and numeroud periods with depressive symptoms
  105. bipolar disorder - NOS
    very rapid alternation between manic symptoms and depressive symptoms that meet symptom thershold criteria but not min duration criteria
  106. non-episodic irritability
    • not occuring for a long period of time, but just very irritable
    • *predominately male
    • *most dont grow up to have bipolar as an adult
    • *more likely to develop unipolar depressive and anxiety disorders as adults
    • *cannot be differentiated between oppositional defiant disorder (most extreme 15% odd cases)
  107. temper dysregulation disorder with dysphoria for non-episodic irritability
    • *severe recurrent temper outbursts in response to common stressors (3 or more per week)
    • *mood between outbursts is negative
    • *12+ months in duration
    • * at least 6 years-old
    • *no mania lasts longer than 1 day
    • *not better accounted for by bipolar
  108. interventions for bipolar
    • *Phamaceuticals: mood stabilizers, antipsychotics
    • *psychosocial: family-focused treatment for adolescents, multi-family psychoeducation
  109. probably efficacious treatments for bipolar
    • *family focused treatment for adolescents
    • *multi-family psychoeducation
  110. FFT-A for bipolar
    • family-focused treatment for adolescents
    • *21 session, 9 month outpatient intervention with four phases:
    • -assessmrnt of child & fam
    • -psychoeducation of coping with m.d. & how to prevent mania or depression
    • -comm enhancing skills training
    • -problem-solving skills training
  111. child & family-focused cognitive-behavioral therapy: RAINBOW
    • Routine to encourage stable schedule
    • Affect regulation and anger control
    • I can do it - positive self talk
    • No negative thoughts
    • Be a good friend & balanced lifestyle
    • Optimal problem solving
    • Ways to get support
  112. Adjustment Disorders
    • -emotional or behavioral symptoms
    • -response to stressors
    • -within 3 months of stressors onsent
    • -clinically sig distress or impairment
    • -not already an axis I disorder
    • -not normal bereavement(loss of loved one)
    • -not longer than 6 months after stressor are terminated
  113. adjustment disoder subtypes
    • -with depressed mood
    • -with anxiety
    • -with mixed anxiety & depressed mood
    • -with disturbance of conduct
    • -with mixed disturbance of emotions & conduct
    • -unspecified
  114. Physical Abuse
    • *an intentional act that causes injury: bites, bruises, done fractures, burns
    • *or creates a substantial risk of physical injury: choking/smothering, shaking/throwing, threatening
    • *acts of torture
    • *inflits excessive corporal punishment
    • *female genital mutilation
    • *giving a controlled substance to a child under 18
  115. PTSD is common for kids that have been abused
  116. Reactive attachment disorder of infancy or early childhood
    • *inappropriate social relatedness (failure to respond in social interactions or inability to exhibit selective attachments--overresponding to everyone)
    • *grossly pathogenic care of child (disregard for emotiona needs, diregard for physical or repeated changes in caregiver
    • *must begin before age 5
  117. subtypes of reactive attachment disorder
    • *inhibited type (failure to respond)
    • *disinhibited type (no selective attachments
  118. Tretament for abusing parents
    • *parent training
    • *anger management
    • *social support
    • *treat psychopathology

    **want to keep families together & help parents not abuse
  119. treatment for abused children
    • *under researched*
    • -play therapy, family therapy, group therapy, cognitive & behavioral therapies
    • *treating the subsequent psychopathology
  120. EBTs for exposure to traumatic events
    • WELL ESTABLISHED
    • *Trauma focused CBT

    • PROB EFFIC.
    • *school-based CBT
  121. core values of trauma focused CBT
    • Components bases
    • Respectful of cultural values
    • Adaptable & flexible (pick & choose treatment)
    • Family focused
    • Therapeutic relationship is central (alliance)
    • Self-efficacy is emphasized (take charge of your life
  122. core components of TR-CBT
    • Psychoeducation & parenting skills
    • Relaxation
    • Affective Mdulation
    • Cognitive coping & processing
    • Trauma Narrative (exposure through narrative)
    • In vivo mastery of trauma reminders
    • Conjoint child-parent sessions
    • Enhancing future safety & development
  123. Affective Modulation
    • Goal: enhance feelings identification & expression skills
    • *generate lists of all emotions & last time felt
    • *practice identifying feelings with games
    • *positive self-talk
    • *enhancing sense of safety
    • *problem solving & social skills
  124. Trauma Narrative
    • Goal: unpair thoughts, reminders or discussions of the traumatic event from overwhelming negative emotions
    • *gradually describe events (details, thoughts & emotions)
    • *results in a complete written narrative
    • *share narrative with parent
  125. Cutting and/or boarderline personality disorder
    • *children that have been abused
    • *dialectical behavior therapy, mindfulness component variation of CBT
  126. Personality disorders criteria
    • *pattern of inner experience and behavior that deviates markedly from the expectations of the individs culture (cognition, affectivity, interpersonal functioning, impulse control)
    • *pattern is inflexible
    • *clinically sig distress or impairment
    • *stable & of long duration
  127. diagnosing a personality disorder
    • -individ. must be under 18 & feautres present for at least 1 year
    • -the one exception is APD, which cannot be diagnosed in individs under 18
  128. Personality disorders: Cluster A "odd or eccentric"
    • *Paranoid Personality (distrust & suspiciousness)
    • *Schizoid Personality (detachment from social relationships)
    • *schizotypal personality disorder (acute discomfort w/ close relationships, cog or perceptual distortions)
  129. Personality disorders: Cluster B "dramtic, emotional or erratic"
    • *APD (violation of rights of others)
    • *Borderline personality disorder (instability or interpersonal relationships, self-image & affects)
    • *histrionic personality disorder (excessive emotionality & attention seeking)
    • *narississtic personality disorder (grandiosity, need for admiration & lack of empathy)
  130. Personality disorders: Cluster C "anxious or fearful"
    • *avoidant P.D.(social inhibition, feelings of inadequacy & hypersensitivity)
    • *dependant personality disorder (need to be taken care of)
    • *obsessive-compulsive P.D. (proccupation w/ orderliness, perfectionism, & control)
  131. Substance Dependence
    • *maladaptive impairment & distress
    • *12+ month period w/ 3+:
    • -tolerance, withdrawl, more taken than intended, persistent desire to cut down, take a lot of time, gived up positive activities, continues despite related problems
  132. Substance Abuse
    • maladaptive impairment & distress
    • *12+ month period w/ 1+:
    • -failure to fulfill obligations, physically hazardous, recurrent legal problems, recurrent social problems
  133. factors that influence readiness to change
    • Feedback (clear & specific)
    • Responsibility(putting responsibility on them)
    • Advice (what you think they can change)
    • Menu of Options (of what to do)
    • Empathetic
    • Self-efficacy enhancement (that they can do this)
  134. S-O-R-C Analysis
    • Stimuli (friends, time of day you are most likely to use drugs)
    • Organism(heredity)
    • Response (whats the drug & how much)
    • Consequences (why are they doing it)

    *want to figure out why its happening
  135. stubstance abuse treatment
    • stimulus control
    • set goals
    • self monitor
    • deal with cravings
    • address cog distortions
    • adaptive alternative behaviors
    • drink/drug refusal skills
  136. well established & prob effic treatment for substance abuse for adolescents
    • WELL ESAB
    • *multidimensional family therapy
    • *functional family therapy
    • *group cbt
    • *individual cbt

    • PROB EFF.
    • *brief strategic fam therapy
    • *behavioral family therapy
    • *multisystemic therapy
  137. ACRA
    adolescent community reinforcement approach
  138. empirically supported therapy relationships
    • *theraputic alliance
    • *empathy
    • *goal consensus & collaboration
    • *cohesion in group therapy
  139. Primary Sleep disorders
    • *Parasomnias
    • *Dyssomnias
  140. Parasomnias
    • abnormal events
    • *nightmare disorder
    • *sleep terror disorder (dazed but you dont remember having a nightmare, just wake up in a startled state)
    • *sleepwalking disorder
  141. Dyssomnias
    • amount, quality, timing
    • *primary insomnia
    • *primary hypersomnia (excessive sleepiness)
    • *narcolepsy(randomly falling asleep throughout day)
    • *breathing-related sleep disorder
    • *circadian rhythm sleep disorder
  142. top ranked behavior problems in 3 year olds
    4 out of the top ten for boys & girls were sleep related
  143. Assessments of sleep problems
    • *always ask about sleep
    • *keep a sleep record (for 2 weeks)
    • -time child goes to bed
    • -time child falls asleep
    • -wake up in the middle of the night
    • -wake up in the morning
    • -when the nap during the day
  144. Establish a bedtime routine
    *develops good sleep hygeine**

    • example routine:
    • 7:50 bedtime
    • change diaper
    • put jammies on
    • sit on floor & read a book
    • sing song outside of crib
    • sing song in crib
    • say "heres you blanket & nightlight is on..go to sleep we love you"

    *put in crib sleepy but not asleep*
  145. establish a consistent sleep schedule
    • wake up at 7:30 (dont let them sleep in)
    • nap from 10-11
    • nap from 2-3
    • go to bed at 8
    • feed at 5am & go back to sleep
  146. avoid negative sleep associations
    *falling asleep originally that is not availible if you wake up in the middle of the night. ie. being rocked to sleep, music (cd runs out, binky (falls out & cant find it)
  147. Bedtime environment conducive to sleep
    • nonstimulating
    • dark
    • quiet
    • comfortable temp
  148. "crying it out"
    • *unmodified systematic ignoring
    • *systematic ignoring with parental presence
    • *graduated systematic ignoring
  149. "crying it out": unmodified systematic ignoring
    • *unless child is ill or in danger just ignore the cries
    • *fastest way to break habit
    • **put baby in crib & walk out of room**
    • WELL ESTABLISHED
  150. "crying it out" systematic ignoring with parental presence
    • child cries in crib but you sit in the room with them & day by day parent moves closer to the door
    • PROB EFFICIACIOUS
  151. "crying it out" graduated systematic ignoring
    • immeadiate parent response for shorter duration or parent waits longer before responding OR parent quick checks at reg intervals but leaves room after checking
    • *WELL ESTABLISHED
  152. well established treatment for night terrors
    • scheduled awakenings.
    • -parents wakes up child 15 prior to childs expected awakening
    • -puts child back to sleep
    • -gradually faded
  153. faded bedtime procedure
    • *set initial bedtime for when child is likely to fall asleep
    • *fade bedtime up to normal
    • **want bedtime to be when they are likely to be tired & fall right asleep. that way they are conditioned to fall right asleep when they lay on their bed
  154. the sleep fairy
    • book that goes over rewards
    • *if child falls asleep w/o calling out for the parent the fairy comes in the middle of the night & puts a prize under the pillow.
    • -eventually fade out prizes
  155. bedtime pass
    child can call out for one thing (pass) but if they dont call out at all then they get a prize or privelidge in the morning
  156. Anorexia Nervosa Criteria
    • *refusal to maintain body weight (less than 85% of that expected)
    • *intense fear of gaining weight
    • *disturbance in body perception
    • *absence of at least 3 consectuive menstrual cycles (in postmenarcheal females)
  157. Types of Anorexia
    Restricting type: weight loss through dieting & excessive exercise & they have not regularly enagged in binge-eating or purging behaviors

    Binge-eating/purging type: during the current episode the person has regularly engaged in binge-eating or purging behavior
  158. Whats the difference between anorexia & bulimia
    individuals with BN are able to maintain a body weight at or above a minimally normal level
  159. Bulimia Nervosa Criteria
    • *recurrent episodes of binge eating by eating in a discrete period of time, and a sense of lock of control over eating
    • *recurrent inappropriate compensatory behavior in order to prevent weight gain (vomitting, laxatives, etc)
    • *on average at least twice a week for 3 months
    • *self eval is unduly influenced by body shape & weight
  160. types of Bulimia
    • *Purging type: during episode the person has reg engaged in self-induced vomitting or the misuse of laxatives, diuretics or enemas
    • *nonpurging type: during the current episode the person has used other compensatory behaviors such as fasting or excessive exercise, but has not regularly engaged in the misuse of laxatives, diuretics or enemas
  161. treatments for eating disorders
    • WELL ESTABLISHED
    • *maudsley method of family therapy (for adolescents)
    • *CBT for adults with bulimia
  162. Tics
    • *sudden, rapid, recurrent, nonrythmic stereotyped motor movement or vocalization
    • *motor=eye blinking, head rolling, etc
    • *vocal=throat clearing
  163. chronic motor or vocal tic disorder
    • chronic motor or vocal tics
    • *at least a year
  164. tourette's disorder
    • 2+ motor & 1+ vocal tics
    • *at least a year
  165. Transient tic disorder
    • begining of the disorder (w/in first 12 months)
    • *between 4weeks-12 months
  166. types of tics
    • motor:
    • -simple: eye blink, nose wrinkle, etc
    • -complex=hand gestures, jumping, facial contortions

    • Vocal:
    • -simple: throat clearing, grunting, sniffling
    • -complex: words, phrases, repeat self
  167. Sensory urges
    *precedes the tic*

    • -urges are relieved by the tic
    • -efforts to suppress often intensify tic
    • -common areas of the urge (shoulders, hands, abdomen, throat
  168. trichotillomania
    • *impulse control disorder*
    • -recurrent pulling out of ones hair resulting in noticeable hair loss
    • -sense of tension before pulling or when resisting
    • -pleasure/relief when pulling hair out
    • -distress of impairment
    • *could also be eyelashes or arm hair
  169. assessment of tics/trichs
    • -operationality: frequency, rank order
    • -identify antecedents & consequences: setting, social reinforcement, automatic reinforcemnt
    • -establish ongoing assessment plan
    • *more likely in times of anxiety or stress
  170. well established treatment for tics/trichs: habit reversal
    awareness training
    • habit reversal*
    • -awareness training
    • -describe the behavior
    • -describe preceding sensations/behaviors
    • -acknowledge therapist simulations
    • -acknowledge actual (situational) tic/trich
    • *kids are often oblivious
  171. well established treatment for tics/trichs: habit reversal.

    competing response training
    • -choose a competing response (slow & deliberate)
    • -practice the response
    • -do the competing response when...you notice a warning sign, you start doing the behavior
  172. well established treatment for tics/trichs: habit reversal.

    social support training
    • -identify the support person
    • -acknowledge correct implmentation of competing responses
    • -prompt competing response
  173. medication for tourettes
    • haloperidol*
    • -effective in 80% of patients
  174. enuresis
    • -repeated voiding of urine into bed or clothes
    • -2+ times a week for 3+ months (or sig distress/impairment)
    • -must be 5+ years old
    • -specifify if nocturnal, diurnal or both
  175. encopresis
    • -repeated passage of feces into inappropriate places
    • -1+ times a month for 3+ months
    • -must be 4+ years old
    • -code as "w/" or "w/o constipation & overflow incontinence". do they have a blockage with constipation
  176. enuresis & encopresis
    • *primary: never had control over it
    • *secondary: had control before and then lost it
  177. effective treatment for bedwetting
    • *bedwetting alarm
    • *self-monitoring
    • *motivational system
    • *relapse program
  178. bed-wetting alarm
    • superior to med & other treatments*
    • -lay on a pad & when it gets wet it sounds an alarm to wake you up
  179. motivational system
    get a reward every time you get up to go to the bathroom
  180. relapse prevention
    • -family support agreement
    • -overlearning (fluid challange. drink a lot right before bed to imcrease possible bed wetting)
    • -fade alarm
  181. encopresis treatment
    • -continued monitioring
    • -use of lubricant
    • -demystification (education)
    • -scheudled sits (if they have to go or not)
    • -reward for participating in treatment

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