abnormal psychology test 2

fear is the body's response to a serious threat to ones well being (something specific and dangerous)

is the body's response to a vague sense of danger (general) (nonspecific response to danger)

• both have the same psysiological features- increase in respiration, perspiration, muscle tension, etc.
• fear is in the moment and anxiety is thinking about the future

they prepare us for action- for fight or flight when danger threatens

• everybody experiences daily anxieties or fears but it becomes an anxiety disorder when it causes distress and dysfunction
• for some people the discomfort of fear and anxiety is too severe or too frequent and lasts too long, or is too easily triggered

18%

• 29%
• one fifth

from a second one as well

anxiety and substance abuse go hand in hand very often

• generalized anxiety disorder (GAD)
• phobias
• social anxiety disorder
• panic disorder
• obsessive-compulsive disorder (OCD)

• characterized by excessive anxiety under most circumstances and worry about practically anything
• sometimes called free floating anxiety
• an anxious personality, a person who is just anxious
• common with western society
• usually appears first in childhood or adolescence

• feeling restless, keyed up, or on edge, fatigue, difficulty concentrating; muscle tension, and/or sleep problems
• symptoms must last at least three months

women are diagnosed more often than men by 2:1 ratio (discrimonation women face)

one quarter

• GAD is most likely to develop in people faced with social conditions that truly are dangerous
• research supports this theory (ex: Three mile Island in 1979, Hurricane Katrina in 2005, Haitian earthquake in 2010)
• one of the most societal stress is poverty

• run down communities, higher crime rates, fewer educational and job opportunities and greater risk for health problems
• there are higher rates of GAD in lower SES groups

• race is closely tied to stress in the US it is not surprising that it is tied to GAD
• in any given year African Americans are 30% more likely than white americans to suffer from GAD
• multicultural researchers have not consistently found a heightened rate of GAD among Hispanics in the US, although they do note the prevalence of nervios in that population
• african americans are usually in more poverty

do not relate it emotionally

most people living in dangerous environments do not develop GAD

• Freud believe that all children experience anxiety (realistic, neurotic, moral)
• some children experience particularly high levels of anxiety or their defense mechanisms are particularly inadequate and they may develop GAD

• realistic anxiety
• neurotic anxiety
• moral anxiety

when they face actual danger

when they are prevented from expressing id impulses

a repression of id, constantly thinking everything you do is wrong

when they are punished for expressing id impulses

• Theorist propose that GAD like other psychological disorders arises when people stop looking at themselves honestly and acceptingly
• view is best illustrated by Carl Rogers's explanation (client centered therapy)
• practitioners using this client centered approach try to show unconditional positive regard for their clients and to empathize with them
• despite optimistic case reports controlled studies have failed to offer strong support
• in addition only limited support has been found for rogers's explanation of GAD and other forms of abnormal behavior

• lack of unconditional positive regard in childhood leads to condition of worth (harsh self standards)
• these threatening self-judgements break through and cause anxiety, setting the stage for GAD to develop

• followers of this model suggest that psychological problems are often caused by dysfunctional ways of thinking causing a feeling of excessive worry
• given that excessive worry- a cognitive symptom- is a key characteristic of GAD, these theorists have had much to say
• initially said that GAD is caused by maladaptive assumptions
• have found that people with GAD do hold maladaptive assumptions particularly about dangerousness

• Albert Ellis identified basic irrational assumptions
• it is a dire necessity for an adult human being to be loved or approved of by virtually every significant person in his community
• it is awful and catastrophic when things are not the way one would very much like them to be
• when these assumptions are applied to everyday life and to more and more events, GAD may develop

• cognitive theorists
• argued that those with GAD constantly hold silent assumptions that imply immanent danger
• a situation/person is unsafe until proven safe
• it is always best to assume the worst

• metacognitive theory
• intolerance of uncertainty theory
• avoidance theory

all of these have recieved considerable research support

developed by Wells suggests that the most problematic assumptions in GAD are the individual's worry about worrying (meta worry)

meta means whatever that thing is (worrying about your worries)

certain individuals consider it unacceptable that negative events may occur, even if the possibility is very small, they worry in an effort to find correct solutions

• developed by Borkovec
• holds that worrying serves a positive function for those with GAD by reducing unusually high levels of bodily arousal

• changing maladaptive assumptions (based on work of Ellis and Beck--> RET)
• helping clients understand the special role that worrying plays, and changing their views and reactions to it (therapist teaches patient on role that worrying plays in life)

• point out irrational assumptions
• suggest more appropriate assumptions
• assign related homework
• studies suggest at least modest relief from treatment

• biological theroists believe that GAD is caused chiefly by biological factors
• supported by family pedigree studies
• biological relatives more likely to have GAD (15%) than general population (6%)
• the closer the relative, the greater the likelihood
• there is however a competing issue of shared environment (nuture)

• makes sense biologically but overly simplistic
• gamma-aminobutyric acid
• is an inhibitory neurotransimitter
• GABA stops nurons from firing allowing the state of excitability to cease
• a type of biofeedback that when interupted can cause GAD

• antianxiety drug therapy
• relaxation training (learn how to lower heart rate)
• biofeedback (relaxation training hooked up to machines) (as you become more aroused there is another part of the system that dearrouses you)

• from the greek word for fear
• formal names are also often from the Greek
• persistent and unreasonable fears of particular objects, activities, or situations
• people with a phobia often avoid the object or thoughts about it
• some people can tolerate it with dread

• phobias are more intense and persistence fears
• phobias have a greater desire to avoid the feared object or situation
• in distress that interferes with functioning

• most phobias are technically categorized as specific
• there is also a broader kind of phobia called agoraphobia
• category of most phobias is specific and you would write after what specific thing a person is scared of

• being afraid of being caught somewhere
• is its own category of phobia
• afraid of being in situations where escape might be difficult should they experience panic or become incapacitated
• about 2% of adults experience this problem, women twice as frequently as men
• the disorder also is twice as common among poor people vs wealthy ones
• about one fifth of those with agoraphobia are in treatment
• avoid crowded places, driving, public transportation
• many also are prone to experience extreme and sudden explosions of fear called panic attacks- may recieve a second diagnosis of panic disorder

• persistent fears of a specific object or situation
• when exposed to the object or situation sufferers experience immediate fear
• most common: phobias of specific animals or insects, heights, thunderstorms, and blood
• many suffer from more than one phobia at a time
• women outnumber mean at least 2:1
• prevalance differs across racial and ethnic minority groups, reason is unclear
• most people with specific phobia do not seek treatment

• 9%
• 12%

is someone who has had a panic attack who has a fear of getting more panic attacks

• means fear of market place, afraid to leave the house, fear of not being able to escape from a public place
• do not want to go anywhere because they are afraid that they may have a panic attack in a public place and cant get away
• main symptom is the resistance to leave a home

• evidence tends to support the behavioral model
• phobias develop through conditioning
• once fears are acquired the individuals avoid the dreaded object or situation permitting the fears to become all the more entrenched
• behaviorists propose a classical conditioning model
• phobias can develop through modeling
• phobias are maintained through negative reinforcement
• phobias may develop into GAD when a person acquires a large number of them (process of stimulus generalization: responses to one stimulus are also elicited by similar stimuli)

• classical
• operant
• modeling

• Little Albert
• Dr. Watson took albert and gave him a fluffy white rat to play with, albert was not scared, they began to make loud noises when albert saw the white rat
• albert quickly became scared of the white rat and eventually became afraid of anything white and fluffy (stimulus generalization)

• Bandura, confederates, buzz, and shock
• bandura showed kids videos of other people reacting to objects and the kids began to be afraid of the same object

it appears that a phobia can be acquired in these ways however researchers have not established that the disorder is ordinarily acquired in this way

• some specific phobias are much more common than others
• theorists argue that there is a species-specific biological predisposition to develop certain fears
• called preparedness because human beings are theoretically more prepared to acquire some phobias than others
• model explains why some phobias (snakes, spiders) are more common than others (meat, houses)

become phobias because they are genetically programmed for the survival of the race

• "exposure treatments"
• desensitization
• flooding
• modeling

• technique developed by Joseph Wolpe
• teach relaxation techniques
• create a fear hiearchy
• pair relaxation with feared objects or situations (since relaxation is incompatible with fear the relaxation response is thought to subsitute for the fear response)

• in vivo desensitization (live)
• covert desensitization (imaginable)

• forced non gradual exposure
• can not escape the object of the phobia until they are not afraid any more, breaks the chain of avoiding something you fear
• clinical research supports this treatment

• therapist confronts the feared object while the fearful person observes
• therapist does it with you to show you that you will be okay

• behavioral therapy with an exposure approach is most common and effective
• therapist help clients venture farther and farther from their homes to confront the outside world
• therapists use techniques similar to those used for treating specific phobia but, in addition, use support base and home-group progams

• severe persistant and irrational anxiety about social or performance situations in which scrutiny by others and embarrassment may occur
• may be narrow (talking, performing, eating, or writing in public)
• may be broad (general fear of functioning poorly in front of others)
• in both forms people judge themselves as performing less competently than they actually do
• use to be called social phobia
• can greatly interfere with one's life
• begins in childhood and may continue into adulthood

7.1%

60%

50%

there are also some indications of racial/ ethnic differences

• leading explanation proposed by cognitive theorists
• they contend that people with this disorder hold a group of social beliefs and expectations that consistently work again them including:
• unrealistically high social standards
• views of themselves as unattractive and socially unskilled

• people with social anxiety disorder anticipate that social disasters will occur and they perform avoidance and safety behaviors to prevent them
• after a social event they review the details and overestimate how poorly things went or what negative results will occur

• overwhelming social fear (address fears behaviorally with exposure)
• lack of social skills (social skills and assertiveness trainings have proved helpful)

combination of behavioral and psychoanalytical techniques

• avoidance
• do something to modify the situation
• divert attention away from what your afraid of
• changing your thoughts about what your afraid of

easier to change beliefs about something than it is to change behavior-- cognative disanance--excuses for smoking

unlike specific phobias, social fears are often reduced through medication (particularly antianxiety and antidepressants)

• several types of psychotherapy have proved at least as effective as medication
• people treated with psychotherapy are less likely to relapse than people treated with drugs alone
• one psychological approach is exposure therapy either in an individual or group setting
• cognitive therapies have also been widely used
• social skills training is also used (combination of several behavioral techniques also used to help people improve their social functioning)
• therapists provide feedback and reinforcement
• in addition social skills training groups and assertiveness training groups allow clients to practice their skills with other group members

exposed to specific situations (group therapy works very well)

an extreme anxiety reaction that can result when real threat suddenly emerges

• are periodic short bouts of panic that occur suddenly, reach a peak, and pass
• sufferers often fear they will die, go crazy, or lose control
• can occur without a real threat
• should end in around 10 minutes
• attacks can happen in the absence of real danger

• when you have a panic attack and become afraid of having another
• disorder tends to develop late adolescence and early adulthood
• women are twice as likely as men to be affected
• poor people are 50% more likely than wealthier people to experience these disorders
• the prevalence is the same across cultural and racial groups in the US and seems to occur in cultures across the world
• approximately one third of those with panic disorder are in treatment
• will usually land patients in the ER thinking they have heart attacks

• 2.8%
• 5%

agoraphobia

• people are afraid to leave home and travel to locations from which escape might be difficult or help unavailable
• in such cases panic disorder typically sets the stage for agoraphobia

• drug therapies
• antidepressants are effective at preventing or reducing panic attacks
• function at norepinephrien receptors in the panic brain circuit
• bring at least some improvement to 80% of patients with panic disorder
• improvements require maintance (must keep taking it) of drug therapy
• some benzodiazepines (especially Xanax [alprazolam]) have also proved helpful
• they seem to indirectly affect the activity of norepinephrine

• recognize biological factors are only part of the cause of panic attacks
• in their view full panic reactions are experienced only by people who misinterpret bodily events
• cognitive treatment is aimed at correcting such misinterpretations
• highly sensitive to changes in physiological (slight change in heart rate, or oxygen levels in blood) can cause their panic

• experience more frequent or intense bodily sensations
• have experienced more trauma filled events over the course of their lives

• anxiety sensitivity
• they focus on bodily sensations much of the time, are unable to assess the sensations logically and interpret them as potentially harmful

• tries to correct peoples misinterpretations of their bodily sensations
• may also use biological challenge procedures to induce panic situations
• induce physical sensations which cause feeling of panic like jumping up and down and climbing flights of stairs and then practice coping strategies and making more accurate interpretations
• often help people

• 1) educate clients
• about panic in general, about the causes of bodily sensations, about their tendency to misinterpret the sensations
• 2) teach clients to apply more accurate interpretations (especially when stressed)
• 3) teach clients skills for coping with anxiety (relaxation and breathing)

• 80%
• 13%

• at least as helpful as drug therapy with antidepressents
• combination therapy is most effective

• made up of two compnonents
• obsessions and compulsions

• is equally in men and women and among different racial and ethnic groups
• more than 4% of those with OCD seek treatment

persistant thoughts or ideas or images that seem to invade a persons consciousness (thoughts you do not want)

• thoughts that feel both intrusive and foreign
• attempts to ignore or resist them trigger the anxiety
• have common themes such as dirt/contamination, violence, aggression, orderliness, religion, sexuality

• a repetitive and rigid behavior or mental act that person act that a person often feels compelled to perform always in an identical manner
• voluntary behaviors or mental acts
• feel mandatory/unstoppable
• most recognize that their behaviors are unreasonable
• believe though that something terrible will occur if they do not perform the compulsive acts
• behavior reduces anxiety for short time and eventually develops into rituals
• common themes: cleaning, checking, order or balance, touching, verbal and or counting

• feel excessive or unreasonable
• causes great distress
• takes up much time
• interferes with daily functions

• 1%
• 2%
• 3%

• behaviorists have concentrated on explaining and treating compulsions rather than obsessions
• they propose that people happen upon compulsions quite randomly
• break the relationship between compulsions and the obsessions
• in a fearful situation they perform a particular act
• when threat lifts they associate the improvement with the random act
• after repeated associations they believe the compulsions is changing the situation
• the act becomes a key method to avoiding or reducing anxiety
• try to break the chain and the negative feedback (works like flooding)

exposure and response preventions (ERP)

• clients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions
• therapists often model the behavior while the client watches (homework is important component)
• between 55-85% of clients have been found to improve considerably with ERP and improvements often continue indefinitly

• begin by pointing out that everyone has repetitive unwanted and intrusive thoughts
• people with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result
• everyone has repetitive unwanted thoughts-- normalization--you just have more
• to avoid negative outcomes they attempt to neutralize their thoughts with actions or compulsions

• seeking reassurance
• thinking good thoughts
• washing
• checking

• when a neutralizing action reduces anxiety it is reinforced
• client becomes more convinced that the thoughts are dangerous
• as fear of thoughts increases the number of thoughts increase

• people with OCD tend to
• have exceptionally high standards of conduct and morality
• believe thoughts are equal to actions and are capable of bringing harm
• believe that they can and should have perfect control over their thoughts and behaviors

• psychoeducation
• guiding the client to identify, challenge, and change distorted conditions
• cognitive behavioral therapy (CBT)

research suggests that combination of the cognitive and behavioral models is often more effective than either intervention alone

• two lines of research provide evidence for the key role of biological factors
• serotonin
• orbitofrontal cortex and caudate nuclei

• evidence that serotonin based antidepressants reduce OCD symptoms; recent studies have suggested other neurotransmitters also may play important roles
• low levels of serotonin cause OCD

glutamate, GABA and dopamine also play roels in OCD development

• frontal cortex and caudate nuceli compose brain circuit that converts sensory information into thoughts and actions
• either area may be too active letting through troublesome thoughts and actions
• thoughts begin in orbitofrontal cortex and then are sent to the caudate nuclei which filters information

• serotonin based antidepressents
• bring improvement to 50-80% of those with OCD
• relapse occurs if medication is stopped
• research suggest that combination therapy (medication+ cognitive behavioral therapy approaches) may be most effective

• hoarding, hair pulling, shopping, sex are linked to OCD
• DSM-5 has created the group name obsessive compulsive related disorders and assigned four patterns to that group hoarding disorder, hair pulling disorder, skin picking disorder, and body dysmorphic disorder
• with their addition to DSM it is hoped that they will be better researched understood and treated

• depression
• mania

low, sad state in which life seems dark and its challenges overwhelming

state of breathless euphoria or frenzied energy

• depressive disorders which suffer from only depression
• person has no history of mania
• mood returns to normal when depression lifts

experience periods of mania that alternate with periods of depression

• millions
• economic costs of mood disorders amount to many billions of dollars each year
• human suffering is beyond calculation

general sadness or unhappiness

can bring severe and long lasting psychological pain that may intensify as time goes by

• around 8% of adults in us suffer from severe unipolar depression in any given year
• as many as 5% suffer from mild forms
• around 19% of all adults experience unipolar depression at some point in their lives
• the prevalence is similar in canada england france and many other countries
• the rate of depression is higher among poor people than wealthier people
• women are twice as likely as men to experience severe unipolar depression
• 26% of women to 12% of men
• among children the prevalence is similar among boys and girls
• approximatly 85% of people with unipolar depression recover (some without treatment)
• around 4% will have another episode in their lives

• vary from person to person
• five main areas of functioning may be affected
• emotional symptoms
• motivational symptoms
• behavioral symptoms
• cognitive symptoms
• physical symptoms

• feeling miserable empty humiliated
• experiencing little pleasure

• lacking drive initiative spontaneity
• between 6-15% of those with severe depression die by suicide

• less active
• less productive

• hold negative views of themselves
• blame themselves for unfortunate events
• pessimistic

• headaches
• dizzy spells
• general pain

period of two or more weeks marked by five or more symptoms of depression


in extreme cases symptoms are psychotic including delusions and hallucinations

bizarre ideas without foundation

perceptions of things that are not actually present

• major depressive disorder
• dysthymic disorder
• premenstrual dysphoric disorder
• disruptive mood dysregulation disorder

people who experience a major depressive episode with no history of mania

individuals who experience a longer lasting (at least two years) but less disabling pattern of depression

a diagnosis given to women who repeatedly experience clinically significant depressive symptoms during the week before menstration

characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper

• people with depression experience a greater number of stressful life events during the month just before the onset of their symptoms
• stress may be a trigger for depression
• some clinicians distinguish reactive depression from endogenous depression which seems to be a response from internal factors rather than following stressful events

• genetic factors
• biochemical factors
• brain anatomy and brain circuits
• immune system

• family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a predisposition
• have found as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population
• twin studies demonstrate strong genetic component
• concordance rates for identical twins MZ=46%
• concordance rates for fraternal twins DZ=20%
• using molecular biology techniques researchers have found evidence that unipolar depression may be tied to specific genes

• neurotransmitters norepinephrine and serotonin
• in 1950s medications for high blood pressure were found to cause depression (some lowered serotonin and others lowered norepinephrine)
• discovery of turly effective antidepresant medications which relieved depression by increasing either serotonin or norepinephrine confirmed
• depression likely involves not just serotonin nor norepinphrine a complicated interaction is at work and other NTs may be involved
• endocrine system and hormone release has an effect too
• people with depression have been found to have abnormal levels of cortisol released from adrenal glands during times of stress
• preople with depression have been found to have melatonin excess (dracula hormone)
• other researchers are investigating deficiencies of important proteins within neurons as tied to depression

• reliance on analogue studies (create symptoms in lab animals, how do we know that this research correlate with human emotions?)
• technology was limited (current studies using newer technology are attempting to address this issue) could not always know what was going on in brain

• biological researchers have determined that emotional reactions of various kinds are tied to brain circuits
• these are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction
• although research is far from complete a circuit responsible for unipolar depression has begun to emerge
• likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and brodmann area 25

• this system is the body's network of activities and cells that fight off bacteria and other foreign invaders
• when stressed the immune system may become dysregulated, which some believe may halp produce depression

usually biological treatments means antidepresent drugs but for severely depressed individuals who do not respond to other forms of treatment it sometimes includes electroconvulsive therapy or brain stimulation

• one of the most controversial forms of treatment
• procedure consists of targeted electrical stimulation to cause brain seizure
• usual course of treatment is 6-12 sessions over 2-4 weeks
• discover of effectiveness was accidental
• procedure has been modified in recent years to reduce some negative effects (patients are given muscle relaxants and anesthetics before and during procedure)
• patients generally report some memory loss
• is effective but has been difficult to determine why
• studies find improvement in 60-80%
• most effective in severe depression cases that have delusions

• in the 1950's two kinds of drugs were found to reduce symptoms of depression
• monoamine oxidase inhibitors (MAO inhibitors)
• tricyclics
• these drugs have been joined in recent years by a third group, the second generation antidepressants
• do not work on everyone even the most successful of them fails to help at least 35% of clients with depression

• a third group of antidepresant drugs is structually different from mao inhibitors and tricyclics
• most of the drugs in this group are labeled selective serotonin reuptake inhibitors (SSRIs)
• these drugs increase serotonin activity specifically (no other NTs are affected)
• fluoxetine, seraline, escitalopram
• selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available
• just as effective and as fast as tricyclics, yet sales have skyrocketed
• clinicians ofter prefer these because they are harder to overdose on and do not pose dietary problems
• do not have the undesirable effects like the tricyclics
• can cause weight gain and reduction in sex drive

• in recent years three additional biological apporaches have been developed
• vagus nerve stimulation
• transcranial magnetic stimulation (TMS)
• deep brain stimulation

• depression researchers surmised they might be able to stimulate the brain by electrically stimulating the vagus nerve through the use of a pulse generator implanted under the skin of the chest
• research has found that the procedure brings significant relief to as many as 40% of those with treatment-resistant depression

• another technique designed to stimulate the brain without the undesired effects of ECT,
• TMS has been found to reduce depression when administered daily for 2-4 weeks

• theorizing a depression switch located deep within the brain, researcchers have successfully experimented with electrode implantation in the brain's Brodman Area 25
• research is in its earliest stages

• psychodynamic model
• behavioral model
• cognitive model

no strong research

• modest research support
• depression results from changes in the number of rewards and punishments received in their lives
• Lewinsohn suggests that the positive rewards in life dwindle for some people leading them to perform fewer and fewer constructive behaviors and they spiral toward depression
• research supports the relationship between the number of rewards received and the presence or absence of depression
• social rewards are especially important

• considerable research support
• two main theories
• learned helplessness
• negative thinking

• many studies have produced evidence in support of becks explanation
• high correlation between the level of depression and the number of maladaptive attitudes held
• both the cognitive triad and errors in logic are seen in people with depression
• automatic thinking has been linked to depression

• behavioral therapists use a variety of strategies to help increase the number of rewards experienced by their clients
• 1) therapists selects activities that client considers pleasurable often using a weekly schedule
• 2) therapist makes sure the person's various behaviors are rewarded correctly
• 3) behavioral therapist may train clients in effective social skills
• behavioral techniques seem to be of limited help when just one is applied
• when two or more are applied  together behavioral treatments does seem to reduce depressive symptoms particularly if mild
• it is worth noting that Lewinsohn himself has combined behavioral techniques with cognitive strategies in recent years

this theory asserts that people become depressed when they think that:

• they no longer have control over the reinforcements (rewards and punishments) in their lives
• they themselves are responsible for this helpless state
• theory based on seligman's work with dogs
• there has been
• there has been significant research support for this model
• human subjects who undergo helplessness training score higher on depression surveys
• animal subjects lose interest in sex and social activities
• recent versions focus on attributions helplessness theory
• internal attributions that are global and stable lead to greater feelings of helplessness and possible depression (I am inadequate at everything and I always will be)
• if people make other kinds of attributions this reaction is unlikely (she never did know what she wanted, but the way i have behaved the past couple weeks blew this relationship) (i dont usually act like that)
• some theorist have refined helplessness model yet again in recent years, they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness

• dogs subjected to uncontrollable shock were later placed in a shuttle box
• even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so
• seligman theorized that the dogs had learned to be helpless to do anything to change negative situations and drew parallels to human depression

• much of the research relies on animal subjects
• the attributional component of the theory raises particularly difficult questions, especially in terms of animal models of depression

• beck theroizes four interrelated cognitive components combine to produce unipolar depression:
• 1) maladaptive attitudes
• self defeating attitudes are developed during childhood
• beck suggests that upsetting situations late in life can trigger an extended round of negative thinking
• 2) negative thinking takes three forms called the cognitive triad
• interpre 1) their experiences 2)themselves and 3)their futures in negative ways leading to depression
• 3) depressed people make errors in thinking
• arbitrary interferences
• minimization of the positive and magnification of the negative
• 4) depressed people also experience automatic thoughts
• a steady train of unpleasant thoughts that suggest inadequacy and helplessness

• beck's cognitive therapy- which includes a number of behavioral techniques-- is designed to help clients recognize and change their negative cognitive processes
• this approach follows four phases and usually lasts fewer than 20 sessions
• Phases
• 1) increasing activities and elevating mood
• 2) challenging automatic thoughts
• 3) identifying negative thinking and biases
• 4) changing primary attitudes
• over the past several decades, hundreds of studies have shown that cognitive therapy helps unipolar depression
• around 50-60% of clients show near-total elimination of symptoms
• a growing number of todays cognitive-behavior therapist disagree with Becks proposition that individuals must fully disregard negative cognitions (guide clients to recognize and accept negative cognitions)

• sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people
• this belief is supported by the finding that depression is often tirggered by outside stressors
• ther are two kinds of sociocultural views
• family social perspective
• multicultural perspective

• the belief  in the connection between declining social rewards and depression (as discussed by the behaviorists) is consistent with family social perspective
• depression has been tied repeatedly to the unavailablilty of social support
• people who are separated of divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married
• it also appears that people who are isolated and without intimacy are particularly likely to become depressed in times of stress

• therapists who use family and social approaches help depressed clients change their approach to close relationships in their lives
• the most effective family-social approaches are interpersonal psychotherapy and couple therapy

• this model holds that four interpersonal problems may lead to depression and must be addressed
• interpersonal loss
• interpersonal role dispute
• interpersonal role transition
• interpersonal deficits
• studies suggests that IPT is as effective as cognitive therapy for treating depression

• the main type of couple therapy is behavioral marital therapy (BMT)
• focus is on developing specific communication and problem solving skills
• if marriage is filled with conflict
• BMT is as effective as other therapies for reducing depression

• two issues have captured the interest of multicultural theorists
• gender and depression
•    a strong link exists between gender and depression
•    women cross culturally are twice as likely as men to receive diagnosis of unipolar depression
• cultultural background and depression
•     depression is worldwide and certain symptoms seem to be constant across all countries including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicides that precise picture of depression varies from country to country
•      beyond such core symptoms research suggest
• each explanation offers food for thought and has gathered just enough supporting evidence to make it interesting (and just enough contrary evidence to raise question about its usefulness)
• depressed people in non western countries are more likely to be troubled by physical symptoms than by cognitive ones

• artifact theory
• hormone explanation
• life stress theory
• body dissatisfaction
• lack of control theory
• rumination theory

holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men

holds that hormone changes trigger depression in many women

suggests that women in our society experience more stress than men

states that females in Western society are taught, almost from birth to seek a low body weight and slender body shape- goals that are unreasonable, unhealthy, and often unattainable

picks up the learned helplessness research and argues that women may be more prone to depression because they feel less control than men over their lives

• holds that people who ruminate when sad
• keep focusing on their feelings and repeatedly consider the causes and consequences of their depression are more likely to become depressed and stay depressed longer

• within US researchers have found few differences in depression symptoms among members of different ethnic or racial groups or amoung overall rates of depression
• hispanic americans and african americans are 50% more likely than white americans to have recurrent episodes of depression-- a finding possible related to limited treatment opportunities
• research has also revealed that depression is distributed unevenly within some minority groups

• culture sensitive seek to address the unique issues faced by members of cultural minority group
• they include special cultural training of therapists, heightened awareness of cultural values, stressors, and prejudices faced by clients, and efforts by therapists to help clients recognize the impact of culture on their self-views
• culture sensitive approaches increasingly are being combined with traditional forms of psychotherapy to help improve the likelihood of minority clients overcoming their disorders

• people with a bipolar disorder experience both the lows of depression and the highs of mania
• many describe their lives as an emotional roller coaster

unlike those experiences depression, people in state of mania typically experience dramatic and inappropriate rises in mood and activity

• emotional symptoms (active, powerful emotions in search of outlet)
• motivational symptoms (need for constant excitement, involvement, companionship)
• behavioral symptoms (very active, more quickly, talk, loudly or rapidly, flamboyance is not uncommon)
• cognitive symptoms (show poor judgement or planning, may have trouble remaining coherent or in touch with reality)
• physical symptoms (high energy level- often in the presence of little or no rest)

• people are considered to be in full manic episode when for at least one week, they display an abnormally high or irritable mood, increased activity or energy and at least three other symptoms of mania
• in extreme cases symptoms are psychotic
• when symptoms are less severe the person is said to be experiencing a hypmanic episode
• disorders are equally common in men and women
• disorders more common among people with low incomes
• onset usually occurs between the ages of 15-44 years
• in most untreated cases the manic and depressive episodes eventually subside only to recur at a later time

when symptoms are less severe in mania

• full manic and major depressive episodes
• most experience an alteration of episodes
• some have mixed episodes

hypomanic episodes alternate with major depressive episodes

if people experience four or more episodes within a year period

1-2.6%

• when a person experiences numerous periods of hypomanic symptoms and mild depression
• symptoms continue for 2 or more years interrupted by periods of normal mood
• the disorder usually begins in adolescence and affects at least 0.4 percent of the population
• it may eventually blossom into bipolar I or II

• neurotransmitters
• ion activity
• brain structure
• genetic factors

• after finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania
• this theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine
• because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity
• although no relationship with high serotonin has been found, bipolar disorder may be linked to low serotonin activity
• low serotonin may open the door to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take:
• low serotonin+ low norepinephrine= depression
• low serotonin+ high norepinephrine= mania

• ions which are needed to send incoming messages to nerve endings may be improperly transported through cells of individuals with bipolar disorder
• some theorists believe that irregulatiriies in transport of these ions may cause neurons to fire to easily (mania) or to stubbornly resist firing (depression)

• ·Brain imaging and postmortem
• studies have identified a number of abnormal brain structures in people with
• bipolar disorder; in particular, the basal ganglia and cerebellum among others

• ·It is not clear what role such
• structural abnormalities play

• many theorists believe that people inherit a biological predisposition to develop bipolar disorders
• family pedigree studies support this theory
• identical MZ twins=4% likelihood
• fraternal DZ twins and siblings= 5% to 10% likelihood
• general population= 1-2.6% likelihood
• researchers have conducted genetic linkage studies to identify possible patterns of inheritance
• other researchers are using techniques from molecular biology to further examine genetic patterns in large families
• such wide ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders

• use of lithium (a metallic element naturally occuring as mineral salt) and other mood-stabilizers has dramatically changed this picture
• all manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating manic episodes
• more than 60% of patients with mania improve on these medications
• most individuals experience fewer new episodes while on the drug
• findings suggest that the mood stabilizers are also antidepressant drugs ones that actually help prevent symptoms from developing
• mood stabilizers also help those with bipolar disorder overcome their depressive episodes to a lesser degree
• researchers do not fully understand how mood stabilizing drugs operate
• they suspect that drugs change synaptic activity in neurons but in a different way from that of antidepressant drugs
• although antidepressant drugs affect a neurons initial reception on NTs mood stabalizers appear to affect a neurons second messengers
• these drugs also increase the production of neuroprotective proteins which may decrease bipolar symptoms
• adjuctive psychotherapy is also a tool

• psychotherapy alone is rarely helpful for persons with bipolar disroder
• mood stabilizing drugs alone are also not always sufficient
• 30% or more of patients may not respond to lithium or a related drug may not receive the proper dose or may relapse while taking it
• as a result clinicians often use psychotherapy as an adjunct to lithium (or other meidcation based therapy)
• therapy focuses on medication management social skills and relationship issues
• few controlled studies have tested the effectiveness of such adjunctive therapy
• growing research suggests that it helps reduce hospitalization improves social functioning and increases clients ability to obtain and hold a job