Clinical

All PSYC1030 Clinical topic notes

Psychological Therapies

Clinical Psychology

• Diagnose and treat mental, emotional, and behavioural disorders

• Integrates scientific research, psychological theory, and clinical knowledge to understand and alleviate psychological distress

• Sits within a broad group of mental health professionals including psychiatrists, therapists, counsellors, social workers, etc

• Clinical psychologists often specialise in different areas, such as child and adolescent psychology, forensic psychology, neuropsychology, or health psychology.

• Work settings include private practice, hospitals, community mental health centers, rehabilitation facilities, and academic institutions.

Role of Psychologists

• It focuses on psychological therapy, assessment, and behavioural interventions

• Assess and diagnose psychological conditions using clinical interviews, psychometric assessments, and observation.

• Develop and implement evidence-based treatments tailored to individual needs.

• Promote mental health and well-being through therapy, psychoeducation, and preventative interventions.

• Conduct research to improve psychological treatments and understand mental health disorders.

• Provide consultation and supervision to other professionals in clinical and academic settings.

• Use standardized psychological tools, such as MMPI (Minnesota Multiphasic Personality Inventory), WAIS (Wechsler Adult Intelligence Scale), and Beck Depression Inventory.

• Collaborate with other healthcare professionals to provide holistic care.

Why see a Clinical Psychologist?

• Clinical psychologists support individuals across various psychological and life challenges. Common reasons for seeking therapy include:

  • Mental Health Conditions

    • Mood disorders: Major Depressive Disorder (MDD), Bipolar Disorder, Dysthymia

    • Anxiety disorders: Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Phobias

    • Obsessive-Compulsive & Related Disorders: OCD, Body Dysmorphic Disorder, Hoarding Disorder

    • Trauma & Stress-Related Disorders: PTSD, Acute Stress Disorder, Adjustment Disorder

  • Developmental and Neurological Disorders

    • Autism Spectrum Disorder (ASD): Social communication difficulties, repetitive behaviors

    • Attention-Deficit/Hyperactivity Disorder (ADHD): Impulsivity, inattention, hyperactivity

    • Learning Disabilities: Dyslexia, dyscalculia, executive functioning deficits

  • Health Psychology & Psychosomatic Issues

    • Chronic illness coping: Cancer, diabetes, autoimmune disorders

    • Pain management: Fibromyalgia, migraines, chronic pain conditions

    • Stress-related physical conditions: Hypertension, irritable bowel syndrome

  • Behavioural and Emotional Issues

    • Anger management: Difficulty regulating emotions

    • Interpersonal and relationship difficulties: Family, romantic, or workplace conflicts

    • Adjustment to life changes: Divorce, job loss, relocation, grief

  • Severe and Enduring Mental Illness

    • Schizophrenia and psychotic disorders: Hallucinations, delusions, disorganized thinking

    • Personality disorders: Borderline, Antisocial, Narcissistic, Avoidant Personality Disorders

  • Support for Specific Populations

    • Children and adolescents: Emotional regulation, bullying, school stress

    • Older adults: Dementia, late-life depression, grief counseling

DSM

Diagnostic and Statistical Manual of Mental Disorders

• The DSM-5 (latest version) provides a biopsychosocial approach to diagnosing mental disorders.

• Divides disorders into 18 different classes (e.g., neurodevelopmental disorders, schizophrenia spectrum, mood disorders, anxiety disorders, etc.).

• Contains over 300 diagnoses with clearly defined criteria for diagnosis.

• Sets thresholds and rules for meeting diagnostic criteria (e.g., symptom duration, impact on daily functioning).

• Used by psychologists, psychiatrists, and mental health professionals worldwide.

Key Concepts in Diagnosis

Heterogeneity

• Two people with the same diagnosis can experience very different symptoms.

• Example: Two individuals with depression—one might have insomnia and anxiety, while another experiences lethargy and social withdrawal.

Comorbidity

• If a person has one disorder, they are more likely to have another.

• Example: Major Depressive Disorder (MDD) frequently co-occurs with Anxiety Disorders.

Psychological Therapies

Four Foundational Models of Psychological Therapy

1. Psychodynamic (Unconscious processes, early experiences)

2. Biological (Brain structure, genetics, neurotransmitters)

3. Behavioural (Learned behaviours, conditioning)

4. Cognitive-Behavioural (CBT) (Thought patterns influencing behaviour)

Psychodynamic

• Rooted in Freudian theory but evolved significantly.

  • “Two things you need to know about Feud. One is he was wrong, and the second is that he’s dead.:

• Explores unconscious processes, early childhood experiences, and internal conflicts.

Core Concepts

1. Unconscious Processes

   • Behavior, thoughts, and emotions are shaped by unconscious drives & motivations.

   • Therapy seeks to bring these hidden elements to awareness.

2. Early Childhood Experiences

   • Personality & relationship patterns are shaped by early experiences.

   • Unresolved past conflicts can manifest in current behaviors and emotional difficulties.

3. Internal Conflicts and Defense Mechanisms

   • Psychological distress stems from inner conflicts between unconscious desires & societal expectations.

   • Defense mechanisms (e.g., repression, denial, projection) help manage distress but may become maladaptive.

   • Therapy examines whether these defenses are helpful or hindering.

4. Transference and Countertransference

   • Transference: Client projects feelings from past relationships onto the therapist.

   • Countertransference: Therapist's emotional reaction to the client.

   • Exploring these dynamics reveals relational patterns and emotional blind spots.

5. Therapeutic Relationship

   • The therapist-client relationship serves as a microcosm for understanding a client’s emotional world.

6. Techniques

   • Free association (express thoughts without censorship)

   • Interpretation (analyzing themes in speech and behavior)

   • Dream analysis (examining unconscious symbolism)

Biological

• Mental disorders have biological causes (e.g., brain structure, neurotransmitters, genetics).

Key Factors

• Neurological & neurochemical: Imbalances in dopamine, serotonin, etc.

• Genetic & epigenetic: Inherited vulnerabilities, environmental triggers.

• Endocrine system: Thyroid, stress hormones affecting mood.

• Medication: Antidepressants, anxiolytics, antipsychotics, mood stabilizers.

• Other interventions: ECT (electroconvulsive therapy), TMS (transcranial magnetic stimulation), VNS (vagus nerve stimulation), DBS (deep brain stimulation), neurofeedback

  • ect and tms helps with severe depression that nothing else seems to work for

• Lifestyle factors: Diet, sleep, and exercise significantly impact mental health.

Biopsychosocial

• biological — physical health and genetics → medical interventions

• psychological and social factors interpret more broadly and inform complementary strategies

Behavioural

• Focuses on observable behaviors and how they are learned through conditioning.

Key Concepts

• Classical Conditioning (Pavlov): Learning through association.

• Operant Conditioning (Skinner): Behavior shaped by rewards and punishments.

• Social Learning (Bandura): Observing and imitating others.

Therapeutic Techniques

• Systematic Desensitization: Gradual exposure for phobias.

• Token Economies: Reward-based systems for behavior change.

Cognitive

• cognitions (thoughts) are also important — dysfunctional thinking leads to dysfunctional emotions or behaviours

• identify and challenge distorted or irrational thoughts and beliefs, and replace them with more realistic, positive ones

• Focuses on how thoughts influence emotions and behaviors.

• Developed into Cognitive-Behavioral Therapy (CBT), which combines cognitive and behavioral strategies.

• techniques include cognitive restructuring, problem-solving, and skills training

• explain the rationale for the importance of thoughts — their relationship with feelings and behaviours

Techniques

1. Cognitive Restructuring:

   • Identifying and challenging distorted thoughts.

   • Example: Changing “I’m a failure” to “I made a mistake, but I can improve.”

2. ABC model

   • “A”ctivating event

   • “B”eliefs or thoughts about that event

   • “C”onsequences — that is, your emotional, physiological and behavioural consequences

   • Example

     • **Activating event—**Partner not home from work an hour later than usual – they are rarely late and there has been no call or text

       1. **Belief—**Stuck in a meeting → **Consequences—**Maybe a bit annoyed;Maybe a bit empathetic; Maybe a bit happy; Delay dinner

       2. **Belief—**In a serious accident → **Consequences—**Worried; Increased heart rate; Call the hospital/police

       3. **Belief—**Cheating on you → **Consequences—**Angry/upset; Heart races; Short of breath; Panic/anxiety; Destroy their stuff

Evaluating Therapies

• How do we know which therapies work?

• Must be evidences based

• Must use APA guidelines

• Treatments must be evidence-based to be considered effective.

• 3 criteria:

  1. at least two independent randomised controlled trials (RCTs) that indicate that the intervention is useful in treating a particular presenting problem

  2. the active treatment must be better than either a placebo condition or an alternative active reaction

  3. the rct must be competently carried out

Randomised Controlled Trials

• should be registered on a clinical trials register

• full protocol for the trial should be outlined

• recruitment procedures plus inclusion/exclusion criteria specified

• random assignment to conditions (conditions clearly described - active intervention, a placebo or a wait list control)

• assessment before and after the intervention (plus follow-ups)

• enough participants to be able to detect a difference between conditions if such a difference exists – adequately powered

• Gold standard for research.

• Includes pre/post-assessment, randomization, control groups.

• Example: Comparing CBT for anxiety vs. medication.

Depression and Anxiety

Introduction to Anxiety and Mood Disorders

• Unlike physical disorders, which are diagnosed through physical tests (blood tests, scans, biopsies, etc), mental illnesses are diagnosed through the assessment of signs and symptoms.

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD) are the ‘bibles’ of diagnoses

Depressive Disorders

• Within the DSM-5, there are from depressive disorders

  • Major Depressive Disorder

  • Persistent Depressive Disorder (Dysthymia)

  • Disruptive Mood

  • Dysregulation Disorder

  • Premenstrual Dysphoric Disorder

  • Substance/Medication-Induced Depressive Disorder

  • Other Specified Depressive Disorder

  • Unspecified Depressive Disorder

Major Depressive Disorder

• The diagnostic criteria states that:

  • a person needs to have demonstrated 5 or more symptoms during the same 2-week period for most of the day, nearly everyday;

  • the person’s presentation needs to represent a significant change compared to their previous functioning;

  • and that one of 5 symptoms needs to be either persistent sad mood most of the days and on most days—or loss of interest or pleasure

    • ‘sad mood’ may manifest as irritable in children and adolescents

    • loss of interest/pleasure in previously enjoyed activities is referred to anhedonia

• Some other symptoms are:

  • loss of weight or appetite in either direction — an increase or decrease

    • weight loss may be deliberate

    • weight gain needs to be a change of 5% within a month

  • change in sleep patterns — increase or decrease, insomnia or hypersomnia

    • people are more than likely to sleep more when they are depressed, as they become tired and physically exhausted when constantly sad

    • the desire to sleep can also be an escape mechanism of sorts, a desire to escape the symptoms of depresion

  • psychomotor behaviour — agitation or ‘retardation’

    • psychomotor = someone who is very fidgety and can’t sit still when they’re depression

    • psychomotor retardation = reduced and slow movement; very common

  • fatigue, loss or energy

  • thoughts of worthlessness or excessive/inappropriate guilt nearly every day, which may be delusional

  • diminished ability to think or concentrate, or indecisiveness, nearly everyday

  • suicidal thinking or ideation, reoccurring thoughts of death, but not just a fear of dying

    • suicidal thoughts/ideation without a plan, an attempt, or a specific plan for suicide.

• The DSM notes that the symptoms must represent a significant change from a person’s previous level of functioning, and the symptoms of MDD must cause clinically significant distress or impairment in a person’s functioning

  • the idea of distress and impairment is critical — this is because many symptoms of diff mental illness are things that everyone can experience from time to time

• When considering the symptoms, note that other disorders could present with these too. This requires the consideration of other potential explanations for the symptoms that the person is displaying.

• One exclusion criterion specifics that psychologists need to be sure that the symptoms are not able to be explained by physiological effects of a substance, another medical condition, or grief/loss

  • if there is reason to believe it is a substance, appropriate investigations (tox screen, blood test) should be concluded to rule out these causes.

  • grief/loss can take many forms — death, financial ruin, end of a relationship.

    • psychologists must be mindful of this as they do not want to slap a diagnostic label on a very normal process and pathologise it

    • in some cases, however, if the symptoms persist for a long time, the grief may have become a depressive disorder

• People may show symptoms of MDD as a result of a medical condition or substance use. For example, weight loss with untreated diabetes or fatigue, as a consequence of cancer, not necessarily MDD.

• Psychologists need to be mindful in thinking about, “Is the diagnosis we are considering the must accurate way of explaining or thinking about this presentation?”

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Persistent Depressive Disorder (Dysthymia)

• Eeyore has Dysthymia :(

• Dysthymia is a chronic, but lower grade intensity version of MDD. In saying this, however, it is important to emphasise that the impact of this disorder can be as or more significant than the impact of MDD

• The symptoms are very similar. In order to meet the criteria, a person needs to demonstrate depressed mood for most of the day, more days than not, for at least two years. For children and adolescents the criterion is one. In addition, people need to display two symptoms from this list:

  • poor appetite or over eating

  • insomnia or hypersomnia

  • low energy or fatigue

  • low self-esteem

  • poor concentration or problems making decisions

  • a sense of hopelessness

• This disorder is an amalgamation of two DSM-4 disorders = dysthymic disorder and chronic major depressive episode

• Someone can have both MDD and Dysthymia at the same time = double depression

Prevalence of Depression Disorders

• AUS & US data indicate that the 12-month prevalence of MDD in adults is between 6 & 7%. In 18-29 year olds, the prevalence is 3 times more than people aged 60 or older. Many adults with depression say it started within adolescence or early adulthood

• Females are more than likely to develop MDD than males, the difference 1.5 to 3 times.

The Course of Depressive Disorders

• MDD can begin at any age but onset does increase with puberty. In Western nations, incidence seems to peak in the 20s although it isn’t uncommon for onset to be later in life

• Dysthymia tends to have an early and chronic onset. MDD has remission (2 or more months with no symptoms or no more than 2 symptoms at a mild level) and some can go for a number of years without experiencing a major depressive episode.

• Most people, given enough time, will recover without intervention. This is called spontaneous recovery. For 2 in 5 people with MDD, spontaneous recovery will occur within 3 months of onset; and for 4 in 5 people this will happen within 12 months of onset

• Features associated with lower rates of recovery from a major depressive disorder include

  • symptom severity

  • personality disorders

  • psychotic features

• Factors associated with increased risk of experiencing another episode of MDD include:

  • the severity of preceding episode

  • being younger at onset

  • having experienced more prior episodes.

• If a person with dysthymia develops symptoms that meet criteria for a major depressive episode, what will typically happen is that the symptoms will return to a lower level — such that the criteria for dysthymia but not major depressive disorder continue to met

• In terms of symptom resolution, this is more likely to occur spontaneously with MDD than dysthymia.

The Causal Models of Depressive Disorders

• There is good evidence that biological and genetic factors play an important role in development of depressive disorders.

• Disrupted neurotransmitter functioning has been implicated - in particular, the neurotransmitters, serotonin, dopamine, and noradrenaline

• First degree relatives of individuals with MDD are at risk for developing this disorder compared to the general population. The increased odds are 2-4 times

• Research suggests dysthymia has an even heavier genetic loading.

• Prejudicial childhood experiences — trauma, abuse, and/or neglect — are risk factors for developing depression. Stressful life events have also been found to be associated with the onset of major depressive episodes.

• It is very unlikely for depression to occur without stressful life events—it’s just that not everyone will develop a depressive disorder in response to stressful life events

• So, the best and more accurate way of thinking about aetiology or development of a depressive illness is in terms of a diathesis-stress model.

• A person may have an underlying predisposition, this may be a genetic, physiological or a psychological vulnerability to develop depression, which is then triggered by exposure to stressful life events for example — causing the predisposition to convert into a disorder.

Cognitive Behavioural Model of Depression

• From the cognitive behavioural perspective, thinking about the development/aetiology of depressive disorders, the behavioural component suggests that depression is maintained by the lack of positive reinforcement that results from a person’s failure to engage in previously enjoyed activities

• This in turn feeds into a sense of learned helplessness; a sense of utter powerlessness in relation to the external environment

• Learned helplessness might be expressed in thoughts such as “There is nothing I can do to make myself feel better. I may as well just stop trying.” Depression is very much about negative thoughts relating to the self, the world and the future.

• People who are clinically depressed often demonstrate what is referred to as a pessimistic explanatory style, where bad things are attributed to internal, stable, and global factors; while positive things are attributed to external, random factors.

Treatment for Depressive Disorders

• Antidepressant medication is very commonly used in the management of depression. The most commonly prescribed class of antidepressants is the Selective Serotonin Reuptake Inhibitors or SSRIs

• Another biological treatment for depressive disorders that tends to be used as a last resort, for treatment-resistant depression, is Electroconvulsive therapy or ECT

• In terms of psychological interventions, cognitive behavioural therapy or CBT has the strongest evidence base, with Interpersonal therapy or IPT also showing good outcomes.

• Two of the key strategies within CBT for the treatment of depression are behavioural activation and cognitive restructuring.

• Behavioural activation, also known as Pleasant Events Scheduling, targets the depressive symptom of loss of pleasure or interest in previously enjoyed activities.

  • With this strategy, psychologist work with their client to figure out what activities they used to enjoy before they became depressed. Then, they set homework tasks in which the client has to engage in activities they previously enjoyed.

  • The rationale for behavioural activation is that, with some time, the client will begin to experience positive reinforcement for engaging in these activities, which will lead to an improvement in their mood.

• The second strategy of cognition restructuring involves working with a client to help them identify or catch the thoughts that are contributing to their sadness and hopelessness; and evaluating the evidence for and against the likelihood of these thoughts being accurate.

Anxiety

• Anxiety, as an emotion, is a normal part of being human—everyone gets anxious. The problem is how one distinguishes between anxiety that falls within the broad parameters of normal, and anxiety that as become clinically significant.

• Clinically significant is if a person’s anxiety is causing them a great deal of distress and/or it’s really interfering with their functioning. It comes down to two key constructs — distress caused and associated impairment or interference in functioning

• There are a number of DSM-5 anxiety disorders:

  • Separation Anxiety Disorder

  • Selective Mutism

  • Specific Phobia

  • Social Anxiety Disorder (social phobia)

  • Panic Disorder

  • Agoraphobia

  • Generalised Anxiety Disorder

  • Substance/Medication Induced Anxiety Disorder

  • Anxiety Disorder Due to Another Medical Condition

  • Other Specified Anxiety Disorder

  • Unspecified Anxiety Disorder

• There is an idea of 3 systems of anxiety

  • the cognitive system — what people think either before, during, or after a situation where they feel anxious

  • the behavioural system — what people do when they are anxious

  • the physiological system — what happens in people’s bodies when they are anxious

Specific Phobia

• People with a Specific Phobia demonstrate a really high level of fear, anxiety, or avoidance in relation to very specific, circumscribed situations or objects

• Essentially, very specific fears that are out of all proportion to any actual danger. The fear may be manifested in children and adolescents as behaviours such as crying. tantrums, and clinging.

• The most common types, and diagnostic specifiers, of phobic stimuli are

  • animals — snakes, spiders, etc

  • natural environment — storms

  • blood-injection-injury — injections

  • situational — enclosed spaces

  • other situations — a situation that a person associates with choking or vomiting

• In order to meet the criteria for a Specific Phobia, a person must demonstrate:

  • extreme fear or anxiety about a specific situation/object almost always when confronted with it

  • avoided or endured the phobic stimulus, which is out of proportion to any actual danger posed by it

  • the fear/anxiety/avoidance must have been experienced for 6 months or longer, and must cause clinically significant distress or interference

  • must not be better explained by symptoms of another mental illness

• These phobias usually develop in early childhood, with most cases beginning before the age of 10. The prevalence rate for Specific Phobia is around 5% going up to 16% in adolescents, and 3-5% to beyond adolescence. It affects twice as many females compared to males

Social Anxiety Disorder

• Social Anxiety Disorder is different to generally feeling anxious in social situations, as it is a fear/anxiety about or avoidance of social situations and interactions in which there is the possibility of being scrutinised or judged by others

• Common social interactions that may provoke anxiety include:

  • eating in front of others

  • performing in front of others

  • having to meet someone new

• These situations almost always provoke anxiety and are either avoided or endured with extreme anxiety. Anxiety must have been present for at least 6 months, and must be out of proportion for what it is, resulting in either intense distress and/or significant impairment in functioning

• In Western Countries, the 12-month prevalence rate for Social Anxiety Disorder is around 7% across all ages, ,ore common in females, with 75% of onset between ages of 8 and 15. Social anxiety forming in adulthood is reasonably rare.

Panic Disorder

• Characterised by recurrent, unexpected panic attacks. Panic attacks are defined as ‘an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes’

• A panic attack involves four or more of the symptoms:

  • palpitations, pounding heart, accelerated heart rate

  • sweating

  • trembling or shaking

  • sensations of shortness of breath or smothering

  • feelings of choking

  • chest pain or discomfort

  • nausea or abdominal distress

  • feeling dizzy, unsteady, lightheaded, or faint

  • chills or heat sensations

  • paresthesias —numbness or tingling sensations

  • derealisation — feelings of unreality, or depersonalisation, being detached from oneself

  • fear of losing control or going crazy

  • fear of dying

• To meet the criteria for Panic Disorder, at least one panic attack must have been followed by at least a month of either or both of:

  • persistent anticipatory anxiety or concern about having another attack or the consequences of having an attack

  • a significant and problematic behavioural change related to the attack, for example avoiding exercise as one might induce a panic attack

• While many of the listed symptoms are common in general anxiety and a panic attack, there are differences in the usual thinking. For example, someone having anxiety may think ‘the reason my heart is racing is that i’m anxious’, whereas someone having a panic attack will think ‘my heart is beating so fast, i must be having a heart attack.’

• Typically, by the time somebody with panic disorder ends up seeing a mental health professional, they have done the rounds in terms of various medical specialists. Often, people with panic disorder are pretty unhappy to be seeing a mental health professional.

• 12 month prevalence is around a 2-3 rate across adolescents and adults. Not commonly seen in children. Diagnosed about twice as often in females as males.

Comorbidity—Focus on Panic Disorder

• Comorbidity = where a person meets criteria simultaneously for more than one diagnosis.

• Somewhere between 10 and 65% of people with a primary diagnosis of Panic disorder will also meet criteria for MDD. In most cases, MDD develops either around the same time or subsequent to the panic disorder

• The co-occurrence of panic disorders and substance use problems is due to people using substances to self-medicate or to try to reduce the distress and interference caused by their anxiety symptoms. This is very common.

Generalised Anxiety Disorder

• Essentially defined by excessive worrying. Differences between GAD and non-clinical worrying would be that people with GAD may tell you that they experience their worry as totally uncontrollable.

• People with GAD may worry about all manner of things: work, school, health, health of others, the impression they make on others, things that are happening elsewhere-natural disasters, civil wars, etc

• A person must find it difficult to control worry or anxiety for more than 6 months and 3 out of 6 symptoms:

  • muscle tension & restlessness

  • distress or impairment

  • hypervigilance

  • being easily fatigued

  • difficulty concentrating or mind going blank

  • sleep disturbance.

• GAD has a 12 month prevalence rate of 0.9% in adolescents and 2.9% in adults, females twice as likely as males to be diagnosed

Causal Models of Anxiety Disorders

• Anxiety runs in families — if one your relatives with an anxiety disorder, your odds of developing an anxiety disorder increases.

• Common features across anxiety disorders are

  • heritability, which accounts for upwards of 30-40% of the variance in the development of anxiety disorders

  • temperament — an innate rather than learned aspect of personality — has been found to be important in the development. In particular, the temperamental quality of behavioural inhibition—characterised by shyness, fear of unfamiliar situations and withdrawal—has been identified as an important risk factor.

  • environmental factors including exposure to potentially traumatic events, an accumulation of stressful life events, and parenting behaviours, such as modelling and overprotection

• The best way of understanding how anxiety develops is by considering the ways in which biological risks may interact with environmental triggers

Cognitive Behavioural Models of Anxiety

• From a cognitive behavioural perspective, the behavioural component in the aetiology of anxiety disorders is informed by Stanley Rachman’s work published in 1977

  • Rachman proposed three pathways through which people might develop fear.

  • The first is through their own direction experience, which may become generalised through conditioning (eg, if you’re bit by a dog, you’re gonna fear dogs)

  • The second pathway is instructional learning, which involves the transmission of information relating to danger (eg when a parents warns a child to stay away from a pool as people drown, the child may be fearful of pools)

  • The third is vicarious learning, which is when you repeatedly see someone else, usually an important person in your life like a parent, behave fearfully the confronted by a particular stimulus, then you develop that fear.

Cognitive Behavioural Therapy for Treating Anxiety Disorders

• The frontline intervention for treating anxiety disorders is cognitive behavioural therapy (CBT)

• CBT is an efficacious treatment across diagnoses, resulting in superior outcomes compared to waitlist control conditions and expectancy control treatments.

• CBT seems to work better for GAD than Social Anxiety Disorder.

• A review of treatment in anxiety disorders in children and adolescents reported an average remission rate of 56.5%. It isn’t a perfect treatment though, as some didn’t feel it worked whatsoever and others reported reoccurring symptoms, albeit not as strong

Other Treatments for Anxiety Disorders

• Medication is an option but no the frontline intervention

• Some other treatments include

  • psychoeducation about anxiety — educating clients about anxiety, including telling them that it is normal, often adaptive or helpful, and that we understand it to consist of threep separate but interrelated systems (cognitive, behavioural, physiological systems)

  • cognitive restructuring and exposure — requires the client to understand the important of thoughts. Would ask the client to start identifying the unhelpful thoughts that are making them anxious in ways like a thought diary. These thoughts are then worked through to evaluate the evidence for and against the likelihood of the thoughts being accurate.

    • Children go through the ‘Scientific Approach’ where kids are encouraged to think of themselves as scientists who have to evaluate the evidence for and against their ‘hypotheses’ (anxious thoughts)

    • Adults go through ‘Socratic Questioning’

• These strategies tend to be used together.

• Systematic desensitisation or exposure aims to address the avoidance of feared stimuli that tends to go with the anxiety. This strategy is based on the psychological principle of habituation and involves deliberately and repeatedly placing yourself in anxiety-provoking situations that would normally be avoided.

  • Treatment begins with creating a list of anxiety provoking situations in a hierarchy. Relaxation was used before to reduce the anxiety in these situations, however research as showed this to be a subtle form of avoidance. Thus, the aim is to be exposed to the situation and fully experience the anxiety to realise that you can handle handle the situation through relaxing within it. The experiences in the hierarchy needs to be experienced (imaginally or in real life) repeatedly until the fear response has been extinguished.

• The most common behavioural response to anxiety is avoidance. Avoidance means that the individual misses out on the opportunity to discover that he or she actually can cope with that feared situation. Instead, it strengthens and reinforces anxiety

Personality 1

What is Personality?

• personality refers to the character traits that identify what makes a person who they are

• the unique way of each of us responds to the world around us — our consistent pattern of behaviours, thoughts, and emotions

  • these patterns define an individual and differentiate them from others

  • represents a dynamic combination of biological, psychological, environmental influences

• consistency = personality traits tend to be relatively stable across time and situations

• uniqueness = personality highlights what makes an individual distinct from others

• individuality = encompasses both innate tendencies and learned behaviours

• patterns = refer to the repeated ways in which individuals interact with the world

• individual differences = variability in personality traits and behaviours across people. differences are what make each person unique

• Why study personality?

  • clinical = diagnosing and treating mental health conditions

  • social = predicting social interactions and relationships

  • developmental = understanding how traits emerge and evolve throughout life

• Approaches to studying personality

  • Nomothetic = searching for general laws that govern all human behaviour

    • focuses on identifying general laws or principles that apply to all individuals

    • emphasises universality and generalisation

    • personality models

    • studies of genetic contributions to personality

  • idiographic = focusing on unique aspects of individuals

    • focuses on understanding the unique characteristics of an individual

    • emphasises individuality over generalisation

    • tracking the personality development of a single person over decades to understand how traits evolve with age and life event

    • designing a therapy plan for a person with PTSD

Why Study Personality?: Clinical

• Diagnosis and treatment

  • certain issues may be linked to stable patterns in personality

  • tailor interventions, predict treatment challenges, and guide therapeutic approaches

• Risk factors and prognosis

  • traits can predispose individuals to anxiety or depression onset and outcomes

• Therapeutic Relationships

  • traits can affect engagement and response to therapy

Causes of Personality

• Nature and Nurture

• Shaped by a combination of biological inheritance and environmental influences

  • genetic factors

    • influence brain structure and function, such as neurotransmitter activity, which impacts personality traits

    • eg dopamine systems are linked to traits like extraversion and reward sensitivity

  • shared environmental factors

    • parenting style: authoriative, permissive, or authoritarian parenting may influence personality development

    • socioeconomic status: access to resources, education, and social norms can shape personality

    • cultural value: a shared emphasis on collectivism or individualism within a family

  • non-shared environmental factors

    • explains majority of environmental variances in personality traits

    • different peer groups: friends can shape attitudes, behaviours, and preferences

    • unique life events: personal traumas, achievements, or opportunities that differ between siblings

    • birth order: firstborns may receive more parental attention, while later-borns may have different expectations place upon them

Psychodynamic Approach

• Interaction between id, ego, superego

• Developed through psychosexual stages

• Criticised for its lack of empirical evidence and its focus on sexuality

• Dynamic interplay

  • the id wants instant gratification

  • the superego imposes strict moral guidelines

  • the ego mediates to achieve balance, often leading to internal tension

Id

• pleasure principles, seek pleasure and avoid pain

• primitive and instinctual part of the mind, operating entirely on the unconscious level

• contains biological drives and instincts

Ego

• reality principle, delay gratification when necessary

• rational and realistic part of the mind that mediates. between the id and the eternal world

• executive decision maker — balances the impulsive desires of the id and the moral constraints of the superego

Superego

• perfection principle, pushing the individual to strive for moral perfection

• moral and ethical component of personality, representing societal and parental standards

• develops around age 5-6 through internalisation of rules and values

• two subsystems

  • conscience = guilt for violating moral standards

  • ego ideal = aspirations for achieving moral and ideal behaviours

Psychosexual Stages of Development

• personality develops through a series of stages, each centred on a specific erogenous zone

• at each stage, children experience conflicts between their biological drives and societal expectations

• successful resolution of these conflicts is essential for healthy personality development

• fixation at a stage can lead to personality and behavioural issues later and life

Criticisms of Freud’s Theories

• lack of empirical evidence

  • freud’s theories are difficult to test scientifically and lack of falsifiability

• Overemphasis on sexuality

  • his psychosexual stages have been criticised for being overly focused on sexual development

• Cultural and Gender bias

  • concepts like “penis envy” are considered sexist and reflective of Victorian-era values

• Subjectivity

  • ideas were based on case studies and subjective interpretations rather than controlled research

Freud’s Contributions

• importance of early childhood experiences in shaping personality

• Concepts like fixation and unconscious conflict laid groundwork for modern psychodynamic therapies

• Freud’s ideas have permeated literature, art, and discussion of human behaviour, even beyond psychology

• Freud’s theories actually gave people a socially acceptable way to talk about sexuality by giving sexual interpretations to everyday behaviours

• Sexual development and sexuality is an important part of psychology

Behavioural Theories of Personality

• Early psychology focused on unconscious processes, but moved onto focusing on things people can measure

• Behaviourists thought that people should explain personality in terms of people’s behaviour rather than just their thoughts — because that could be measured

• B.F. Skinner proposed behaviourism mainly

• The behavioural approach to personality is the idea that personality is under the control of genetic factors and environmental reinforces and punishers

• Skinner, like Freud, thought that our behaviour is strictly deterministic, that one doesn’t consciously chose how we behave, as well that is is determined by unconscious processes

• Freud however says unconscious processes are things that happen deep inside our psyche, outside of our level of awareness, whereas Skinner thought the unconscious things that affect us are things that are in the environment that reinforce or punish us

• Skinner thought that the unconscious variables are outside of oneself.

Social Learning Theories of Personality

• Albert Bandura took Skinner’s idea of environmental influences on people’s behaviour, but also that cognition was still important in terms of behaviour and how we express personality

• Bandura argued that personality is the interaction between a person’s traits, their thoughts, and the environment that their behaviour is expressed in

• Reciprocal determinism refers to the idea that behavioural, cognitive, and environmental variable interact to produce personality

• Although, Bandura’s social learning approach relies on expectancies — you need to have the cognitive machinery to be able to form these expectancies which is a higher level of cognitive function, but we still see social learning in animals that don’t have cognitive machinery

Humanistic Theory of Personality

• More positive = how positive motivations can be related to the expression of personality

• Two main proponents of these perspectives, Carl Rogers and Abraham Maslow

• Rogers thought that personality was a function of the person, the self which is the self-concept, and what he called the Conditions of Worth

• Conditions of Worth are the expectations or rules that society puts on our behaviour, which can lead to an inconsistency between people’s self-concept and what they are actually like

• Personality development will be fully realised in a world where there were no expectancies about what people are meant to be like = Roger’s idealised this world

• Maslow thought that positive motivation was important for personality

• Maslow defined personality as the expression of the tendency to strive for what he calls self-actualisation, which is the idea that people want to fulfil their potential.

• Hierarchy of needs = the idea that if our phsyiological needs are met (food, water, oxygen, rest), we would be motivated by the next tier up, which are safety needs

• The idea is we can’t be motivation by self-actualisation unless all of these lower order needs are satisfied first — however, the needs are defined subjectively, thus hard to test

Types versus trait models of personality

• Humoral theory = first theories of personality was a type model

• Humoral theory characterised a person’s personality based on what sort of humour/fluid they had in excess in their body

  • choleric type people—too much yellow biles, they would be bad tempered and irritable

  • melancholic people = too much black bile, gloomy & pessimistic

• No biological evidence for humoral theory, but people still think about personality in terms of types

Personality traits

• Traits are the building blocks of personality and refer to enduring characteristics that influence behaviour

  • stable tendencies to think, feel, or behave in certain ways across different situations

  • they exist on dimensions or spectrums, rather than as categorical types

  • they help predict behaviours

  • traits contribute to individual differences in how people respond to similar situations

• Trait theorists think that traits are the factors that are responsible for causing patterns of behaviour, that traits are things that reside in our brains

  • brain injuries, drugs, etc, may affect your personality when changing the brain

• To determine personality traits, you can give someone a questionnaire and ask them how many personality specific words apply to them. Then, perform a statistical test — factor analysis — on the responses, which tells us what the minimum number of things we need to summarise the data and the minimum number of things are the dimensions of personality. You can then plot the responses and see if you need a certain amount of dimensions

• From research, people seem to agree that there are between 3 and 16 dimensions of personality that are necessary for describing it.

• Raymond Cattell came up with ‘16PF’ = 16 personality factors

• Neil Mccrae and Paul Costa came up with Big Five = 5 factors to personality

  1. neuroticism = tense and moody

  2. extraversion = social and lively

  3. openness = intellectually curious and unconventional

  4. agreeableness = friendly and easy to get along with

  5. conscientiousness = careful and responsible

• Hans Eysenck came up with three bipolar dimensions

  1. extraversion to introversion = going from outgoing nature, high level of activity, to shuns crowds, prefers solitary activity

  2. neuroticism to emotional stability = going from full of anxiety, worries and guilt to relaxed and at peace

  3. psychoticism to self-control = aggressive, egocentric and antisocial

The Big 5 Across Cultures

• China has 26 different personality constructs = Chinese Personality Assessment Inventory (CPAI)

  • dependability = responsibility, optimism, trustworthiness

  • interpersonal relatedness = harmony, thrift, relational orientation, tradition

  • social potency = leadership, adventurousness, extraversion

  • individualism = logical orientation, defensiveness, self-orientation

• Overlaps with B5 — neuroticism was correlated with dependability, extraversion with social potency, agreeableness with individualism

Biopsychological Theory of Personality

• Jeffery Gray developed the idea that personality is explained by physical differences in the brain

• Gray proposed the behavioural inhibition system (BIS) and behavioural approach system (BAS)

• BIS

  • related to the individuals sensitivity to punishment and motivation for avoidance

• BAS

  • related to the individuals sensitivity to reward as well as their motivation for approach

Personality Assessment: Objective Tests

• Minnesota Multiphasic Personality Inventory (MMPI)

  • questionnaire measure of personality with a large number of items

  • designed for a clinical setting

  • MMPI is useful for diagnosing psychological disorders

  • yet comes with the risk of being deceived even if made to detect deception and social desirability bias

• Thematic Apperception Test

  • present people with an ambiguous stimuli and ask people to describe whats in the image

Personality Assessment: Projective Tests

• Rorschach inkblot

  • shows someone an ambiguous inkblot and ask them to describe what they see, then score according to different coding schemes.

  • Involves subjective judgements = low reliability and low validity

Schizophrenia

Prevalence of Mental Illness

• Western nations = 1 in 5 people will have a mental illness across their lifespan, the type depending on ages, gender, culture, etc

Schizophrenia

Key Facts

• Prevalence = 0.5 - 1 %

• Similar prevalence between males and females, but difference in the age range for onset — common between ages 15 and 35. Late onset is considering 40+

• The Lifetime risk for suicide in people living with schizophrenia is 5%. Risk factors associated with suicide including being male, being younger, and having a high level of education, as does a history of suicide and substance abuse

• People with schizophrenia die much earlier than expected with up to 40% of premature mortality attributed to suicide and unnatural death

• Referred to as the prototypical psychotic disorder as it one of the most common and covers the main 5 symptoms

• One of the highest impact disorders, having the most impact on the individual and the people around them, as well as the economic cost

The Costs Associated with Schizophrenia

Diagnostic Criteria

DSM-5

• Within the Schizophrenia Spectrum and Other Psychotic Disorders category

• Not all symptoms have to be demonstrated, only two or more

• Criterion A

  • symptoms must be present for a six-month period or longer, with at least one month of active symptoms

  • Delusions

  • Hallucinations

  • Disorganised speech

  • Grossly disorganised or catatonic behaviour

  • Negative symptoms

• Positive symptoms = the fact that the behaviours or experiences that make up these symptoms are happening too much

• Negative symptoms = behaviours that are in a deficit

Delusions

• Positive symptom

• A false belief, so the content of their thought is inaccurate or false. Are not explained by religious or cultural beliefs.

• Are believed despite all the evidence to the contrary; it is pointless to try and persuade someone that they are inncorrect

• Delusions of Persecution = paranoid flavour with a theme of others being out to get you. May think that they are being followed everywhere

• Delusions of Grandeur = someone believes that they possess qualities or attributes that make them superior to other people — money, fame, talent, intelligence, special relationship with someone in power. May think they’re Taylor Swift’s best friend

Disorganised Speech

• Positive symptom

• Reflects a disturbance in the form of thought as opposed to the content of though

• When somebody’s thoughts, the form and the process of them, are disorganised, their speech will also be affected

• Speech disturbance involves prolonged patterns of disorganised speech that are much more extreme

• Neologism = when a person makes up a word. The word has no meaning and is often a combination of two words

• Word Salad = words tossed together that makes no sense, has no meaning

• Tangential speech = changes topic from a specific trigger, and never returns to the original topic of conversation and lacks insight into this behaviour

Hallucinations

• Disturbances of perception, a false sensory experience

• Any hallucinations could be a product of organic brain disease and this must be ruled out very early on (MRIs, etc)

• Believe they are experiencing something through one of the five senses when they are not

• Very distressing as it feels real and they fully believe it so

• Most common are auditory hallucinations = hearing voices, ones that are usually derogatory and negative. May be more than one voice.

• Visual hallucinations = the experience of seeing something that is not actually there.

• Olfactory hallucinations = smelling something that isn’t there

• Gustatory hallucinations = tasting something that theyre not actually tasting

• Tactile Hallucination = false sensory experience in relation to sense of touc

Disorganised or Abnormal Motor Behaviour

• Can manifest in many different ways, such as:

  • Psychomotor agitation, such as restlessness and inability to stay still

  • Behaviour may be characterised by childish silliness or a complete lack of focus

  • Excessive purposeless activity that is unrelated to anything going on in the environment going on in the environment

  • Self-initiated bizarre postures, such as standing bent at the waist with one arm in the air

  • Complete lack of response to all stimuli, like not responding when someone talks to you, prods you, and os on

• Catatonia = neurogenic motor immobility, or behavioural abnormality manifested as stupor; where some can become rigid and immobile. Not very common

Negative Symptoms

• Reflects normal behaviours that are in deficit

• Expression of affect or emotion, speech, and motivation

• Affect or expression of emotion

  • ‘flat affect’, where the expression of emotion through tone of voice and facial expression is significantly reduce

• Speech

  • alogia = poverty of speech, involves a lack of spontaneous speech, reflects impoverish thought processes

• Motivation

  • avolition = inability to initiate or engage in goal-directed behaviours

  • depression

  • lack of self-care around personal hygiene

Course of Schizophrenia

• Is an episodic illness, with majority of people experiencing more than one psychotic episode

• Three phases

  • Prodromal phase = decline in functioning. Negative symptoms such as motivation, social withdrawal, and a decline in self-care appear

  • Active phase = positive symptoms appear.

  • Residual phase = positive symptoms have remitted, usually with help of medication, but some negative symptoms remain.

Aetiology of Schizophrenia

• Genetics and biology are extremely important — the prevalence wherein you have a biological relative goes up to 10% from 1%. For monozygotic twins, this goes up to 50%

• People with schizophrenia have been found to have structural brain abnormalities and biochemical abnormalities (neurotransmitter dopamine)

• Being exposed to pregnancy and birth complications that may have caused structural damage to the brain is another factor

• Social factors, particularly low socioeconomic status (SES), is associated with schizophrenia.

  • More common but not restricted to

  • Some potential harmful characteristics associated with lower SES include stress, social isolation, poor nutrition, lack of access to medical services

• Social dislocation is another social factor linked to schizophrenia

  • higher rates are found in people who have migrated to a new country

• Expression emotion is a psychological factor

  • refers to the level of criticism, hostility, and emotional over-involvement that exists within a family

  • people who live in a family with a high level of negative emotion expressed are significantly more likely to relapse into schizophrenia than those not

  • With family though — no do not fall into the trap of blaming family members. Have empathy for those who have to live with someone with this disorder

Diathesis-stress model of Schizophrenia

• Proposes that, with schizophrenia, there is an underlying vulnerability that is most likely related to a genetic predisposition

• However, this vulnerability may only convert into an illness in the context of the environmental stressors

• Hypothesised diatheses for schizophrenia include

  • genetic factors

  • physical trauma prenatally or during birth

  • structural abnormalities of the brain

  • abnormalities in the neurotransmitter

• Environmental stressors may include

  • chronic psychological and social stressors, such as poverty

  • living in a family environment with a high level of negative expressed emotion

  • drug use, especially marijuana

Treatment of Schizophrenia

• Medication = anti-psychotics (good responses in positive symptoms)

• Anti-psychotics don’t work with one quarter of people however, and have many negative side effects such as weight gain and tardive dyskinesia (involuntary neurological movement disorder affecting lower face)

• Psych-education = done with the schizophrenic person and their family members to educate them about the signs of relapse and what to do if it happens

• Behavioural strategies = help people with schizophrenia to develop their social skills, with a view to promote the development and maintenance of social relationships and friendships

• CBT = recommended to those with well-managed or stable schizophrenia, but treats symptoms in the small range

• Support to families is imperative

Measurement and Intelligence

Test Standardisation

• ‘Do we know what the average level of performance is? Do we know what the mean score is? DO we know something about how much scores vary around that mean?’

• Done by surveying/testing a large number of people and calculating the mean, and thus how much variation there is around that average

The Normal Distribution

• Coverting data into standardised scores/converting the distribution of scores into a standard normal distribution

• A normal distribution where the mean is ‘zero’ and the standard deviation is ‘one’

• For height, you subtract the mean from the high value and dividing it by the standard deviation, which is 10. Someone with a height of 180cms will now how a standardised score of 1 on this standard normal distribution (180-170 / 1)

• From that, one can see that they are one standard deviation above the mean, and we cam tell how small or large the score is because we know the properties of the standard normal distribution

Alternate Forms and Split Half Reliability

• Reliability is the extent to which a measure gives you consistent measures on repeated measures

• Measuring intelligence tests on reliability has different techniques: alternate forms reliability, split half reliability, and test retest reliability

• Alternative forms reliability involved the evaluation of two different versions of the same test. The scores are compared to see if the test is reliable

• Split half reliability involves the evaluation of two tests, however, it may not be possible for researchers to develop two versions of the test, so they test one test into two tests. You evaluate different parts of the test, like their first performance compared to the second performance.

  • By cutting the one test in half, we’re assuming that the first half of the test is measuring the same thing as the second half.

  • But, if we then split the test in half and compare performance between the two, the performance could be different––not because the test is not reliable, but because the parts of the test we’re comparing are measuring different things.

  • Well, we can solve this problem by dividing the test in many different ways. There are many different ways we can split the test in half. We could take the odd and even items, or jumble them up and sort them into two parts randomly. Split half reliability effectively does that, statistically. What it will do is jumble up the test in all different possible halves and give us the average correlation of all those halves.

• Test retest reliability involves getting the same group of people to complete the same test twice.

  • However, if the test reliability is low, it looks like there's no relation between the scores for the first time the test is taken compared to the second time the test is taken.

  • Now, test retest reliability assumes that what we're measuring in the test is stable.

  • Test retest reliability also assumes that any changes in the responses given by people in the test are not due to repeated exposure to the same test.

Validity

• Assesses the accuracy of the test in measuring what it is meant to measure

Predictive

• Refers to whether or not the scores on the test match with later outcomes

• For examples, when using an intelligence test to predict job performance, what we would want to do is measure a person’s intelligence at one point, and then some time later, compare their performance in the job to their scores on the intelligence test. If their intelligence test scores predict their job performance, then we would say that it has predictive validity for that purpose.

• We then use the intelligence test when hiring new people for the job to give us some idea about who might be the best candidate. Then, six months later, we test it again on the person and compare the validity of using the intelligence test to assess possible job performance

• Measure someone’s performance on an intelligence test once, and then measure the same person again six months later to see how well they’re doing in their new job = Predictive

Criterion

• Matches the scores on the test with some other measure—either a previous measure or concurrent measure of the same thing.

• For example, if we’re interested to see whether or not your grades in this course are a valid measure of you academic performance, what we could do is compare your grades from this course with your grades from high-school, because your performance in high school is another measure of your academic ability.

• Typically, student’s grades from high school are taken over a number of years and have been assessed over a range of topics, so they should be a pretty good stable measure for academic ability

• Compare someone’s grades from a particular course at university with their grades from high school = Criterion

Construct

• The idea that when we design a measure for something, the way we’ve designed the measure follows the underlying theory that we think represents the concept of what we’re measuring

• For example, if we develop an intelligence test on the basis of six underlying constructs that are supported by theory and evidence, we need to assess those six underlying constructs in our test

• If the test we’ve developed for personality is made up of three factors, we need to measure those three factors. Refers to how well a test maps onto the underlying theory with regard to think we’re measuring

• Assess the six theoretically supported underlying constructs that a newly developed intelligence test is based on = Construct

Test Bias

• The extent to which everybody has the same chances to do well on the test, which can be dependent on culture and other factors

• If the test has been developed in one culture and administered in another, people from a different culture where the test was developed may be at a disadvantage

• If its an intelligence test, it’s not because people from a different culture are less intelligent than those from where the test was developed, it was because it is biased to the people from one cultural background compared to another.

• Age is another factor = if you develop a test for adults and give it to children, the children will do bad but not because they’re not intelligent enough, just that the test is biased towards adults

Origins of Measuring Intelligence

• The first attempt to assess intelligence was in France, when the education board decided they needed to do something about children who were struggling in school to kick them out so they didn;t detract from the schooling of other children

• Alfred Binet and Theodore Simon were two French academics who were interested in measuring children’s intelligence, and they made a book for the children known as the ‘Binet-Simon Scale’

• American Psychologist, Lewis Terman was interested in measuring intelligence, and he took the Binet-Simon measure and adapted it for the American context. He translated and standardised it, introducing the concept of IQ

• IQ stands for the intelligence quotient and the scale was called the Stanford-Binet scale as he worked at the Stanford Graduate School of Education

• For example, if a seven year old child passed all the aged seven normed items on the Binet-Simon Scale, they would score a mental age of seven. To work out their IQ, they would divide their mental age of seven by their chronological age, which is also seven, and multiply it by 100. Then they would score a 7, and is performing at their expected level for their age.

• If a seven year old child was able to answer all the 14-year-old age-normed questions, it would mean that they would have an IQ of 200. The problem with the Stanford-Binet Scale is that the age-normed items only really go up to 16 years of age, but chronological age keeps rising. What happens is, if you gave a person with an IQ of 100 this test every year and graphed how they scored, the measured mental age would increase in lockstep with their chronological age and they would have an IQ of 100 at each time we measured it because their mental age would match their chronological age, so the IQ stays the same.

• However, when they hit 16 years of age, the measured IQ would actually start decreasing because as their chronological age increases, their measured mental age is at the top of the scale and so doesn’t keep up with their chronological age any more. This is purely a function of the maths calculating IQ this way. It's not that people become less intelligent in their teenage years, despite what their parents might say. It's just because the scale doesn’t have any items beyond age 16. This way of calculating IQ fell out of favour over time, because it wasn't very adaptable to broader age groups.

• Today when we measure IQ, we're not talking about the ratio of chronological age to mental age. What we do is we compare performance on an IQ test to the standardised data we have about performance on that test. If someone scored 115 on an IQ test, that's one standard deviation above the mean. IQ scores by definition have a mean of 100, and a standard deviation of 15. Overtime, because people’s average performance on the test gradually increases, we have to re-standardise the test so that the average is always back to 100. This is how we work with IQ tests now. It's literally on the basis of the standard normal curve.

Contemporary Tests of Intelligence

• American Psychologist, David Wechsler, developed the the Wechsler Adult Intelligence Scale in 1955, known as the WAIS, for adults

• In the contemporary age, we are up to the WAIS-IV (FOUR) and there are separate versions for children and adults, as well as for different age groups

• People’s performance on the test is then compared to the standardised information. On the completion of the test, they receive a score that represents the overall or fullscale IQ, which is broken down into verbal and performance IQ

• Verbal IQ includes verbal comprehension, working memory

• Performance IQ includes perceptual organisation and processing speed.

• These indicators provide people with fairly detailed information about their performance across a number of different domains from the test. They are typically administered by trained test administrators.

• Typically these tests assess things like digit span or the ability to keep a series of numbers in working memory, which is a component of verbal IQ

What is Intelligence?

• Psychologists agree with what it is they’re measuring when it comes to intelligence, like the person’s ability to learn and remember information, to recognise concepts and their relations, and to apply the information to their own behaviour in an adaptive way

• Multiple Intelligence is the perspective where we have a number of sub-skills. “Look, I’m not real good at math, but I’ve got really good emotional intelligence and I can connect with people

General Intelligence

• General Intelligence is the underlying of all our abilities. For example, if someone is good at maths, they’re probably going to be good at music because they’re both driven by the same thing

• Spearman proposed the idea of the Two Factor Theory of Intelligence, and he thought that people’s performance on tests was a function of two factors. One is the ‘G’ factor (general intelligence) and the other is the ‘S’ factor, which is specific intellectual abilities

• Spearman thought that general intelligence influences our general performance on all mental tasks whereas ‘S’ is unique individual abilities on a particular task

• Education of relations = being able to compare something and look at what was consistent across the shapes and work out what the rule is

• Education of correlates = doesn’t require the ‘G’

Components of Intelligence

• Factor analysis = advance statistical technique

• Imagine that we have a couple of tests and we measure people’s performance on those tests, and we plot them on a graph like this as a correlation. We could plot a line there that’s designed to summarise those scores and reduce the error as much as possible in summarising those scores. We can see how much error there is by looking at where the individual responses fall in relation to that line. When the scores are far from the line the amount of error seems to increase as the scores get higher, the points of data get further and further away from the line. The scores seem to be clumping more together down here, but they’re spreading more apart up there. Therefore, this might suggest that using a single correlation or factor is not the best way to describe this data.

• What factor analysis does is it looks at whether one, two, or even three factors better describe the data. It goes up to any number it needs to describe the data. It goes up to any number it needs to describe the data. How you know when it's adequately describing the data is the variation around those factors is reduced to a statistical minimum. It's not eliminated, but there is an optimal number where adding more won't get rid of any more error. In actual fact, it can induce more error. So, we can statistically tell what number of factors we need to represent these scores.

• The idea is, if we give people a bunch of intelligence tests, do factor analysis on their performance, we should be able to work out how many factors we need to describe their performance. These statistical factors map onto how many factors intelligence has. If we can use a single line to represent their performance, then there's a single factor, and we might call it “G”, for general intelligence. If we need seven lines to represent their performance on the tests, then there's seven underlying factors to intelligence. Using factor analysis, we can work out, statistically, the number of factors we need to describe intelligence.

Health in Later Life

What is Normal Ageing?

• Gerontology is the study of aging, that while most people want to live a long time, no one wants to get old

• Key principles in gerontology:

Differences in Primary and Secondary Aging

• Primary aging reflects changes in the organism that are a result of the passage of chronological time

• Over time, many parts of our physical psychological and social make-up will change; this happens to everyone.

• For example, visual acuity declines and so most people need ready glasses to read print after a certain age. This happens as one’s ability to focus short distances declines with age

• Changes that are due to aging are due to a specific disease process or a result or trauma, or lifestyle choices.

• Only 6% of people over 65 have dementia. This risk can be lowered however, unlike primary aging

Heterogeneity

• Increases with age, making older adults a great population to study because there’s a lot of variance in the population

Cohort Effects

• When people who have been born in a certain period of time and gone through a certain set of experiences will tend to share a relatively similar outlook

• Best way to answer questions about changes in people over time, with age, is to do a longitudinal study = asks the same people questions over time, measures changes in physiology or behaviour over many years of time

WHO’s Definition of Health

• goes beyond physical health to encompass “a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity”

• This holistic principle of care underlies the best practice care principles of those who care for older, or geriatric patients.

• Some examples of later life health care professionals include geriatricians — physicians who specialise in later life medical care — and geriatric psychologists, or geroplychologists, like myself

Mental Health in Later Life

• Older adults in the general population have about a 15 to 25 % chance of having a serious mental illness compared to a 20% in the general population

• Older adults show more variance partly due to them being more heterogeneous as a group and whether or not they are in a nursing home.

• People in nursing homes make up 6-7% of the population but 70-90% of that nursing home population have either a psychiatric condition, and/or dementia.

• The chance of having a diagnosable psychiatric condition decreases with increasing age, however dementia risks increases

• The majority of older adults, whatever setting they live in, are neither assessed nor treated for psychiatric disorders.

  • In a study, Helmes and Gee presented psychologists with a vignette of a depressed patient and manipulated their age.

  • The client was described as a white female patient and describing symptoms to her psychologists included tearfulness, loss of interest in activities, early morning awakening, and weight loss.

  • The two versions were 42 or 72 and both ages received a diagnosis of depression, however the older client was described as having a poorer prognosis as being less able to develop an adequate therapeutic relationship with the therapists, and ultimately less appropriate for therapy. The therapists also felt less competent and less willing to accept the older client — ageism

Depression and Anxiety in Later Life

• Depression and anxiety present differently in older people than when they occur in earlier life, which leads to a frequent misdiagnosis of dementia

• For example, a patient with depression in their later years may talk about feeling less able to enjoy their favourite activities, or talk about decreased appetite and weight loss, but they will usually emphasise difficulties in remembering common things such as items at the grocery store, or a good friend’s telephone number.

• Key risk factors for depression include: disability, newly diagnosed medical illness, poor health status, poor self-perceived health, prior depression, and bereavement.

• Protective factors include greater perceived social support, regular physical exercise and higher socioeconomic status.

• Older adults are less likely to get a thorough work-up and are less likely to be offered the widest range of treatment options compared to younger adults

• Anxiety is actually more common later in life when compared to the incidence of depression in later life. Many risk factors are the same for both anxiety and depression.

• Key risk factors for anxiety include poor self-rated general health status, physical or sexual abuse in childhood, and being a current smoker.

• Protective factors include greater perceived social support, regular physical exercise, and higher level of education.

• Both socioeconomic status and education are really reflective of economic resources. And research shows greater resources confer greater protection against both depression and anxiety, at all ages.

Therapy in Later Life for Depression and Anxiety

• Cognitive behavioural therapy, relaxation training, and support therapy help older adults with anxiety

• In CBT the emphasis is on making explicit links between how you are thinking and behaving, and how you are feeling. It teaches patients to pay attention to shifting negative thoughts and behaviours to shift their emotions in a positive direction

• Relaxation training is very useful to combat anxiety at any age — involves improving, reinforcing, or sustaining a patient’s physiological well-being or psychological self-esteem and self-reliance

• Older adults in many surveys expressed a distinct preference for psychotherapy over medication, especially if they already have a physical illness which requires medication. Avoiding polypharmacy, or multiple medications where possible, helps decrease the chance of adverse medical reactions or side effects in older people.

• Interpersonal psychotherapy, problem-solving therapy, and brief psychodynamic psychotherapy help older adults with depression

• Interpersonal psychotherapy (IPT) is a highly structured and time-limited therapy approach that focuses on helping the patient to resolve interpersonal problems, which are thought to underlie depression

• Problem-solving therapy is a form of CBT is aimed at improving an individual’s ability to cope with stressful life experiences, and improve depressed or anxious mood. In this approach the therapist tries to give the patient more positive coping strategies to replace those which may be unhelpful or maladaptive

• Psychodynamic therapy include increased client self-awareness and improved understanding of the influence of past experiences on present behaviour. This is a time-limited intervention which, while focused on past experiences, is nevertheless oriented to current goals such as better coping with anxiety or depression

• Interdisciplinary treatment models are highly effective with older persons, particularly those with complex mental illnesses and dementia. This usually involves a physician, nurse, psychologist, and other allied health professionals such as occupational therapists, physical therapists, and social workers. They are both effective in treating complex long-standing psychiatric conditions such as schizophrenia, memory clinics where the source by by from physical or psychiatric causes, or end of life treatment in cases of terminal illness

Psychosis and Bipolar Disorder in Later Life

• Older adults with such issues did not, and to a certain extent still may not, receive the support they need to maintain functionality and quality of life

• Importantly, both current and past diagnostic criteria for psychosis and related disorders also remain problematic for older people. For example, the research on whether presentations of schizophrenia and bipolar disorder differ at different ages of first onset is still lacking.

• Both disorders are relatively rare in later life. 75% of older patients with schizophrenia will have experienced the onset of the disorder in early and mid-life, and 25% in later life

• Older bipolar patients can appear similar to older patients with schizophrenia in terms of their levels of disability and functioning in the community.

• People psychoses also learn from their experiences about how to manage the illness and avoid distressing relapses. Coping strategies also appear in some studies, to evolve and improve with age, however a lack of treatment for those with schizophrenia in later life increases their risk of nursing home placement.

• Therapy approaches often target areas of everyday functioning—medication management, social skills, communication, organisation and planning, transportation, and financial management

• In working with older adults with chronic mental illness, drawing on their past experience of how they have come to understand their illness and what they have learned from past treatment efforts, both positive and negative, is a rich resource for intervention

What is Dementia?

• Forgetting simple things, like where your keys are, is a normal part of aging. If you put keys into a dementia patient’s hand, they wont even know what they are for.

• Alzheimer’s disease is a kind of dementia and the most prevalent, between 50-70% of all dementias can be attributed to Alzheimer’s disease

• Dementia characterised by changes in memory, thinking, personality, and behaviour, and can manifest in different symptoms. Also involves intellectual impairment and language and executive functions such as goal setting can be affective

• A good definition is that it is an acquired syndrome of intellectual impairment produced by brain dysfunction

• Early onset can be in your 30s and 40s. Most form of dementia are inheritable.

• Lifestyle risk factors can be much more influential than your genes, such as smoking.

• Dementia signs can be subtle but they usually develop quickly—if you cannot remember things, even when people remind you or give you hints, that is more likely to be dementia

• What is being processed within the brain is no longer reliably stored in the brain, due to cellular changes in the brain resulting from the disease process.

• People with dementia can have really big changes in personality—someone introverted can become suddenly extroverted or vice versa

Incidence of Dementia

• The estimated number of people to be living with Alzheimer’s disease and dementia stands at between 27-36million, with increasing financial and social costs

• Two thirds of people with dementia are estimated to be living in the developing world, where access to diagnosis and treatment is underdeveloped

• 10% of less of population-based research on dementia has been carried out on the two thirds, or 66%, of people with dementia live in low and middle income countries

• Dementia is the most common age-related cognitive condition among Aboriginal peoples worldwide

Caring for Dementia Patients

• The cells in the brain die as a result of dementia, and we have no way to halt this even though Alzheimer’s has been studied for over a hundred years

• People with dementia don’t usually die due to the disease, they die of other related diseases like a stroke or pneumonia, usually between 8 and 10 years after diagnosis

• Interventions include various activity based therapies to keep with dementia stimulated, as well as supportive therapies to help those with dementia with symptoms of depression or anxiety

• Environmental approaches help to make living spaces easy to navigate and homelike

• Kitwood’s person centred care model involves having the focus of care on the person, not fulfilling tasks or just attending to the person’s physical health needs

• Person centred care includes every sort of interaction with the person with dementia. It is a very specific intervention, and importantly includes how medical or health care is given

Innovative Technology in Aged Care

• One area of technological development is helping innovate care delivered to older patients: age specialised health care settings. This will in part encompass rethinking how health care services are organised and delivered, with geriatric surgical centres and emergency rooms already in place.

• Staff in such setting undergo specialised training, and the environment, instruments, tests performed, and interventions used are all designed specifically with older adults in mind, to translate what is known about best standards of geriatric care into practice

• Netherland’s town for dementia patients

Designing to be age-friendly

• World Health Organisation has developed an age-friendly cities and environments program. It is aimed at positively affecting the health and wellbeing of older adults by ensuring that the physical and social aspects of their living environments support their needs. Eight dimensions of the living environment are targeted:

  • the built environment, transport, housing, social participation, respect and social inclusion, civic participation and employment, communication, and community support and health services.

• The WHO Global Network of Age-Friendly Cities and Communities was established. Communities in the program range from very large cities to relatively smaller cities. This guide is informative for anyone wanting specific knowledge about avenues of potential improvement to the living spaces older adults inhabit.

Dementia and Pets

• For many people in aged care who may not be able to keep their own animal, interactions with visiting or on site animals are very important.

• All of these environmental enrichment principles can help with good mental health in the nursing home.