An Integrative Approach to Psychopathology Chapter 2 An Integrative Approach to Psychopathology

Outline One-dimensional vs. Multidimensional Models Genetic Contributions Neuroscientific Contributions Behavioral and Cognitive Science Emotions Cultural and Social Factors Lifespan Development

Focus Questions What are the features of unidimensional and multidimensional models of psychopathology? How do genes interact with environment to influence behavior? How do different brain regions and neurotransmitters influence psychopathology? How to behavioral, emotional and cognitive science influence explanations of mental illness? How do cultural factors affect psychopathology?

One-Dimensional vs. Multidimensional Models One-dimensional Models Explain behavior in terms of a single cause Could mean a paradigm, school, or conceptual approach Tend to ignore information from other areas Example: Explaining obsessive-compulsive disorder as the result of family history alone

One-Dimensional vs. Multidimensional Models Interdisciplinary, eclectic, and integrative “System” of influences that cause and maintain suffering Draw upon information from several sources Abnormal behavior results from multiple influences Discussion Tip: Have students brainstorm all of the possible dimensions that could constitute a one-dimensional model and use this as a platform to discuss their integration in multidimensional models. Examples of dimensions: (as discussed on next slide) Genetic, biological, social, learning/behavioral, cultural, environmental

Multidimensional Models of Abnormal Behavior Major Influences Biological Behavioral Emotional Social & cultural Developmental Environmental

EXAMPLE of multidimensional influences contributing to a blood-injection-injury phobia FIGURE 2.1  EXAMPLE of multidimensional influences contributing to a blood-injection-injury phobia . The original case description is found on page 3 of Chapter 1.

Genetic Contributions to Psychopathology Phenotype vs. genotype Nature of genes Deoxyribonucleic acid (DNA) – the double helix 23 pairs of chromosomes Dominant vs. recessive genes Development and behavior is often polygenetic Genetic contribution to psychopathology Less than 50% Genotype = genetic status (e.g. having a certain allele) Phenotype = how it manifests in the person (e.g., having brown eyes) Polygenetic = several genes contribute to the outcome Technology Tip: The Human Genome Project website provides excellent information about genetics and related research. (http://www.ornl.gov/sci/techresources/Human_Genome/faq/faqs1.shtml)

Chromosomes

The Interaction of Genetic and Environmental Effects Eric Kandel and gene-environment interactions The genetic structure of cells actually changes as a result of learning experiences E.g., an inactive gene may become active because of environmental influences The diathesis-stress model Examples: Blood-injury-injection phobia, alcoholism Diathesis stress model: Disorders are the result of underlying risk factors (e.g., intolerance of distress, sensitivity to physical sensations) and life stressors (e.g., losing a job, getting married).

The Interaction of Genetic and Environmental Effects Reciprocal gene-environment model Outcomes are a result of interactions between genetic vulnerabilities and experience Examples: depression, impulsivity Epigenetics and the Non-genomic inheritance of behavior Genes are not the whole story Environmental influences (e.g., parenting style) may override genetics Discussion Tip: Have students discuss the potential pros, cons, and ethical issues related to genetic testing for disorders. You may want to start with physical disorders and then include psychological disorders.

Neuroscience Contributions to Psychopathology The field of neuroscience The role of the nervous system in disease and behavior Branches of human nervous system The central nervous system (CNS) Brain and spinal cord The peripheral nervous system (PNS) Somatic and autonomic branches

Neuroscience and the Central Nervous System The Neuron Soma – cell body Dendrites – branches that receive messages from other neurons Axon – trunk of neuron that sends messages to other neurons Axon terminals – buds at end of axon from which chemical messages are sent Synapses – small gaps that separate neurons Soma is the central cell body. Dendrites extend from the cell body to receive chemical messages from other nerve cells that are converted into electrical impulses. Axon transmits these impulses to other neurons. Synaptic cleft is a small space that exists between the axon of one neuron and the dendrites of another.

Neuroscience and the Central Nervous System Neurons operate electrically, but communicate chemically Neurotransmitters are the chemical messengers

Overview: Neuroscience and Brain Structure Two main parts Brainstem Contains hindbrain, midbrain, thalamus and hypothalamus (between brainstem and forebrain) Forebrain Contains limbic system, basal ganglia, cerebral cortex (larges part of the brain, the wrinkled outer structure) Structures of the brain and nervous system are often some of the hardest material for students to grasp. Encourage students to come back to this chapter later in the course when these brain structures start to be referenced in the context of specific disorders.

Neuroscience and Brain Structure Hindbrain – regulates automatic processes Medulla – heart rate, blood pressure, respiration Pons – regulates sleep stages Cerebellum – involved in physical coordination Midbrain Coordinates movement with sensory input Contains parts of the reticular activating system (RAS) RAS contributes to arousal and tension, which influences sleep and wakefulness.

Neuroscience and Brain Structure Limbic system includes amygdala, hippocampus, cingulate gyrus, and septum regulates emotional experiences and expressions regulates, to a degree, ability to learn and control impulses involved in basic drives of sex, aggression, hunger, and thirst

Neuroscience and Brain Structure Forebrain Most sensory, emotional, and cognitive processing Cerebral cortex contains two specialized hemispheres (left and right) Each hemisphere has four lobes with specialized processes

Neuroscience and Brain Structure Lobes of the Cerebral Cortex Frontal – thinking and reasoning abilities, memory Parietal – touch recognition Occipital – integrates visual input Temporal – recognition of sights and sounds, long-term memory storage Technology Tip: Accessible, basic site regarding brain lateralization: (http://faculty.washington.edu/chudler/split.html)

Neuroscience: Peripheral Nervous System Somatic branch of PNS Controls voluntary muscles and movement Autonomic branch of the PNS Involuntary processes Sympathetic and parasympathetic branches Regulates cardiovascular system & body temperature Also regulates the endocrine system and aids in digestion Teaching Tip: Have students activate their sympathetic nervous system by in vivo or covert means (i.e., running in place while breathing through a straw or imaging having a pop quiz on today’s lecture) and then activating the parasympathetic system by breathing or relaxation exercises.

Neuroscience: Endocrine Systems The Endocrine System Regulates release of hormones The Hypothalamic-Pituitary-Adrenalcortical axis (HPA axis) Integration of endocrine and nervous system function

Neurotransmitters Functions of Neurotransmitters “Chemical messengers” - transmit messages between brain cells Other chemical substances in the brain Agonists Inverse agonists Antagonists Most drugs are either agonistic or antagonistic Agonists increase the activity of a neurotransmitter by mimicking its effects. Antagonists inhibit or block the production of neurotransmitter or function indirectly to prevent the chemical from reaching the next neuron by closing or occupying the receptors. Inverse Agonists produce effects opposite to a given neurotransmitter

Neuroscience: Functions of Main Types of Neurotransmitters Serotonin (5-HT) Glutamate Gamma aminobutyric acid (GABA) Norepinephrine Dopamine GABA – main inhibitory neurotransmitter Glutamate – main excitatory neurotransmitter Norepinephrine = noradrenaline, epinephrine = adrenaline

Serotonin Also known as 5-hydroxytryptamine (5-HT) Influences information processing, behavior, mood and thoughts Dysregulated serotonin may contribute to depression Very low serotonin linked to instability and impulsivity

Serotonin Pathways in the Brain FIGURE 2.11  Major serotonin pathways in the brain.

Norepinephrine Also called noradrenaline Involved in alarm responses and basic bodily processes (e.g. breathing)

Norepinephrine Pathways FIGURE 2.13  Major norepinephrine pathways in the human brain. (Adapted from Kalat, J. W., 2009. Biological Psychology, 10th edition, © 2009 Wadsworth.)

Dopamine Implicated in depression and ADHD Link between excessive dopamine and schizophrenia Link between reduced dopamine and Parkinson’s disease

Dopamine Pathways FIGURE 2.14  Two major dopamine pathways. The mesolimbic system is apparently implicated in schizophrenia; the path to the basal ganglia contributes to problems in the locomotor system, such as tardive dyskinesia, which sometimes results from use of neuroleptic drugs. (Adapted from Kalat, J. W., 2009. Biological Psychology, 10th edition, © 2009 Wadsworth.)

Implications of Neuroscience for Psychopathology Relations between brain and abnormal behavior Example: Obsessive Compulsive Disorder (OCD) Man developed OCD after part of his frontal cortex was damaged during brain surgery Psychosocial influences Can change brain structure and function Discussion Tip: Have students examine their beliefs about the directionality of effects (i.e., how much does the brain influence behavior or mood, versus behavior or mood influencing the brain). What implications does this have for treatments? The role of the patient?

Implications of Neuroscience for Psychopathology Treatments for mental health problems may now focus on the brain regions found to be relevant for these problems Psychotherapy Also can change brain structure and function Medications and psychotherapy are often used together

The Contributions of Behavioral and Cognitive Science Conditioning and cognitive processes Early research on classical conditioning: Simple associations are learned between two things that tend to occur together Later research indicated that it is not that simple – this sort of learning is influenced by higher-order cognitive processes.

The Contributions of Behavioral and Cognitive Science Other types of learning Respondent and operant learning Learned helplessness Social learning Modeling and observational learning Prepared learning Respondent/operant learning = Repeat behaviors that are followed by good consequences. Perform behaviors less that are followed by bad consequences. Prepared learning = it is easier to learn associations that were adaptive for our ancestors to have in the past. For example, it is easier to acquire a fear of spiders because it was useful for our ancestors to fear (possibly poisonous) creatures like that in the past. (In contrast, it is less easy to acquire a fear of rabbits because there has been no evolutionary advantage to avoiding rabbits). Technology Tip: This Psychology Today article presents Susan Mineka’s work on prepared learning related to fear of snakes and other threatening animals (http://www.psychologytoday.com/articles/pto-19920301-000014.html) Learned helplessness = When you try to exert influence over a challenging situation and you’re repeatedly unable to, you stop trying – even when the circumstances change such that you COULD make a difference. Demonstrated by Martin Seligman.

Cognitive Science and the Unconscious There may be a dissociation between behavior and consciousness Implicit memory Acting on the basis of experiences that are not recalled Blind sight Some people who are blind can still sense objects that would be in their visual field even if they do not experience sight Some experimental tests reveal implicit processing Example of implicit processing: Stroop paradigm, p. 54. Participants are slowed down in their performance by words that have emotional significance, even if they are not aware of this

The Role of Emotion in Psychopathology The nature of emotion To elicit or evoke action Action tendency different from affect and mood Intimately tied with several forms of psychopathology Many types of psychopathology can be boiled down to problematic reactions to our own emotions. For example, people with social anxiety don’t like the way they feel in social situations, so they attempt to avoid these situations in order to not feel that uncomfortable emotion.

The Role of Emotion in Psychopathology Components of emotion Behavior, physiology, and cognition Example of fear: Anxious thoughts, elevated heart rate, tendency to flee Harmful side of emotional dysregulation Emotions like anger, hostility, sadness and anxiety play a key role in psychopathology Some emotions (e.g., chronic hostile arousal) and emotion suppression can have negative health consequences

Cultural, Social, and Interpersonal Factors in Psychopathology Cultural factors Influence the form and expression of behavior Gender effects Men and women may differ in emotional experience and expression Social support effects on health and behavior Frequency and quality important Related to mortality, disease, and psychopathology Discussion Tip: Have students break into groups or split up by gender and discuss how men and women typically display and cope with depression, anxiety, and stress. It may be helpful to first have each group discuss how the other group experiences these before talking about their own group.

Social Stigma of Psychopathology Culturally, socially, and interpersonally situated Problems with social stigma May limit the degree to which people express mental health problems E.g., concealing feelings of depression > unable to receive support from friends May discourage treatment seeking

Life-Span and Developmental Influences Over Psychopathology Life-span developmental perspective Addresses developmental changes Influence and constrain what is normal and abnormal The principle of equifinality From developmental psychopathology Several paths to a given outcome Paths vary by developmental stage Some things that are normal at a certain age or stage, are not normal at another. EXAMPLE OF EQUIFINALITY: Delirium can be caused by a number of separate or related underlying conditions, including post-operative states, drugs and alcohol, urinary tract infections, fever, and organ failure. Elderly individuals and children are also at a higher risk for delirium than are adults. Equifinality = the same outcome can be arrived at from different origins Multifinality = the same origin can end up at different outcomes

Summary of the Multidimensional Perspective of Psychopathology Multiple causation The rule, not the exception Take a broad, comprehensive, systemic perspective Biological and neuroscientific Cognitive and emotional Social, cultural, and developmental factors

Summary of the Multidimensional Perspective of Psychopathology A multidimensional, comprehensive approach puts us in the best position to: Understand the causes of psychopathology Alleviate and prevent psychopathology