Psychological Models II PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. September 8, 2011

1. Psychological Models II PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.September 8, 2011

2. Announcements • Exam #1 is next Thursday, September 15th • Sona pretest is open • Next response paper is due next Tuesday, September 13th • France, C. M., Lysaker, P. H., & Robinson, R. P. (2007). The “chemical imbalance” explanation for depression: Origins, lay endorsement, and clinical implications. Professional Psychology: Research and Practice, 38, 411-420.

3. Questions for France et al. (2007) article; Response paper due Tuesday 9/13 • 1. The United States is one of 2 countries in the world to allow direct-to-consumer marketing of prescription drugs. How do you think this practice affects the beliefs and behaviors of persons living in the United States? • 2. Look at the percentage of participants who endorsed “agree” or “undecided” to questions 3, 4, and 5 in Table 4 on page 417. Why do you suppose so many people endorsed these questions? • 3. Describe two ways in which depressed clients who believe they suffer from a chemical imbalance might pose a challenge for providers of psychotherapy.

4. Request for Assistance • A little help, please, one last time….

5. An Interesting Email “I have been a practicing counselor since late 2004. I started out working with traumatized youth in state custody for approximately two years and then went into private practice after that. I've had my private practice since 2006. The majority of my clients both past and present have been traumatized (i.e. childhood abuse/neglect, abandonment, sexual abuse, death/loss etc...) and on top of many other mental health conditions most have high levels of anxiety. All I can truly say is this, my career and perspective have significantly changed as a result of learning ______. I've only been using it in my practice for two years. Now this is the tricky part. I could literally go on and on about how great I think it is, and how it's truly one of the most powerful techniques/approaches I've ever known. Or I could consult with you on the many clients in my clinic, and how this form of therapy has made drastic transformations that years and years of other forms of therapy (many CBT) could not. However, I would just like to make two key points. The first being, that I too like most other therapists was extremely skeptical of the principles behind ______. I was in graduate school when I first heard about it and I remember thinking the idea of people being healed through ______ was laughable and very discrediting to our profession. So I ask that you learn more about it, talk to others trained in ______, and be open to its theoretical explanation. The second point I'd like to make is that just because a particular therapeutic approach is not the most empirically supported doesn't necessary mean that it is not the best approach. I believe the heart of any successful therapeutic service lies in the relationship, the techniques or approaches used are simply tailored to the client to achieve his/her goals.  ______has been my main therapeutic tool for many reasons. In my opinion it takes treatment to the next level. ______ looks at the ______ that contribute to the anxiety and (helps) the negative cognitions, beliefs, feelings, physiology, sensations, and urges. It (helps) in a thorough, efficient and fairly permanent manner. I don't know of any other therapy that can do this.”

6. From Last Class • Essential features of pseudoscience (continued) • Importance of models in clinical psychology • Humanistic and psychoanalytic models (briefly) • Classical conditioning

7. For Today • Operant conditioning • Cognitive model • Exam review

8. Operant Conditioning • Behavior is modified by its consequences • Pleasurable consequences strengthen behavior • Positive reinforcement • Negative reinforcement • Aversive consequences weaken behavior • Positive punishment • Negative punishment

9. Operant Conditioning – Clinical Applications • Everyday examples of operant conditioning: • A child learning to be potty trained by receiving M&M’s as rewards • Using an umbrella to avoid being wet • Spanking a child for misbehaving • Revoking a child’s TV privileges for misbehaving • http://www.youtube.com/watch?v=euINCrDbbD4

10. Operant Conditioning – Clinical Applications Miguel is depressed and socially anxious. He sleeps 12 hours a day and spends most of his waking hours alone in his room. He resists his parents’ efforts to make him leave his room and join the family for meals and activities, and he vigorously fights their attempts to make him leave the house for any reason. After a few halfhearted attempts to persuade Miguel to leave his room, including threatened consequences that Miguel knows will not occur, the parents usually give up, and Miguel remains alone in his room, and the parents do not have to deal further with his oppositional behavior.

11. Operant Conditioning – Clinical Applications • What operant conditioning process is maintaining Miguel’s oppositional behavior? • What operant conditioning process is maintaining his parents’ acquiescent behavior? • How could you use operant conditioning principles to help change this problematic pattern of interactions? What would help Miguel? His parents?

12. Operant Conditioning – Clinical Applications Irene is a recovering heroin addict with mild mental retardation. On the inpatient substance abuse unit, she often engages in a form of self-injurious behavior in which she stares at a staff member, smiles, strikes her ears with her hands, and repeats the word “no” while shaking her head. Staff members typically respond by approaching her, gently grabbing her hands, and reminding her that such behavior is not acceptable. The persistent nature of this behavior is a serious concern among staff members who don’t want Irene to hurt herself but are also concerned that she is manipulating them.

13. Operant Conditioning – Clinical Applications • What operant conditioning process is maintaining Irene’s self-injurious behavior? • What operant conditioning process is maintaining the staff’s response to Irene’s self-injurious behavior? • How could you use operant conditioning to change Irene’s behavior?

14. Summary of Classical and Operant Conditioning • Classical conditioning may cause psychological problems (e.g., phobias, PTSD) to develop • Conditioned responses disappear as a result of extinction (repeated pairing of the CS without the UCS) • Operant conditioning can prevent extinction via negative reinforcement which prevents exposure to the CS, which is necessary to learn that CS is no longer associated with the UCS

15. Clinical Applications Jenny was a shy child with poor social skills. She was teased and taunted by her classmates throughout elementary and secondary school. She tried to avoid interpersonal contact whenever possible, and when she cannot she avoids eye contact and tries to be “invisible.” She worries that other people will be critical of her social skills and that she will behave in a socially inept fashion. She is particularly self-conscious about her propensity to sweat when anxious and has had several surgical procedures to reduce sweating in her armpits. She managed to function well in college and got into medical school. Unfortunately, her first year class was very small and she found that she could not be “invisible” in this new setting. Her social anxiety increased to the point where she can no longer attend her classes. She went on medical leave and was referred for treatment.

16. Clinical Applications • What learning process caused Jenny’s social anxiety to develop? • What conditioning process is maintaining Jenny’s social anxiety?

17. Cognition • But what about cognition? Do Jenny’s thoughts and beliefs play a role in the problem? • Did she experience any cognitive changes (e.g., expectancies, beliefs) when her fear of negative evaluation by others was acquired? • How might Jenny’s social avoidance, avoidance of eye contact, attempts to appear invisible, and armpit surgeries actually be maintaining her negative beliefs about other people?

18. Problems with “Pure” Behavioral Models • Difficulty explaining fears that arise in the absence of conditioning • Difficulty explaining why aversive conditioning doesn’t invariably lead to problems • Dog phobia studies • Difficulty explaining why irrational concerns about negative outcomes persist when they never come to pass • Insufficient attention to the cognitive aspects of learning

19. The Basic Cognitive Principle • People are upset not because of events or situations, but by the meaning that people give to events or situations • When the meaning is negative, negative emotions result

20. The Cognitive Model • Emotions are specific to particular ways in which we interpret events and situations • Depression: personal loss • Anger: perceived unfairness • Guilt: you broke your own rules • Anxiety: Potential threat or danger

21. A Non-Clinical Example • A friend is due at your home for dinner at 7:00, but it’s now 7:30 and there is no sign of her - not even a phone call • How you feel and what you do about this is determined by what you tell yourself or how you interpret the situation

23. Cognitive Models – Clinical Applications Alex is extremely anxious in the presence of people he believes are immoral or mentally deficient. He is concerned that he will literally take on these characteristics via physical proximity to such individuals. Alex takes special care to not inhale, or swallow, in unison with perceived immoral or mentally deficient persons in order to prevent himself from becoming like them.

24. Cognitive Models – Clinical Applications • Can classical and/or operant conditioning explain the development of this problem? • From a cognitive perspective, why does Alex have this problem? • How might Alex’s avoidance and safety-seeking behavior actually be maintaining this problem? • How would you use cognitive principles to help Alex overcome this problem?

25. Exam Review • General notes • Part I: 25 multiple choice/true false questions • Handful of questions answered in book only • Part II: 25 points worth of matching, fill in the blank, short answer, brief essay • All questions from lecture material

26. Exam Review • Chapter 1 • Nature of clinical psychology • Clinical psychology vs. related professions • Different training models

27. Exam Review • Science and Pseudoscience • Lilienfeld et al. chapter • Lett article • Why science matters in clinical psychology • Essential features of science • Essential features of pseudoscience

28. Exam Review • Chapter 2 • No questions on the exam

29. Exam Review • Chapter 3 • Psychoanalytic models – personality structure and levels, psychosexual stages, defense mechanisms, current status

30. Exam Review • Chapter 3 • Humanistic Models – key assumptions of Client-Centered Therapy • Behavioral models – classical and operant conditioning, how to understand a client’s symptoms using this model • Cognitive models – key assumptions, how to understand a client’s symptoms using this model

31. Exam Review • Chapter 4 and Biological Model lectures • Chapter 4: • Behavioral genetics; family, twin, & adoption studies; current status • Omit pp. 107-115 • Lecture • Disease/chemical imbalance model (popularity, sources, accuracy, critique, effects on stigma, etc.)

32. Exam Review • Chapter 5 • pp. 128-133 only for the first exam • Classifying mental disorders • Diagnosis • Characteristics of the DSM-IV