Development

1. Development Stages 1 & 2 Anxiety & Mood Disorders

2. The Scientific Method Science is a systematic pursuit of knowledge through observation • Forming a theory • Systematically gathering data to test a theory (Observations must be replicable) • Forming a Hypothesis (what should occur if the theory is true) Science proceeds by disproving theories

3. Science in Mental health Mental health is a term used to describe either a level of cognitive or emotional wellbeing or an absenceof a mental disorder

4. APA DSM-IV-TR American Psychiatric Association (2000) Diagnostic and Statistical Manual Revision IV, Text Revision Reliability & Validity – Psychometrics DSM is so widely accepted that a psychiatrist must classify their patients’ disorders according to DSM listing number in order to be reimbursed by government of insurance companies

5. Psychodynamics • Childhood experiences help shape adult personality • There are unconscious influences on behaviour • The causes and purposes of human behaviour are not always obvious Freud: Psychopathology results from unconscious conflict • Anecdotal evidence, not the scientific method Benefits of gameplay, maintenance of negative schema  internal cognitive processes

6. Cognitive Behaviourism Thorndike (1874-1949): Law of Effect Behaviour that is followed by consequences satisfying to the organism will be repeated, and behaviour that is followed by noxious or unpleasant consequences will be discouraged Skinner (1904-1990): operant conditioning -Positive reinforcement -Negative reinforcement -Automatic reinforcement

7. Reinforcement of behaviour Problem behaviour is thought to be reinforced by four possible consequences: Getting attention Escaping from tasks Generating sensory feedback (automatic) Gaining access to desirable things or situations

8. Behavioural Treatments Trauma Fear Conduct Disorder Autistic Spectrum Disorder etc

9. Cognition Perceiving, recognising, conceiving, judging and Reasoning The learning process is far more complex than stimulus-response associations (behaviourism) The learner is an active interpreter of a situation using past experience in a cognitive set/schema

10. Attention Individuals with psychopathologies tend to focus their attention on threats or anxiety, producing events or situations in the environment. e.g. “The world is a dangerous place” • Self-fulfilling prophecy Many people who are depressed believe that they have no important effect on their surroundings regardless of what they do

13. Developmental Stages • Completing a developmental stage supports the healthy awakening of the next stage • Developmental behaviour usually graduates in sequence along with chronological age

14. Maslow’s Hierarchy of Needs

15. Maslow’s Heirarchy of Needs • Needs on lower levels must be met before larger identities can be sustained. • Lower identities take their places as no less important, but supporting of a larger and more powerful whole. • A.H. Maslow, A Theory of Human Motivation, Psychological Review 50(4) (1943):370-96.

16. Stage 1: Womb – 12 months • Motor Functions and security • Stage 2: 6 months – 2 years old • Mobility and emotion • Stage 3: 18 months – 4 years old • Will and action • Stage 4: 4 – 7 years old • Social Identity • Stage 5: 7 – 12 years old • Social contract • Stage 6: Adolescence • Reconstitution • Stage 7: Early Adulthood and Beyond • Self-knowledge

17. Stage 1: Womb – 12 months • Formation of the physical body during prenatal development and infancy • Body growth is rapid at this stage • Motor operations: suck, eat, digest, grasp, crawl, stand, walk, manipulate objects, gravity • Little awareness of the outside world • Fused symbiosis with the mother • No separate sense of self • Awareness of survival and physical comfort

18. Stage 1: Comparative Models • Freud: Oral Stage • Oral cavity is primary focus of libidal energy • Characterised by under-nursing: pessimism, envy, suspicion and sarcasm • Characterised by over-nursing: optimistic, gullible, admiration for others • Conflicts in nursing: deprivation of sensory pleasure and mothering • Erikson: Trust vs Mistrust (predictability)

19. Stage 1: Comparative Models • Piaget: Sensory-motor stage 1 & 2 • All knowledge is acquired through senses • No sign of object permanence (ability to know that an object exists when it is out of reach of your senses) • Primary circular reactions: repetition of movement (e.g. touching hand and foot) • Vision can follow moving objects

20. Stage 1: Psychological Development • Basic psychological identity associates with the physical body. • The self is identified with biological urges • IAmhungry • When to eat, When to rest, Limitations of the body • Individuality & The feeling of having the right to exist • Independence & The right to take care of ourselves • Interaction & The right to have, contain and create • Self-preservation

21. Stage 1: Trauma • Trauma may result in fear, insecurity, confusion • Symptoms of disorganisation or depression • Feelings of insanity, excessive thinking • Little “grounding” – detachment from body and basic consensus reality structures • Anxiety in mundane tasks, hypervigilance (high responsiveness to stimuli and constant scanning of environment for threats) • Healthy development teaches security, focus, calm and vigilance

22. Stage 2: 6 months – 2 years • Visual acuity allows the child to focus on outside objects and gain a wider visual perspective • Awareness grows of objects outside of immediate range • “Hatching” (Mahler) – moving away from mother in brief episodes of independence • Begins to separate self from other eliciting • Fear and excitement • Diversity and choice

23. Stage 2: Emotions • Primary method of obtaining information about our well-being • Primary language prior to verbal language • Adds dimension and texture to the mind-body experience • Identification with emotional body • I am scared, rather than I have fear

24. Stage 2: Comparative models • Freud: Oral stage • The id: need, sensation and desire is the fundamental cause of motivation. • Seeing something, moving towards it, merging with it (usually through the mouth) • Erikson: • Trust vs mistrust • Attachment vs separation

25. Stage 2: Separation and Connection • Separation from the mother corresponds with separation of self from other • Separation from primary attachment figure leads to binary distinctions • Duality: • good-bad, • pleasure-pain, • closeness-distance, • self-other

26. Stage 2: Trauma Trauma may cause numbness (lack of feeling), disconnection with self Difficulty in knowing what we want Unhealthy sexuality Excessive inhibition  Guilt

27. Anxiety Disorders ‘Angere’: to choke, to torment Fear: Reaction to immediate danger Anxiety: Apprehension over an anticipated problem Both are adaptive strategies A small degree of anxiety has been found to improve performance on laboratory tasks

28. Anxiety Disorders Specific Phobia Panic Disorder Separation Anxiety Disorder Generalised Anxiety Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder

29. Anxiety Disorders Phobia: A disruptive fear of a particular object or situation that is out of proportion to any danger posed 3-5% prevalence in children and adolescents

30. Anxiety Disorders There is a great deal of overlap between Axis I Anxiety Disorders and axis II Personality Disorders. Personality disorders (e.g. Borderline, Paranoid, or Avoidant Personality Disorders) may be considered to evoke contrasting ways of perceiving and coping with Axis I disorders Children’s Anxiety may not be focused enough to make specific diagnoses useful for intervention. Culture influences the development of anxiety disorders

31. Specific Phobias • Alliumphobia • Fear of garlic • Musophobia • Fear of mice • Helienophobia • Fear of pseudoscientific terminology • Arachibutyrophobia • Fear of peanut butter sticking to the roof of the mouth www.phobialist.com

32. Specific Phobias 2 - 4% prevalence in children More common in girls Some have clear genetic influences (e.g. snakes, injections)

33. Social Phobia 1% prevalence in children and adolescents May lead to substance related disorders and depression 33% concordant with Avoidant Personality Disorder

34. Panic Disorder (w/without Agoraphobia • Panic attacks: • Intense apprehension, terror, feelings of impending doom • Choking, nausea, sweating, etc. • Recurrent, uncued panic attacks • Agoraphobia • Anxiety about situations in which it would be embarassing or difficult to escape

35. Separation Anxiety Disorder 2 – 4% prevalence from preschool Specific to children Often tied to stressful life event of loss/separation

36. Generalized Anxiety Disorder Unable to let go of a worrisome problem Typically chronic, beginning in adolescence or late adolescence

37. Obsessive-Compulsive Disorder (OCD) • 2% prevalence, common onset around age 10 • Obsessions: • Intrusive and recurring thoughts, images or impulses that are uncontrollable and come unbidden • e.g. contamination, safety, religious issues • Compulsions: • Repetitive, clearly excessive behaviours or mental acts to reduce anxiety caused by obsessive thoughts. • e.g. elaborate rituals of orderliness, repetitive, magically protective acts (superstitions) • Repeatedly checking that these acts are carried out •  lack of confidence in memory, unduly concerned about gaps in memory

38. Obsessive-Compulsive Disorder (OCD) 78% of compulsives viewed their rituals as rather silly or absurd, but unable to stop performing them. Rituals allow attention to be drawn away from the obsessions. This perpetuated the obsessions, as thought supression makes thoughts stronger and more frequent Exposure and Ritual prevention (ERP)

39. Post-Traumatic Stress Disorder (PTSD) • Also Acute Stress Disorder • Extreme response to an actual stressor involving threatened death, serious injury, or threat of these. • E.g. war veterans, rape victims • Symptoms are categorised under • Re-experiencing the trauma (e.g. night terrors) • Avoidance of associated stimuli (numbing) • Increased arousal  high anxiety (problems with sleep and concentration)

40. Anxiety Disorders • Comorbidity • Over 50% of those diagnosed meet criteria for another anxiety disorder • ~60% of people in treatment for Anxiety disorders meet criteria for Depression • Substance disorders and Personality Disorders • Women are twice as likely to be diagnosed with anxiety disorders (except in OCD) • Syndromes are related to beliefs and attitudes of specific cultures

41. Common Etiology of Anxiety Disorders • Genetic vulnerability • Increased activity in the fear circuit of the brain (amygdala) • Decreased functioning of GABA and serotonin, increased norepinephrine activity • Behavioural Inhibition – agitation to new stimuli in infancy • Predictive to a 30% level of development of social anxiety • Neuroticism • Personality trait with a tendency to react with greater than average negative emotion • Twice as likely to develop into an Anxiety Disorder • Cognitive Factors (e.g. attention to cues of threat and low perception of control) • Negative Life events

42. Common Treatments of Anxiety Disorders • Fewer than 20% of people with Anxiety Disorders receive minimally adequate treatment • Psychological: • Exposure • Cognitive reorganization, rationalizing, etc. • Medical Treatment: Sedatives, tranquilizers and anxiolytics (“to loosen”) • Benzodiaxepines (e.g. Valium, Xanax)  GABA. • Cognitive and motor side effects  memory lapses and addiction • Antidepressants, tricyclics and SSRIs (e.g. Fluoxetine, Imipraming – Prozac, Zoloft) • Jitteriness, weight gain, high blood pressure, sexual dysfunction

43. Mood Disorders • E.g. Depression: Depressed mood, inability to experience pleasure, fatigue, concentration problems and suicidal ideation. • Children and adolescents show higher rates of suicide attempts and guilt

44. Major Depressive Disorder (MDD) • Diagnosis • MDD: Sad mood or loss of pleasure for 2 weeks, with at least 4 other symptoms, such as • Changes in sleep pattern • Change in appetite • Problems with attention • Feelings of worthlessness • Suicidality • Not just a single episode • Episodic Disorder: may be periodic, then clear • Subclinical depression can remain for years • Dysthymic Disorder (Dysthymia): Chronic depression for more than half the time for 2 years

45. Depression • One of the most prevalent psychiatric disorders • Adults: • ~ 16.4% of adults are diagnosed with MDD • 2.5% with dysthymia • Children & Adolescents: • 1% in preschoolers • 2-3% in school-age children • 7-13% in adolescent (girls) • Up to 18% in late adolescents • over 20% in 12-16 year olds (Burns and Rapee, 2006) • Twice as common among girls than boys (women than men) after the age of 12 • Twice as common in women (except for Jewish men) • Three times more common in impoverished Socio-economic conditions

46. Depression • Age of Onset is in late teens, early 20s, and decreasing • Varies culturally • People of Mexican descent are more likely to develop MDD if born in USA • 1.5% in Taiwan, 19% in Beirut, Lebanon • Comorbidity: • Two thirds of MDD diagnoses will meet criteria for diagnosis of an anxiety disorder • Comorbid with Anxiety and Substance-related disorders

47. Bipolar Disorder Mania: • A state of intense elation or irritability lasting from weeks to months • Flight of ideas • Imprudent sexual activities, over-spending, risk-taking, anger or rage • Hypomania: less extreme

48. Bipolar Disorder • Bipolar I Disorder: “Manic Depressive Disorder” • Bipolar II Disorder • Cyclothymic Disorder (Cyclothymia) • Chronic mood disorders for at least 2 years • Mild alternative depression and mania • 1% Prevalence rate for BPI, 40,000 in Ireland • 4% for BPII and Cyclothymia

49. Bipolar Disorder • Average age is in the 20’s, but is increasing among children and adolescents • Equal in men and women (more depression in women) • High risk for cardiovascular disease, diabetes, obesity and thyroid disease • Associated with creativity and achievement

50. Etiology of Mood Disorders • Genetics • Neurobiology • Social Factors • Psychological Factors