CP – Samenvatting Hoorcolleges
HC 1: Data, phenomena, theory
There are several types of clinical phenomena:
1. Behavioral= behavior that is different from the norm, and deviates in such a matter that it
passes the criteria from which we see something as clinical.
VB: Drinking a lot of alcohol.
2. Emotional= emotional states that are different from the norm and deviate in such a matter
that it is seen as clinical.
VB: Very low mood.
3. Cognitive= cognitive processes like attention that are different from the norm in such a
matter that it is seen as clinical.
VB: Body dysmorphia;
People focus a lot on bodily characteristics, like their nose or the shape of their head, and
they are convinced that somethings wrong with these characteristics they focus on so much.
There are many phenomena, some of which are very prevalent in the population.
Taxonomy= a scientific way of classification.
Nosology= a scientific way of classification of psychological disorders.
VB: DSM-5.
These nosology classifications describe disorders as:
- Deviations from the norm:
As such, several clinical phenomena ended up in these types of classification handbooks.
VB: Alcohol use disorder, body dysmorphic disorder, major depressive disorder.
- Time period:
They also include a certain period of time that the deviation has to be present in order to fit
in the classification.
- Syndromes:
Handbooks like the DSM, talk about syndromes. These syndromes are not observable, but
they cause symptoms that are observable.
VB: Major depressive disorder;
Low mood, anhedonia, poor concentration are caused by the syndrome major depressive
disorder.
- Distress:
The symptoms have to cause distress, or they infer with the functioning of the person.
- Not better explained by:
To fit into a classification, the symptoms have to be caused by the syndrome and not by
something else.
VB: Contraceptives;
These can also cause symptoms that correspond with major depressive disorder, but because
these symptoms are caused by the contraceptive, it does not fit into the classification.
- Syndromes cause the symptoms:
- In order to fit into the classification, it can not be the other way around. The symptoms
cannot cause the syndrome.
VB: When someone had a low mood and a low sex drive, the patient only fits into the
classification of major depressive disorder when the low sex drive is caused by the
depression/low mood and not the other way around.
,The nosological systems that are used for classification have several limitations:
1. Atheoretical:
The handbooks don’t specify where the syndromes originate from. When you know the
origin of something, it is possible to understand it way better. This knowledge is also very
important in regard to treatment of certain disorders. The nosological handbooks however,
don’t specify on this matter which causes limitations in regard to understanding and treating
the disorders effectively.
2. Classification as separate entities:
In the DSM, the different classifications are seen as separate entities. However, this is rarely
the case in real life. A lot of the classifications overlap in symptoms, but they also co exist a
lot of the time in patients (comorbidity). There are many associations between the different
disorders.
VB: Body dysmorphic disorder;
This often comes with a depression disorder and alcohol abuse. This is not strange, if you feel
like something is wrong with your body it makes sense that you also get a low mood because
of that. At the same time, if you focus on your body a lot, it makes sense that someone starts
drinking more to lessen that focus.
VB: Association between disorders like alcohol and mood disorders;
When someone experiences low mood, it makes sense that they would like to get a break
from those feelings and start drinking to do so. And if someone suffers from an alcohol abuse
disorder, it also makes sense that (in between the use of alcohol) people realize how much
they’ve lost due to their illness, which gives them a low mood.
3. Cultural/time differences:
The deviations that the classification systems describe take place in a certain culture and
time.
VB: Homosexuality was long listed as a DSM disorder.
Some deviations also work for certain time periods.
VB: Hysteria;
This diagnosis was put in the DSM during turbulent times, during which women were asking
for their rights. The male dominated (scientific) field could not deal with that very well, which
is why they came up with a diagnosis to classify the women that “deviated” in their views.
It is very likely that some diagnosis that we use now adays are also flawed in similar ways.
This can already be noticed in certain diagnosis.
VB: Somatic symptom disorder;
The main characteristic is that people have physical complaints that cannot be explained by
the current medical knowledge. In definition this would possibly be explained with future
knowledge.
VB: ADHD;
It probably does exist, but in the USA 50% of boys is treated for it. This makes you wonder if
maybe a lot of those boys don’t have ADHD, and the symptoms are a reflection of a
mismatch between societal/school demands and the nature of young boys.
Problems emerge in life when:
- There is little reward
- There is a low of threat
But these things are way more likely to become a problem when there is no way of coping (or poor
coping) with the situation.
VB: Drugs or alcohol use to cope with little reward and a lot of threat.
,However, the example above is a poor coping mechanism because it may block you’re way to future
rewards:
In normal day to day life we receive rewards from everyday rewarding stimuli, like being with
friends, eating nice things, exercise, etc.
These stimuli cause a rewarding response in the mesolimbic areas in the brain (=lower brain areas
driven by dopamine).
Drugs or alcohol are very strong rewarding stimuli, way stronger than the usual stimuli. So when
people use drugs or alcohol as rewarding stimuli, there’s a way bigger reward response in the
brain.
When this bigger reward response is triggered for a while, desensitization can occur= the brain
gets less sensitive for rewarding stimuli.
This then causes someone to not experience reward anymore from normal/less strong reward
stimuli. The reward response is only triggered by strong stimuli like drugs and alcohol. But the fact
that it gets harder for someone to experience reward may also explain the association between
multiple disorders.
The core of science is trying to explain the things that you see. This is done using the scientific cycle,
in this course it is illustrated as a linear model.
1. Data:
This is the starting point of explaining the things you come across. The data is made up of
raw observations. These can be numbers, answers to questionnaires, or just simple
observations in your daily life. These observations/data are evidence for the phenomenon.
2. Phenomenon:
From the data, certain patterns can emerge. These patterns are called phenomena=relatively
stable features of the world or certain observations.
VB: If someone is exposed to traumatic events, they are more likely to develop a depression.
VB: If someone is exposed to a placebo, they are more likely to have a placebo effect.
3. Theory:
A theory= a description of how a phenomenon comes about.
VB: The mentalistic theory for placebo response;
The expectation of the patient is the primary cause of the effect.
In this way, clinicians come up with theories about their patients. These theories may differ
according to their specific background. A psychiatrist might explain a depression focusing on
biological explanations, whilst a psychotherapist might explain a depression focusing on the
cognitive explanations.
Example of explaining a phenomenon:
1. Phenomenon:
People who drink too much alcohol, very often actually don’t like drinking alcohol.
2. Theory:
Incentive sensitization theory: liking becomes wanting and craving in addiction. There’s a
shift in positive reinforcement to negative reinforcement fed by cues like withdrawal
symptoms. In the beginning, people drink because it gives them positive reinforcement.
They like it. But then, after a while, the reason people drink shifts to negative reinforcement.
They drink to prevent/treat withdrawal symptoms.
Tasks of a clinician:
- Verstehen:
Show an understanding of intersubjective meaning and empathy for the situation of the
patient.
- Explanation:
Have causal knowledge as to why someone experiences certain symptoms.
, But what the patient experiences is (partly) different from what the clinician sees, there’s a
mismatch:
The client experiences the illness= the subjective experience of symptoms, the reason that the client
is at the clinicians office.
But the clinician sees the disease= is what the clinician uses to explain the symptoms of the client.
This explanation is based on pathology/biology/illness from the clinicians perspective and the
clinicians theory.
When these two are considered as a whole, it is referred to as holism= understanding of each
other and room for change.
Social construction= a range of views can be valid in different ways. This means that several
explanations are available for the same phenomenon.
So a phenomenon can be understood from different perspectives, but only when you follow the
rules of positivism= there are general rules underlying causes and effects, which you can asses using
scientific experiments. If this is true, than all the different explanations can be equally valid, as long
as they’re proven scientifically.
But not all people/theories follow the rules of positivism.
VB: Disorders are described as punishments for sins;
This can not be scientifically proven, and thus does not correspond with the rules of positivism. So
this explanation can not be equally true as scientifically proven explanations.
Theories that aim to explain the syndrome of major depressive disorder:
1. Neurotrophic account of major depression:
- This theory states that when people are exposed to stressors early in their life, it
changes the expression of neuronal growth factors. These factors are important for
survival of cells, cell division and the cell health of the brain.
- Hippocampus (dental gyrus) is the only area in the brain where neurogenesis takes
place during life (and not only during childhood). When the expression of growth
factors is disturbed, it impacts the neurogenesis in the hippocampus. This then
causes a loss of concentration and later on also a poor mood.
- The therapeutic consequence of this theory is to prescribe SSRI antidepressants,
because these are known to increase the expression of neurotrophic factors. This
could restore the disturbed processes in the hippocampus.
2. Cognitive account of major depression (Aaron Beck):
- This theory states that when people are exposed to stressful events in early life, it
creates a vulnerability for the development of a depression later in life. This
vulnerability takes its form in latent dysfunctional schema’s which can be triggered
during stress. These dysfunctional schema’s present as a negative cognitive bias
towards the self, the world and the future. This can cause a depression to emerge.
- This is a very good theory because it presents an explanation as to why a depression
emerges, but is also presents a treatment option. It is impossible to go back to
negative events form the early life, but the negative cognitive bias is something that
can be worked with. This is done using CBT.
Death by adversity (Angus Deaton):
In the deathrate of the USA it can be observed that it increases after 1995, which means that people
are dying younger. In other developed country this trend does not occur. It was observed that the
increase in deathrate only occurred in middle aged people, Caucasian race and below average
income. Angus Deaton then hypothesized that this increase in deathrate was due to adversity that
came about when a lot of factories closed in the USA during 1995. The people working there were
mainly white, middle aged and had a below average income. When the factories closed, they were
exposed to adversity because they lost their jobs. When taking a closer look, the numbers showed
that 85% of the causes of death were rather unusual (like liver failure, poisoning, overdoses, suicide).
HC 1: Data, phenomena, theory
There are several types of clinical phenomena:
1. Behavioral= behavior that is different from the norm, and deviates in such a matter that it
passes the criteria from which we see something as clinical.
VB: Drinking a lot of alcohol.
2. Emotional= emotional states that are different from the norm and deviate in such a matter
that it is seen as clinical.
VB: Very low mood.
3. Cognitive= cognitive processes like attention that are different from the norm in such a
matter that it is seen as clinical.
VB: Body dysmorphia;
People focus a lot on bodily characteristics, like their nose or the shape of their head, and
they are convinced that somethings wrong with these characteristics they focus on so much.
There are many phenomena, some of which are very prevalent in the population.
Taxonomy= a scientific way of classification.
Nosology= a scientific way of classification of psychological disorders.
VB: DSM-5.
These nosology classifications describe disorders as:
- Deviations from the norm:
As such, several clinical phenomena ended up in these types of classification handbooks.
VB: Alcohol use disorder, body dysmorphic disorder, major depressive disorder.
- Time period:
They also include a certain period of time that the deviation has to be present in order to fit
in the classification.
- Syndromes:
Handbooks like the DSM, talk about syndromes. These syndromes are not observable, but
they cause symptoms that are observable.
VB: Major depressive disorder;
Low mood, anhedonia, poor concentration are caused by the syndrome major depressive
disorder.
- Distress:
The symptoms have to cause distress, or they infer with the functioning of the person.
- Not better explained by:
To fit into a classification, the symptoms have to be caused by the syndrome and not by
something else.
VB: Contraceptives;
These can also cause symptoms that correspond with major depressive disorder, but because
these symptoms are caused by the contraceptive, it does not fit into the classification.
- Syndromes cause the symptoms:
- In order to fit into the classification, it can not be the other way around. The symptoms
cannot cause the syndrome.
VB: When someone had a low mood and a low sex drive, the patient only fits into the
classification of major depressive disorder when the low sex drive is caused by the
depression/low mood and not the other way around.
,The nosological systems that are used for classification have several limitations:
1. Atheoretical:
The handbooks don’t specify where the syndromes originate from. When you know the
origin of something, it is possible to understand it way better. This knowledge is also very
important in regard to treatment of certain disorders. The nosological handbooks however,
don’t specify on this matter which causes limitations in regard to understanding and treating
the disorders effectively.
2. Classification as separate entities:
In the DSM, the different classifications are seen as separate entities. However, this is rarely
the case in real life. A lot of the classifications overlap in symptoms, but they also co exist a
lot of the time in patients (comorbidity). There are many associations between the different
disorders.
VB: Body dysmorphic disorder;
This often comes with a depression disorder and alcohol abuse. This is not strange, if you feel
like something is wrong with your body it makes sense that you also get a low mood because
of that. At the same time, if you focus on your body a lot, it makes sense that someone starts
drinking more to lessen that focus.
VB: Association between disorders like alcohol and mood disorders;
When someone experiences low mood, it makes sense that they would like to get a break
from those feelings and start drinking to do so. And if someone suffers from an alcohol abuse
disorder, it also makes sense that (in between the use of alcohol) people realize how much
they’ve lost due to their illness, which gives them a low mood.
3. Cultural/time differences:
The deviations that the classification systems describe take place in a certain culture and
time.
VB: Homosexuality was long listed as a DSM disorder.
Some deviations also work for certain time periods.
VB: Hysteria;
This diagnosis was put in the DSM during turbulent times, during which women were asking
for their rights. The male dominated (scientific) field could not deal with that very well, which
is why they came up with a diagnosis to classify the women that “deviated” in their views.
It is very likely that some diagnosis that we use now adays are also flawed in similar ways.
This can already be noticed in certain diagnosis.
VB: Somatic symptom disorder;
The main characteristic is that people have physical complaints that cannot be explained by
the current medical knowledge. In definition this would possibly be explained with future
knowledge.
VB: ADHD;
It probably does exist, but in the USA 50% of boys is treated for it. This makes you wonder if
maybe a lot of those boys don’t have ADHD, and the symptoms are a reflection of a
mismatch between societal/school demands and the nature of young boys.
Problems emerge in life when:
- There is little reward
- There is a low of threat
But these things are way more likely to become a problem when there is no way of coping (or poor
coping) with the situation.
VB: Drugs or alcohol use to cope with little reward and a lot of threat.
,However, the example above is a poor coping mechanism because it may block you’re way to future
rewards:
In normal day to day life we receive rewards from everyday rewarding stimuli, like being with
friends, eating nice things, exercise, etc.
These stimuli cause a rewarding response in the mesolimbic areas in the brain (=lower brain areas
driven by dopamine).
Drugs or alcohol are very strong rewarding stimuli, way stronger than the usual stimuli. So when
people use drugs or alcohol as rewarding stimuli, there’s a way bigger reward response in the
brain.
When this bigger reward response is triggered for a while, desensitization can occur= the brain
gets less sensitive for rewarding stimuli.
This then causes someone to not experience reward anymore from normal/less strong reward
stimuli. The reward response is only triggered by strong stimuli like drugs and alcohol. But the fact
that it gets harder for someone to experience reward may also explain the association between
multiple disorders.
The core of science is trying to explain the things that you see. This is done using the scientific cycle,
in this course it is illustrated as a linear model.
1. Data:
This is the starting point of explaining the things you come across. The data is made up of
raw observations. These can be numbers, answers to questionnaires, or just simple
observations in your daily life. These observations/data are evidence for the phenomenon.
2. Phenomenon:
From the data, certain patterns can emerge. These patterns are called phenomena=relatively
stable features of the world or certain observations.
VB: If someone is exposed to traumatic events, they are more likely to develop a depression.
VB: If someone is exposed to a placebo, they are more likely to have a placebo effect.
3. Theory:
A theory= a description of how a phenomenon comes about.
VB: The mentalistic theory for placebo response;
The expectation of the patient is the primary cause of the effect.
In this way, clinicians come up with theories about their patients. These theories may differ
according to their specific background. A psychiatrist might explain a depression focusing on
biological explanations, whilst a psychotherapist might explain a depression focusing on the
cognitive explanations.
Example of explaining a phenomenon:
1. Phenomenon:
People who drink too much alcohol, very often actually don’t like drinking alcohol.
2. Theory:
Incentive sensitization theory: liking becomes wanting and craving in addiction. There’s a
shift in positive reinforcement to negative reinforcement fed by cues like withdrawal
symptoms. In the beginning, people drink because it gives them positive reinforcement.
They like it. But then, after a while, the reason people drink shifts to negative reinforcement.
They drink to prevent/treat withdrawal symptoms.
Tasks of a clinician:
- Verstehen:
Show an understanding of intersubjective meaning and empathy for the situation of the
patient.
- Explanation:
Have causal knowledge as to why someone experiences certain symptoms.
, But what the patient experiences is (partly) different from what the clinician sees, there’s a
mismatch:
The client experiences the illness= the subjective experience of symptoms, the reason that the client
is at the clinicians office.
But the clinician sees the disease= is what the clinician uses to explain the symptoms of the client.
This explanation is based on pathology/biology/illness from the clinicians perspective and the
clinicians theory.
When these two are considered as a whole, it is referred to as holism= understanding of each
other and room for change.
Social construction= a range of views can be valid in different ways. This means that several
explanations are available for the same phenomenon.
So a phenomenon can be understood from different perspectives, but only when you follow the
rules of positivism= there are general rules underlying causes and effects, which you can asses using
scientific experiments. If this is true, than all the different explanations can be equally valid, as long
as they’re proven scientifically.
But not all people/theories follow the rules of positivism.
VB: Disorders are described as punishments for sins;
This can not be scientifically proven, and thus does not correspond with the rules of positivism. So
this explanation can not be equally true as scientifically proven explanations.
Theories that aim to explain the syndrome of major depressive disorder:
1. Neurotrophic account of major depression:
- This theory states that when people are exposed to stressors early in their life, it
changes the expression of neuronal growth factors. These factors are important for
survival of cells, cell division and the cell health of the brain.
- Hippocampus (dental gyrus) is the only area in the brain where neurogenesis takes
place during life (and not only during childhood). When the expression of growth
factors is disturbed, it impacts the neurogenesis in the hippocampus. This then
causes a loss of concentration and later on also a poor mood.
- The therapeutic consequence of this theory is to prescribe SSRI antidepressants,
because these are known to increase the expression of neurotrophic factors. This
could restore the disturbed processes in the hippocampus.
2. Cognitive account of major depression (Aaron Beck):
- This theory states that when people are exposed to stressful events in early life, it
creates a vulnerability for the development of a depression later in life. This
vulnerability takes its form in latent dysfunctional schema’s which can be triggered
during stress. These dysfunctional schema’s present as a negative cognitive bias
towards the self, the world and the future. This can cause a depression to emerge.
- This is a very good theory because it presents an explanation as to why a depression
emerges, but is also presents a treatment option. It is impossible to go back to
negative events form the early life, but the negative cognitive bias is something that
can be worked with. This is done using CBT.
Death by adversity (Angus Deaton):
In the deathrate of the USA it can be observed that it increases after 1995, which means that people
are dying younger. In other developed country this trend does not occur. It was observed that the
increase in deathrate only occurred in middle aged people, Caucasian race and below average
income. Angus Deaton then hypothesized that this increase in deathrate was due to adversity that
came about when a lot of factories closed in the USA during 1995. The people working there were
mainly white, middle aged and had a below average income. When the factories closed, they were
exposed to adversity because they lost their jobs. When taking a closer look, the numbers showed
that 85% of the causes of death were rather unusual (like liver failure, poisoning, overdoses, suicide).
