Samenvatting alle hoorcolleges Understanding Psychopathology
Hoorcollege 1 – Understanding Psychopathology
Nothing as practical as a good theory
Theories as starting point
Making sense of loose facts and observations.
Guides further inquiries (leidt tot verdere onderzoeken).
Why are theories important/helpful?
Example of a woman who had red arms, because of repetitive washing behavior.
She was abused in her childhood and years later (now) she has to give a witness
statement in court.
She had blocked the memory of the abuse out, but needed to retrieve this in order to
give the statement.
Due to this recalling of the traumatic memory, she felt dirty and started the repetitive
washing behavior.
Fitting theory:
A model of the development and maintenance of the FBC:
CSA = Childhood sexual abuse.
FBC = Feeling of being contaminated
Treatments of PTSD are not always effective (originally CBT without focusing on the
contamination of the self), probably because they missed the feelings of being contaminated.
Expose people to their trauma in their imagination. You block the escaping. Gradually it will
become less toxic.
Because of feelings of disgust people have the urge to avoid.
During exposure people go to a more “abstract” level and prevent to fully experience the
detailed, sensoric, perceptual features of what is happening. Thereby the exposure will not
be functional.
1
,After this new model was introduced easier to connect the dots and focus on two
particular things:
Cognitive restructuring: correct dysfunctional appraisals FBC.
Example: renewing of the body cells.
“Understanding” that their whole body isn’t connected to the perpetrator
anymore.
Imagery modification: create effective competing memory representations.
Example: standing in a waterfall imagining feeling really clean.
At home training to make this image as accessible as possible.
Able to stand the confrontation of the traumatic memory because of the less
toxic and positive imagination. They didn’t escape and the exposure was
effective.
Illustration of proving your conceptualization:
1. Before the model, people who were suffering from PTSD missed a particular
important component the association of disgust with the own body, which results in
escaping/avoidance.
2. And now by making a better conceptualization of the issue/better understanding of
the mechanisms that play a role in the ineffectiveness of the earlier treatment.
3. After this the therapy became highly effective.
Why are theories important?
Making sense of loose facts and observations.
Guides further inquiries.
Theory
A series of coherent hypotheses or propositions about one phenomenon or a series
of phenomena.
A summary of known ‘facts’ and conjecture about how these facts are related.
Theories can be about:
Everything (all)
Psychopathology
Certain disorders
Certain aspects/features of disorders (example of FBC)
Why are theories important?
Making sense of loose facts and observations.
Understanding the origin of psychopathology.
Predict who and under what type of conditions (prevention).
Understanding factors involved in the persistence of psychopathology (the “loop”).
Predict for whom and under what conditions symptoms will or will not persist
(interventions).
2
,“Nothing so practical as a good theory”.
“A fool can propose more theories than 10 scholars can test in their entire life”.
What are criteria/characteristics of a “good” theory?
Necessary/desirable features:
External criteria:
Is consistent with known facts (summary).
Testable/falsifiable.
Tested and showed predictive validity.
Internal criteria:
Internally consistent (no conflicting predictions).
As simple as possible (parsimony).
The fewer the number of assumptions the better (Occam’s razor).
The more assumptions, the weaker your theory.
Many different theories in psychopathology
Example of Social Anxiety Disorder
Complementary (additional)
Genetic theory (behavioral inhibition)
Developmental psychological theory (e.g. attachment)
Associative learning theory
“Convertible”
Gen x development x learning experiences.
More theories than one.
Incompatible? Only one can be the best.
For example in the case of Panic Disorder.
Panic attack (DSM-V) examples of features:
Dizziness, weakness, pounding heart, chest pain, fear of dying, fear of going crazy,
transpiration, shaking, etc.
Psychiatric/Neurological ‘theory’:
CO2 increase rat brain leads to hyperarousal Locus Coeruleus.
Hyperarousal LC causes panic symptoms?
Idea: Panic Disorder is caused by a neurophysiological defect that renders people
hypersensitive for increase in CO2-levels.
How can this theory be tested?
The logic here is: If A (increase CO2) leads to B (panic attack).
Induce/heighten A and examine if B occurs/increases.
We only expect this idea in people with panic disorder (because they “should” have the
neurophysiological defect).
3
, Experimental Lactate infusion
Panic Incidence (%).
Lactate = a substance that implies more CO2 in the brain; so it increases CO2 in the
brain.
Experimental group (panic patients) and control group (people without panic).
Lactate or placebo.
Specifically the people with panic disorder were the ones that reported symptoms that
could reflect a panic attack. This was ONLY the case with lactate and NOT when they
got the placebo.
In the control group nothing happened: neither with the CO2 nor the placebo.
Result of this study “Results of lactate studies suggest that panic disorder is a biological
disease”.
Conceptual replications are important
They also did the same study with increasing CO2 by inhaling.
Hyperventilation.
Hyperventilation: you wash out more CO2 then your baseline
metabolism is producing. So gradually your CO2 level then declines
due to hyperventilation.
Hyperventilation symptoms: dizziness, depersonalization, weakness, parestesias,
shaking/trembling, pounding heart, breathlessness, anxiety, etc.
It looks similar to the symptoms of a panic attack.
So after this was introduced the new idea was:
Lowering CO2 results in a panic attack.
Exit Carr’s/Klein’s theories Thus a PA (panic attack) is elicited by hyperventilation?
This is incompatible (both theories can’t go together).
Reasoning:
A leads to B so B leads to A???
Wrong reasoning. Its reversed reasoning, there can be another reason why.
WRONG: Good treatment results in recovery patient recovered thus it was a
good treatment.
Next step:
To test reducing CO2 results in PA.
Is indeed in naturalistic contexts PA (panic attack) accompanied by reduction in CO2
level?
To test this: in therapy in an exposure context when feelings of panic attacks occur
click on a button on a special device that can measure the CO2 level This is an
Ambulant assessment.
Result: no CO2 reduction just before a panic attack, but also no increase in CO2.
Actually it appeared that there was no relation whatsoever between the CO2 levels
and a panic attack.
4
Hoorcollege 1 – Understanding Psychopathology
Nothing as practical as a good theory
Theories as starting point
Making sense of loose facts and observations.
Guides further inquiries (leidt tot verdere onderzoeken).
Why are theories important/helpful?
Example of a woman who had red arms, because of repetitive washing behavior.
She was abused in her childhood and years later (now) she has to give a witness
statement in court.
She had blocked the memory of the abuse out, but needed to retrieve this in order to
give the statement.
Due to this recalling of the traumatic memory, she felt dirty and started the repetitive
washing behavior.
Fitting theory:
A model of the development and maintenance of the FBC:
CSA = Childhood sexual abuse.
FBC = Feeling of being contaminated
Treatments of PTSD are not always effective (originally CBT without focusing on the
contamination of the self), probably because they missed the feelings of being contaminated.
Expose people to their trauma in their imagination. You block the escaping. Gradually it will
become less toxic.
Because of feelings of disgust people have the urge to avoid.
During exposure people go to a more “abstract” level and prevent to fully experience the
detailed, sensoric, perceptual features of what is happening. Thereby the exposure will not
be functional.
1
,After this new model was introduced easier to connect the dots and focus on two
particular things:
Cognitive restructuring: correct dysfunctional appraisals FBC.
Example: renewing of the body cells.
“Understanding” that their whole body isn’t connected to the perpetrator
anymore.
Imagery modification: create effective competing memory representations.
Example: standing in a waterfall imagining feeling really clean.
At home training to make this image as accessible as possible.
Able to stand the confrontation of the traumatic memory because of the less
toxic and positive imagination. They didn’t escape and the exposure was
effective.
Illustration of proving your conceptualization:
1. Before the model, people who were suffering from PTSD missed a particular
important component the association of disgust with the own body, which results in
escaping/avoidance.
2. And now by making a better conceptualization of the issue/better understanding of
the mechanisms that play a role in the ineffectiveness of the earlier treatment.
3. After this the therapy became highly effective.
Why are theories important?
Making sense of loose facts and observations.
Guides further inquiries.
Theory
A series of coherent hypotheses or propositions about one phenomenon or a series
of phenomena.
A summary of known ‘facts’ and conjecture about how these facts are related.
Theories can be about:
Everything (all)
Psychopathology
Certain disorders
Certain aspects/features of disorders (example of FBC)
Why are theories important?
Making sense of loose facts and observations.
Understanding the origin of psychopathology.
Predict who and under what type of conditions (prevention).
Understanding factors involved in the persistence of psychopathology (the “loop”).
Predict for whom and under what conditions symptoms will or will not persist
(interventions).
2
,“Nothing so practical as a good theory”.
“A fool can propose more theories than 10 scholars can test in their entire life”.
What are criteria/characteristics of a “good” theory?
Necessary/desirable features:
External criteria:
Is consistent with known facts (summary).
Testable/falsifiable.
Tested and showed predictive validity.
Internal criteria:
Internally consistent (no conflicting predictions).
As simple as possible (parsimony).
The fewer the number of assumptions the better (Occam’s razor).
The more assumptions, the weaker your theory.
Many different theories in psychopathology
Example of Social Anxiety Disorder
Complementary (additional)
Genetic theory (behavioral inhibition)
Developmental psychological theory (e.g. attachment)
Associative learning theory
“Convertible”
Gen x development x learning experiences.
More theories than one.
Incompatible? Only one can be the best.
For example in the case of Panic Disorder.
Panic attack (DSM-V) examples of features:
Dizziness, weakness, pounding heart, chest pain, fear of dying, fear of going crazy,
transpiration, shaking, etc.
Psychiatric/Neurological ‘theory’:
CO2 increase rat brain leads to hyperarousal Locus Coeruleus.
Hyperarousal LC causes panic symptoms?
Idea: Panic Disorder is caused by a neurophysiological defect that renders people
hypersensitive for increase in CO2-levels.
How can this theory be tested?
The logic here is: If A (increase CO2) leads to B (panic attack).
Induce/heighten A and examine if B occurs/increases.
We only expect this idea in people with panic disorder (because they “should” have the
neurophysiological defect).
3
, Experimental Lactate infusion
Panic Incidence (%).
Lactate = a substance that implies more CO2 in the brain; so it increases CO2 in the
brain.
Experimental group (panic patients) and control group (people without panic).
Lactate or placebo.
Specifically the people with panic disorder were the ones that reported symptoms that
could reflect a panic attack. This was ONLY the case with lactate and NOT when they
got the placebo.
In the control group nothing happened: neither with the CO2 nor the placebo.
Result of this study “Results of lactate studies suggest that panic disorder is a biological
disease”.
Conceptual replications are important
They also did the same study with increasing CO2 by inhaling.
Hyperventilation.
Hyperventilation: you wash out more CO2 then your baseline
metabolism is producing. So gradually your CO2 level then declines
due to hyperventilation.
Hyperventilation symptoms: dizziness, depersonalization, weakness, parestesias,
shaking/trembling, pounding heart, breathlessness, anxiety, etc.
It looks similar to the symptoms of a panic attack.
So after this was introduced the new idea was:
Lowering CO2 results in a panic attack.
Exit Carr’s/Klein’s theories Thus a PA (panic attack) is elicited by hyperventilation?
This is incompatible (both theories can’t go together).
Reasoning:
A leads to B so B leads to A???
Wrong reasoning. Its reversed reasoning, there can be another reason why.
WRONG: Good treatment results in recovery patient recovered thus it was a
good treatment.
Next step:
To test reducing CO2 results in PA.
Is indeed in naturalistic contexts PA (panic attack) accompanied by reduction in CO2
level?
To test this: in therapy in an exposure context when feelings of panic attacks occur
click on a button on a special device that can measure the CO2 level This is an
Ambulant assessment.
Result: no CO2 reduction just before a panic attack, but also no increase in CO2.
Actually it appeared that there was no relation whatsoever between the CO2 levels
and a panic attack.
4
