Aaron Beck

Aaron Beck is an American psychiatrist and a professor emeritus in the department of psychiatry at the University of Pennsylvania.  He is the recipient of the Lasker-DeBakey Clinical Medical Research Award for his creation of cognitive therapy. In addition, he is an Honorary President of the Academy of Cognitive Therapy and a fellow of the American Academy of Arts and Sciences. Beck spent much of his career at the University of Pennsylvania and along with his daughter Judith, advocated for the application of cognitive behavioral therapy for the treatment of depression and other mood problems. And he is considered by many to be the father of cognitive therapy.

Beck's cognitive triad 

is a triad of types of negative thought present in depression proposed in 1976. The triad forms part of his Cognitive Theory Of Depression.

The triad involves negative thoughts about:

1. The self (i.e., self is worthless)
2. The world/environment (i.e., world is unfair), and
3. The future (i.e., future is hopeless).

Cognitive Behavioral Therapy (CBT)

A therapy was devised that could effectively treat a variety of disorders. Cognitive behavioral therapy is beneficial for treating several psychological, psychiatric and medical disorders. Patients with psychological disorders like uncontrollable anger and compulsive gambling can be treated with this therapy. Psychiatric problems like depression, substance abuse, personality disorders, etc., can also be dealt with it.

Aaron Beck laid major emphasis on understanding and changing core beliefs as an approach to treating depression. By restructuring destructive thinking, he believed that positive changes could be brought in the patient. He considered the role of a therapist as crucial in the treatment. The therapist involves the patient in setting realistic goals and taking responsibilities for action and thought. By changing thought and perception, a change can be brought in behavior and emotional responses. A course is outlined to educate the patient on the concept of faulty thinking. New ideas and ways are generated to develop a positive outlook of oneself, experiences and the environment around. Sometimes, home assignments are also given to help the depressed person review and understand the impact of faulty thinking on his behavior and emotional well-being.

Three methods of treating mental disorders

Lithium

• a naturally occurring salt and is classified as a mood stabiliser. It may be used both in the treatment of bipolar disorder and also in the case of previously treatment-resistant severe forms of depression.
• This medication affects neurotransmitters and their receptors within the brain; it decreases the likelihood of relapse by around one third and short-term use may treat both manic and hypomanic episodes.
  

Cognitive behavioral therapy

• a psychosocial  therapy that assumes that faulty thought patterns cause maladaptive behavior and emotional responses. The treatment focuses on changing thoughts in order to solve psychological and personality problems. Behavior therapy is also a goal-oriented, therapeutic approach, and it treats emotional and behavioral disorders as maladaptive learned responses that can be replaced by healthier ones with appropriate training. Cognitive-behavioral therapy (CBT) integrates features of behavior modification into the traditional cognitive restructuring approach.

selective serotonin reuptake inhibitors

• block the reabsorption (reuptake) of the neurotransmitter serotonin (ser-oh-TOE-nin) in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts mood. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.

Major depressive disorder

• the history of mental illness and treatment
• history: The term Major depressive disorder was introduced by a group of US clinicians in the mid-1970s as part of proposals for diagnostic criteria based on patterns of symptoms (called the "Research Diagnostic Criteria"), and was incorporated in to the DSM-III in 1980. To maintain consistency the ICD-10 used the same criteria, with only minor alterations, but using the DSM diagnostic threshold to mark a mild depressive episode, adding higher threshold categories for moderate and severe episodes. The ancient idea ofmelancholia still survives in the notion of a melancholic subtype.
• treatments:
• psychotherapy - Initially, depression was always blamed on some conflict in the individual's life. This could mean emotional conflict or problems with her environment. For this reason, psychiatrists believed that depression could always be dealt with through psychotherapy. 
• Iproniazid - Originally developed to treat tuberculosis in the early 1950s, it was noticed that iproniazid worked to elevate the patients' moods. In 1957, iproniazid was first prescribed to patients with clinical depression. Studies revealed that the drug blocked the enzyme monoamine oxidase's destruction of norepinephrine, serotonin and dopamine.
• TCAs - The first tricyclic antidepressant (TCA) was called "imipramine." While this medication helped depressed patients, it had no mood-enhancing effects on nondepressed people. The drug was found to inhibit the reuptake of norepinephrine and serotonin into neurons in the brain, making it the first medication to specifically deal with depression and inspiring important research. 
• MAOIs - Like tricyclic antidepressants, monoamine oxidase inhibitors (MAOI) decrease the activity of the enzymes that destroy norepinephrine, serotonin and dopamine and are called "monoamines." MAOIs are still in use today, although MAOI popularity is waning due to potentially severe side effects.
• SSRIs - Selective serotonin reuptake inhibitors (SSRI) were the result of research based on what had been learned from MAOIs and tricyclics. To decrease the incidence of side effects, SSRIs target specific monoamines, thus increasing only the amount of serotonin in the brain.
• SNRIs - Serotonin-norepinephrine reuptake inhibitors (SNRIs) are very similar to SSRIs, except that SNRIs target both serotonin and norepinehprine. They are beginning to take over for SSRIs, but are still not as popular as their predecessor.

• symptoms:
• Difficulty concentrating, remembering details, and marking decisions fatigue and decreased energy
• Feelings of guilt, worthless, and/or helplessness
• Feelings of hopelessness and/or pessimism¨
• Insomnia, early-morning wakefulness, or excessive sleeping 
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable
• Overeating or appetite loss
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• Persistent sad, anxious, or “empty” feelings
• Thoughts of suicide attempts
  

• Risk-factors:
• Having biological relatives with depression
• Being a woman
• Having traumatic experiences as a child
• Having family members or friends who have been depressed
• Experiencing stressful life events, such as the death of a loved one
• Having few friends or other personal relationships
• Recently having given birth (postpartum depression)
• Having been depressed previously
• Having a serious illness, such as cancer, diabetes, heart disease, Alzheimer's or HIV/AIDS
• Having certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or illicit drugs
• Taking certain high blood pressure medications, sleeping pills or certain other medications (Talk to your doctor before stopping any medication you think could be affecting your mood.)

• treatments:
• There are four (4) groups of antidepressant medications most commonly used to treat depression:
  • Tricyclic antidepressants (TCAs), which include:amitriptyline (Elavil)
    imipramine (Trofanil,Janimine)
    nortryptyline (Pamelor)
    despiramine (Norpramin)
    TCAs work by slowing the rate at which neurotransmitters (chemical messengers) re-enter brain cells. This increases the concentration of the neurotransmitters in the central nervous system which relieves depression.
  • Monoamine oxidase inhibitors (MAOIs) include phenelzine (Nardil) and tranylcypromine (Parnate). MAO is an enzymeresponsible for breaking down certain neurotransmitters in the brain. MAOIs inhibit this enzyme and restore more normal mood states.
  • Lithium carbonates, including Eskalith and Lithobid. Lithium reduces excessive nerve activity in the brain by altering the chemical balance within certain nerve cells. This drug has been used to improve the benefit of SSRIs and alone is effective in treating bipolar disorder.
  • Selective serotonin reuptake inhibitors (SSRIs) include:fluoxetine (Prozac)
    fluvoxamine (Luvox)
    paroxetine (Paxil)
    sertraline (Zoloft)
    citalopram (Celexa)
    escitalopram oxalate (Lexapro)
    SSRIs act specifically on serotonin, making it more available for nerve cells, thus easing the transmission of messages without disrupting the chemistry of the brain. Two other antidepressants that affect two neurotransmitters, serotonin and norepinephrine, are venlafaxine (Effexor) and nefazodone (Serzone). Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin.
  Medication usually produces a marked improvement by six weeks, but may require up to 12 weeks for full effect.
  Psychotherapy
  Psychotherapy involves talking to family doctor, counselor, psychiatrist or therapist about things that are occurring in a person's life. The aim of psychotherapy is to remove all symptoms of depression and return a person to a normal life.
  There are three psychotherapies commonly used to treat depression: behavioral therapy, cognitive therapy or interpersonal therapy. Behavioral therapy focuses on current behaviors, cognitive therapy focuses on thoughts and thinking patterns, and interpersonal therapy focuses on current relationships.
  Although psychotherapy may begin to work right away, it may take eight to 10 weeks to show a full effect for some people.
  Electroconvulsive therapy (ECT)
  ECT, also called electroshock treatment, is used for severely depressed patients and/or those who have not responded to antidepressant medication and/or psychotherapy. During this therapy, an electric current travels through electrodes placed on the temples, causing a generalized shock that produces biochemical changes in the brain
  Atypical antidepressants
  These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone (Oleptro) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep. The newest medication in this class of drugs is vilazodone (Viibryd). Vilazodone has a low risk of sexual side effects. The most common side effects associated with vilazodone are diarrhea, nausea, vomiting and insomnia.
  Tricyclic antidepressants
   These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more-severe side effects, a tricyclic antidepressant generally isn't prescribed unless you've tried an SSRI first without an improvement in your depression. Side effects can include dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain.
  Monoamine oxidase inhibitors (MAOIs)
   MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods, such as certain cheeses, pickles and wines, and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs. These medications can't be combined with SSRIs.

Errors of Attribution

1. What is the difference between dispositional factors and situational factors?

• Dispositional attribution is that you think that there is something wrong with person who did something wrong. It's his/her fault.
• Situational attribution is when you are finding the reasons why the person did it wrong, but it's not his/her fault.
• For example.: You are standing in a line to buy tickets for a movie, when someone pushes you and goes ahead. Dispositional Attribution: He is thoughtless, rude and uncivilized. Situational Attribution: He was pushed by someone else; he did not intend to cut the line

2. Explain and give an example of the fundamental error of attribution.

• The fundamental attribution error describes the tendency to over-value dispositional or personality-based explanations for behavior while under-valuing situational explanations. The fundamental attribution error is most visible when people explain the behavior of others.
• For example, when a student fails to turn in a homework assignment, a teacher is too ready to assume that the student was too lazy to finish the homework, without sufficiently taking into account the situation that the student could have some trouble with something.

3. Explain and give an example of the self-serving-bias error of attribution.

• attributing dispositional and internal factor for success and external, uncontrollable factors for failure. 
• For Example: Chad wins a poetry competition but fails to get the poem published in a magazine he sent it to. He attributes his success in the competition to his talent. He attributes his failure to get it published to bad luck.

5. What does the study by Miyamoto and Kitayama tell us about cultural differences in attribution errors?

• People from individualist cultures are more inclined to make fundamental-attribution error than people from collectivist cultures. Individualist cultures tend to attribute a person’s behavior to his internal factors whereas collectivist cultures tend to attribute a person’s behavior to his external factors.

Trait theory of personality

1. What is the primary focus of trait theory of personality?

• Trait theory is focused on identifying and measuring  individual personality characteristics and the link to anti-social behavior, i.e., aggression, violence, and criminality 

2. Explain the differences between cardinal traits, central traits and secondary traits.

• Central Traits: The general characteristics that form the basic foundations of personality. These central traits, while not as dominating as cardinal traits, are the major characteristics you might use to describe another person. Terms such as intelligent, honest,shy and anxious are considered central traits.
• Secondary Traits: The traits that are sometimes related to attitudes or preferences and often appear only in certain situations or under specific circumstances. Some examples would be getting anxious when speaking to a group or impatient while waiting in line.
• Cardinal Traits: Traits that dominate an individual’s whole life. The peple consider the origin and meaning of the following descriptive terms: Freudian, Machiavellian, narcissism, Don Juan, Christ-like, etc.

3. What are two common criticisms of trait theory?

• Poor Predictor of Future Behavior: While a person falls on the high end or low end of a specific trait, trait theory fails to address a person's state. A state is a temporary way of interacting and dealing with the self and others.

• No Means of Change: Perhaps because trait theory does little to offer ideas about trait development, it also provides little or no guidance in the changing of negative aspects of a trait. Without understanding how a trait develops, how do we then change that trait? Many argue that the application of trait theory is significantly reduced because it lacks a means for change. What good is to measure something or to know something if we can do nothing about it?

4. Identify and briefly explain each of the five dimensions of personality according to McCrae and Costa.

• Openness to experience – Appreciation for art, emotion, adventure, unusual ideas, curiosity, and variety of experience.
• Conscientiousness –  A tendency to show self-discipline, act dutifully, and aim for achievement; planned rather than spontaneous behavior.
• Extraversion – Energy, positive emotions, surgency, and the tendency to seek stimulation in the company of others.
• Agreeableness –  A tendency to be compassionate and cooperative rather than suspicious and antagonistic towards others.
• Neuroticism –  A tendency to experience unpleasant emotions easily, such as anger, anxiety, depression, or vulnerability.

Placebo effect

   A placebo is a substance or procedure used as a control in an experiment. The placebo effect is the measurable, observable, or felt improvement in health not attributable to an actual treatment.
   When a treatment is based on a known inactive substance like a sugar pill, distilled water, or saline solution rather than having real medical value, a patient may still improve merely because their expectation to do so is so strong.


      It is important to understand that not all placebo effects are good. Just as some patients improve with the power of positive thinking, some get worse and drop out of research studies because of the side effects caused by the placebo. In a recent, well-publicized and fascinating study of Parkinson disease, it was discovered that the patients who improved with placebo had changes in their brain that were identical to the changes caused by the actual medication. Levodopa causes an increase in brain dopamine, and the placebo should not. However, the patients who got better with placebo had a similar increase in dopamine, identical to what happened in those who were given the drug.

      

PTSD Cognitive Behavioral Treatment and medical or drug treatment

1. Explain briefly how each treatment is conducted 

• Cognitive-behavioral treatments describe any kind of treatment that is based on the idea that psychological problems arise as a result of the way in which people interpret or evaluate situations, thoughts, and feelings, as well as the behaviors that stem from these evaluations. Several different therapies would be considered "cognitive-behavioral" that are regularly used to treat PTSD: Exposure Therapy, Stress-Inoculation Training, and Cognitive Processing Therapy.
• There is a definite need for treatments for substance abuse and PTSD. This is because it is common for individuals with PTSD to also develop problems with alcohol and drug use. In fact, these problems co-occur quite frequently. Alcohol and drug use can interfere with standard treatments for PTSD. Therefore, people have developed specialized cognitive-behavioral treatments for substance abuse and PTSD. One such treatment is called Seeking Safety.

2. Explain briefly how each treatment works (be specific)

• CBT - writing about the trauma. The patient is asked to write about his traumatic event in detail. The patient is then instructed to read the story aloud repeatedly in and outside of session. The therapist helps the client identify and address stuck points and errors in thinking, sometimes called "cognitive restructuring." Errors in thinking may include, for example, "I am bad person" or "I did something to deserve this." The therapist may help the patient address these errors or stuck points by having the client gather evidence for and against those thoughts.

3. Explain how these two treatments can be used in combination with each other

• CBT and medication are each effective alone but many studies have shown that a combination of CBT and medication is the best approach for treating anxiety disorders. Combination CBT and medication is particularly effective for children and adolescents. Evidence clearly supports the combination approach is benefits for treating pediatric cases of generalized anxiety disorder, separation anxiety, social phobia, and obsessive compulsive disorder. Studies suggest that CBT is also helpful for patients who have additional conditions, such as depression, a second anxiety disorder, or alcohol dependency. CBT is often given along with drug treatment. Both individual and group treatments work well.