11/29 Readings

Lilienfeld, 2007

Initially when I was reading this paper, I was surprised that some of the PHTs Lilienfeld mentioned could even be considered to fall under the purview of psychology — Facilitated Communication, for example, and “Scared Straight” programs. As I was reading about some of these PHTs, I was truly wondering, “why is Lilienfeld even wasting his time talking about these clearly bogus things?” They just seem so far removed from any kind of psychological science. In his conclusion, Lilienfeld addressed this issue: “It may be tempting to turn a blind eye to these treatments on the grounds that they do not pass the “smell test” for scientific plausibility and therefore do not merit serious consideration…this complacent attitude is likely to be detrimental to client welfare.” In other words, researchers can tell that these “treatments” seem phony, and don’t want to waste time researching them, but laypeople might not be so discerning. And without research proving that the “treatments” are harmful, there’s nothing to stop uninformed laypeople from seeking them out. It’s a good point. But the issue of how to actually conduct research on PHTs is a challenge. First of all, it’s not easy to get excited or motivated to research a PHT that is so clearly bogus. Second, I’d imagine it would be hard to apply for funding to conduct such a study, given that your hypothesis going in would be that the so-called treatment would not be beneficial. And third, there are of course the ethical issues that Lilienfeld mentions (i.e. just as it wouldn’t be ethical to randomize people to smoke cigarettes, you probably shouldn’t randomize people to undergo PHTs).

I was also very interested in Lilenfeld’s small section on therapist variables. “Therapist variables may turn out to account for considerably more variance than therapeutic modality in treatment-induced deterioration.” A few potentially detrimental therapist traits that Lilienfeld mentions are low empathy, low warmth, and high intrusiveness/ tendency to be confrontational. Should psychologists-to-be be assessed on these types of traits before they can become licensed? Should PhD/PsyD/MSW programs take on any responsibility in weeding out students who appear to have these traits that are detrimental to client progress?

Lilienfeld, 2017

I thought that Lilienfeld’s discussion of the role of negative emotionality in interpreting ambiguous situations was really fascinating. That said, I think one needs to tread carefully in identifying these types of personal vulnerabilities, so as not to come across as blaming the victim. Might NE mediate the relationship between experiences of racism and psychological outcomes? Sure. I’ll bet it mediates the relationship between all types of negative experiences (e.g. sexual assault) and psychological outcomes. But one needs to make sure that one isn’t placing equal weight/”blame” on the individual-specific diathesis (NE) and the external stressor (racism, etc).

Overall, I found this paper most valuable not for its discussion of microaggressions per se, but more for its discussion of how properly to embark on a research program exploring a novel construct/issue. In naming a concept, for example, you want to make sure that you aren’t casually using terminology that already has its own meaning within psychology, that does not actually align with your definition (here, “aggression” in “microaggression.”) When generating items for new scales, you want to use focus group members or other individuals drawn from a wide variety of backgrounds and perspectives, rather than drawing from a group of people who inherently support your concept. You also want to consider incremental validity. Table 1 delineates further recommendations. I thought it was useful to see these recommendations applied to microaggression as a type of case-study, but I imagine that many other emerging research programs could benefit from these recommendations. These recommendations are also useful for me, as a relatively new/inexperienced researcher, to keep in mind.

11/15 Readings

Caspi et al., 2014

In this paper, the authors sought to identify several higher-order factors that underlie psychological disorders. Ultimately, they found that three factors — Internalizing, Externalizing, and Thought Disorder — best explained the 11 disorders that they had data on. The model was improved by the inclusion of a broader General Psychopathology factor which influences the the initial three factors.

I was glad that the authors included thought disorders in their models. I feel like thought disorders are typically seen as highly distinct/qualitatively different from internalizing/externalizing disorders. But the authors point out that “psychotic disorders are striking in their especially high rates of comorbidity.” It makes sense that if there really is some underlying general psychopathology factor, thought disorders would have to be subsumed under it. I also thought that their proposed model of a developmental progression of severity was interesting–but I certainly had some questions about it. They suggested that a lot of people just experience a brief episode of a disorder, a subset of those people develop persistent internalizing/externalizing disorders, and then a subset of those people “progress to the extreme elevation of p, ultimately emerging with a psychotic condition.” To support this, they say that people with schizophrenia typically had previous forms of psychopathology, like conduct disorder or social phobia. Is that really the rule, across the board? I just think the way they present it makes it seem like first you get a bout of anxiety, then you get a bout of depression, then you get schizophrenia, and I find that hard to believe. Aren’t there plenty of people with really severe, crippling, recurring depression, for example, who don’t go on to develop schizoprenia? Moreover, I would think that many lifetime comorbidities with schizophrenia (e.g. depression in childhood) might just be a misinterpretation of prodromal symptoms of schizophrenia.

Tying this in to last week’s article by Fletcher & Frith, I am also wondering if p would have something to do with prediction-error signaling. I know that we don’t know that prediction-error signaling is the accurate, whole story with psychotic disorders, but Fletcher & Frith did pretty much sell me that they’re onto something. So I wonder if there would be some spectrum of trouble with prediction-error signaling across a multitude of diorders.

This paper also ties in with Barlow’s work on neuroticism. Barlow had focused on how neuroticism might be a transdiagnostic factor in internalizing disorders. Caspi et al reported that low agreeableness, high neuroticism and low conscientiousness tend to be associated with higher levels of p. They describe these traits as “processes by which people maintain stability,” which I thought was an interesting characterization. So in line with Barlow, they seem to be saying that someone might have an underlying predisposition to psychopathology (“high p”) and when paired with the stressor of an inability to maintain stability of your emotions/self-regulate, your chance of actually developing psychopathology rises.

Linehan, 1993

I know very little about borderline personality disorder or about DBT, so this article was very interesting to me.

Linehan spent some time arguing against the pejorative language that is typically used to refer to individuals with BPD (e.g. manipulative, needy). Her arguments do make a lot of sense to me–clearly individuals with BPD are in a great deal of pain, and really need help. That said, I can also see how it would be incredibly difficult to be the therapist of someone with BPD, and how you might, indeed, come to resent the extreme emotional dysregulation and need for caring and approval that come along with this disorder. Linehan states, in reference to the therapist-client relationship, “at times, this relationship is the only thing that keeps them alive.” That seems like such a weight a therapist to carry! Are there self-care guidelines for therapists who work with BPD individuals?

On Monday we heard Thomas Joiner present about his theory of suicide. Now I wish I had asked him about his thoughts of suicidal behaviors in BPD! Most of what he focused on was the behavior of suicidal attempts with intent to die, however, and it seems like a lot of the self-harming behaviors in BPD don’t necessarily fall in this category (e.g. in BPD you might cut to relieve anxiety, but not to die). But a couple of the points he made still tie into some of Linehan’s points. For one thing, he had this model in which “fearlessness” was part of a venn diagram of traits that contribute to suicidal behavior. At the end of the talk, he explained that it wasn’t really labeled very accurately, and he named a few specific traits that actually comprise the construct. Among those were “higher pain threshold” and “previous experiences of physical and sexual abuse.” The abuse background definitely makes sense in relation to BPD. Also, I’ve heard that women have higher pain thresholds than men, and we know that individuals with BPD tend disproportionately to be women, so I wonder if there’s something to that.

 

11/8 Readings

Fletcher & Frith, 2009

Fletcher and Frith outline evidence for a theory which posits that abnormal perceptions (i.e. hallucinations) and abnormal beliefs (i.e. delusions) stem from the same underlying dysfunctions in prediction error.

While reading this paper, a couple questions came up for me. First, I wondered whether testing for dysfunctions in prediction error could be a good way of screening for schizophrenia before the syndrome is full-blown (like in early childhood). The authors mention that it’s possible that “the Bayesian inferential process becomes more prominent with the maturational processes (including those relating to prefrontal connectivity) that occur during adolescence and early adulthood,” but it seems unlikely to me that individuals would show no differences in prediction error until this period. Rather, it seems most likely that pre-existing deficits in prediction error would just become more pronounced during adolescence, to the point where positive symptoms might begin to occur.

I  also wonder if there is any way to train individuals to improve their probabilistic learning, and whether such an exercise would help to mitigate some of the positive symptoms of schizophrenia.

 

Foussias & Remington, 2008

In this paper, the authors seek to clarify what the negative symptoms of schizophrenia really are. They contend that a number of symptoms typically seen as negative symptoms really cluster better with cognitive dysfunction. They ultimately conclude that a) diminished expression and b) amotivation (i.e. avolition) are the two core subdomains of the negative symptom construct.

The authors also suggest that anhedonia may not actually be a symptom of schizophrenia, and that individuals with schizophrenia might just experience deficits in the realm of anticipatory pleasure, rather than experiencing a more general deficit in emotional experiencing.

The authors’ focus on the role of amotivation makes sense to me in light of research on functional outcomes and long-term prognosis of people with schizophrenia in different types of communities. I recall learning in an undergraduate psychology course that individuals with schizophrenia who have duties and defined roles within their communities do a lot better. So for example, someone with schizophrenia who lives in a rural, low-income farming community and is needed and expected to contribute to the farm labor might have a relatively better prognosis than someone raised in a wealthy suburb who is not expected to contribute meaningfully to his or her community. The reason this makes sense to me in light of Foussias & Remington’s arguments is that it seems like having an important, defined job in your community would help to circumvent issues of amotivation, by serving as a type of compulsory behavioral activation. It makes sense, too, that this activation would lead to better outcomes only if people with schizophrenia don’t actually experience general anhedonia–that is, it makes sense that they would have to derive pleasure/satisfaction of some sort from the activities they engage in to actually demonstrate improved functioning. I’d be interested to hear others’ thoughts on these ideas!

 

11/1 Reading

Mineka & Zinbarg’s paper outlines the contemporary learning theory model of anxiety disorders. The authors noted that early behavioral approaches, while not entirely incorrect, were overly-simplistic and failed to take into account the role of individual and contextual differences in the etiology of anxiety disorders.

The newer learning theory model that Mineka and Zinbarg presented in their paper is essentially just a diathesis-stress model, but they did a nice job of fleshing out what the vulnerabilities are likely to be. That said, I found it a bit tedious to read the paper because a lot of the vulnerabilities are the same across anxiety disorders, so the sections felt redundant at times. The disorders that seemed to cluster together the most in terms of shared vulnerabilities were specific phobia, social phobia, panic, and GAD (that is, everything except PTSD and OCD). In all of these disorders, the authors emphasized the role of temperament (e.g. behavioral inhibition), whereas the authors did not mention the role of temperament in the onset of PTSD/OCD.  Mineka & Zinbarg also discussed the role of avoidance in all of the disorders except PTSD, and the the role of feelings of control vs. helplessness in all of the disorders except OCD.

Given how similar the models for specific phobia/social phobia/panic/GAD were, Barlow’s paper from last week was on my mind. Barlow et al had contended that “splitting disorders into such fine categories may be highlighting relatively trivial differences,” and upon reading this paper, I’m somewhat inclined to agree. Do we really gain something by so-specifically delineating the possible differences in the diathesis-stress models between different subtypes of anxiety?