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HD 3700: Adult Psychopathology
Parapraxes |
- Freudian slips, slips of the tongue
- the slip is always the result of a conflict between competing ideas... in which the intended sentence (the 'disturbed' content) is replaced at the last second by slip (the disturbing content)
==> usually the first is reversed by the second
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Fin de Siècle Vienna
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A time of great intellectual and scientific discovery, a challenge to class structure, established relgion & culture norms... but also a time of intense sexual and aggressive repression
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Hysteria |
- Real physical symptoms without a physical cause
- some kind of psychogenic disorder: problem starts in the mind and not a disease process
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(Free) Association
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- A method of exploring the unconscious in which the person relaxes and says whatever comes to mind, no matter how trivial or embarrassing
- For hysteria: therapist asks patient to think and reflect on their illness, leading them first to the onset of the symptoms, then to a traumatic even symbolized by the illness
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Psychoanalytic Method
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lying on a couch, associating freely during the hour, resolving symptoms discovering underlying thoughts and feelings
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Why slips of the tongue are important:
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(1) they are common experiences
(2) we tend to dismiss them as "mental errors"
(3) If we look closely at them, almost none of them are "random" or incomprehensible --> they make "sense" and convey an idea somehow relevant to the sentence
==> product of the slip "has a sense of its own" should be regarded as a completely valid psychological act
==> last minute the mind takes one intended meaning but swaps it for another in place of the expected one
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Degrees of Awareness (on the part of the person who slips)
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(1) the speaker slips but is not surprised by the slip -- he is conscious of what he wanted to say (even though he didn't mean to say it)
(2) the speaker slips, it surprises him, but he immediately knows why he slipped
(3) the speaker slips but doesn't know afterward why
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Other instances of unconscious wishes/fears/thoughts/feelings acting as intrusions
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(1) Forgetting a name, a memory, an appointment... these are intrusions too
(2) writing the wrong thing down, sending an email to the wrong person, hitting "reply all" by mistake
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What are dreams?
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(1) we are asleep during them (p.107)
(2) the consciousness in dreams is qualitatively different from that of waking life (p.110)
(3) dreams often incorporate internal and external stimuli (ex. noise, stomach aches, etc.)
(4) the variety of dreams is unlimited... from short snippets quickly forgotten to novelistic epics remembered throughout one's life (p.111)
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Built-in resistance
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- Freud insisted that we have a built-in resistance to considering these errors as having any meaning
- we are motivated to dismiss them as "random errors"
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Freud's 3 rules on associating dreams
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(1) do not worry about what the dream appears to tell us, whether it is absurd of intelligible, it is not the conscious meaning you're searching for
(2) Associate to element of the dream without judging associations... just keep the ideas coming
(3) keep associating until the connections between the dream materials and the underlying thoughts emerge
--> despite the rules, most patients find themselves stopping their associations, dismissing them as "irrelevant" <== resistance
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Having Dreamer Interpret His Own Dream
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(1) He always says he doesn't know what it means
(2) ask the dreamer how he arrived at the dream, and his first remark is an explanation
(3) encourage free association, asking the dreamer to keep the dream or dream element in mind as he does so
(4) reason this works: all thoughts are connected with earlier thought = psychic continuity
(5) A dream often leads to a though indirectly connected to it
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Psychic continuity
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- all thoughts are connected with earlier thoughts
- why associating with dream in mind works to interpret dreams
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The divided mind
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- the mind wants to know more but also wants to protect itself
(ex. Freud lectures p.144: resistant woman = book of jokes AND conscious woman = god wearing blinders
Also know p. 142: ideas: critical objection is not justified --> ideas we try to suppress are invariably the most important when searing the unconscious.
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Dream Structure & Dreamwork
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(1) Thoughts occur to the dreamer during dream states... these are dream thoughts which Freud always thought were wishes
(2) these thoughts constitute the latent content of the dream
(3) Dream Work takes the dream thoughts and expresses them in hallucinatory images composed of related thoughts which nevertheless disguise and distort the dream thoughts. by doing so, the anxiety or strong feelings evoked by the dream thoughts are reduced. Without framework, we might not stay asleep
(4) In this was, dreams are the guardians of sleep (and a nightmare is a dream that failed)
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Dream thought
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Thoughts that occur to the dreamer during dream states (wishes/fears/feelings/thoughts)
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Freud's 2 provocative hypotheses
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(1) That we experience as consciousness is only a part of mental life-- that there are mental processes which influence us greatly but remain unconscious (25)
(2) The sexual impulses -- broadly and narrowly defined -- play an important role in nervous disorders AND that sexual energy when channeled psychologically fuels creativity, rationality, achievement, and the emergence of culture and civilization (26-7)
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The erotic drive
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If pain = indicator of not doing things to avoid feeling badly, then good feelings = indicators of things we should do
- we need to feel pleasure, and there is a necessary release from this pleasure
- people learned to channel this sexual energy into creativity
- almost all things pleasurable start with a physical reward
--- Starts at "Pleasure of an idea" ----> "Sexual Intercourse"
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Aggressive Drive
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- By nature, we are violent and aggressive creatures
- Starts at "rape/murder" ----> "having ambitions"
- rape/murder = more about agression/domination than sex, followed by beating someone up
- ambitions falls behind debate
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Condensation
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- compressing the latent dream thoughts into images that omit, combine, or reverse, those meanings
ex. rosie's boyfriend was portrayed as someone else (better looking, less smart)
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Displacement |
- a latent thought is replaced by a part of itself or a symbol of itself, or by an "allusion" to it
- ex. instead of seeing a wedding or marriage, the object of affection could be wearing a white dress in another setting
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Transformation into Visual Images
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- these hallucinatory "movies" you experience every night
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Language is often reversed or doubled
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- the ambiguous meaning of primal words is often exploited in dreams (ex. cleave = to cut apart and join together)
- freud argues that dreams rarely depict "no" but instead represent both sides of a wish or fear
- ex. Rosie didn't want to see the monsters but could still see them
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Sublimation |
- creation of more energy and time by suppressing urges (sexual and aggressive)
--> civilization only exists because of suppression
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ID |
- basic, animal part of a person
- expresses the urges of the erotic and aggressive drives, seeking to discharge gathering energy through pleasurable acts (physical or mental)
-obeys "pleasure principle"
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Ego |
- the conscious part of a person
- strives to take control of ID's urges, and their compelling fantasies/daydreams, and act in the world according to the "reality principle"
- Ego struggles to maintain control of its urges and wishes for gratification in accordance to the stands of the super ego which can be quite permissive (ex. Greek life) or strict (ex. convents)
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Super Ego
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- the minds internalization of family/surrounding culture's values
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Psychosexual Stages
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- 0-2 = oral
- 2-3 = anal
- 3-5 = phallic
- 5-7 = oedipal
- 7-11 = latency
- 12+ = genital adolescence
** children need to learn how to sublimate and suppress their primal needs
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Oral Stage
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- Pleasure Principle (0-2)
- first part of our body where we can first release that need for erotic pleasure is nursing (very important to baby's life)
- our mouths are an erogenous zone (ex. babies fall asleep while nursing)
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Anal Stage
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- Rise of the Ego (2-3)
- First moment when child has to physically delay gratification through potty-training
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Phallic Stage
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- Exhibitionism (3-5)
- (ignore ideas on females/penis envy)
- Child starts to believe they are in control of anything/everything
children learn that toughing your private parts feels good
- learning self control while learning self pleasure
- love to take off clothes and be center of the universe
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Oedipal Stage
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- Rise of the superego (5-7)
- NOT physical at all... only psychological
- starts to develop romantic feelings for parent of opposite-sex (or same-sex) and competition towards the other parent
- at some point, child must renounce all these feelings
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Latency Stage
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- Social/Culture Internalizations (7-11)
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Genital Adolescence Stage
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- Reworking of oedipal stage (and any other unresolved stages) (12 +)
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Neurosis
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A repetition or symptom that doesn't make sense and won't go away (it's plaguing you)
Ex. 1: the "jealous" delusion <-- woman with erotic feelings toward her son-in-law that were unacceptable to her... disguised her feelings by projecting the idea of infidelity onto her husband
Ex. 2: the "obsessive" neurosis <-- girl struggling with oedipal desire for her father, wishes to interfere with parent's relationship, and fears of growing up and separating from her parents... feeling disguised by symbolic compulsions
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Signal Anxiety
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- When little kids begin to encounter their aggressive thoughts they fear that their parents will be mad at them...
- signal anxiety = fear of losing affection or approval from a loved one
- these feeling mobilizes defenses
==> ego: moves to suppress the wish by mobilizing a defense ("reaction formation")
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Reaction Formation
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- the defense mechanism mobilized by the ego due to signal anxiety
- whatever the aggressive thought or desire is, reaction formation transforms it into the opposite
==> instead of the villain, child is the hero
(ex. Sarah "don't fall Hannah")
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Compromise Formation
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- Conscious Wish is in conflict with Unconscious Wishes
- Signal Anxiety ==> compromise formation
- Compromise formation = the unconscious and conscious wishes are partially satisfied
ex. Joe & paying attention at college; Betsy wanting a relationship but making self unavailable
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Ways Ego defends against unacceptable feelings/thoughts/wishes/fears
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- Repression
- Projection
- Denial
- Rationalization
- Reaction Formation
- Isolation Affect
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Repression |
- When memories of emotionally or physically traumatic experiences are put in the unconscious
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Projection
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- unconscious attribution of our negative characteristics to others
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Rationalization
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Justifying you behavior by giving reasonable and rational but false reasons for it
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Isolation of Affect
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- Separation of feelings from ideas and events
-- your mind takes away the experience of the anger and isolates the emotion away from th action
- you mentally understand what you were feeling, but you don't feel it
- Ex. Not feeling anger because you have become anxious
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Countertransference
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- the therapists behavior and emotional response to the client
- may be related to unresolved feelings toward significant others from therapist's own past, or they may be generated in response to transference feelings on the part of the client
ex. "Fat Lady" ---> feelings of therapist about fat people due to family history of obesity
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Transference |
- when client unconsciously starts relating to their therapist in ways that mimic critical relationships in their lives
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Defense within the hour
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--> Fat Lady: by making jokes or by using tones, Betty might be saying certain things but NOT feeling them (isolation of affect)
==> you must have emotional activation during therapy
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Westen's 5 Postulates
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1. Much of mental life (including thoughts, feelings, and motives) is unconscious, which means that people can behave in ways or develop symptoms that are inexplicable to themselves
2. Mental processes, including affective and motivational processes, operate in parallel so that toward the same person or situation, individuals can have conflicting feelings that motivate them in opposing ways and often lead to compromise solutions
3. Stable personality patterns begin to form in childhood, and childhood experiences play an important role in personality development, particularly in shaping the ways people form later social relationships
4. Mental representations of the self, others, and relationships guide people's interactions with others and influence the ways they become psychologically symptomatic
5. Personality development involves not only learning to regulate sexual and aggressive feelings, but also moving from an imature, socially dependent state to a mature, interdepenedent one
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Westen's 5 postulates (simplified/rephrased)
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(1) much of mental life is unconscious --> people can have inexplicable behaviors and developed symptoms
(2) Mental processes work in parallel (leading toconflicts & compromises).
(3) Early experience has a profound impact on laterdevelopment, personality, patterns of intimacy …
(4) Mental representations of self and others guide interactions, influence feelings, relationships.
(5) Personality development involves regulating aggression, sexuality, as well as achieving identity and mature independence
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Clinical Psychology
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two traditions:
(1) Experimental Physiology--> objective approach
(2) Philosophy --> projective approach
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Experimental Physiology/Objective Approach
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- Theory = empiricism, behaviorism, materialism
- Data = observed, measured, quantified
- Tests = self-report measures, cognitive tests (IQ), biological markers, brain scans (fMRI-PET)
- Therapy = short-term, outcome-based & measured, focus on behavior, cognitions
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Philosophy/ProjectiveApproach
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- Theory = psychoanalysts, existentialism, phenomenology
- Data = reported, remembered, interpreted
- Tests = in-depth interviews, Rorschach, thematic apperception test, memories
- Therapy = long-term, subjective, focus on wishes, self-acceptance
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DSM-IV-TR Multi-Axial System of Diagnosis
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- Axis I: clinical disorders (mood-thought-anxiety)
- Axis II: (a) Personality Disorders (Borderline, Narcissistic, Dependent, Avoidant, Antisocia) OR (b) Mental Retardation
- Axis III: General Medical Conditions (Asthma, Diabetes...)
- Axis IV: Psychosocial & Environmental Functioning
- Axis V: Global Assessment of Functioning (0-100)
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Interviews (Diagnostic Data)
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asking questions along the lines of DSM-IV-TR
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Structured Interviews (Diagnostic Data)
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established questions that follow the DSM
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Self-Report Measures (Diagnostic Data)
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- questions that measure mood, anxiety, quality of life satisfaction
- CES-depression, Beck Depression Inventory (BDI), Rosenberg Self-Esteem Inventory, Dissociative Experiences Questionnaire (DEQ), MMPI
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Norm-Based Measures (Diagnostic Data)
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IQ, MMPI (Minnesota Multiphasic Personality Inventory), PAI
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Projective Tests (Diagnostic Data)
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- mental associations to pictures, fill-in-the-blanks and inkblots
- rorschach inkblot test, TAT, draw a person test, early memories test, narrative completion test
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Ways to gather diagnostic data
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(1) Interviews
(2) Structured interviews
(3) Self-report measures
(4) Norm-based measures
(5) Projective tests
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Thematic Apperception Test (TAT)
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- type of projective test
- stories are elicited by photos and pictures
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Shedler
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-Aim - to show empirically the limits to self-report depression measures, specifically the BDI
-Gave students: BDI, Physiological measures of stress, and Early memories test (scored by clinicians and students)
- Findings:
==> many students = low BDI/low stress/positive memories
==> some students = high BDI/high stress/negative memories
==> for a subset = low BDI/high stress/negative memories
**** SUBSET = "DEFENSIVE MENTAL HEALTH"
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Defensive Mental Health
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If a person has a bias against thinking of themselves as being depressed, the you will report yourself as not depressed HOWEVER physiological tests did catch the symptoms
ex. class data: DURING THE PAST WEEK: 50% said rarely depressed, but 18% had said they rarely/occasionally felt as good as other people
==> 36% of class: mild depression (> 18 score)
==> 25% of class: clinically relevant depression (>22)
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Shedler |
- Aim = to show empirically the limits toself-report depression measures, specifically the BDI
- Data = BDI score, physiological measures of stress, early memories test (scored by clinicians/then by students)
- Findings
==> many subjects: Low BDI/Low Stress/Positive Memories
==> some subjects: HIgh BDI/High Stress/Negative Memories
==> a subset: Low BDI/HIgh Stress/Negative Memories
*** Subset = "Defensive Mental Health"
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Defensive Mental Health
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- If a person has a bias against thinking of themselves as being depressed, then they will report themselves as not depressedHOWEVER the physiological tests did catch the symptoms
- ex. Class assessment: CES-D (DURING PAST WEEK) --> 50% said rarely felt depressed; but almost 40% said rarely felt as good as other people
==> 36% of class = "mildly depressed" (> 18 score)
==> 25% of class = "clinically relevant depression" (>25)
==> 60% positive Early memory tests (30 neg)
==> 50% negative Narrative completion (30 pos)
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