Anxiety

idea of anxiety as a defense mechanism- one of the last paragraphs talks about it

i like this definition of GAD and worry 

phobia development through vicarious experiences or watching tv- i would think especially when you're young. very interesting, didn't know that

new forms of social anxiety about saftey?- in school, maybe with health because of covid

I really enjoyed both readings because it took the dynamic approach to disorder that we have been discussing. Anxiety is not simple, it does not show up the same way and that is important. I liked the distinction between anxiety and worry becuase I think that worry can oversimplify anxiety and GAD. As I was reading, I started thinking of anxiety as a defense mechanism and the readings later discussed the same idea. It would make sense that a lack of control in one area can lead your mind finding a way to protect itself from being out of control again. At least Freud might agree (or find a way to relate it to sex at least).  I thought both papers did a great job at explaining how embedded anxiety can be in a person. Therapy for anxiety disorders is so difficult because of the learning dynamic. Yes, if a behavior can be learning it can be unlearned, but what if that behavior feels like a major part of you? The cognitions and behaviors have become so imbedded, people with anxiety disorders might not want to get rid of them out of that fear of losing control again. I think becuase anxiety is so common, people downgrade the severity of it at times. 

I also found it intresting that phobias can sometimes develope through watching TV. I think this goes to show that what we surround ourselves with greatly impacts us rather we know it or not. It also made me think about social anxiety and a possible new wave of it. With COVID and a rise is school shootings, I wonder if there will be an increase in phobias or social anxiety around crowds of people? We are constantly hearing stories on the news about shootings; COVID marked crowds as dangerous and to avoid them. I would think people, esspecially those a few years younger than me, would be fearful of thier safety in schools, malls, concerts, or other crowded places due to these experiences. What will this reasearch show in the next five years? 

RDoC and Network Theory

 RDoC: 

The video we watched last week in class initially made me very skeptical of the RDoC model. If we found a way to make it work, it would be revolutionary, but finding a way to make it work is a giant task. I found it funny that toward the end, the authors wrote that even though we should implement all these ideas they just wrote about, we don't really know how to do it yet. I do think it is a very attractive model because it focuses on the range from normal to abnormal instead of seeing those as distinct factors. Most of my experience during undergrad was in neuropsychology, so a brain-behavior relationship makes sense to me because I've seen it done well. I think it has a lot of usage in research but is too complex for clinical work. However, I agree with the authors that it holds a lot of potential for new treatments and interventions because of its take on lifespan development. Treating disorders and symptoms based on the stage they are in instead of a stagnant approach would greatly benefit the people involved. The emphasis on the constructs overlapping too reminds me of the chart we have been doing in V Team. It is a clear picture of how the constructs are overlapping and can help a clinician get down to some central issues. Perhaps prolonged use could start to reduce stigma and lead more people to get help before everything comes crashing down. It can promote getting treatment at the first signs rather than waiting until someone's life is in shambles.  I am a bit confused about the environment's role. Would this model argue that the environment plays a role in the disorder but it cannot be the sole cause of it? I am also wondering what the RDoC framework would look like in cases that aren't as clear-cut? I found an article that used the RDoC framework with schizophrenia that was interesting- 

I really like the network approach and getting away from our medical roots a little bit. We have been treating the disease and not the symptoms, but the diseases are constructs that we have created. So is it more important to treat something we have deemed important or treated the symptoms that are undeniable? I think this mindset would also help in the treatment process. As the authors mentioned, this approach focuses on tracking progress based on goals rather than just a decrease in symptoms. I think this is good but is it always the best approach? In cases where there is suicidal ideation or significant psychosis, might it be more important to decrease symptoms than to help a client focus on meditation? No matter which model is on trend, it is important for me to remember to treat a diagnosis as a piece of the puzzle and not the end all be all. As the article mentioned, the goal isn't to get rid of diagnoses because they provide important information, but do not stop there. I like this chart because it helps me to visualize it. We, humans, are intricate, complex beings, so I do not think we should be looking for one answer.  

HiTOP

    Both authors made valid points regarding the reliability and utility of the HiTOP model compared to the DSM. I think HiTOP provides a unique perspective that psychologists have needed for years. It allows for a descriptive and dimensional approach to diagnosing that the DSM has not historically offered. As we have discussed in class, there is a need to look at certain disorders on a scale, and HiTOP offers that. The authors used social anxiety as an example. One disorder can have two extremes that look completely different so how are we supposed to diagnose it? I think this is one strength of the HiTOP model. 

    However, when I first saw the diagram, I was very underwhelmed. How can they take nine-hundred pages of diagnostic material and put it into one graph? I know it is not covering all disorders, but is it simplifying the disorders it does cover too much? I also wondered how it would be used in a clinical setting. This article provided an example and compared it to the DSM: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859953/. I really liked the emphasis HiTOP puts on treating symptoms instead of the disorder alone. Since disorders can have different symptoms, it is important to notice these differences, which is not something the DSM traditionally emphasizes. It also allows for more room for different psychological approaches. If you focus on the symptoms, and the similarities between disorders, clinicians can do what they will with the information. Is the eating disturbance a behavioral problem, a cognitive problem, or an unconscious issue? 

    Like most things, I think there needs to be a balance. Both the DSM and HiTOP are essential and helpful for clinicians to use to best help their patients. A combination of understanding the "by the book" diagnosis and the more abstract, holistic side of diagnoses is important. Both have pros and cons, but if it is our job to constantly be learning, we should be aware of these limitations and find better ways to go about them. 

Biomedical and DSM

 9/11/2022

    Each article exposed key issues with the DSM and mental health diagnoses that create long-term problems. These problems create a chain reaction- the DSM's struggle to define disorders or include/exclude certain disorders leads to problems with therapy approaches, which then leads to harmful or unhelpful treatment. In a way, our field has tried to simplify disorders to make the job of a clinician easier, but, in turn, it created a larger mess that needs a radical change. Psychology cannot be reduced to biology or another specific area. People are complicated and there is no one answer to mental health diagnoses. 

    The DSM holds a vast group of disorders that then has huge variability within individual criteria. The umpire analogy helped to understand different approaches to mental disorders. Specifically, the 3rd umpire showed the dangers a diagnosis can have. A certain label can kick people off of insurance, institutionalize them unwillingly, incarcerate them because of a threat they possess, and possibly put them on medication. As discussed in the Biomedical Model, psychotropic medications actually have little foundation in addressing the real issues of disorders. They have been promoted by major drug companies, the FDA, and the APA but have little science to back them up. Psychologists have followed the lead of these major corporations to promote medical treatment, and few people have looked at the real science. This was shocking to me. How are we as clinicians supposed to properly help people if the literature and the APA are not telling the whole truth? It is important to apply critical thinking skills to all situations, but psychotropic medication is a difficult topic to uncover. There have been plenty of cases where they seem to work and help people with certain disorders, so why does science not support it? Maybe we are measuring the wrong thing and looking at the wrong parts of the brain? As a future clinician, should I encourage the use of medication if I know the science isn't there, but have testimonies of times it was helpful? Is that ethical? There are not a lot of people pushing back on using medication because it is a huge money maker. A revealing experiment would be to include caffeine dependency in the DSM to see how quickly new medications arise to "treat" it and how quickly people are diagnosed even though it is not a major issue for most people. 

    Before I could even consider medication, however, I would have to figure out a diagnosis. As seen in these articles, there are plenty of problems with the DSM. I had not considered that the DSM is not inclusive of all perspectives of psychology. It describes symptoms that are behaviors, not cognitions, or past experiences as they are much more difficult to assess. At the same time, it assumes that these behaviors are symptoms of mental illness whereas some may see disorders as problems with behavior. I also wondered if parts of the DSM are measuring normal, human nature things, and making it a disorder. If 50% of the population qualifies for anxiety disorders then is it really a disorder? Of course, there are people who cannot function and have extreme cases of anxiety, but for others, it could be more attributed to personality or skill. For example, people in police departments, FBI, or CIA should be constantly thinking of what could go wrong, be hyper-aware of their surroundings, and feel high levels of stress because that is their job. Does that mean that they have an anxiety disorder or are they good at their job? One article mentioned that diagnoses are sometimes more founded on consensus than data. How would I go about this differently as a clinician? 

With all of this in mind, it is important to take everything with a grain of salt. Nothing is simple, money will always control our society, and our field needs skeptical clinicians with a focus on the patient.