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Abnormal Psychology & Therapy Chapters 16 & 17 Part I: Psychological Disorders.

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2 Abnormal Psychology & Therapy Chapters 16 & 17

3 Part I: Psychological Disorders

4 Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is unjustifiable (not rational), maladaptive, atypical (violates the norm), and disturbing psychiatrists and psychologists label it as disordered. Remember: U-MAD

5 Medical Perspective Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. He suggested humane treatment. “Lunatic Ball”

6 Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders.

7 Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, DSM- IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to the 60 identified in the 1950s.

8 Goals of DSM 1.Describe (400) disorders. 2.Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Also, insurance companies usually require a firm diagnosis to cover health care costs. Others criticize DSM-IV for classifying almost anything as a disorder/syndrome.

9 Anxiety Disorders Feelings of excessive apprehension and anxiety that cause distress or cause maladaptive behaviors to reduce the levels of stress. 1.Generalized anxiety disorders (GAD) 2.Phobias 3.Panic disorders 4.Obsessive-compulsive disorders (OCD) 5.Post-Traumatic Stress Disorder (PTSD)

10 Generalized Anxiety Disorder (G.A.D) 1.Disorder characterized by persistent and uncontrollable tenseness and apprehension (worrying). 2.Autonomic arousal. 3.Inability to identify or avoid the cause of certain feelings. Must have at least three of the following: - Restlessness - Feeling on edge - Difficulty concentrating/mind going blank - Irritability - Muscle Tension - Sleep Disturbance

11 Panic Attack Disorder Minute-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. Anxiety is a major component of panic attack disorder, making people avoid situations that cause it. Panic Attack disorder and agoraphobia (fear of open/public places) usually go together.

12 Phobias Phobias are marked by a persistent and irrational fear of an object or situation that disrupts behavior. Agoraphobia – fear of open places (only phobia listed in the DSM)

13 Obsessive-Compulsive DisorderObsessive-Compulsive Disorder (O.C. D.)(O.C. D.) Persistence of unwanted thoughts (obsessions) and urges/behaviors (compulsions) to engage in senseless rituals that cause distress.

14 Post-Traumatic Stress Disorder (P.T.S. D.) Often caused by severely threatening uncontrollable events. Four or more weeks of the following symptoms constitute Post-Traumatic Stress Disorder: 1.Haunting memories (flashbacks) 2.Nightmares 3.Social withdrawal (uncommon anger or substance abuse) 4.Jumpy anxiety 5.Sleep problems (insomnia)


16 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.

17 The Learning Perspective Learning theorists suggest that (classical) conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced (operant). Investigators believe that fear responses can be passed along to others through observational learning (modeling).

18 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Perhaps it’s part of Jung’s collective unconscious? Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

19 The Biological Perspective A PET scan of the brain of a person with Obsessive- Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Too little of the neurotransmitter Serotonin can also contribute to anxiety disorders

20 Dissociative Disorders Usually nurture-based where conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.. 1.Having a sense of being unreal. 2.Being separated from the body. 3.Watching yourself as if in a movie. Depersonalization Disorder

21 Other Dissociative Disorders Dissociative Amnesia – amnesia caused by some kind of trauma (not by injury). For example, soldiers in combat. Dissociative Fugue (flight) – Person totally forgets who they are and may develop a completely new identity, personality, etc. in a new place. Like “witness protection” from yourself!

22 Dissociative Identity DisorderDissociative Identity Disorder (D.I.D.)(D.I.D.) Formerly called Multiple Personality Disorder (MPD), it is a disorder in which a person exhibits two or more distinct and alternating personalities (each with its own name, voice, mannerisms, occupations, etc). Chris Sizemore, the basis for the movie The Three Faces of Eve m/video/watch/?id=485 2295n&tag=mncol;lst;2

23 Mood Disorders Emotional extremes of mood disorders come in two principal forms. 1.Major depressive disorder 2.Bipolar disorders

24 Major Depressive Disorder Major depressive disorder occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions. 5 of the following: (at least one of which has to be depressed mood or loss of interest/pleasure) -depressed mood -loss of interest/pleasure -weight loss -insomnia/hypersomnia -psychomotor agitation/retardation - loss of energy/fatigue -feelings of worthlessness/guilt - decreased concentration -suicidal ideation/thoughts of death.

25 Dysthymic Disorder Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by mild daily depression lasting two years or more with two or more of the following symptoms: Major Depressive Disorder Blue Mood Dysthymic Disorder -poor appetite/overeating -insomnia/hypersomnia -fatigue/low energy -low self-esteem -decreased concentration -hopelessness

26 Bipolar Disorder Formerly called Manic-Depressive Disorder, it is an alternation between depression and mania (highs & lows). Multiple ideas Hyperactive Desire for action Euphoria Elation Manic Symptoms Slowness of thought Tired Inability to make decisions Withdrawn Gloomy Depressive Symptoms

27 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman WolfeClemensHemingway

28 Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn notes that a theory of depression should explain the following: 1.Behavioral and cognitive changes 2.Common causes of depression 3.Gender differences 4.Depressive episodes usually self-terminate. 5.Depression is increasing, especially in the teens

29 Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.


31 Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Linkage analysis and association studies link possible genes and dispositions for depression.

32 Biological Perspective Post-synaptic Neuron Pre-synaptic Neuron Norepinephrine Serotonin Neurotransmitters: A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine.

33 Biological Perspective PET scans show that brain energy consumption rises and falls with manic and depressive episodes.

34 Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.

35 Depression Cycle 1.Negative stressful events. 2.Pessimistic explanatory style. 3.Hopeless depressed state. 4.These hamper the way the individual thinks and acts, fueling personal rejection.

36 Explanatory style plays a major role in becoming depressed.

37 Psychotic Disorders Schizophrenia Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease. Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women.

38 Symptoms of Schizophrenia The literal translation is “split mind” but is not the same as DID. Schizophrenia is a group of severe disorders characterized by the following: 1.Disorganized (word salad) & delusional thinking. 2.Disturbed perceptions (hallucinations). 3.Inappropriate emotions & actions. John Nash

39 Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” This monologue illustrates fragmented, bizarre thinking with distorted beliefs (usually of grandeur or persecution) called delusions (“I’m Mary Poppins”). It also demonstrates a principle called “word salad” (jumbling up ideas in sentences).

40 Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual or tactile.

41 Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (apathy/flat affect). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).

42 Subtypes of Schizophrenia Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes.

43 Positive and Negative Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms - inward). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms - outward).

44 Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative (outward) symptoms. When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive (inward) symptoms.


46 Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. Brain Abnormalities

47 Abnormal Brain Activity, Etc. Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles.

48 Pre-natal/Neo-natal development Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. There is also evidence of people who suffered from oxygen deprivation at birth and/or poor fetal nutrition may also have higher rates of schizophrenia. Malnutrition, methamphetamine and cocaine abuse, and social conditions (urban life, racial discrimination, adversity and family dysfunction) have also been contributed to the development of the disorder.

49 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease. 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated

50 Warning Signs Early warning signs of schizophrenia include: Birth complications, oxygen deprivation and low-birth weight. 2. Short attention span and poor muscle coordination. 3. Poor peer relations and solo play.6. Emotional unpredictability.5. Disruptive and withdrawn behavior.4. A mother’s long lasting schizophrenia.1.

51 Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.

52 Some Personality Disorders Avoidant Personality Disorder – the person commonly withdraws due to fear of rejection Narcissistic Personality Disorder – the person is very self-absorbed and have delusions of grandeur Narcissistic Personality Disorder Borderline Personality Disorder – the person has unstable emotions and relationships and ultimately an unstable identity Antisocial Personality Disorder – the person (usually male) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath. Dependent Personality Disorder – the person is abnormally dependent on other people

53 Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age.

54 Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to non-murders. Normal Murderer

55 Understanding Antisocial Personality Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications.

56 Somatoform Disorders Disorders that usually involve abnormal bodily sensation or body image: Hypochondriasis – fear of or believing that you have illnesses that you don’t really have Conversion Disorder – developing physical symptoms without an actual biological cause Conversion Disorder Body Dysmorphic Disorder – belief that one or more of the features/parts of your body are abnormal/grotesque and need to be fixed

57 Childhood Disorders Attention-Deficit Hyperactivity Disorder (ADHD) – 3 key symptoms Inattention Hyperactivity Impulsivity – The Big Questions: Is it over diagnosed? Is it a real syndrome at all? How can it be better diagnosed? What causes it?

58 Childhood Disorders Autistic Disorders – Key symptoms Impaired speech or development Impaired social interaction (such as decreased eye contact and inability to carry on a conversation) Impaired theory of mind (understanding of others’ point of view) Behaviorally inflexible – stick to routine; distress when it changes Tends to occur more in males than in females Asperger syndrome -“high functioning” form of autism with normal (or high) levels of intelligence and possible savant syndrome yet with decreased social functioning – Possible Causes? Differences/damage in the brain’s neural connections? Genetic Factors? Mercury in Vaccines?

59 Other Disorders Tic Disorders – facial tics, blurted out words or sounds – Tourette’s Syndrome Tourette’s Syndrome Factitious Disorders – disorders in which the person fakes symptoms or inflicts symptoms on self or others to gain attention/sympathy (malingering = sickness for personal or monetary gain) – Munchausen Syndrome – person claims to have symptoms and undergoes many treatments/surgeries to receive attention – Munchausen Syndrome by Proxy – person induces illnesses in others (usually parents do this to kids) to receive indirect attention – Causes? Perhaps person was given great care by a doctor growing up and neglected by parents? Other, underlying personality disorders?

60 Part II: Psychological Treatment/Psychotherapy

61 History of Insane Treatment Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, and downright dangerous treatments.

62 History of Insane Treatment Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick. Philippe Pinel (1745-1826) Dorthea Dix (1745-1826)

63 Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, curing him or her of psychological disorders. An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems.

64 Psychological Therapies We will look at four major forms of psychotherapies based on different theories of human nature: 1.Psychoanalytical theory 2.Humanistic theory 3.Behavioral theory 4.Cognitive theory

65 Psychoanalytic Therapy The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Sigmund Freud's famous couch

66 Psychoanalysis Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. When energy devoted to id-ego- superego conflicts is released, the patient’s anxiety lessens.

67 Psychoanalysis Freud developed the method of free association to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks about whatever comes to his or her mind.

68 Psychoanalysis Criticism During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up and reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. 1.Psychoanalysis is hard to refute because it cannot be proven or disproven. 2.Psychoanalysis takes a long time and is very expensive.

69 Humanistic Therapy Humanistic therapists aim to boost self-fulfillment by helping people grow in self-awareness and self- acceptance. Unlike psychodynamic therapies, humanistic therapies focus on  The present and future, not past conflicts  Conscious issues not unconscious conflicts  Taking responsibility for one’s feelings and behaviors, not finding what is hidden  Promoting individual growth, not curing illnesses - Person in therapy called client (not patient)

70 Humanistic Therapy Developed by Carl Rogers, person-centered therapy is a form of humanistic therapy. The therapist listens to the needs of the patient in an accepting and non-judgmental way (unconditional positive regard), addressing problems in a productive way and building his or her self-esteem. Therapist also demonstrates empathy and genuineness.

71 Humanistic Therapy The therapist engages in active listening and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings.

72 Behavior Therapy Therapy that applies learning principles to the elimination of unwanted behaviors. To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes.

73 Behavior Therapy Exposure therapy involves exposing people to fear-driving objects in real or virtual environments.

74 Behavior Therapy Systematic Desensitization (Counter-conditioning) is a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli (commonly used to treat phobias).

75 Behavior Therapy Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished. A number of withdrawn, uncommunicative 3-year-old autistic children have been successfully trained by giving and withdrawing reinforcements for desired and undesired behaviors.

76 Aversion Therapy Aversive Conditioning Aversive Conditioning is a type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported (but doesn’t seem to work long-term).

77 Behavior Therapy Therapists may create a token economy in which patients exchange a token of some sort (usually a secondary reinforcer), earned for exhibiting the desired behavior, for various privileges or treats (perhaps a primary reinforcer). It’s often used by parents and teachers.

78 Behavior Therapy Criticisms Will the desired behaviors continue and/or undesirable behaviors come back when the training/reinforcement stops? Is it really ethical for one human being to “train” another?

79 Cognitive Therapy Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions.

80 Cognitive Therapy Rational-Emotive Therapy - Albert Ellis developed a theory that irrational thoughts led to self-defeating emotions. Ellis developed the ABCD model to explain this: A = Activating event that triggers the emotion (e.g. failing a test) B = Belief System: how person appraises the event (e.g. “I’m stupid and no good at this subject”) C = emotional/behavioral Consequences of the appraisal in step B (e.g. feeling worthless and dumb) D = Disputing their erroneous beliefs in step B (e.g. “I’m not dumb. I just did not study hard enough and go in for the extra help that I needed”) This is what Ellis wanted to train his clients to be able to do through Rational Emotive Therapy. Therapists present common irrational beliefs to clients and help to train them to cognitively restructure/reappraise their thinking.

81 Cognitive Therapy Cognitive therapists often combine the reversal of self-defeated thinking with efforts to modify behavior. Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy). AP Psych Rocks!

82 Group & Family Therapy Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication. Marriage counseling is a form of this.

83 Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? DisorderTherapy DepressionBehavioral, Cognitive, Interpersonal AnxietyCognitive, Exposure, Stress Inoculation BulimiaCognitive-behavioral PhobiaBehavioral Bad HabitsBehavior Modification

84 Alternative Therapies Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy.

85 Therapists & Training Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

86 Therapists & Training Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers. Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

87 The Biomedical Therapies These include physical, medicinal, and other forms of biological therapies. 1.Drug Treatments 2.Surgery 3.Electric- shock therapy

88 Drug Therapies Psychopharmacology is the study of drug effects on mind and behavior. With the advent of drugs, hospitalization in mental institutions has rapidly declined. However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society.

89 Antipsychotic Drugs Classical antipsychotics: (Thorazine) Remove a number of positive symptoms (inward) associated with schizophrenia such as agitation, delusions, and hallucinations. Atypical antipsychotics: (Clozapine & Risperdal) Remove negative symptoms (outward)associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.

90 Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia. Antianxiety Drugs Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.

91 Antidepressant Drugs Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. Mood-Stabilizing Medications Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.

92 Brain Stimulation Electroconvulsive Therapy (ECT) ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.

93 Psychosurgery Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. Psychosurgery (trephination/lobotomy) is used as a last resort in alleviating psychological disturbances. Removal of brain tissue changes the mind and psychosurgery is irreversible

94 Rosemary Kennedy’s Lobotomy We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch." The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside," he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backwards.... "We made an estimate on how far to cut based on how she responded."... When she began to become incoherent, they stopped.—James W. Watts

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