8 Psychological Disorders I felt the need to clean my room … spent four to five hours at it … At the time I loved it but then didn't want to do it any more, but could not stop … The clothes hung … two fingers apart …I touched my bedroom wall before leaving the house … I had constant anxiety … I thought I might be nuts. Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996)
9 Psychological Disorders People are fascinated by the exceptional, the unusual, and the abnormal. This fascination may be caused by two reasons: 1.During various moments we feel, think, and act like an abnormal individual. 2.Psychological disorders may bring unexplained physical symptoms, irrational fears, and suicidal thoughts.
10 Psychological Disorders To study the abnormal is the best way of understanding the normal. 1.There are 450 million people suffering from psychological disorders (WHO, 2004). 2.Depression and schizophrenia exist in all cultures of the world. William James (1842-1910)
Psychological Disorder a “harmful dysfunction” in which behavior is judged to be: atypical--not normal disturbing--varies with time and culture maladaptive--harmful unjustifiable--sometimes there’s a good reason 11
12 Defining Psychological Disorders Definition (part A) - Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. Definition (part B) - When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered (Comer, 2004).
13 Deviant, Distressful & Dysfunctional 1.Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest. 2.Deviant behavior must accompany distress. 3. If a behavior is dysfunctional it is clearly a disorder. In the Wodaabe tribe men wear costumes to attract women. In Western society this would be considered abnormal. Carol Beckwith
14 Trephination (boring holes in the skull to remove evil forces) John W. Verano Perceived Causes movements of sun or moon lunacy--full moon evil spirits Ancient Treatments exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood
16 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1.Etiology: Cause and development of the disorder. 2.Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3.Treatment: Treating a disorder in a psychiatric hospital. 4.Prognosis: Forecast about the disorder.
17 Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders.
19 1. The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. 2. The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. 3. Neurotic Disorder (term seldom used now) usually distressing but that allows one to think rationally and function socially 4. Psychotic Disorder -person loses contact with reality experiences irrational ideas and distorted perceptions
20 Multiaxial Classification Are Psychosocial or Environmental Problems (school or housing issues) also present? Axis IV What is the Global Assessment of the person’s functioning? Axis V Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Axis III Is a Personality Disorder or Mental Retardation present? Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Axis I
21 Multiaxial Classification Note 16 syndromes in Axis I
22 Multiaxial Classification Note Global Assessment for Axis V
23 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. Others criticize DSM-IV for “putting any kind of behavior within the compass of psychiatry.” The danger of over diagnosis The power of diagnostic labels Confusion of serious mental disorders with normal problems The illusion of objectivity
24 Labeling Psychological Disorders 1.Critics of the DSM-IV argue that labels may stigmatize individuals. Asylum baseball team (labeling) Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press.
25 2.Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. 3. “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. Theodore Kaczynski (Unabomber) Elaine Thompson/ AP Photo Rampage 1987-R-91 minutes Rampage delves into the subject of legal insanity, so often the default defense in modern-time gruesome crime trials. Alex McArthur plays an outwardly normal guy who goes on incredible killing and mutilating sprees until (and even after, when he escapes for a short time) he's captured. When he comes to trial, the liberal DA (Michael Biehn) is torn between his own leftist leanings and the reality of the heinous crimes for which the accused is being tried. He must argue for the death penalty
26 Feelings of excessive apprehension and anxiety. Anxiety Disorders distressing, persistent anxiety or maladaptive behaviors that reduce anxiety Generalized Anxiety Disorder person is tense, apprehensive, and in a state of autonomic nervous system arousal Panic Disorder marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensation Phobia persistent, irrational fear of a specific object or situation Obsessive-Compulsive Disorder unwanted repetitive thoughts (obsessions) and/or actions (compulsions)
27 SOME COMMON & UNCOMMON FEARS This national survey ranked the relative fear levels of Americans to some sources of anxiety. A fear becomes a phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situations. Marked by a persistent and irrational fear of an object or situation that disrupts behavior.
28 Kinds of Phobias Phobia of blood.Hemophobia Phobia of closed spaces.Claustrophobia Phobia of heights.Acrophobia Phobia of open places.Agoraphobia
29 Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.
30 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. Brain Imaging Brain image of an OCD
31 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD): 1.Haunting memories 2.Nightmares 3.Social withdrawal 4.Jumpy anxiety 5.Sleep problems Bettmann/ Corbis
32 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Holocaust survivors show remarkable resilience against traumatic situations. All major religions of the world suggest that surviving a trauma leads to the growth of an individual.
33 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.
34 The Learning Perspective Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced. John Coletti/ Stock, Boston
35 The Learning Perspective Investigators believe that fear responses are inculcated through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes.
36 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.
37 The Biological Perspective Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex. Anterior Cingulate Cortex of an OCD patient. S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
38 Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms 1.Having a sense of being unreal. 2.Being separated from the body. 3.Watching yourself as if in a movie.
39 Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. Chris Sizemore (DID) Lois Bernstein/ Gamma Liason formerly called multiple personality disorder Multiple Personality Tony, walking down a country road, is shown talking to himself about his multiple personalities. Dr. Frances Howland of the Yale University School of Medicine describes Tony’s case, and viewers are shown Tony’s therapy sessions as different personalities emerge. The narrator explains the phenomenon as triggered in childhood by the need to flee psychologically from physical or sexual abuse.
40 DID Critics Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. Critics’ Arguments 1.Role-playing by people open to a therapist’s suggestion. 2.Learned response that reinforces reductions in anxiety.
41 Emotional extremes of mood disorders come in two principal forms. 1.Major depressive disorder - a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities; usually rebounds to normalcy. “common cold” of psych disorders; pervasive as well! #1 reason why people seek mental health services. Mood Disorders: Mania and Depression Presents vivid examples of the mood fluctuations of patients who suffer from periodic affective episodes.
42 2. Bipolar Disorder - a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania –formerly called manic-depressive disorder –Manic Episode »a mood disorder marked by a hyperactive, wildly optimistic state Multiple ideas Hyperactive Desire for action Euphoria Elation Manic Symptoms Slowness of thought Tired Inability to make decisions Withdrawn Gloomy Depressive Symptoms
43 The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine
44 Dysthymic Disorder Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by daily depression lasting two years or more. Major Depressive Disorder Blue Mood Dysthymic Disorder
45 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 Bettmann/ Corbis George C. Beresford/ Hulton Getty Pictures Library The Granger Collection Earl Theissen/ Hulton Getty Pictures Library
46 Explaining MOOD DISORDERS – top 5 list… Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the following: 1. Many behavioral & cognitive changes accompany depression 2. depression is wide spread 3. compared w/ men women are twice as likely to get major depression, & even more so if they have been depressed before! (see chart next slide) 4. most major depressive episodes last less than 6 months 5. stressful events related to work, marriage, and close relationships often precede depression
47 38,000 adults in 10 countries confirm what many smaller studies have found. NOTE – lifetime risk of depression varies by culture (1.5% in Taiwan to 19% in Beirut).
48 Among the 1-3 million Canadians who acknowledge having suffered depression for at least 2 weeks in the previous year, young adults and women were at most risk. Canadian depression rates, by gender & age
49 Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide. 1.National differences 2.Racial differences 3.Gender differences 4.Age differences 5.Other differences Suicide Statistics
50 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. Jerry Irwin Photography Mood Disorders: Hereditary Factors Illustrates the findings of a 10-year study that involved 12,000 volunteers in an Amish community and represents careful analysis of genetic factors related to manic-depressive disorders.
51 Post-synaptic Neuron Pre-synaptic Neuron Norepinephrine Serotonin the depressed brain… neurotransmitters - norepinephrine arousal and mood => overabundant during mania, during depression serotonin also during depression! Therapy => Prozac, Zoloft, Paxil, OR regular exercise … norepinephrine, serotonin Best thing to beat the blues…get a good workout! No wonder why Oz is always in a good mood! He worked out this morning! Mood Disorders: Medication and Talk Therapy Shows the effectiveness of combining drug therapies with traditional psychotherapy. Bipolar Disorder => lithium bicarbonate
52 Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.
53 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. Negative moods = negative thoughts. Which comes first? They coincide. Happiness creates happy behaviors, negativity creates negative behavior.
54 Example Explanatory style plays a major role in becoming depressed.
55 Schizophrenia If depression is the common cold of psychological disorders, schizophrenia is the cancer. Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002). Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women.
56 Symptoms of Schizophrenia The literal translation is “split mind.” A group of severe disorders characterized by the following: 1.Disorganized and delusional thinking. 2.Disturbed perceptions. 3.Inappropriate emotions and actions.
57 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.” (Sheehan, 1982) This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).
58 Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts).
59 Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
60 Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (apathy). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia). Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes.
61 Positive and Negative Symptoms positive symptoms: Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals. negative symptoms: Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals. + symptoms = presence of inappropriate behavior - symptoms = absence of appropriate behaviors chronic => slow developing => recovery is doubtful acute / reactive => immediate reaction => recovery is more likely Schizophrenia: Symptoms In this module, mental health professionals observe a patient named Jerry, a classic schizophrenic. Jerry’s case and medication schedule are described, and his disordered speech and behavior are shown. Prominent psychiatrists describe schizophrenia and the prognosis for those diagnosed with this disease; a locked psychiatric ward provides a graphic illustration.
63 **most dreaded psychological disorder => disease of the brain exhibited in symptoms of the mind! Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. Brain Abnormalities DOPAMINE LEVELS ARE HIGH! => MORE HALLUCINATIONS AND PARANOIA **AMPHETAMINES AND COCAINE WILL INCREASE
64 Abnormal Brain Activity Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health **Brain Anatomy => PET scans reveals activity in the thalamus when hallucinating; shrinking of cerebral tissue (involving the hypothalamus and amygdala)=> greater the shrinkage, greater the problem…this is a problem of not a single area of the brain, but rather several brain regions!
65 Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC RISK OF DEVELOPING SCHIZOPHRENIA Lifetime risks of developing schiz. vary w/ one’s genetic relatedness to someone having this disorder….risk increases w/ genetic closeness to relative w/ schiz. (approx. 7% from a sibling to over 40% from an identical twin.) My identical twin (who has Schizophrenia) has an enlarged fluid-filled cranial cavity & I do NOT! Since not all IT get Schiz., there MUST be other factors as well such as … viruses, nutritional or oxygen deprivation at birth etc.
66 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development.
67 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 1991). 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated
68 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries.
69 Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. Courtesy of Genain Family
70 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.
71 Definition: Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. *They are usually without anxiety, depression, or delusions. *SOME CLUSTERS / TYPES: Avoidant personality disorder Schizoid personality disorder Histrionic personality disorder Narcissistic personality disorder Borderline personality disorder
72 Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. may be aggressive and ruthless or a clever con artist Formerly, this person was called a sociopath or psychopath.
73 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. COLD BLOODED AROUSABILITY & RISK OF CRIME levels of stress hormone adrenaline were measured in 2 groups of 13 yr. Old Swedish boys. In both stressful and non- stressful situations, those who were later convicted of a crime (as 18-26 yr olds) showed relatively low arousal =>fearless approach to life!!!!
74 PET scans of 41 murderers revealed reduced activity in the murder’s frontal lobes, a brain area that helps brake impulsive, aggressive behavior. Frontal lobe damage can impair people’s discerning right from wrong. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et al., 1999; 2000). Normal Murderer Courtesy of Adrian Raine, University of Southern California
75 Understanding Antisocial Personality Disorder bio-psycho-social roots of crime Danish male babies whose backgrounds were marked BOTH by obstetrical complications and social stresses associated with poverty were twice as likely to be criminal offenders by ages 20-22 as those in either the biological or social risk groups. The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000). Double the RISK! When nature and nurture interact! Biological risk factors @ birth
76 NIMH => US National Institute of Mental Health: representative sample of 20,000 institutionalized and community resident revealed 1 in 3 US adults had experienced a psychological disorder AND 1 in 5 was currently experiencing a disorder. The 3 most common were: Phobic disorder Alcohol abuse / dependence (men 5 to 1 vs. females) Mood disorder (women 2 to 1 vs. males)
77 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004).
78 Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004).
82 Therapy The Psychological Therapies Psychoanalysis Humanistic Therapies Behavior Therapies Cognitive Therapies Group and Family Therapies
83 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. The Granger Collection
84 History of Insane Treatment Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick. http://wwwihm.nlm.nih.gov Philippe Pinel (1745-1826) Dorthea Dix (1745-1826) Culver Pictures
85 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.
86 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
87 1. PSYCHOTHERAPY- an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties Eclectic Approach - an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy Psychoanalysis- Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight use has rapidly decreased in recent years Resistance- blocking from consciousness of anxiety-laden material Interpretation-the analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight Transference- the patient’s transfer to the analyst of emotions linked with other relationships e.g. love or hatred for a parent Dorthea Dix (1745-1826) Philippe Pinel (1745-1826)
88 Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Sigmund Freud's famous couch Edmund Engleman
89 Therapy Evaluating Psychotherapies The Effectiveness of Psychotherapy The Relative Effectiveness of Different Therapies Alternative Therapies Evaluated Commonalities Among Psychotherapies Culture and Values in Psychotherapies
90 Psychoanalysis: Aims 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.
91 Psychoanalysis: Methods Dissatisfied with hypnosis, 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. http://www.english.upenn.edu
92 Psychoanalysis: Methods 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.
93 Psychoanalysis: Criticisms 1.Psychoanalysis is hard to refute because it cannot be proven or disproven. 2.Psychoanalysis takes a long time and is very expensive.
94 Psychodynamic Therapies Influenced by Freud, in a face-to-face setting, psychodynamic therapists understand symptoms and themes across important relationships in a patient’s life.
95 Psychodynamic Therapies Interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here and now, not an overall personality change.
96 Humanistic Therapies Humanistic therapists aim to boost self- fulfillment by helping people grow in self- awareness and self-acceptance.
97 Person-Centered 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, addressing problems in a productive way and building his or her self-esteem.
98 2. HUMANISITIC APPROACH Client-Centered Therapy developed by Carl Rogers therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth Active Listening-empathic listening in which the listener echoes, restates, and clarifies
99 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.
100 Classical Conditioning Techniques Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors. It is based on classical conditioning and includes exposure therapy and aversive conditioning.
101 3. BEHAVIOR THERAPY- therapy that applies learning principles to the elimination of unwanted behaviors Counter conditioning -procedure that conditions new responses to stimuli that trigger unwanted behaviors -based on classical conditioning -includes systematic desensitization and aversive conditioning -treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid
102 Systematic Desensitization -type of counter conditioning -associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli -commonly used to treat phobias
103 Aversive Conditioning -type of counter conditioning that associates an unpleasant state with an unwanted behavior nausea ---> alcohol OPERANT CONDITIONING => Token Economy -an operant conditioning procedure that rewards desired behavior -patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats
105 Exposure Therapy Exposure therapy involves exposing people to fear-driving objects in real or virtual environments. N. Rown/ The Image Works Both Photos: Bob Mahoney/ The Image Works
106 Operant Conditioning 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.
107 In institutional settings therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats.
108 COGNITIVE THERAPY -teaches people new, more adaptive ways of thinking and acting -based on the assumption that thoughts intervene between events and our emotional reactions The Cognitive Revolution ½ OF ALL FACULTY IN ACCREDITED CLINICAL PSYCH. DOCTORAL PROGRAMS NOW ALIGN THEMSELVES W/ A COGNITIVE OR COG-BEH. THERAPY ORIENTATION.
109 Person’s emotional reactions are produced not directly by the event but by the person’s thoughts in response to the event.
110 Cognitive Therapy for Depression Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression. Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.
111 Cognitive Therapy for Depression Rabin et al., (1986) trained depressed patients to record positive events each day, and relate how they contributed to these events. Compared to other depressed patients, trained patients showed lower depression scores.
112 Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”
113 Cognitive-Behavior 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).
114 FAMILY THERAPY -treats the family as a system -views an individual’s unwanted behaviors as influenced by or directed at other family members -attempts to guide family members toward positive relationships and improved communication
115 Regression toward the mean tendency for extremes of unusual events/ EMOTIONS/ behaviors/ scores/performances to fall back (regress) toward their average state ***thus anything we try in the interim may seem to be effective **apply to therapy!
116 Psychopharmacology study of the effects of drugs on mind and behavior Lithium =>chemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders The emptying of U.S. mental hospitals: After the widespread introduction of antipsychotic drugs, starting in 1955, the number of residents in state and county mental hospitals declined sharply. Rush to deinstitutionalize the mentally ill => homelessness increased!
117 Drug Therapies However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society. Les Snider/ The Image Works
118 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.
119 Antipsychotic Drugs Classical antipsychotics [Chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations. Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.
120 Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.
121 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.
122 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.
123 Brain Stimulation Electroconvulsive Therapy (ECT) therapy for severely depressed patients, although controversial, it is the preferred treatment for depression that DOES NOT respond to drug therapy. A brief electric current is sent through the brain of an anesthetized patient, might result in a slight memory loss. Psychosurgery surgery that removes or destroys brain tissue in an effort to change behavior lobotomy now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients
126 Who do people turn to for help with psychological difficulties? Evaluating Therapies
127 Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. 1.Does the patient sense improvement? 2.Does the therapist feel the patient has improved? 3.How do friends and family feel about the patient’s improvement?
128 Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. 1.Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). 2.Clients may need to believe the therapy was worth the effort. 3.Clients generally speak kindly of their therapists.
129 Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. 1.Clinicians are aware of failures, but they believe failures are the problem of other therapists. 2.If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. 3.Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.
130 Outcome Research How can we objectively measure the effectiveness of psychotherapy? Meta-analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy.
131 Outcome Research Research shows that treated patients were 80% better than untreated ones.
132 The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? DisorderTherapy DepressionBehavior, Cognition, Interpersonal AnxietyCognition, Exposure, Stress Inoculation BulimiaCognitive-behavior PhobiaBehavior Bed WettingBehavior Modification
133 Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific therapies against popular therapies through electronic means. The results of such a search are below:
134 Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. EMDR has not held up under scientific testing.
135 Light Exposure Therapy Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated. Courtesy of Christine Brune
137 Culture and Values in Psychotherapy Psychotherapists may differ from each other and from clients in their personal beliefs, values, and cultural backgrounds. A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable.
138 Therapists & Their 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.
139 Therapists & Their 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.
140 The Biomedical Therapies These include physical, medicinal, and other forms of biological therapies. 1.Drug Treatments 2.Surgery 3.Electric-shock therapy
141 Double-Blind Procedures To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo.
143 Alternatives to ECT Transcranial Magnetic Stimulation (TMS) In TMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects.
144 Psychosurgery Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. http://www.epub.org.br
145 Psychosurgery Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.
146 Psychosurgery Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery. http://www.epub.org.br
147 Preventing Psychological Disorders “It is better to prevent than cure.” Peruvian Folk Wisdom Preventing psychological disorders means removing the factors that affect society. Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, and sexism.
148 Psychological Disorders are Biopsychosocial in Nature
149 DIRECTIONS Using the term you have chosen create a piece of graffiti or a cartoon to hang in the room. Include: Term picture depicting/illustrating the term definition/ explanation/ symptoms etc BE Creative and hang ANYWHERE you want to in the classroom! 3D’s Medical model Pinel Biopsychosocial approach DSM-IV AXIS 1 & 2 AXIS 3,4,5 GAD Panic Disorder Phobias OCD PTSD DID Depression Bipolar Disorder glucose Suicide Linkage studies Schizophrenia Dopamine Twin studies Personality disorders Frontal lobe D. Dix Psychotherapy Eclectic approach Transference Free association Active listening Exposure therapy Systematic desensitization Aversive conditioning Family therapy Regression toward the mean Psychopharmacology SSRI’s ECT lobotomy