Presentation on theme: "Chapter 11 Psychological Disorders and Their Treatment"— Presentation transcript:
1 Chapter 11 Psychological Disorders and Their Treatment
2 Prevalence of Psychological Disorders In a year in the U.S.:20% of persons experience psychological problems severe enough to adversely affect their daily living.40% of persons experience at least mild mental health problems.About 2.1 million people are admitted to hospitals due to serious psychological problems.Worldwide:About 400 million people are afflicted with psychological disorders.
3 How Should We Understand Psychological Disorders? The medical model proposes that psychological disorders have a biological basis and can be classified into discrete categories and are analogous to physical diseases.
4 How Should We Understand Psychological Disorders? Although not agreeing that all mental health problems have a biological basis, mainstream psychology has adopted the medical model’s terminology.Symptom: a sign of a disorderDiagnosis: distinguishing one disorder from anotherEtiology: a disorder’s apparent causes and developmental historyPrognosis: prediction about the likely course of a disorder
5 Defining Psychological Disorders A pattern of atypical behaviorResults in personal distress orSignificant impairment in a person’s social or occupational functioning
6 Defining Psychological Disorders Major criteria used to differentiate normal from disordered behavior:AtypicalSignificantly above or below the average in its frequency of occurrenceViolates cultural normsMaladaptiveInterferes with ability to perform normal activitiesCauses personal distressIndividuals who report experiencing troubling emotions are often considered to have psychological problems.
7 Numerous Theoretical Explanations Five primary perspectives to understand mental illness:Psychodynamic: Disordered behavior is controlled by unconscious forces shaped by childhood experiences.Behavioral: Disordered behavior is caused by identifiable factors in the person’s environment and results from learning.Cognitive: ineffective or inaccurate thinking is the root cause of mental illness
8 Numerous Theoretical Explanations Five primary perspectives to understand mental illness:Sociocultural: Mental illness is the product of broad social and cultural forces .Biological: Disordered behavior is caused by biological conditions, such as genetics, hormone levels, or neurotransmitter activity in the brain.
9 Combined ModelsDiathesis-stress model: a predisposition to a given disorder (diathesis) that combines with environmental stressors to trigger a psychological disorderBio-psycho-social model. Takes into account predispositions, personal experience, and life circumstances.
11 Psychological Disorders Biological(Evolution,individualgenes, brainstructuresand chemistry)Psychological(Stress, trauma,learned helplessness,mood-related perceptionsand memories)Sociocultural(Roles, expectations,definition of normalityand disorder)Bio-psycho-social Perspectiveassumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
12 Models from Outside Psychology Spirit PossessionTrephiningLunacyCursesFamily/generationalOccult (voodoo, witchcraft)SinGuiltUnforgiveness, bitterness
13 Risks of Using Diagnostic Labels David Rosenhan demonstrated diagnostic labels’ biasing effects.Misdiagnosis of insanity by hospital personnel due to their bias toward calling a healthy person sickDiagnostic labels can harm patients in several ways.Label may “dehumanize” patients by encouraging mental health practitioners to treat them as labels rather than as unique individuals with problems.Labeled individuals may experience discrimination and may cause people to expect those labeled to behave abnormally and thus to misperceive normal behavior as disordered.
14 Benefits of Using Diagnostic Labels Despite ethical concerns, diagnostic labels are used because they serve several important functions:Summarize patient’s symptoms or problems, and thus, communicate great deal of information with a single wordConvey information about possible causes of the disorderConvey information about the patient’s prognosis
15 DSM Classification System Diagnostic and Statistical Manual of Mental Disorders (DSM) use to diagnose mental disordersPublished by the American Psychiatric Association.Since 1980, DSM has been updated several times and is now in its fourth edition, text revision, or DSM-IV-TR.
16 DSM Classification System DSM classification system is descriptive rather than explanatory, meaning that:it is not based on a particular theory concerning the cause(s) of psychological disorders.diagnoses are based mainly on observable symptoms.DSM provides clearer directions concerning number, duration, and severity of symptoms necessary to assign a diagnosis.By recognizing that two patients with same disorder may substantially differ from one another, clinicians much more likely to acknowledge uniqueness of all patients.
17 Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior Characterized by distressing, persistent anxiety or maladaptive behaviorAbout 25 percent of the population will experience this disorder in our lifetime.Anxiety disorders occur across the life span and commonly co-occur with many other disorders, such as depression and substance abuse.
18 Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior Five major anxiety disorders:Panic disorder: brief episodes of intense anxiety with no apparent reasonPhobic disorder: strong irrational fears of specific objects or situations, called phobiasGeneralized anxiety disorder (GAD): a constant state of moderate anxiety
19 Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior Five major anxiety disorders:Obsessive-compulsive disorder: repetitive, unwanted, and distressing actions and/or thoughtsPost-traumatic stress disorder: occurs among individuals who have experienced or witnessed traumatic eventsLater reexperience the event through nightmares, flashbacks, and avoid situations or persons that trigger flashbacks
20 Anxiety Disorders Common Obsessions and Compulsions Among People With Obsessive-Compulsive DisorderThought or BehaviorPercentage*Reporting SymptomObsessions (repetitive thoughts)Concern with dirt, germs, or toxinsSomething terrible happening (fire, death, illness)Symmetry order, or exactnessExcessive hand washing, bathing, tooth brushing,or groomingCompulsions (repetitive behaviors)Repeating rituals (in/out of a door,up/down from a chair)Checking doors, locks, appliances,car brake, homework
21 Anxiety DisordersPET Scan of brain of person with obsessive/ compulsive disorderHigh metabolic activity (red) in frontal lobe areas involved with directing attention
22 Etiology of Anxiety Disorders Genetic and biological factors:Genetic heritage may predispose us to more easily develop phobic reactions or to respond intensely to stressful events.Behavioral or conditioning factors:Classical conditioning may instill conditioned emotional responses, and operant conditioning may reinforce and maintain the person’s avoidance responses.Cognitive factors:People suffering from panic disorder closely monitor their physiological reactions, and often exaggerate the significance of their physiological symptoms.
23 Mood Disorders: Emotional Extremes Characterized by emotional extremes that cause significant disruption in daily functioning.To qualify as a mood disorder, emotional extremes must persist for a long time.Most common mood disorder is depressionCharacterized by extreme and persistent negative moods and the inability to experience pleasure by participating in activities one previously enjoyed (Kramlinger, 2001)
24 Mood Disorders: Emotional Extremes Depressed individuals:Often experience physiological problems such as lack of appetite, weight loss, fatigue, and sleep disordersOften experience behavioral symptoms, such as slowed thinking and acting, social withdrawal, and decreased activityExhibit cognitive symptoms, such as low self-esteem, thinking about death and/or suicide, and having little hope for the future
25 Mood Disorders-Depression The vicious cycle of depression can be broken at any point1Stressfulexperiences4Cognitive andbehavioral changes2Negativeexplanatory style3Depressedmood
26 Mood Disorders-Depression Percentageof populationaged 18-84experiencingmajordepressionat somepoint In life2015105USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea NewRico Germany ZealandAround the worldwomen are moresusceptible to
27 Mood Disorders: Emotional Extremes Bipolar disorder: characterized by swings between the emotional extremes of mania and depressionLess common than major depressive disorder, occurring in about 1 percent of the populationUnlike major depression, this disorder occurs about equally in men and women and tends to occur earlier than major depression
28 Mood Disorders: Emotional Extremes Bipolar disorderBipolar patients’ depressive episodes differ from the depressive episodes in major depression in that they tend to be more severe, are accompanied by higher suicide risks, and have a distinct pattern of brain activity during sleep.
29 Mood Disorders-Bipolar PET scans show that brain energy consumption rises and falls with emotional swingsDepressed stateManic state
30 Suicide A major danger of depression is suicide. As many as 30% of people with severe mood disorders die from suicide.In the U.S. suicide rates are higher among:Men than women;Elderly adults than younger adults;Unemployed (& retired) adults than employed persons;Widowed adults than married adults;Native & European Americans than Asian. Hispanic, and African Americans.
31 Etiology of mood disorders Genetic/ biological influence?Bipolar patients show imbalances in neural circuits using serotonin, norepinephrine, etc.? Enlarged amygdala?Major depressive disorder: Family, twin, and adoption studies indicate at least a moderate genetic influence on depression.Cognitive contributions:Depressed persons have negative views and they misinterpret daily experiences so that their negative outlook is supported.Behavioral psychologists propose that depression results from low social reinforcement.
32 Gender & Mood Disorders Why is depression more common among women?May due to biological factors.Sociocultural factors: Women have fewer educational and occupational opportunities, receive less money for their work, and experience more violence due to their gender than men.Difference in diagnosis?Women may be diagnosed more frequently because they are more likely to seek help for their problems.Gender bias among mental health professionals may result in women and men with identical symptoms being diagnosed differently, i.e., women labeled as depressed and men diagnosed with other conditions
33 Dissociative Disorders: Loss of Contact with Consciousness or Memory Characterized by disruptions in consciousness, memory, sense of identity, or perceptionDissociative amnesia: a sudden loss of memory of one’s identity and other personal informationDissociative fugue: a sudden departure from home or work, combined with loss of memory of identity and the assumption of a new identity
34 Dissociative Disorders: Loss of Contact with Consciousness or Memory Dissociative identity disorder (DID): characterized by the presence of two or more distinct identities or personalities, which take turns controlling the person’s behavior (also known as multiple personality disorder)
35 Etiology of Dissociative Disorders Psychodynamic theory: results from the individual’s attempt to repress some troubling eventBiological explanation: patient may have a neurological problem that has not yet been detectedCognitive perspective: individuals learn to dissociate as a way to cope with intense distress
36 Schizophrenia: Disturbances in Almost All Areas of Psychological Functioning Characterized by severe impairment in thinking, including hallucinations, delusions, or loose associationsDiagnosed when symptoms persist for at least six months, are not due to some other condition, and cause significant impairment in daily functioningSchizophrenics often cannot work, manage a home or apartment successfully, or care for their basic needs.
37 Schizophrenia Delusions false beliefs, often of persecution or grandeur, that may accompany psychotic disordersHallucinationsfalse sensory experiences such as seeing something without any external visual stimulus
39 Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning Personality disorders: general styles of living that are ineffective and lead to problems for the person and for othersTen personality disorders in the DSM-IV-TR.
40 Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning Three common personality disorders are:Paranoid personalities: habitually distrustful and suspicious of others’ motivesHistrionic personalities: excessively emotional and attention seeking, often turning minor incidents into full-blown dramasNarcissistic personalities: desire constant admiration from others
41 Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning The personality disorder that receives the most attention is the antisocial personality disorder.Exhibit a persistent pattern of disregard for and violation of the rights of othersRepeatedly exhibit antisocial behavior across all realms of life, lying, cheating, stealing, and manipulating othersWhen caught, they take no responsibility and feel no remorse.
42 Personality Disorders Those with criminalconvictions have lowerlevels of arousal15105Adrenalineexcretion(ng/min)NonstressfulsituationStressfulsituationNo criminal convictionCriminal conviction
43 Personality Disorders PET scans illustrate reduced activation in a murderer’s frontal cortexNormalMurderer
44 Etiology of Personality Disorders A genetic component: related to abnormal brain development or chronic underarousal of both the autonomic and central nervous systemsMay be caused by the interaction of both biological and environmental factors.Children in chaotic households who have a biological predisposition for this disorder may not learn to control their impulses, and so behave in ways to maximize their benefit even if this means violating social rules.
45 What Are the Therapies for Psychological Disorders? The two broad categories of therapy:Psychotherapy: psychological methods that include a personal relationship between a trained therapist and a clientBiomedical therapies: the treatment of psychological disorders by altering brain functioning with physical or chemical interventions
46 What Are the Therapies for Psychological Disorders? The two broad categories of therapy:Psychotherapy: psychological methods including a personal relationship between a trained therapist and a clientBiomedical therapies: altering brain functioning with physical or chemical interventions
47 What Are the Therapies for Psychological Disorders? Three mental health professions:PsychiatrySocial workPsychologyTwo specialty areas in psychology:Clinical psychologyCounseling psychology
48 Psychodynamic Therapies A group of psychotherapies based on the work of Sigmund Freud that say that psychological disorders stem from unconscious forcesImportant psychodynamic terms:Free association: therapy technique in which clients say whatever comes to mindResistance: anything client does to interfere with free chain of thought or therapeutic progressTransference: client transfers feelings for significant others early in life to therapist (countertransference)
49 Behavior TherapiesPsychotherapies that apply learning principles to the elimination of unwanted behaviors.Counterconditioning is based on classical conditioning.Counterconditioning: involves conditioning new responses to stimuli that trigger unwanted behaviors
50 Counterconditioning: Three Techniques Systematic desensitization:used to treat phobias in which client is gradually exposed to feared object, while remaining relaxedResponse prevention:used to treat obsessive-compulsive disorder; client is exposed to situation that triggers the compulsive behavior but is not permitted to engage in the ritualAversive conditioning:a classically conditioned aversive response is conditioned to occur in response to a stimulus that has previously been associated with an undesired behavior
54 Humanistic Therapies Focus on Feelings and Personal Growth Goal: To help people get in touch withtheir feelings,their “true selves”their purpose in life
55 Humanistic Therapies Focus on Feelings and Personal Growth Humanistic therapies: help people get in touch with their feelings, with their “true selves,” and with their purpose in lifeClient-centered therapy: Carl RogersTherapists should be facilitators of personal growth providing supportive environment—clients discover their “true selves.”Gestalt therapy: Fritz PerlsTherapists help people become aware of their true feelings or some other important aspect of the self.
56 Cognitive Therapies: Focus on Altering Dysfunctional Thought Patterns Cognitive therapies seek to identify and then modify faulty cognitive processes.Rational-emotive behavior therapy (REBT): Albert EllisMental distress is caused by the irrational thinking people have about those events.Cognitive-behavior therapy (CBT): Aaron BeckDepressed people have negative views of themselves, the world, and their future, and they misinterpret everyday events to support these negative views.
57 Cognitive Therapy Cognitive Therapy teaches people new, more adaptive ways of thinking and actingbased on the assumption that thoughts intervene between events and our emotional reactions
59 Cognitive Therapy Cognitive-Behavior Therapy a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)
60 Cognitive Therapy A cognitive perspective on psychological disorders Lost jobDepressionInternal beliefs:I’m worthless.It’s hopeless.My boss is a jerk.I deserve something better.NodepressionA cognitive perspective on psychological disorders
61 Child, Group & Family Therapy Child therapiesCommon approach used—play therapyTherapist provides children with toys and drawing materialsAssumption is that whatever is troubling them will be expressed in play
62 Child, Group & Family Therapy Group therapiesSimultaneous treatment of several clients under the guidance of a therapistVariation of group therapy is the self-help group:Several people regularly meeting and discussing their problems with one another without the guidance of a therapist
63 Child, Group & Family Therapy Family and couples therapiesFamily therapies—designed to constructively modify the dysfunctional relationships among family membersCouples therapy—designed to help couples improve the quality of their relationship
64 Who Does Therapy?Where do people turn for help?
65 Who Does Therapy? Therapists and Their Training Type Description Psychiatrist Physicians (M.D.) who specialize in the treatment of psychologicaldisorders.Not all psychiatrists have had extensive training in psychotherapy Can prescribe medications.Clinical Ph.D. In psy6chology or Psy.D.Clinical or A two-year Master of Social Work plus postgraduate supervisionpsychiatric About half have earned the National Association of Social Workers’Social worker designation of clinical social worker.Counselors LPC,Marriage & Family (MFT)PastoralAbuse
66 Evaluating Therapy Client Perceptions Clinician’s Perceptions Consumer Reports StudyClinician’s PerceptionsOutcome ResearchSpontaneous RemissionRegression toward the mean
67 Does Therapy Work? Meta-analysis procedure for statistically combining the results of many different research studiesPoor outcomeGood outcomeAverageuntreatedpersonpsychotherapyclientNumber ofpersons80% of untreated people have pooreroutcomes than average treated person
68 Alternative Therapies Disconnect between Research and TherapyAlternative TherapiesTherapeutic touchEye movement desensitizationLight exposure therapy
69 Commonalities among Therapies A new perspectiveTrusting, caring relationshipCulture and values (therapist-client match)
70 Biomedical Therapies Psychopharmacology Lithium study of the effects of drugs on mind and behaviorLithiumchemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders
71 Biomedical Therapies The emptying of U.S. mental hospitals Year Introduction of antipsychotic drugsRapid declinein the mentalhospitalpopulationYear700600500400300200100State and countymental hospitalresidents, inthousands
72 Biomedical TherapiesToday in the United States, less than one-third the number of people are full-time residents in psychiatric hospitals.Reason for this sharp decrease—the widespread use of drug therapies in treating psychological disordersThis form of therapy is often less expensive than psychological therapies.
73 Use of Drugs in Treating Psychological Disorders
74 Biomedical Therapies Prozac blocks normal reuptake of the neuro- transmitter serotonin;excess serotonin indynapse enhances itsmood-lifting effect.Vesiclescontainingneurotrans-mittersSendingneuronActionpotentialNeurotransmittermoleculeSynapticgapReceptorsReceivingReuptakeProzacMessage is sentacross synaptic gap.Message is received;excess neurotransmittermolecules are reabsorbedby sending neuron.Serotonin
75 Antipsychotic Drugs Reduce Dopamine Activity a group of medications that are effective in treating the delusions, hallucinations, and loose associations of schizophrenia by blocking dopamine receptors & thereby reducing dopamine activityDo not actually “cure” schizophrenia. They merely help control its severe symptoms.
76 Classes of Psychoactive Drugs AntipsychoticsThorazineClozapineOlanzapine, etc.Block dopamine receptor sitesTreat Schizophrenia & other psychosesMay cause sluggishness & muscle tremors
77 Classes of Psychoactive Drugs AntianxietyValium, Librium, Xanax, etc.Tend to be addictive
78 Classes of Psychoactive Drugs AntidepressantsIncrease availability of epinephrine or serotoninProzac, Zoloft, Paxil, etc. world’s most widely prescribed drugsRequire about a month for full effectiveness
79 Antidepressant Drugs: Increase Serotonin and Norepinephrine MAO inhibitors (MAOI) inhibit the enzyme involved in breaking down norepinephrine and serotonin are called the monoamine oxidase inhibitors (MAOI).Tricyclics are antidepressant drugs that have milder side effects than MAOI inhibitorsAntidepressants that affect only serotonin are selective serotonin reuptake inhibitors (SSRIs).
80 Biomedical Therapies Electroconvulsive Therapy (ECT) Psychosurgery therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patientPsychosurgerysurgery that removes or destroys brain tissue in an effort to change behavior
81 Electroconvulsive Therapy (ECT) A physiological treatment for severe depression in which a brief electric shock is administered to the brain of an anesthetized patientAlthough ECT is effective in treating severe depression, no one knows for sure why it works.Several temporary negative side effects, including confusion, loss of memory, and impaired motor coordination
83 Psychosurgery: Destroys Portions of the Brain Most radical & controversial treatmentA seldom-used surgical procedure in which brain tissue thought to cause the disorder is destroyed.Today, MRI-guided precision psychosurgery is performed only in extreme cases and it focuses on much smaller brain areas than those involved in lobotomies.
84 Lobotomynow-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patientscut the nerves that connect the frontal lobes to the emotion-controlling centers of the brain