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Abnormal Psychology Chapter 10

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1 Abnormal Psychology Chapter 10
The scientific study of mental disorders and their treatment Prepared by J. W. Taylor V

2 Abnormal Psychology College reading:
363 – 365 general info about disorders and DSM 5 – 375 – 380 schizophrenia READING QUIZ SOON….

3 This unit is about… The Diagnosis and Classification of Mental Disorders Three Major Categories of Mental Disorders The Treatment of Mental Disorders

4 What is abnormal behavior?
Write 3 characteristics

5 Criteria for a Behavior/Thought Process to be a “Disorder”
1. Is the behavior/thought process atypical? 2. Is the behavior/thought process maladaptive? 3. Is the behavior/thought process personally distressing? 4. Is the behavior/though process irrational?

6

7 Perceptual Bias of Labeling
Problem: when we classify mental disorders we label people, and this biases our perception of these people in terms of the labels Ex: the word “crazy” has strong connotations

8 Mental disorders fall into 4 major categories
Anxiety disorders: highly anxious or fearful behavior Ex: Mood disorders: emotional extremes Ex: Schizophrenic disorders: disorganized thinking, disturbed perceptions, inappropriate actions/emotions Ex: personality disorders: inflexible, long-standing personality traits, impaired social functioning, deviate from cultural norms Ex:

9 Diagnostic and Statistical Manual: Official book of mental disorders
The DSM-IV, published in 1994 by the American Psychiatric Association, is the most widely used diagnostic system for disorders First appeared in At that time, 60 disorders. Now contains more than 300 disorders DSM-IV classification required by health insurance companies before they will pay for therapy

10 Three Major Categories of Clinical Disorders
Category Specific Disorders within Category Anxiety disorders Specific phobia, social phobia, agoraphobia, panic disorder with and without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder Mood disorders Major depressive disorder, bipolar disorder Schizophrenic disorders Schizophrenia (paranoid, disorganized, catatonic, undifferentiated, and residual subtypes)

11 By the way… Be wary of the medical school syndrome: the tendency to think that you have a disorder when you read about its symptoms It’s normal to feel depressed, spazz out, have occasional OCD etc… Remember, to be abnormal your behavior must be: Atypical Maladaptive Personally distressing Irrational

12 Schizophrenic disorder
What are 3 of Jani’s symptoms/behaviors? Describe how her behavior fits the definition of “abnormal”. Do you feel her parents are responding appropriately? Why/not?

13 Schizophrenic disorder
Is NOT multiple personality disorder Schizophrenics have one personality, but it is disorganized and irrational They typically Have hallucinations (hear voices) Are delusional (irrational beliefs, ex: “I am a messenger of God”) Are paranoid (“the government is spying on me”) Have erratic emotional responses/violent outbursts

14 Many homeless people are schizophrenic

15 How does the prevalence of schizophrenia compare to other disorders?

16 Create a profile

17 Pair assignment – profile of a schizophrenic
Make a detailed profile of a person who is schizophrenic Include their name, age, living conditions, personality and other personal identifying information Describe their schizophrenic symptoms. Be descriptive, and realistic (base on research) Describe any treatment, relapses, family response etc

18 Grading criteria BEST poster: all members get 11 points!
Second best: all members get 10 Third: 9 And so on It’s a competition!!

19 Schizophrenic Disorders
More people are institutionalized with schizophrenia than any other disorder About 1% of the population suffers from schizophrenia The onset tends to be in late adolescence or early adulthood Tends to strike men earlier and more severely, though both sexes are equally vulnerable Higher incidence in lower socioeconomic groups and for people who are single, separated or divorced rather than married

20 What does this graph tell us about schizophrenia?

21 Schizophrenia Is a psychotic disorder because it is characterized by a loss of contact with reality Schizophrenia means “split mind,” as mental functions do indeed become split from each other and detached from reality

22 Symptoms of Schizophrenia
Positive symptoms are abnormal behaviors that exist, but should not. Added symptoms. Hallucinations (false sensory perceptions) Hallucinations tend to be auditory, such as hearing voices that are not real Delusions (false beliefs) Delusions of persecutions involve thoughts of conspiracy against you Delusions of grandeur involve believing that you are a person of great importance, such as Jesus Christ

23 Symptoms of Schizophrenia
Negative symptoms refer to things that have been removed Loss of emotion, energy, social activity, even drives like hunger Disorganized symptoms include disorganized speech, disorganized behavior, and inappropriate emotion When the person’s speech is disorganized, it might be like a “word salad,” with unconnected words incoherently spoken together

24 Technical Definition According to the DSM-IV, schizophrenia is defined as the presence, most of the time during a one-month period, of at least two of the following symptoms Hallucinations Delusions Disorganized speech Disorganized or catatonic behavior Any negative symptoms (such as loss of emotion)

25 Catatonic schizophrenia
This person might sit frozen in this position for hours Is this a positive, negative or disorganized symptom?

26 Five Subtypes of Schizophrenic Disorder
Symptoms Disorganized Disorganized speech, disorganized behavior, or inappropriate emotion Catatonic Extreme movement symptoms ranging from excessive motor activity to posturing (immobility for long periods) Paranoid Organized cognition and emotion, but with hallucinations and delusions that are usually concerned with persecution Undifferentiated Mixed-bag category—symptoms fit the criteria of more than one of the above three types or none of them Residual There has been a past schizophrenic episode, but presently only some negative symptoms and no positive symptoms (hallucinations and delusions)

27 Schizophrenics What type of schizophrenic are these people? What are their symptoms? https://www.youtube.com/watch?v=bWaFqw8XnpA

28 Type I and Type II Another distinction is between Type I and Type II schizophrenia Type I schizophrenia is characterized by positive symptoms Type II schizophrenia is characterized by negative symptoms Type I is more acute, as the person functioned normally before the disorder strikes and has a better chance of recovery because Type I can usually be alleviated with drugs, whereas Type II tends to stem from more permanent brain abnormalities

29 Causes of Schizophrenia
Concordance rate is about 50%, although no particular genes have been identified, and it is possible different genes might be involved in the different types of schizophrenia One hypothesis involves prenatal viral infections People are at increased risk if there was a flu epidemic during the middle of their fetal development In the northern hemisphere, people born in the winter/spring months, January through April, following the fall/winter flu season, are more at risk than people born other months of the year

30 Causes of Schizophrenia
A second hypothesis involves neurotransmitters Schizophrenics have elevated levels of dopamine activities in certain areas of their brains A third hypothesis involves various brain abnormalities, especially among those with Type II schizophrenia Shrunken cerebral tissue and enlarged fluid filled areas The thalamus seems to be smaller and the frontal lobes less active in many schizophrenic brains

31 Causes of Schizophrenia
A popular bio-psycho-social explanation is the vulnerability-stress-model that contends that genetic, prenatal, and postnatal biological factors render a person vulnerable to schizophrenia, but environmental stress determines whether it develops A person’s level of vulnerability interacts with the stressful social-cognitive events in their live to determine the likelihood of schizophrenia The disorder does tend to strike in late adolescence and early adulthood, periods of unusually high stress levels

32

33 Perspectives The causes of abnormal behavior and thinking can be found in the four major research perspectives Biological Behavioral Cognitive Sociocultural However, no one perspective adequately explains even one disorder The biopsychosocial approach to explaining abnormality examines the interaction between biological, behavioral, cognitive, and social/cultural factors

34 Treatment Fortunately, schizophrenia can be successfully treated with antipsychotic medications If the patient continues to take them, the disorders stays away If they stop, the symptoms return Problem: many schizophrenics don’t identify as such, or are too paranoid to swallow pills

35 Create a profile

36 Look up: What is a personality disorder? Use your ipads. Share out.

37 Personality disorders
Borderline personality: Sociopath/Antisocial personality: Narcissistic: Histrionic: , Schitzoid vs schizotypal: Passive aggressive behavior:

38 Personality disorder party!
Complete worksheet What disorder does each person have? Underline the key words in their description Create a person with the disorder listed who is not present at the party (8 people come, but 9 disorders on back of sheet) Answer Q3 – are personality disorders easy to diagnose and treat? Dating – describe the relationship or fist date of two party goers DUE NEXT CLASS!

39 Anxiety Disorders Disorders in which excessive anxiety leads to personal distress and atypical, maladaptive and irrational behavior Specific Phobia Social Phobia & Agoraphobia Panic Disorder Generalized Anxiety Disorder Obsessive-Compulsive Disorder

40 Phobia: irrational fear
A strong and persistent fear of specific objects/situations that is excessive or unreasonable (irrational)

41 Specific Phobia For example, there was woman with a specific phobia of birds. She became housebound because of her fear of encountering a bird. Any noises she heard within the house she thought were birds that had broken in to get her. When she did leave the house, she was careful not drive near any birds, because if she hit a bird, they would take revenge on her. She knew her fears were irrational, but she could not control their effects on her behavior and thinking.

42 Causes of Specific Phobias
Classical conditioning In Little Albert study, the infant was conditioned to fear white rats by pairing together a loud startling noise (an unconditioned stimulus) with a white rat (a conditioned stimulus) CREATE ANOTHER EXAMPLE: Biological predispositions Some people are naturally more nervous and scared Certain associations (such as taste and sickness) are easy to learn, while others (such as taste and electric shock) are much more difficult to learn

43 Phobia treatment Systematic desensitization
Slow, progressive exposure to the stimulus that causes fear Gradual exposure leads to lessening of fear Start with “safe” stimulus and build up

44 Social Anxiety/Phobia
Fear or anxiety of social interaction Hard time making eye contact Nervous at parties, social events Feels extremely self conscious, awkward AVOIDS social interaction because too difficult to deal with Much stronger than introverted personality

45

46 Start at 5.55

47 Agoraphobia A fear of being in places or situations from which escape might be difficult or embarrassing Includes crowds, standing in line, traveling in a crowded bus, stuck in heavy traffic People avoid such situations, won’t leave home

48 Panic Disorder A condition in which a person experiences recurrent panic attacks Sudden onsets of intense fear Can be triggered by stressful event (giving a speech) or NO apparent reason Symptoms: Difficulty breathing Chest pain Feel like going to faint FEAR!! And PANIC!

49 Generalized Anxiety Disorder
Excessive, global anxiety and worry General sense of dread, fear, anxiety Cannot control Period of at least 6 months Anxiety not tied to any specific object or situation (not a phobic disorder) May be related to low GABA, a calming neurotransmitter People with generalized anxiety disorder may have problems with activation of GABA, allowing more and more neurons to get excited

50 Obsessive-Compulsive Disorder
recurrent obsessions (thoughts) and/or compulsions (behaviors) cause significant distress and disruption in the person’s daily life An obsession is a persistent intrusive thought, idea, impulse, or image that causes anxiety A compulsion is a repetitive and rigid behavior that a person feels compelled to perform to reduce anxiety

51 Obsessive-Compulsive Disorder
Although it is not known for sure what causes OCD research suggests that neurotransmitter serotonin may be involved Antidepressent drugs that increase serotonin activity (e.g., Prozac and Anafranil) help many obsessive-compulsive patients

52 Obsessive-Compulsive Disorder
Two parts of the brain, the orbital region of the frontal cortex (the area just above our eyes) and the caudate nucleus (an area in the basal ganglia), have significantly higher than normal level of activity in obsessive-compulsive people These two areas help filter out irrelevant information and disengaging attention, two central aspects of obsessive-compulsive disorder

53

54 Compulsive (OCD): http://www.youtube.com/watch?v=_wEU-165NRY

55 Obsessive-Compulsive Disorder
One strange case of obsessive-compulsive disorder highlights the importance of the frontal lobe region A man with obsessive-compulsive disorder got severely depressed and attempted suicide He shot himself in the head, but fortunately survived and was cured of his disorder The bullet removed some his orbital front cortex and the disorder with it

56 Post Traumatic Stress Disorder (PTSD)
severe anxiety disorder that can develop after exposure to any event that results in psychological trauma War Rape Flashbacks and nightmares common Can’t cope with life

57

58 Anxiety screening test – 10 questions

59 College Reading assignment
(mood disorders) 367 – 372 (anxiety disorers)

60 Depression test – 10 questions

61 What were some of the keywords/concepts you noticed in the online test?

62 Bipolar Disorder I and II
Mood Disorders Dramatic changes in a person’s emotional state that are irrational and maladaptive Clinical Depression Bipolar Disorder I and II Cyclothymia

63 Clinical Depression One or more major depressive episodes, lasting 2 weeks or longer Symptoms include Feelings of intense hopelessness Low self-esteem and worthlessness Extreme fatigue/lack of energy Dramatic changes in eating and sleeping behavior Inability to concentrate Diminished interest in family, friends, and activities

64 Note: sadness and downward mood following stressful life events (such as a death in the family) are understandable and normal, and are usually self-correcting Such feelings do not necessarily indicate a major depressive disorder

65 Who gets clinically depressed?
Women suffer from major depressive disorder twice as often as men Middle aged (45-65 y o) most likely time of life States in the deep south highest rates

66 Cause of clinical depression
Low serotonin and norepinephrine Biological predisposition For identical twins, the concordance rate is 50%, much higher than for fraternal twins and rate of occurrence in the general population

67 Major Depressive Disorder
Non-genetic factors are also important “Pessimistic explanatory style” a person explains events in terms of causes that are internal (their own fault), stable (here to stay), global (applies to all aspects of their life)

68 Depression definition video

69 Bipolar Disorder The person’s mood takes dramatic swings between depression and mania recurrent cycles

70 Mania!!!!! A manic episode is a period of at least a week of abnormally: elevated mood inflated self-esteem grandiose delusions decreased need for sleep constant talking, distractibility restlessness, excess energy poor judgment Impulsivity (will go shopping or gambling)

71 Bipolar Disorder In bipolar I disorder, the person has both major manic and depressive episodes (clinical depression) In bipolar II disorder, the person has full-blown depressive episodes, but the manic episodes are milder; hypomania Cyclothymia is a milder cycling from depression to mania

72 Doc trailer about bipolar disorder
Another one: Second one not as good

73 Graph of 4 mood disorders

74 Psychiatrist vs psychologist
Psychiatrist – has medical degree (MD). Can prescribe medications, ex: xanax, prozac. Psychologist – has PhD or Masters degree. Cannot prescribe drugs. Practices talk therapy, ex: cognitive therapy, client centered therapy.

75 Case worker and client role play
Pair up. One of you will be clinical psychologist/psychiatrist, other will be patient Patient is seeing therapist for first time. Record your “session”. Therapist must: Diagnose mood disorder by asking questions Determine course of treatment (type, time frame, name of meds if prescribed) research this on iPad Your skit must be at least 2 minutes long – detailed! A mood disorder Clinical depression Bipolar 1 Bipolar 2 Cyclothymia

76 Find your partner: Pair up with same number/face card
Red card – psychologist/psychiatrist Interview your patient to diagnose them and determine treatment You must distinguish between BP I, BP II and cyclothymia Black card – patient Decide which mood disorder you have, then answer Q’s accordingly. Psychologist must diagnose you.

77 Some things you can discuss:
Eating habits (eating schedule, type of food eaten, health awareness) Overall physical health (Exercise? Self harm or kind to self? Body type, hair style and grooming habits, general physical description). Medications (name, dose, schedule of when taken, side effects) Other treatments (psychologist therapy, self-help books, support groups, self-medicating, lifestyle modifications, diary writing…) Relationships (describe nature of relationships with significant other, parents, children, colleagues, strangers… give specific examples). Home (size, how much stuff, messy or cluttered? Organized or not? Quiet or noisy?)

78 The Treatment of Mental Disorders
Biomedical Therapies Psychotherapies

79 Early treatments for mental illness (circa 1950)

80 Two Major Types of Therapy
Biomedical Therapy Involves the use of biological interventions, such as drugs Psychotherapy Involves the use of psychological interventions

81 Treatment concept chart – group activity
Read each person’s illness and underline keywords Write neatly what they suffer from Can be specific: “phobia of spiders” Or general: “schizophrenia” Think about what treatments would best serve each person

82 Mental illness treatment
Cut the paper into people and treatments Make a large “map” of mental illness treatment using the people and therapy types provided The format/arrangement of the papers is up to you Connect the people and their treatments Add: (use your ipad to research) A statistic about the treatment Why it’s effective One criticism of this treatment type

83 Content to know for abnormal psych test (next class)
Definition of abnormal (4 things) Schizophrenia – positive and negative symptoms, types of schizophrenia Anxiety disorders – characterized by fear or dread. Know the different types, treatments Personality disorders – characterized by social and emotional expression outside the range of normal. Know the different types Mood disorder – characterized by irrational changes in emotional state. Depression, BP I and BP II, cyclothymia. Know treatments. Therapies – know diff between psychiatrist and psychologist, systematic desensitization, different talk therapies, group therapy, medications, ECT.

84 Suggested answers… Joan (mood swing drug)+ Tom (self help group, AA) Melissa (anti-depressant, perhaps ECT) Barry (psychosurgery?) Archie (cognitive therapy) Anna (psychoanalysis) Susan (behavior therapy) Lyle (humanistic/existential therapy) Martha and Joe (marital therapy) Sharon (group therapy) Willy (anti-anxiety drug) Harry (anti-psychotic drug) The Smiths (family therapy & child therapy) Sam (ECT)

85 Different Types of Mental Health Professionals
Credential and Job Description Clinical psychologist Doctoral degree in clinical psychology; provides therapy for people with mental disorders Counseling psychologist Doctoral degree in psychological or educational counseling; counsels people with milder problems such as academic, job, and relationship problems Psychiatrist Medical degree with residency in mental health; provides therapy for people with mental disorders; only therapist who can prescribe drugs or other biomedical treatment Psycho- analyst Any of the above credentials, but with training from a psychoanalytic institute; provides psychoanalytic therapy for psychological disorders Clinical social worker Master’s or doctoral degree in social work with specialized training in counseling; helps with social problems (e.g., family problems)

86 Biomedical Therapies The earliest use to biomedical therapy may date to the Stone Age, when trephination was used Here, a trephine (a stone tool) was used to cut away a section of the person’s skull, supposedly to let evils spirits causing the disorder to exist the body In the early 1800s, the “tranquilizing chair” was used, in which the patient was strapped into a chair, with their head enclosed inside a box for a long periods of time Such restriction was designed to calm the person

87 Biomedical Therapies Even modern biomedical therapies are not without controversy Direct biological interventions have a downside in that they involve potential dangers and possible serious side effects High levels of some drugs can be toxic and potentially fatal if not monitored carefully

88 Electro- convulsive Therapy
Biomedical Therapies Drug Therapy Electro- convulsive Therapy Psycho- surgery

89 Drug Therapy Lithium Antianxiety Drugs Antidepressants
Antipsychotic Drugs

90 Lithium Not a drug, but rather a naturally occurring metallic element (a mineral salt) that is used to treat bipolar disorder Around 1950, John Cade, a psychiatrist, injected guinea pigs with a mixture of uric acid, which he thought was the cause of manic behavior, and mixed lithium with it so that the acid more easily liquefied Instead of becoming manic, the guinea pigs became lethargic, and later tests with human showed that lithium stabilized the mood of bipolar patients Lithium levels in the blood must be monitored carefully because of possible toxic effects Because of lithium’s side effects, anticonvulsant drugs are now sometimes prescribed for people with bipolar disorder

91 Antidepressant Drugs Monoamine oxidase (MAO) inhibitors break down neurotransmitters such as serotonin and norepinephrine in the synaptic gap This means that MAO inhibitors increase the availability of these neurotransmitters by preventing their breakdown Can have very dangerous side effects, particularly interactions with several different foods and drinks that lead to high blood pressure and possibly death Tricyclics are agonists for norepinephrine, serotonin, and dopamine and make these neurotransmitters more available by blocking their reuptake during synaptic gap activity

92 Antidepressant Drugs The most common anti-depressant drugs are selective serotonin reuptake inhibitors (SSRIs) They selectively block the reuptake of serotonin in the synaptic gap, keeping the serotonin active and increasing its availability Examples include Prozac, Zoloft, and Paxil Very mild side effects Usually required 3-6 weeks to being to see mood improvement

93 Antidepressant Drugs Neurogenesis is the growth of new neurons
The neurogenesis theory of depression assumes that neurogenesis in the hippocampus stops during depression, and neurogenesis resumes, the depression lifts Research has shown that SSRIs lead to increased neurogenesis in other animals It takes about 3-6 weeks for new cells to mature, the same timeframe it takes SSRI patients to improve This means that, in the case of the SSRIs, the increased serotonin activity may be responsible for getting neurogenesis going again and lifting our moods

94 Antidepressant Drugs There is controversy about the effectiveness of antidepressant drugs Some research suggests a placebo effect, improvements due to expectations of getting better Why would placebo effects make people feel better? It may also be the case that positive thinking, in the form of a strong placebo effect, might also get neurogenesis going again

95 Antianxiety Drugs Drugs that treat anxiety problems and disorders
Benzodiazepines reduce anxiety by stimulating receptor sites for GABA and also increasing the receptivity of these sites, which increases GABA activity Examples of benzodiazepines include Valium and Xanax

96 Antipsychotic Drugs Drugs that reduce psychotic symptoms
Early antipsychotic drugs (e.g., Thorazine and Stelazine) greatly reduced the positive symptoms of schizophrenia, but had little impact on the negative symptoms Greatly reduced the need to institutionalize people with schizophrenia Produced side effects in motor movement caused by their antagonistic effect on dopamine

97 Antipsychotic Drugs New-generation antipsychotic drugs (e.g., Clozaril amd Risperdal) are more selective in where in the brain they reduce dopamine activity Consequently, they do not produce the severe movement side effects, such as tardive dyskinesia, in which the person has uncontrollable facial tics, grimaces and other involuntary movements of the lips, jaw, and tongue

98 Electroconvulsive Therapy (ECT)
A biomedical therapy for severe depression that involves electrically inducing a brief brain seizure Electrodes are placed on one or both sides of the head, and a very brief electrical shock is administered causing a brain seizure that leads the patient to convulse for a few minutes Patients are given anesthetics, so they are not conscious during the procedure, and muscle relaxants to minimize the convulsions

99 Electroconvulsive Therapy (ECT)
We really do not understand why ECT works in treating depression One explanation is that the electric shock increases the activity of serotonin and norepinephrine, which improves mood ECT may also increase neurogenesis, which it has been demonstrated to do in rats ECT does not lead to any type of detectable brain damage or long-term cognitive impairment, but there is memory loss for events prior to and following the therapy ?

100 Psychosurgery The destruction of specific areas in the brain to treat the symptoms of disorders A lobotomy, the most famous type of psychosurgery, involves cutting the neurological connections between the frontal lobes to lower areas of the brain Was the common means to “treat” schizophrenia in the 1940s and 1950s, until drugs became available

101 Psychosurgery Psychosurgery still exists but not in terms of frontal lobe lobotomies For instance, cingulatomies, in which dime-sized holes are surgically burnt in specific areas of the frontal lobes (the cingulate gyrus) are sometimes performed on severely depressed or obsessive-compulsive patients who have not responded to other types of treatment

102 Psychotherapies Psychoanalysis Behavioral Humanistic Cognitive
Four major types Psychoanalysis Behavioral Humanistic Cognitive

103 Psychotherapies Psychoanalysis and humanistic therapies are called insight therapies because they stress that a person achieve understanding of the causes of their behavior and thinking Behavioral and cognitive therapies are usually referred to as actions therapies because they stress that the actions of the person must change for therapy to be effective

104 Psychoanalysis A style of psychotherapy originally developed by Sigmund Freud in which the therapist helps the person gain insight into the unconscious sources of their problems Psychoanalysts must collect data from a multitude of sources

105 Psychoanalysis Free association is a technique in which the patient spontaneously describes, without editing, all thoughts, feelings, or images that come to mind The assumption is that free association will provide clues to the unconscious conflicts leading to a person’s problems A resistance is a patient’s unwillingness to discuss particular topics When a resistance is hit, it may provide clues into unconscious conflicts

106 Psychoanalysis Dream interpretation also provides clues into unconscious conflicts Dreams have two levels of meaning: The manifest content is the surface, literally meaning of the dream; it is what the dream reports when awakening The latent content is the underlying, true meaning of the dream and is of primary interest to the psychoanalyst When we dream, we are not inhibited, and this dreams allow us the chance to symbolically experience our unconscious conflicts

107 Psychoanalysis Transference occurs when the patient acts toward the therapist as she did or does toward important figures in her life, such as her parents Transference is like a reenactment of earlier or current conflicts with important figures in the patient’s life

108 Psychoanalysis Psychoanalysis requires a lot of time because the therapist must piece together clues with only vague circumstantial evidence Critics question the validity of psychoanalysis’ main construct, unconscious conflicts and their impact on behavior and thinking ?

109 Humanistic Therapy The most influential humanistic therapy is Carl Rogers’s client-centered therapy, also called person-centered therapy A style of psychotherapy in which the therapist uses unconditional positive regard, genuineness, and empathy to help the person to gain insight into their true self-concept

110 Humanistic Therapy To achieve this goal, the therapist is non-directive The therapist doesn’t attempt to steer the dialogue in a certain direction; rather, the client decides the direction of each session The therapist’s job is to create the conditions that allow the client to gain insight into their true feelings and self-concept The therapist establishes an environment of acceptance by giving the client unconditional positive regard

111 Humanistic Therapy To achieve this goal, the therapist is non-directive The therapist demonstrates genuineness by honestly sharing his own thoughts and feelings with the client To achieve empathetic understanding of the client’s feelings, the therapist uses active listening to gain a sense of the client’s feelings, and then uses mirroring to echo these feelings back to the client, so the client can gain a clearer image of their true feelings

112 Behavioral Therapy A style of psychotherapy in which the therapist uses the principles of classical and operant conditioning to change a person’s behavior from maladaptive to adaptive The assumption is that maladaptive behaviors are learned and must be unlearned for therapy to be effective

113 Behavioral Therapy In counterconditioning, a maladaptive response is replaced by an incompatible adaptive response Systematic desensitization is a counterconditioning procedure in which a fear response to an object or situation is replaced with a relaxation response in a series of progressively increasing fear-arousing steps

114 Behavioral Therapy For example, a person with a specific phobia of spiders might find that planning a picnic to be a situation that evoked slight fear because of the possibility that a spider might be encountered on the picnic Seeing a picture of a spider might evoke more fear, and being in the same room with a spider would evoke even greater levels of fear Once this “hierarchy” of fear-provoking situations is established, the patient starts working through the hierarchy and attempts to relax at each step

115 Behavioral Therapy In flooding, another counterconditioning technique, the patient is immediately exposed to the feared object or situation Behavioral therapists also use operant conditioning to reinforce desired behaviors and extinguish undesirable behaviors A token economy is an environment in which desired behaviors are reinforced with tokens (secondary reinforcers, such as stickers) which can be exchanged for rewards such as candy or television privileges This technique is often used with institutionalized patients, and has been fairly effective in managing people with autism, mental retardation, and some schizophrenic populations

116 Cognitive Therapy A style of psychotherapy in which the therapist changes the person’s thinking from maladaptive to adaptive The assumption is that the person’s through processes and beliefs are maladaptive and need to change The therapist identifies the irrational thoughts and unrealistic beliefs that need to change, and then helps the person to execute that change

117 Cognitive Therapy In Ellis’s rational-emotive therapy, the therapist directly confronts and challenges the patient’s unrealistic thought and beliefs to show that they are irrational Such irrational thoughts are marked by words such as “must,” “always,” and “every” A rational-emotive therapist will show a person the irrationality of his thinking and how to make it more realistic

118 Cognitive Therapy This is achieved by Ellis’s ABC model A refers to the Activating event (e.g., failure to be perfect at everything) B refers to the person’s Belief about the event (e.g., feeling like a failure for normal levels of imperfection) C is the resulting emotional Consequence (e.g., depression) According to Ellis, A does not cause C; rather, B causes C Rational-emotive therapy is very direct and confrontational is getting people to see the errors of their thinking

119 Cognitive Therapy A therapist using Beck’s cognitive therapy works to develop a warm relationship with the person and has a person carefully consider the objective evidence for their beliefs to see the errors in their thinking For instance, a student who failed a test may think she blew her chance to get into medical school, so the therapist would have the student examine statistics on how few students actually have a perfect GPA and the GPAs of students admitted to medical school

120 Is psychotherapy effective?
Spontaneous remission is getting better with the passage of time without receiving any therapy Thus, the effect of psychotherapy must be statistically significantly greater than that due to spontaneous remission A meta-analysis (i.e., the pooling of results from a large number of studies into one analysis) of 475 studies involving different types of psychotherapy revealed that psychotherapy is indeed effective The average psychotherapy client is better off than about 80% of people not receiving any therapy No one particular type of psychotherapy, however, is superior to the others

121 Psychotherapy vs. No Treatment


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