1. Chapter 15-Psychological Disorders Psychology of Life Skills August 13 th, 2008

2. Criteria of Abnormal Behavior What makes someone ‘abnormal?’ What makes someone ‘abnormal?’ Criteria of Abnormal Behavior: Criteria of Abnormal Behavior: Deviance Deviance Maladaptive Behavior Maladaptive Behavior Personal Distress Personal Distress Viewed as disordered when only one criterion met. Viewed as disordered when only one criterion met. Continuum: Continuum: Normal -------------------------- Abnormal

3. Classification of Disorders Five Axes: Five Axes: I: Clinical Syndromes (anxiety, schizophrenia) II: Personality Disorders (antisocial personality) III: General Medical Conditions (diabetes) IV: Psychosocial & Environmental Problems (stress) V: Global Assessment of Functioning (scale of 1-100)

4. Prevalence of Psychological Disorders 44% of adult population will struggle with psych. Disorder at some point in their life 44% of adult population will struggle with psych. Disorder at some point in their life

5. Anxiety Disorders A class of disorders marked by feelings of excessive apprehension and anxiety. A class of disorders marked by feelings of excessive apprehension and anxiety.

6. Anxiety Disorders Generalized Anxiety Disorder (GAD) Generalized Anxiety Disorder (GAD) Chronic, ‘free-floating’ anxiety Chronic, ‘free-floating’ anxiety Not tied to a specific threat Not tied to a specific threat Phobic Disorder Phobic Disorder Persistent and irrational fear of an object/situation that presents no real danger. Persistent and irrational fear of an object/situation that presents no real danger. Panic Disorder Panic Disorder Recurrent attacks of overwhelming anxiety—usually occur suddenly and unexpectedly. Recurrent attacks of overwhelming anxiety—usually occur suddenly and unexpectedly.

7. Anxiety Disorders Obsessive-Compulsive Disorder (OCD) Obsessive-Compulsive Disorder (OCD) Persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions). Persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).

8. Etiology (Cause) of Anxiety Disorders Biology Biology Temperament and sensitivity might make some people more vulnerable to anxiety disorders. Temperament and sensitivity might make some people more vulnerable to anxiety disorders. Neurotransmitters: GABA and serotonin. Neurotransmitters: GABA and serotonin. Learning Learning An originally neutral stimulus (dog) paired with frightening event (attack). An originally neutral stimulus (dog) paired with frightening event (attack). Person then avoids stimulus. Person then avoids stimulus.

9. Etiology of Anxiety Disorders Cognitive Factors Cognitive Factors Misinterpret harmless situations as threatening Misinterpret harmless situations as threatening Focus excessive attention on perceived threats Focus excessive attention on perceived threats Selectively recall info that seems threatening Selectively recall info that seems threatening “The Dr. examined little Emma’s growth.” Stress Stress

10. Dissociative Disorders Class of disorders in which people lose contact with consciousness/memory. Class of disorders in which people lose contact with consciousness/memory. Results in disruption of sense of identity. Results in disruption of sense of identity.

11. Dissociative Disorders Dissociative Amnesia Dissociative Amnesia Sudden loss of memory—too extensive to be normal forgetting. Sudden loss of memory—too extensive to be normal forgetting. Dissociative Fugue Dissociative Fugue Loss of memory for personal identity. Loss of memory for personal identity. Dissociative Identity Disorder Dissociative Identity Disorder Co-existence in one person of two or more largely complete and different personalities. Co-existence in one person of two or more largely complete and different personalities.

12. Dissociative Disorders are Weird! Really? Really? How often have you: How often have you: Suddenly realized when driving, that you don’t remember what has happened during all or part of the trip? Found that you can’t remember whether or not you have just done something or perhaps had just thought about doing it? Realized when you are listening to someone talk that you didn’t hear part or all of what the person said?

13. Causes of Dissociative Disorders Personality traits like fantasy-proneness? Personality traits like fantasy-proneness? Patients faking? Patients faking? Clinicians creating? Clinicians creating? A dissociative reaction to trauma? A dissociative reaction to trauma?

14. Mood Disorders A class of disorders marked by disturbances in emotion/mood. A class of disorders marked by disturbances in emotion/mood. Tend to be episodic (come and go) Tend to be episodic (come and go) Typically last 3-12 months Typically last 3-12 months Unipolar: Emotional extremes involving depression. Unipolar: Emotional extremes involving depression. Bipolar: Emotional extremes of both depression and mania. Bipolar: Emotional extremes of both depression and mania.

15. Mood Disorders Major Depressive Disorder (MDD) Major Depressive Disorder (MDD) Persistent feelings of sadness and despair and loss of interest in previous sources of pleasure. Persistent feelings of sadness and despair and loss of interest in previous sources of pleasure. Multiple episodes Multiple episodes Bipolar Disorder Bipolar Disorder Marked by the experience of both depressed and manic periods (alternating cycles). Marked by the experience of both depressed and manic periods (alternating cycles). 1—2.5% of population affected. 1—2.5% of population affected.

16. Causes of Mood Disorders Genetic Vulnerability Genetic Vulnerability Strong evidence for biological component Strong evidence for biological component Twin studies Twin studies Neurochemical Factors Neurochemical Factors Norepinephrine and serotonin Norepinephrine and serotonin Cognitive Factors Cognitive Factors Learned Helplessness Learned Helplessness Pessimistic Explanatory Style Pessimistic Explanatory Style Hopelessness Theory Hopelessness Theory Cause and Effect? Cause and Effect?

17. Causes of Mood Disorders Interpersonal Roots Interpersonal Roots Inadequate social skills Inadequate social skills Stress Stress Most likely an interaction of factors! Most likely an interaction of factors!

18. Schizophrenic Disorders Class of disorders marked by disturbances in thought that affect perceptual, social, and emotional processes. Class of disorders marked by disturbances in thought that affect perceptual, social, and emotional processes. 1% of population affected. 1% of population affected.

19. Schizophrenic Disorders General Symptoms General Symptoms Irrational Thought Irrational Thought Deterioration of Adaptive Behavior Deterioration of Adaptive Behavior Distorted Perception Distorted Perception Disturbed Emotion Disturbed Emotion

20. Schizophrenic Disorders Two classes of symptoms: Two classes of symptoms: Positive: Hallucinations, delusions, bizarre behavior. Positive: Hallucinations, delusions, bizarre behavior. Negative: Flattened emotions, social withdrawal, apathy. Negative: Flattened emotions, social withdrawal, apathy.

21. Causes of Schizophrenia Genetic Vulnerability Genetic Vulnerability Strong evidence from twin studies Strong evidence from twin studies Neurochemical Neurochemical Too much dopamine Too much dopamine Brain Abnormalities Brain Abnormalities Enlarged ventricles Enlarged ventricles Frontal Lobes Frontal Lobes Neurodevelopmental Neurodevelopmental Disruptions to the brain before or at birth Disruptions to the brain before or at birth

22. Discussion Question: Recent editions of the DSM include everyday problems that are not traditionally thought of as mental illnesses (e.g., developmental coordination disorder, nicotine dependence disorder). Do you think it's appropriate for these kinds of problems to be included among severe psychological disorders such as multiple- personality disorder and schizophrenia? Recent editions of the DSM include everyday problems that are not traditionally thought of as mental illnesses (e.g., developmental coordination disorder, nicotine dependence disorder). Do you think it's appropriate for these kinds of problems to be included among severe psychological disorders such as multiple- personality disorder and schizophrenia?

23. Discussion Question: If a person does not pose a threat to anyone else and is not unhappy with his or her behavior, but is socially deviant (e.g., a transvestite), should that person be considered abnormal and mentally ill? If a person does not pose a threat to anyone else and is not unhappy with his or her behavior, but is socially deviant (e.g., a transvestite), should that person be considered abnormal and mentally ill?

24. Chapter 16-Psychotherapy

25. What is Psychotherapy? An umbrella term including many types of therapies/treatments. Three Main Elements: –Helping Relationship (treatment) –Professional with special training (therapist) –Person in need of help (client)

26. Who Seeks Therapy? 15% of US population/year Two most common problems: –Anxiety –Depression Women more likely to seek therapy than men. Many people who need therapy don’t receive it.

27. Who Provides Treatment? Psychologists –Clinical and Counseling –Must have doctoral degree Psychiatrist –Must go to medical school (M.D.) –Emphasize drug therapies Psychiatric Social Workers Psychiatric Nurses Counselors

28. INSIGHT THERAPIES Involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior.

29. Client-Centered Therapy Proponent: Carl Rogers Goal: Foster self-acceptance and personal growth. Techniques: –Genuineness –Unconditional Positive Regard –Empathy –Clarification

30. Cognitive Therapy Proponent: Aaron Beck Goal: Change the way clients think. Techniques: –Detect automatic negative thoughts –Subject automatic thoughts to reality testing –‘Thought Records’—Homework!

31. THOUGHT RECORD

32. Evaluating Insight Therapies Insight therapy superior to no treatment or placebo treatment, and effects are relatively durable. Problems with Evaluating Therapy: –Allegiance Effect –Mechanisms of Action/Common Factors

33. BEHAVIOUR THERAPY Involve the application of the principles of learning to direct efforts to change client’s maladaptive behaviors. Two Premises: –All behavior is a product of learning. –What has been learned can be unlearned. Goal: To change behavior.

34. Systematic Desensitization Proponent: Joseph Wolpe Goal: Reduce clients’ anxiety through counterconditioning. Techniques: 1)Build an anxiety hierarchy 2)Deep muscle relaxation 3)Work through the hierarchy while remaining relaxed.

35. Aversion Therapy Goal: To reduce a particular maladaptive behavior. Technique: Pair behavior with a stimulus that elicits an undesirable response.

36. Evaluating Behavior Therapies Place a large emphasis on measuring outcomes Insight vs. Behavioral: –Differences are small –Modestly favour behavioral

37. BIOMEDICAL THERAPIES Psychopharmacotherapy: Treatment of mental disorders with medication.

38. Antipsychotic Drugs Used to reduce psychotic symptoms, like mental confusion and hallucinations. Reduce symptoms in 70% of people. Side Effects: –Drowsiness –Tremors, muscle problems Newer ‘atypical antipsychotics’ have fewer side effects.

39. Antidepressants Gradually elevate mood to bring people out of depression. Prior to 1987: –Tricyclics –MAO Inhibitors Today: –SSRIs (Prozac, Paxil, Celexa) –Effective in 2/3 of patients –Link with suicide?

40. Evaluating Drug Therapies ‘Pretend’ Cure/Band-Aid? Overprescribed? Side effects worse than disorder? Influence of pharmaceutical agencies on research.

41. “The Toronto Affair” David Healy Offered a job in 2000 at CAMH, Toronto. Invited for job talk on November 30, 2000. Ghost Writing December 7, 2000: Job offer retracted. Eli Lilly supports 52% of CAMH mood/anxiety budget. Academic Freedom? Healy filed lawsuit http://www.pharmapolitics.com/

42. Trends/Issues in Treatment Blending Treatments—eclectic approach Multicultural Sensitivity

43. Discussion Question” What do you think would be the benefits and disadvantages of group therapy? Is it possible that it could somehow support the symptoms rather than recovery? Would you prefer to be in group therapy or individual?

44. Discussion Question: One of the main assumptions of behavior therapies is that behavior is a product of learning. On the surface, this seems like a straightforward and reasonable assumption, but do you think that some psychological disorders may develop as a result of genetic factors rather than learning? Why or why not?

45. Final Exam on Monday, August 18th Any Questions let me know.