PSYCHOLOGY 8 th Edition David Myers Power Point

PSYCHOLOGY (8 th Edition) David Myers Power. Point Slides Aneeq Ahmad Henderson State University Worth Publishers, © 2006 1

Psychological Disorders & Therapy Chapter 16, 17 2

3

Psychological Disorders Perspectives on Psychological Disorders Defining Psychological Disorders Understanding Psychological Disorders Classifying Psychological Disorders Labeling Psychological Disorders 4

Psychological Disorders Anxiety Disorders Generalized Anxiety Disorder and Panic Disorder Phobias Obsessive-Compulsive Disorders Post-Traumatic Stress Disorders Anxiety Disorder Explanation 5

Psychological Disorders Mood Disorders Major Depressive Disorders Bipolar Disorder Mood Disorder Explanation Schizophrenia Symptoms of Schizophrenia Subtypes of Schizophrenia 6

Psychological Disorders Schizophrenia Understanding Schizophrenia Personality Disorders Rates of Psychological Disorders 7

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) 8

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. 9

Psychological Disorders To study the abnormal is the best way of understanding the normal. William James (1842 -1910) 1. There are 450 million people suffering from psychological disorders (WHO, 2004). 2. Depression and schizophrenia exist in all cultures of the world. 10

• 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

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). 3 D’s 12

Deviant, Distressful & Dysfunctional Carol Beckwith 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. 13

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 • Trephination (boring holes in the skull to remove evil forces) John W. Verano 14

• Medical MODEL concept that diseases have physical causes can be diagnosed, treated, and in most cases, cured assumes that these “mental” illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago Philippe Pinel (1745 -1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. Dance in the madhouse. 15

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. 2. 3. 4. Etiology: Cause and development of the disorder. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. Treatment: Treating a disorder in a psychiatric hospital. Prognosis: Forecast about the disorder. 16

Biopsychosocial Perspective • Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders. 17

18

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 1950 s. 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 19

Multiaxial Classification Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Is a Personality Disorder or Mental Retardation present? Is a General Medical Condition (diabetes, Axis III hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems Axis IV (school or housing issues) also present? What is the Global Assessment of the person’s Axis V functioning? 20

Multiaxial Classification Note 16 syndromes in Axis I 21

Multiaxial Classification Note Global Assessment for Axis V 22

1. 2. Describe (400) disorders. 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 23

Labeling Psychological Disorders 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press. Asylum baseball team (labeling) 24

2. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. 3. “Insanity” labels raise moral and 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 Mc. Arthur 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 Theodore Kaczynski (Michael Biehn) is torn between his own leftist leanings and (Unabomber) the reality of the heinous crimes for which the accused is being tried. He must argue for the death penalty 25 Elaine Thompson/ AP Photo ethical questions about how society should treat people who have disorders and have committed crimes.

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 26 unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

• Marked by a persistent and irrational fear of an object or situation that disrupts behavior. 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. 27

Kinds of Phobias Agoraphobia Acrophobia Claustrophobia Hemophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. Phobia of blood. 28

Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. 29

Brain Imaging 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 image of an OCD 30

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 Bettmann/ Corbis 4. Jumpy anxiety 5. Sleep problems 31

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. 32

Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. 33

The Learning Perspective John Coletti/ Stock, Boston Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced. 34

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. 35

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. 36

The Biological Perspective Anterior Cingulate Cortex of an OCD patient. 37 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. Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex.

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. 38

Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder Lois Bernstein/ Gamma Liason 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. Chris Sizemore (DID) 39

DID 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. 40

Emotional extremes of mood disorders come in two principal forms. 1. “common cold” of psych disorders; pervasive as well! #1 reason why people seek mental health services. 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. Mood Disorders: Mania and Depression Presents vivid examples of the mood fluctuations of patients who suffer from periodic affective episodes. 41

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 Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Tired Slowness of thought Desire for action Hyperactive Multiple ideas 42

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 43

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. Blue Mood Dysthymic Disorder Major Depressive Disorder 44

Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Clemens Hemingway 45 Earl Theissen/ Hulton Getty Pictures Library The Granger Collection Wolfe George C. Beresford/ Hulton Getty Pictures Library Bettmann/ Corbis Whitman

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 46

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). 47

Canadian depression rates, by gender & age 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. 48

Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide. 1. 2. 3. 4. 5. Suicide Statistics National differences Racial differences Gender differences Age differences Other differences 49

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

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! Mood Disorders: Medication and Talk Therapy Shows the effectiveness of combining drug therapies with traditional psychotherapy. Norepinephrine No wonder why Oz is always in a good mood! He worked out this morning! Pre-synaptic Neuron Serotonin Post-synaptic Neuron Bipolar Disorder => lithium bicarbonate 51

Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles. 52

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. 53

Example Explanatory style plays a major role in becoming depressed. 54

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. 55

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. 56

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) Other forms of delusions include, delusions of This monologue illustrates fragmented, bizarre persecution distorted beliefs called me”) or thinking with (“someone is following delusions grandeur (“I am a king”). (“I’m Mary Poppins”). 57

Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). 58

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 Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg 59

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. 60

Positive and Negative Symptoms 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. positive symptoms: Schizophrenics + symptoms = presence of have inappropriate symptoms inappropriate behavior (hallucinations, disorganized thinking, deluded ways) that are not present in normal - symptoms = absence of individuals. appropriate behaviors negative symptoms: Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals. chronic => slow developing => recovery is doubtful acute / reactive => immediate reaction => recovery is more likely 61

Subtypes 62

**most dreaded psychological disorder => disease of the brain exhibited in symptoms of the mind! DOPAMINE LEVELS ARE HIGH! Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D 4 receptors in the brain. => MORE HALLUCINATIONS AND PARANOIA **AMPHETAMINES AND COCAINE WILL INCREASE 63

Abnormal Brain Activity **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! Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health 64

RISK OF DEVELOPING SCHIZOPHRENIA 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. Both Photos: Courtesy of Daniel R. Weinberger, M. D. , NIH-NIMH/ NSC 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. ) 65

Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. 66

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 67

Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 68

Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). Courtesy of Genain Family Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. 69

Warning Signs Early warning signs of schizophrenia include: 1. A mother’s long lasting schizophrenia. 2. Birth complications, oxygen deprivation and low-birth weight. 3. Short attention span and poor muscle coordination. 4. Disruptive and withdrawn behavior. 5. Emotional unpredictability. 6. Poor peer relations and solo play. 70

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 71

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. 72

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 nonstressful situations, those who were later convicted of a crime (as 18 -26 yr olds) showed relatively low arousal =>fearless approach to life!!!! 73

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). Courtesy of Adrian Raine, University of Southern California Normal Murderer 74

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). Biological risk factors @ birth Double the RISK! When nature and nurture interact! 75

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) 76

Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004). 77

Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004). 78

Risk and Protective Factors 79

PSYCHOLOGY (8 th Edition) David Myers Power. Point Slides Aneeq Ahmad Henderson State University Worth Publishers, © 2006 80

Therapy Chapter 17 81

Therapy The Psychological Therapies Psychoanalysis Humanistic Therapies Behavior Therapies Cognitive Therapies Group and Family Therapies 82

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 83

History of Insane Treatment Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick. Culver Pictures http: //wwwihm. nlm. nih. gov Philippe Pinel (1745 -1826) Dorthea Dix (1745 -1826) 84

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. 85

Psychological Therapies We will look at four major forms of psychotherapies based on different theories of human nature: 1. 2. 3. 4. Psychoanalytical theory Humanistic theory Behavioral theory Cognitive theory 86

Dorthea Dix (1745 -1826) Philippe Pinel (1745 -1826) 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 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 87

Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Edmund Engleman Sigmund Freud's famous couch 88

Therapy Evaluating Psychotherapies The Effectiveness of Psychotherapy The Relative Effectiveness of Different Therapies Alternative Therapies Evaluated Commonalities Among Psychotherapies Culture and Values in Psychotherapies 89

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. 90

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 91

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 therapist. 92

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. 93

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. 94

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. 95

Humanistic Therapies Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance. 96

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. 97

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 98

Behavior 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. 99

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. 100

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 101

Systematic Desensitization -type of counter conditioning -associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli -commonly used to treat phobias 102

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 103

Exposure Therapy The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved. Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared. 104

Exposure Therapy Exposure therapy involves exposing people to fear-driving objects in real or virtual environments. Both Photos: Bob Mahoney/ The Image Works N. Rown/ The Image Works 105

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. 106

Token Economy 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. Operant conditioning Skinner behaviorists 107

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. 108

Person’s emotional reactions are produced not directly by the event but by the person’s thoughts in response to the event. 109

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. 110

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. 111

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. ” 112

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). 113

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 114

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! 115

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! 116

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 117

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. 118

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. 119

Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia. 120

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. 121

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. 122

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 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 123

124

Group Therapy Group therapy normally consists of 6 -9 people attending a 90 -minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. © Mary Kate Denny/ Photo. Edit, Inc. 125

Evaluating Therapies Who do people turn to for help with psychological difficulties? 126

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. 2. 3. Does the patient sense improvement? Does therapist feel the patient has improved? How do friends and family feel about the patient’s improvement? 127

Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. 1. 2. 3. Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). Clients may need to believe therapy was worth the effort. Clients generally speak kindly of their therapists. 128

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. 2. 3. Clinicians are aware of failures, but they believe failures are the problem of otherapists. If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment. 129

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. 130

Outcome Research shows that treated patients were 80% better than untreated ones. 131

The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? Disorder Therapy Depression Behavior, Cognition, Interpersonal Anxiety Cognition, Exposure, Stress Inoculation Bulimia Cognitive-behavior Phobia Behavior Bed Wetting Behavior Modification 132

Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific therapies against popular therapies through electronic means. The results of such a search are below: 133

Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, 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. 134

Light Exposure Therapy Courtesy of Christine Brune Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated. 135

Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are the following: © Mary Kate Denny/ Photo. Edit, Inc. 1. A hope for demoralized people. 2. A new perspective. 3. An empathic, trusting and caring relationship. 136

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. 137

Therapists & Their Training Clinical psychologists: They have Ph. Ds 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. 138

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. 139

The Biomedical Therapies These include physical, medicinal, and other forms of biological therapies. 1. Drug Treatments 2. Surgery 3. Electric-shock therapy 140

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. 141

Schizophrenia Symptoms Inappropriate symptoms present (positive symptoms) Appropriate symptoms absent (negative symptoms) Hallucinations, disorganized thinking, deluded ways. Apathy, expressionless faces, rigid bodies. 142

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. 143

Psychosurgery http: //www. epub. org. br Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. 144

Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind. 145

Psychosurgery http: //www. epub. org. br Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery. http: //www. epub. org. br 146

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. 147

Psychological Disorders are Biopsychosocial in Nature 148

• 3 D’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 DIRECTIONS • Dopamine Using the term you have chosen create a • Twin studies • Personality disorders piece of graffiti or a cartoon to hang in the room. Include: • Frontal lobe • Term • D. Dix • picture depicting/illustrating the term • Psychotherapy • definition/ explanation/ symptoms etc • Eclectic approach BE Creative and hang ANYWHERE you want to in the classroom! • Transference • Free association • Active listening • Exposure therapy • Systematic desensitization • Aversive conditioning • Family therapy • Regression toward the mean • Psychopharmacology • SSRI’s • ECT 149 • lobotomy

150

Some things to remember (do not limit yourself to this list!): NAMES: Pinel, Rogers, Freud, etc. . Perspectives of Psych => diagnosis & treatment Models of Psychological disorders DSMVI ( +/-) Correct terminology “political correctness” Disorders =>definitions, symptoms, treatments Play psychiatrists Subtypes of schizophrenia Therapies/ Treatments Psychoanalysis => free association Humanism => client centered therapy/ active listening VOCAB terms: Transference/ resistance Behavior/ “learning” treatments / examples => token economy psychopharmacology mental hospitals disorders and “brain and biology” => neurotransmitters: dopamine, seratonin, norepinephrine META-Analysis Ellis => RET 151