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Abnormal Psychology
Abnormal Psychology
The scientific study of mental disorders and their treatment
Lifetime prevalence of over 40% for “any type of disorder”
Abnormal Psychology Men: More prevalent substance/alcoholWomen: More prevalent mood/anxiety
The Journey…
The Diagnosis and Classification
of Mental Disorders
The Diagnostic and Statistical Manual
The Perceptual Bias of Labeling
Criteria for a Behavior/Thought Process to be a “Disorder”
Criteria for a Behavior/Thought Process to be a “Disorder”
1. Is the behavior/thought process atypical (statistically infrequent)?
2. Is the behavior/thought process maladaptive (i.e., does it prevent the person from successfully functioning and adapting to life’s demands)?
3. Is the behavior/thought process personally distressing?
4. Is the behavior/though process irrational?
Diagnostic and Statistical Manual
The DSM-IV, published in 1994 by the American Psychiatric Association, is the most widely used diagnostic system for disorders (DSM V: 2013) First appeared in 1952 and at
that time, described only about 60 disorders
During the last half-century, we have learned a lot about various disorders and how to differentiate them, so we can identify more disorders (there are more than 300 known disorders today)
Health insurance companies require a DSM classification before they will pay for therapy
Diagnostic and Statistical Manual
Some disorders share certain symptoms, so the DSM-IV clusters these disorders into major categories Anxiety disorders: Involve highly anxious or fearful
behavior Mood disorders: Involve eccentric or odd behavior patterns Schizophrenic disorders: Involve excessively dramatic,
emotional, or erratic behavior patters
These are known as “Axis I Disorders”, or “principal/psychiatric” disorders that needs immediate attention
Diagnostic and Statistical Manual
Axis I Disorders use a similar language in describing the symptoms, length/term, exclusion criteria, subtypeFunctional EnuresisA. Repeated voiding of urine into bed or clothes (whether involuntary or intentional). B. The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. C. Chronological age is at least 5 years (or equivalent developmental level). D. The behavior is not due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder). Specify type:
Nocturnal Only, Diurnal Only, Nocturnal and Diurnal
Perceptual Bias of Labeling
A problem with classifying mental disorders is that labels are attached to people, and this biases our perception of these people in terms of the labels For instance, the word “crazy”
has strong connotations
Perceptual Bias of Labeling
Rosenhan (1973) wanted to see if researchers could get admitted to mental hospitals when complaining of auditory hallucinations, hearing the words “thud,” “empty,” and “dull” He also wanted to learn what would happen
after such people were admitted – if they acted normal, said that they no longer heard the voices, and said they were feeling normal again.
Perceptual Bias of Labeling
First, the fake patients were indeed admitted based only on this single symptom
Second, their subsequent normal behavior was misinterpreted in terms of their diagnosis For instance, one person’s notetaking (for
research purposes) was interpreted as a function of his illness
Three Major Categories of Mental Disorders
Anxiety Disorders
Mood Disorders
Schizophrenic Disorders
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)
A Caveat… Be wary of the medical
school syndrome, the tendency to think that you have a disorder when you read about its symptoms
Although we all get anxious or depressed from time to time, such symptoms are problematic when they prevent us from functioning normally (i.e., when they are atypical, irrational, maladaptive, and cause us personal distress)
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
Anxiety Disorders
Disorders in which excessive anxiety leads to personal distress and atypical, maladaptive and irrational behavior
Specific PhobiaSpecific Phobia
Social Phobia & AgoraphobiaSocial Phobia & Agoraphobia
Panic DisorderPanic Disorder
Generalized Anxiety DisorderGeneralized Anxiety Disorder
Obsessive-Compulsive DisorderObsessive-Compulsive Disorder
Specific Phobia
Indicated by a marked and persistent fear of specific objects or situations (such as snakes or heights) that is excessive or unreasonable
The anxiety and fear of the specific stimulus may be rational to an extent, but in the case of a specific phobia, the anxiety and fear are in excess of what is typical
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.
Causes of Specific Phobias
Classical conditioning In Watson and Rayner’s study on the infant Little Albert,
they conditioned the infant to fear white rats by pairing together a loud startling noise (an unconditioned stimulus) with a white rat (a conditioned stimulus)
Biological predispositions 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
Social Phobia
A marked and persistent fear of one or more social performance situations in which there is exposure to unfamiliar people or scrutiny by others For instance, a person
may fear eating in public, rejecting all lunch and dinner invitations
Agoraphobia
A fear of being in places or situations from which escape might be difficult or embarrassing Includes being in a crowd, standing in line, and
traveling in a crowded bus or train or in a car in heavy traffic
To avoid such situations a person won’t leave the security of their homes
Panic Disorder A condition in which a person experiences recurrent
panic attacks (i.e., sudden onsets of intense fear) Some panic attacks occur when a person
is faced with something he dreads, such as giving a speech, but other attacks occur without any apparent reason
Panic disorder can occur with or without agoraphobia. (STEVE VIDEO)
One explanation for panic disorder is a fear-of-fear hypothesis: Agoraphobia is the result of the fear of having a
panic attack in public; thus, agoraphobia is a case of classical conditioning in which the fear and avoidance response is a conditioned response to the initial panic attack
Generalized Anxiety Disorder A disorder in which the person has
excessive, global anxiety and worry that they cannot control, for a period of at least 6 months The anxiety is not tied to any specific
object or situation (as it is in a phobic disorder)
May be related to a biochemical dysfunction in the brain, which involves GABA, a major inhibitory neurotransmitter People with generalized anxiety disorder
may have problems with activation of GABA, allowing more and more neurons to get excited
Obsessive-Compulsive Disorder
A person experiences recurrent obsessions or compulsions that are perceived by the person as excessive or unreasonable, and 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
(CHUCK VIDEO)
Obsessive-Compulsive Disorder
Although it is not known for sure what causes obsessive-compulsive disorder, recent research suggests that a neurotransmitter imbalance involving serotonin may be involved Antidepressent drugs that increase serotonin
activity (e.g., Prozac and Anafranil) help many obsessive-compulsive patients
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
Mood Disorders
Involve dramatic changes in a person’s emotional mood that are excessive and unwarranted
Major Depressive DisorderMajor Depressive Disorder
Bipolar DisorderBipolar Disorder
Major Depressive Disorder
To be classified as major depressive disorder, a person must have experienced one or more major depressive episodes
(MARY-DEPRESSED) A major depressive episode is characterized
by symptoms such as Feelings of intense hopelessness, low self-esteem
and worthlessness, and extreme fatigue Dramatic changes in eating and sleeping behavior Inability to concentrate Greatly diminished interest in family, friends, and
activities for a period of two weeks or more
Major Depressive Disorder It is important to note that feelings of sadness
and downward mood following stressful life events (such as a death in the family) are understandable and normal, and given time usually are self-correcting Such feelings under such
circumstances do not necessarily indicate a major depressive disorder
Women suffer from major depressive disorder twice as often as men
Major Depressive Disorder
A leading biological explanation involves neurotransmitter imbalances, primarily inadequate serotonin and norepinephrine activity
SSRIs as anti-depressants
Major Depressive Disorder
There also appears to be a biological predisposition to the disorder For identical twins,
the concordance rate is 50%, much higher than for fraternal twins and the base rate of occurrence in the general population
Major Depressive Disorder
Non-genetic factors are also important For example, the “pessimistic explanatory
style” in which a person explains events in terms of causes that are internal (their own fault), stable (here to stay), and global (applies to all aspects of their life)
Bipolar Disorder
The person’s mood takes dramatic swings between depression and mania, with recurrent cycles of depressive and manic episodes(MARY-MANIC VIDEO) A manic episode is a period of at least a
week of abnormally elevated mood in which the person experiences such symptoms as inflated self-esteem with grandiose delusions, a decreased need for sleep, constant talking, distractibility, restlessness, and poor judgment
Bipolar Disorder
In bipolar I disorder, the person has both major manic and depressive episodes
In bipolar II disorder, the person has full-blown depressive episodes, but the manic episodes are milder
The concordance rate for bipolar is 70%, so biological causes are the most common explanation In fact, current research is trying to identify the
specific genes that make a person vulnerable to this disorder
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
Schizophrenic Disorders
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
Symptoms of Schizophrenia Positive symptoms (things added) are the more active
symptoms that reflect an excess or distortion of normal thinking or behavior, including hallucinations (false sensory perceptions) and delusions (false beliefs) Hallucinations tend to be auditory,
such as hearing voices that are not real There are different forms of delusions
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
(ETTA VIDEO)
Symptoms of Schizophrenia
Negative symptoms refer to things that have been removed There are deficits or losses
in emotion, speech, energy level, social activity, and even basic drives such as 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
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)
Five Subtypes of Schizophrenic Disorder
Subtype 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)
Causes of Schizophrenia Concordance rate is about 50%, although no
particular genes have been identified
Causes of Schizophrenia
A second hypothesis involves neurotransmitters Schizophrenics have
elevated levels of dopamine activities in certain areas of their brains (Awakenings)
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
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
Diagnosis
Can be very difficult In a 2002 survey by the Depression and Bipolar Support
Alliance, 70 percent of bipolar people said their doctors misdiagnosed them at least once, most often with depression or schizophrenia.
In a study published the Journal of Experimental Psychology, two researchers documented just how diagnoses for mental disorders can be swayed by clinicians' theoretical leanings. Experiments conducted with 21 psychologists and psychology graduate students showed that they held complex theories about how symptoms are interrelated. They also regarded certain symptoms as more central to a disease than others. That runs contrary to the DSM's diagnostic model, which gives all
symptoms equal weight.
Diagnosis
Let’s try a case: Charles Manson Clip Schizophrenia? Mania? Bi-polar?
Somatoform disorders pathological concern of individuals with the
appearance or functioning of their bodies when there is no identifiable medical condition causing the physical complaints
Dissociative disorders individuals feel detached from themselves or their
surroundings, and reality, experience, and identity may disintegrate
Historically, both somatoform and dissociative disorders used to be categorized as “hysterical neurosis” in psychoanalytic theory neurotic disorders result from
underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms
Somatoform Disorders
Soma (Body) Preoccupation with health and/or body appearance and
functioning
No identifiable medical condition causing the physical complaints
Types of DSM-IV Somatoform Disorders Hypochondriasis
Somatization disorder
Conversion disorder
Pain disorder
Body dysmorphic disorder
Somatoform Disorders
Somatoform Disorders Hypochondriasis
severe anxiety focused on the possibility of having a serious disease
shares age of onset, personality characteristics anf running in families with panic disorder
illness phobia vs. hypochondriasis 60% of patients with illness phobia develop
hypochondriasis Documented 1% to 5% of medical patients, but <1% treatment usually involves cognitive-behavioral
therapy and general stress management treatment (gain retained after 1 year follow-up)
Somatoform Disorders
Causes of hypochondriasis
Somatoform Disorders Somatization disorder
patients have a history of many physical complaints that can not be explained by a medical condition, the complaints are not intentionally produced
up to 20% of patients in primary care setting develops during adolescence (majority women) 0.2-2% in Women, 0.2% in Men difficult to treat (reassurance, stress reduction, more
adoptive methods of interacting with family are encouraged)
Somatoform Disorders Conversion Disorder
Physical malfunctioning without any physical or organic pathology
Malfunctioning often involves sensory-motor areas
Persons show la belle indifference
(pretend nothing is happening)
Retain most normal functions, but without awareness
Treatment
Similar to somatization disorder
Core strategy is attending to the trauma
Remove sources of secondary gain
Reduce supportive consequences of talk about physical symptoms
Somatoform Disorders Body Dysmorphic Disorder
Preoccupation with imagined defect in appearance Either fixation or avoidance of mirrors
Previously known as dysmorphophobia
Suicidal ideation and behavior are common
Often display ideas of reference for imagined defect
Statistics
More common than previously thought
Usually runs a lifelong chronic course
Seen equally in males and females, with onset usually in early 20s
Most remain single, and many seek out plastic surgeons
Somatoform Disorders Body Dysmorphic Disorder (cont.)
Causes Little is known – Disorder tends to run in families
Shares similarities with obsessive-compulsive disorder
Treatment Treatment parallels that for obsessive compulsive
disorder
Medications (i.e., SSRIs) that work for OCD provide some relief
Exposure and response prevention are also helpful
Plastic surgery is often unhelpful
Dissociative Disorders Derealization
Loss of sense of the reality of the external world Depersonalization
Loss of sense of your own reality 5 types
Depesonalization disorder Dissociative amnesia Dissociative fugue Dissociative trance disorder Dissociative identity disorder
Dissociative Disorders
Depersonalization disorder Severe feelings of depersonalization dominate the
individual’s life and prevent normal functioning It is chronic (immediate) 50% suffer from additional mood and anxiety
disorders Cognitive profile (cognitive deficits in attention,
STM, spatial reasoning, perception (3D))
Dissociative Disorders
Dissociative Amnesia Inability to recall personal information, usually of a
stressful or traumatic nature Generalized vs. selective amnesia
Dissociative Fugue Sudden, unexpected travel away from home,
along with an inability to recall one’s past (new identity)
Occur in adulthood and usually end abruptly
Dissociative Disorders Dissociative trance disorder
Altered state of consciousness in which the person believes firmly that he or she is possessed by spirits; considered a disorder only where there is distress and dysfunction
Trance and possession are a common part of some traditional religious and cultural practices and are not considered abnormal in that context
Only undesirable trance considered pathological within that culture is characterized as disorder
Dissociative Disorders Dissociative Identity Disorder
Formerly multiple personality disorder Many personalities (alters) or fragments of
personalities coexist within one body The personalities or fragments are dissociated Switch (transition form one personality to another,
includes physical changes) Can be simulated by malingers are usually eager to
demonstrate their symptoms whereas individuals with DID attempt to hide symptoms
Very high comorbidity Controversial, Prevalence about 1-3%
Dissociative Disorders Dissociative Identity Disorder
Auditory hallucinations (coming from inside their heads)
97% severe child abuse Extreme subtype of PTSD Onset – approximately 9 years Suggestible people may use dissociation as
defense against severe trauma Real and false memories Temporal lobe pathology (out of body
experiences)
Dissociative Disorders
Treatment Dissociative amnesia and fugue
Get better on their own Coping mechanisms to prevent future episodes
DID Reintegration of identities Neutralization of cues Confrontation of early trauma hypnosis
Diagnostic and Statistical Manual
The DSM-IV also requires a separate decision as whether or not a person has a personality disorder Characterized by inflexible, long-standing personality traits
that lead to behavior that impairs social functioning and deviate from cultural norms
These are known as “Axis II Disorders” or “Personality Disorders” Different Clusters
Diagnostic and Statistical Manual
“Axis II Disorders” Clusters Cluster A (Odd Disorders)
Paranoid personality disorder: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
Schizoid personality disorder: lack of interest and detachment from social relationships, and restricted emotional expression
Schizotypal personality disorder: a pattern of extreme discomfort interacting socially, distorted cognitions and perceptions
Diagnostic and Statistical Manual
“Axis II Disorders” Clusters Cluster B (Dramatic, Emotional, Erratic Disorders)
Antisocial personality disorder: a pervasive pattern of disregard for and violation of the rights of others, lack of empathy (GEORGE VIDEO)
Borderline personality disorder: pervasive pattern of instability in relationships, self-image, identity, behavior and affects often leading to self-harm and impulsivity
Histrionic personality disorder: pervasive pattern of attention-seeking behavior and excessive emotions
Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy
Diagnostic and Statistical Manual
“Axis II Disorders” Clusters Cluster C (Anxious or Fearful Disorders)
Avoidant personality disorder: pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
Dependent personality disorder: pervasive psychological need to be cared for by other people.
Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder): characterized by rigid conformity to rules, perfectionism and control
The Treatment of Mental Disorders
Biomedical Therapies
Psychotherapies
Different Types of Mental Health Professionals
Type 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)
Two Major Types of Therapy
Biomedical Therapy
Involves the use of biological
interventions, such as drugs
Biomedical Therapy
Involves the use of biological
interventions, such as drugs
Psychotherapy
Involves the use of psychological
interventions
Psychotherapy
Involves the use of psychological
interventions
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
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
Biomedical Therapies
DrugTherapy
DrugTherapy
Electro-convulsive
Therapy
Electro-convulsive
Therapy
Psycho-surgery
Psycho-surgery
Drug Therapy
LithiumLithium
AntianxietyDrugs
AntianxietyDrugs
AntidepressantsAntidepressants
AntipsychoticDrugs
AntipsychoticDrugs
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
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
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
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
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
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
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
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
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
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
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
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
Psychotherapies
Four major types
PsychoanalysisPsychoanalysis
BehavioralBehavioral
HumanisticHumanistic
CognitiveCognitive
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Psychotherapy vs. No Treatment