Psychological Dysfunction and Treatment

Disorders are given psychological labels and listed in the DSM

Source of Psychological Disorders

• Nurture or Nature

• Biological or Learned

• Culture invested in biological model but evidence is growing that learning is a significant contributor

Neural Development that results from Excessive Stress

• Stress axis involves the hypothalamus which alerts the pituitary gland which in turn alerts the adrenal glands

• This stress axis is sensitized to over-react to stimuli

• Organisms under stress less open to learning experiences. Why?

Need to survive and protect reduce ability to learn

• If overly concerned about threats, can’t be curious and open to experiences

• Reduced learning results in under-developed cerebral cortex and hippocampus

• Children under stress do show cognitive deficits

Experiences shape genes, brain anatomy and then behaviors

• Classical Conditioning with Aplysia

• Classical conditioning with Howard Hughes

• Classical conditioning with David Helfgot

• Anxiety Disorders result, including schizophrenia

How can children learn to become anxious: Raised in Stressful Environment

• Overly protective, intrusive &/or demanding parents

• Very unstable and unpredictable early environment

• Parents model excessive number of anxieties and fears, as Mrs. Hughes did for Howard toward germs

Classical Conditioning Paradigm

• How Howard Hughes develop phobia toward germs

UCS UCR

CS CR

David Helfgot and volitile, demanding & abusive father

• UCS UCR

• CS CR

Woman with OCD and Authoritarian Father

• UCS UCR

• CS CR

Anxiety Disorders

General Anxiety Disorder

Panic Disorder: Anxiety Levels can result in Panic Attacks

Symptoms:

Racing heartFeel faint and/or dizzyTingling or numbness in hands or armsSense of impending doomChest painsDifficulty with breathingFeel a loss of control

Treatment of Panic Disorder

• People with this disorder often will avoid leaving the house

• Initially will go to ER at nearby hospitals

• Behavioral treatment involves the person intentionally start a panic episode and then demonstrate to self not a serious event

Social Anxiety Disorder

Behavioral Clinic that teaches socially phobic people to learn how to reach out

• Model and rehearse simple and appropriate ways to initiate a social interaction

• Give weekly assignments that start very simple and move forward step-by-step

• Report back to group every week on successes the previous week

Obsessive Compulsive Disorder

Common Thoughts or Obsessions• Fear of dirt or contamination by germs

• Fear of doing harm to another

• Obsess if proper order and neatness has not been maintained

• Excessive doubt and need for constant reassurances

• Fear of thinking evil or sinful thoughts

Common Compulsions• Repeatedly showering or washing hands

• Refuse to shake hands or touch door knobs

• Repeatedly checking things, as locks

• Constantly arranging things in certain order

• Collecting or hoarding items of no value

Aviator: Life Howard Hughes

Childhood of Howard Hughes

• 1) He grew up with a mother who forced him to endure odd cleaning rituals,as dousing himself with mineral oil daily.

• 2) She disapproved of him making friends as believed they were carriers of disease, resulting in him spending much of his childhood alone or with his mother.

• 3) Mother insisted on giving Howard hand baths until he reached his teens.

• 4) She watched for slightest changed in physical condition, sniffles, a cough as well as any abnormality in his feet, teeth or digestion and then would whisk to a doctor, in the process lavishing much attention and sympathy.

• 5) Observers were amazed at the extreme closeness between Howard and his mother and how often they would kiss and hug.

Hughes also developed life-long obsession with germs

• Not like anyone touching him

• Over-react to people around him to be messy or dirty, especially when under stress

• Wash his hands many times every day

• Become more and more reclusive through the years

Last 20 years live alone in hotel room

Cognitive therapy for anxiety: challenge a person’s inaccurate perceptions

• Will touching doorknobs cause contamination & then serious illness?

• What will be the dire consequences of not washing your hands more than 5 times a day?

• Are people really watching and judging you when you walk into a restaurant or library?

• Are you really having a heart attack during a panic episode?

• So what if not do a job perfectly?! So what if not get an A on every tests?!

• Can control habitual anxious thinking & so reduce anxious feelings

Behavioral Therapy: Can learn behaviors that effectively reduce anxiety

• Meditation

Yoga

Depression

Causes of Depression: operant conditioning

• Child receive much extinction &/or lots of discouraging feedback

• Receive very little positive, encouraging feedback

• Not encouraged to become independent—or develop a sense of autonomy

• Given sense that they are not valued, lovable or competent

How do depressed people think?• Learn have very little control over environment so learn

feelings of helplessness and hopelessness

• Learn selective perception: focus on what did wrong, not what did right as what parents did

• Develop pessimistic attitude and low self-esteem

• When experience loss or set-backs, over-react and become depressed and blame self

Cognitive Behavioral Therapy

• Structured therapy where analyze ways think and behave that are causing anxiety and/or depression

• Use role playing and homework assignments to practice new ways of thinking and behaving

Cure for Depression—Become active and productive

Books Cognitive Behavioral Therapy

Cognitive Behavioral Books focused on specific problems

Sociopath: Anti-social Personality

• No conscience• Inability to feel remorse• Lacking structure or restraints in childhood• Lacking loving and affectionate care in

childhood• Serial killers, cheaters, liars• Hurt others with no concern: very self-

absorbed

Treatments for Anti-Social Personalities

• How determine that a person has this disorder?

• Why do they not go for treatment?

• What could the treatment be if they did?

Psychoanalysis

• Sigmund Freud useintuition to develop theoryof role of unconscious mind

Believe essential to explore traumas repressed in unconscious mind

• Free association: lie on couch and talk about whatever enters ones mind

Use Dream Analysis as believed they were road to unconscious

Psychoanalytic Therapy

• Wish to delve into traumas stored in unconscious psyche

• Initially Freud use free-association

• Later therapists started to use hypnosis to get patients to remember early traumas

Problems with foundation of Psychoanalytic Therapy

• Are childhood traumas really “repressed?”

• Is it really of value to dig into our childhood in order to relive and gain insight into our early traumas?

• Does hypnosis really improve our memories of childhood or encourage the development of false memories?

Humanistic Theory: Believe Conscious Mind is in charge

• Carl Rogers

Humanistic School: Client-centered Therapy

• We control our own destiny & are autonomous: conscious mind is in control

• We have the ability to solve our own problems with clarification and support

• Role of therapist is to reflect and clarify, not to give advice

Questions about Client-Centered Therapy

• Can we solve our own problems simply by a therapist providing us support and clarification?

• For which type of issues would we need so direct assistance?

• Panic attacks? Serious depression? Constant concerns about germs and contamination?

Cognitive Behavioral Therapy• Practice new ways of thinking and behaving as

opposed to “talking” about problems

• For anxiety disorders, determine habitual thinking patterns that make you anxious

• Learn to STOP! obsessive worrying

• Learn to start using calming self-statements

Behavioral Changes for Anxiety

• Practice the “relaxation response:" Starts with the mind which, in turn, relaxes the body

• Learn deep muscle relaxation exercises: Starts with the body which, in turn, relaxes the mind (Yoga)

Cognitive-behavioral therapy for depression

• Identify thinking patterns that are common among people who are depressed

• Practice keeping a journal of every positive event that occurred during the day

• Practice positive self-statements about an event or interaction you handled well

Feeling Good Handbook

• All or nothing thinking

• Discounting the positive

• Believe need to be perfect or have failed

• Buy into view ‘am a loser,’ no matter what

Behaviors to reduce depression

• Step-by-step increase in level of exercise do on daily basis: start at 250 steps per day & week by week increase up to 10,000

• Increase social network: create one social interaction during a week

• Join new social groups via meetup.com

Increase One’s Productivity

• Establish goals for each day that are realistic

• Give oneself credit for accomplishing each goal!!

• Slowly increase level of productivity plan for each day

Schizophrenia is most serious psychological dysfunction

• Diathesis-Stress Model: Born with genetic defect that predisposes them to overreact to stressors

OR

• Early severe stressful events cause abnormal neurodevelopment that has caused nervous system to be hyper sensitive to stressors

Abnormalities found in schizophrenics

• Over-reactivity of hypothalamic-pituitary-adrenal axis

• Structural brain changes, including hippocampus damage and cerebral atrophy

• Elevation of release of cortisol and dopamine when exposed to stress

What could these neurological abnormalities explain?

• Oversensitivity to stress

• Cognitive impairments

• Relationship between psychotic and hallucinations, delusions and paranoia

Problem with biological model

• Impede adequate consideration of relevance of stress, trauma, neglect and loss in early childhood

• Diathesis-stress model only measure stressors a few weeks or months prior to outbreak so not consider early life events

• Gross imbalance in examining biological psychological and social factors

“Genotype-environment interaction in schizophrenic-spectrum disorder”

• British Journal of Psychiatry (2004)

• 36% of high-genetic risk adoptees raised in dysfunctional families develop symptoms

• 5.8% of high-genetic risk adoptees raised in healthy families

• Demonstrates protective effect of family

Factors in Environment: High Degree of Stress Early in Life

• Genetic riskcombined withvolatile, hostileunpredictable, judgmental and/or overlyprotective environment

Healthy Families

• Have good sense of humor and can laugh at themselves

• Respect each other’s need for privacy and not engage in mind reading

• Negotiate and compromise

Findings of Adoptee studies

• Genes do not operate alone

• Environmental factors play a significant role

• Much of environmental influences are result of family environment

• Developing brain vulnerable early in life

Traits of Healthy Families

• Speak clearly and are not rigid nor confusing

• Friendly environment & able to disagree without upsetting other members

• Can express happiness or sadness to each other

Treatment for Schizophrenia:Limited to Biological Treatments

Biological Treatments

• Medications

Thorazine one popular anti-psychotic medication: very strong sedative

Action of Antidepressants

ECT: Electro-convulsive therapy

Deep Stimulation of the Reward Centers in the Brain

Trans-cranial Magnetic Stimulation