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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/alcohol
 Women: 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

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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, subtype
Functional Enuresis
A.
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
Anxiety
disorders
Specific Disorders within Category
Specific phobia, social phobia,
agoraphobia, panic disorder with and
without agoraphobia, generalized
anxiety disorder, obsessive-compulsive
disorder
Mood
Major depressive disorder, bipolar
disorders
disorder
Schizophrenic Schizophrenia (paranoid, disorganized,
disorders
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

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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 Phobia
Social Phobia & Agoraphobia
Panic Disorder
Generalized Anxiety Disorder
Obsessive-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.
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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

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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)
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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
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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

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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 Disorder
Bipolar Disorder
Major Depressive Disorder

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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

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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

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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
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In bipolar I disorder, the person has both
major manic and depressive episodes
In bipolar II disorder, the person has fullblown 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

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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

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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
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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
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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

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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
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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

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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:
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Charles Manson Clip
Schizophrenia?
Mania?
Bi-polar?
Somatoform Disorders
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Somatoform disorders
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Dissociative disorders
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pathological concern of individuals with the
appearance or functioning of their bodies when there
is no identifiable medical condition causing the
physical complaints
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
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Somatization disorder
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Conversion disorder
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Pain disorder

Body dysmorphic disorder
Somatoform Disorders

Hypochondriasis
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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
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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.)
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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
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Depersonalization
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Loss of sense of the reality of the external world
Loss of sense of your own reality
5 types
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Depesonalization disorder
Dissociative amnesia
Dissociative fugue
Dissociative trance disorder
Dissociative identity disorder
Dissociative Disorders

Depersonalization disorder
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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
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Inability to recall personal information, usually of a
stressful or traumatic nature
Generalized vs. selective amnesia
Dissociative Fugue
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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

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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
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Dissociative Identity Disorder
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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
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Dissociative Identity Disorder
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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


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Get better on their own
Coping mechanisms to prevent future episodes
DID
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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)

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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)
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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
Psychoanalyst
Any of the above credentials, but with training from a
psychoanalytic institute; provides psychoanalytic therapy
for psychological disorders
Clinical social Master’s or doctoral degree in social work with
worker
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
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
Electroconvulsive
Therapy
Drug
Therapy
Psychosurgery
Drug Therapy
Lithium
Antianxiety
Drugs
Antidepressants
Antipsychotic
Drugs
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 obsessivecompulsive patients who have not responded to
other types of treatment
Psychotherapies

Four major types
Psychoanalysis
Behavioral
Humanistic
Cognitive
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 feararousing 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


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


Thus, the effect of psychotherapy must be statistically
significantly greater than that due to spontaneous
remission
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