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Psychological Disorders &
Treatment
Chapters 15 & 16
Psychological Disorders
• In the past, people went to extremes ( harsh and
ineffective) to cure psychological disorders/demon
posessions:
–
–
–
–
–
Beaten
Burned
Castrated
Removal of teeth, intestines, or
Blood transfusions with animal blood
• Psychological disorder: (as defined by mental health workers)
A “harmful dysfunction” in which behavior is judged to
be atypical, disturbing, maladaptive, and unjustifiable
Mental Health Perspective
• Psychological disorder:
- Being different “atypical” or deviant from most other
people in one’s culture is part of the classification
process….however, DISTURBING to others must also
be a part of this
- Standards of acceptability vary across time,
culture…so what is the key?...
- Maladaptive- so distressing or disabling that it puts
one at risk of suffering or death
- Unjustifiable- not rationally justified/supported
- Personally Distressing- reported by self or others
The Medical Model Perspective
• According to the medical model:
– Psychological disorders are sicknesses that need
to be diagnosed and cured
• Determined once they discovered that syphilis infects
the brain and distorts the mind
• Diagnosis- distinguishing one illness from another
• Etiology- refers to the apparent causation &
developmental history of the illness
• Prognosis- forecast about the probable course of an
illness
The Bio-Psycho-Social Perspective
• Bio-psycho-social perspective
– Contemporary perspective which assumes that
biological (nature), psychological, and sociocultural (nurture) factors combine and interact to
produce psychological disorders
• Basically the mind and body are inseparable
• Environmental impact evidence: some disorders are
across cultures (depression & schizophrenia) and some
are culture bound (eating disorders are mostly western
cultural based)
Classification- The DSM-5
• In order to create order we classify
• The classification scheme for psychological disorders
is the DSM-5
Diagnostic and Statistical Manual of Mental
Disorders (5th Edition) as of 2013
- a widely used system for classifying psychological disorders
- no longer a multi-axial system (AXIS I, II, & III have been combined:
mental, personality, intellectual disability, & medical diagnoses all
combined)
- Now uses classifications along with Level 1 (patient-rated measure
assessing different health domains) & Level 2 (in-depth clinical look at
domain threshold scores) Assessment Measures
The DSM-5
• DSM-5
– It is a reliable system and this can consistently be
used to diagnose a disorder clinician to clinician
based upon observable behavior
– Systematic in its process
– It includes a very broad range of psychological
disorders and some differences are controversial,
such as Asperger’s and Autism being merged into
Autism Spectrum Disorder
The DSM-5
• Criticized for:
– Classifying an excessively broad range of human behaviors
as psychologically disordered (ex. Social phobia &
Disruptive mood dysregulation disorder)
– Comorbidity- coexistence of two or more disorders
– One of the main disagreements with LABELING in general
is that is colors our perceptions or biases our opinions of
people
– Can also lead to stereotypes
• Why people have begun to talk about individuals with
disabilities by placing the classification AFTER the
person
The DSM-5
• Labels can also alter reality
– Self-fulfilling prophecy: people behavior that is
expected of them or that they expect of
themselves
• But Diagnostic Labels are good for:
1. Communication btwn professionals about specific
concerns
2. Comprehending the pathological processes involved in
psychiatric illnesses
3. Controlling psychiatric outcomes
Prevalence of Disorders
• epidemiology- the study of the distribution of
mental or physiological disorders in a
population
• prevalence- refers to the percentage of a
population that exhibit a disorder during a
specified time period
• concordance rate- indicates the percentage of
twin pairs or other pairs of relatives who
exhibit the same disorder
Anxiety Disorders
• Anxiety disorders: psychological disorders
characterized by distressing, persistent anxiety
or maladaptive behaviors that reduce anxiety
– These are the most common mental disorders
4 examples of anxiety disorders
– Generalized Anxiety Disorder
– Panic Disorder
– Phobias/Phobic Disorder
– Obsessive-compulsive disorder
Anxiety Disorders
• Generalized Anxiety Disorder:
an anxiety disorder in which a person is continually
tense, apprehensive, and in a state of autonomic
nervous system arousal
– The symptoms are common but the intensity is not
•
•
•
•
•
2/3 women
Jittery & agitation
Sleeplessness
Sweating
Eye-twitching
• BUT NO IDENTIFIABLE CAUSE
(Freud calls it Free Floating)
Anxiety Disorders
• Panic Disorder:
– Anxiety disorder marked by minute-long episode
of intense dread in which a person experiences
terror and accompanying chest pain, choking, or
other frightening sensations (panic attack=specifier)
– To develop a panic disorder you would have
multiple attacks over time and begin to fear the
fear or the places where the attacks have occurred
– 1 in 75 people
Anxiety Disorders
• Phobias/Phobic Disorder
an anxiety disorder marked by persistent, irrational
fear and avoidance of a specific object, activity, or
situation
• Common and many people suffer from this
• Examples: animals, insects, heights, blood, or tunnels
• Social anxiety phobia: intensely fears of being
scrutinized by others and avoids potentially
embarrassing social situations (sweat, tremble, or
diarrhea) (DSM-IV= social phobia)
• Shyness taken to an extreme
Anxiety Disorders
• Agoraphobia:
Fear or avoidance of situations in which escape
might be difficult or help unavailable when panic
strikes
- may avoid being outside the home, in a crowd,
on a bus, or even on an elevator
Why Anxiety?
• Learning Perspective:
– General Anxiety has been linked to a classical conditioning of fear via
the environment where the unpredictable and uncontrollable aversive
or anxiety-ridden event occurred
1. Classical & Operant Conditioning-natural fears can
become very intense due to conditioning
2.
Stimulus generalization: condition fears overflow to similar
situations creating new fears
• Reinforcement: by avoiding or escaping the situations, reduces
anxiety and then reinforces the phobic behavior
2. Observational learning: observing others’ fears
3. Cognition: interpretations & irrational beliefs
Why Anxiety?
• The Biological Perspective:
– Natural selection
– Genes
– Physiology
Trauma & Stress Related Disorders
Anxiety Related Disorders
• Post-Traumatic Stress Disorder
haunting memories and nightmares, a numbed
social withdrawal, jumpy anxiety, and insomnia
- basic trust erodes
- fearful wariness
- troubled sleep
- nightmares
- sense of hopelessness about their future
Obsessive-Compulsive & Related Disorders
Anxiety Related Disorders
• Obsessive-Compulsive Disorder
An anxiety disorder characterized by unwanted
repetitive thoughts (obsessions) and/or actions
(compulsions)
– Ex. Obsession: thinking about catching a disease
– Ex. Compulsion: continually washing hands
– 2 to 3% of teens & young adults cross the line of
worry into OCD
Mood Disorders- DSM-IV classified
into 2 categories
• Mood disorders
psychological disorders characterized by
emotional extremes.
• 2 main presentations
– Major depressive disorder
– Bipolar disorder (formerly manic-depressive
disorder)
– Now each of these have become Classifications of
their own
Depressive Disorders
• Major Depressive Disorder
Includes lethargy, feeling of personal worthlessness,
or loss of interest in family, friends, & activites
• Symptoms experience for 2 or more weeks with no
identifiable cause
– “Common cold” of psychological disorders
– DSM-5 no longer excludes bereavement if grief lasts longer than 2 wks
– Whereas anxiety is a response to future loss, depression is the
response to past and current loss
– Anhedonia- a diminished ability to experience pleasure
– Usually accompanied anxiety, drug, alcohol abuse
– With or without therapy, episodes of major depression usually end
Depressive Disorders
• Persistent Depressive Disorder (old DSMIV…Dysthymic disorder): a down-in-the-dumps
mood that fills most of the day, nearly everyday for
two years or more
–
–
–
–
Less disabling than major depressive disorder
Experience chronic low energy and low self-esteem
Difficulty concentrating or making decisions
Sleep and eat too much or too little
Bipolar & Related Disorders
• Bipolar I Disorder:
– Alteration between depression and mania
• Manic episode: a abnormally & persistently expansive,
elevated, or irritable mood and increased goal-directed
activity or energy, lasting at least 1 week
• Typically over-talkative, overactive, elated (though easily
irritated), little need for sleep, shows fewer sexual
inhibitions
• Speech is loud, flighty, and hard to interrupt
• Grandiose optimism and high self-esteem
• High levels = reckless behavior
• Lower levels = creativity (Walt Whitman, Virginia Woolf, Edgar
Allen Poe, Mark Twain, Ernest Hemingway, Margot Kidder)
Bipolar & Related Disorders
• Bipolar II Disorder:
• Alteration between depression and mania
• Key Difference is hypomanic episode: period
of at least 4 consecutive days marked by a
abnormally and persistently elevated,
expansive, or irritable mood and abnormally
and persistently increased activity or energy
Research about Mood Disorders
• Women are twice as likely to experience depression
• Stressful events related to work, marriage, and close
relationships often preceded depression
• As with anxiety, the rate of depression is increasing
with each generation; adolescents are 3x more likely
to suffer than grandparents
Why Mood Disorders?
• Psychodynamic Perspective: depression happens
when significant losses evoke losses experienced in
childhood or current unresolved anger towards
parents gets turned inward
• Biological Perspective:
– More prominent in families and twins (depression &
bipolar)
– Looking for a gene connection through linkage analysis
– In depression: reduced levels of serotonin and
norepinephrine (increases arousal and boosts mood)
– In bipolar manic state: increased norepinephrine
– Small frontal lobes (7% decrease)
Why Mood Disorders?
• Social-Cognitive Perspective:
– Learned helplessness can lead to self-defeating beliefs
– 35% women & 16% men going into colleges feel
overwhelmed by all they have to do
– Negative thoughts feed negative moods….attributional
styles
– Rumination: staying focused on a problem
– Explanations of individuals who are depressed state things
as stable, global, and internal
– Seligman states that depression in young westerners stems
from the rise of individualism and the decline of
commitment to religion and family
Why Mood Disorders?
• Social-Cognitive Perspective:
– Negative moods feed negative thoughts…being in a
temporarily good or bad mood colors memories,
judgments, and expectations
– Cycle is often perpetuated by social rejection
1
Stressful
Experience
s
4
Cognitive &
Behavioral
Changes
3
Depressed
Mood
2
Negative
Explanatory
style
Why Mood Disorders?
• Social-Cognitive Perspective:
- Loneliness: painful awareness that social
relationships are deficient
- 4 Types:
- Excluded
- Unloved
- Constricted
- Alienated
Like people suffering with depression people ,with
loneliness tend to blame themselves and own
inadequacies for their social deficiencies
Suicide
• National Differences
– U.S.
• Racial Differences
– Whites/Blacks
• Gender Differences
– Men/Women
• Age/Trend
• Additional Differences
– Alcoholism
Schizophrenia Spectrum & Other Psychotic
Disorders
• Delusions- fixed beliefs that don’t change with contradictory
evidence (ex. Persecution, grandiosity, referential, etc.)
• Hallucinations- sensory experience without external stimuli
• Disorganized Thinking (Speech)- switching from topic to topic,
unrelated answers to questions, incoherent word salads
• Grossly Disorganized or Abnormal Motor Behavior (including
Catatonia)- too little or too much movement, no speech
• Negative Symptoms- diminished emotional expression,
avolition (lacking self-motivation), reduced speech,
experience of pleasure, and social interaction
Schizophrenia Spectrum & Other Psychotic
Disorders
• Schizophrenia
a group of severe PSYCHOTIC disorders characterized by 2 or
more of the previously listed symptoms for the majority of 1
month (disorganized and delusional thinking, disturbed
perceptions, and inappropriate emotions and actions) & leads
to impairment in major life areas with some disturbances for
at least 6 months
• Delusions: false beliefs, often of persecution or grandeur,
that may accompany psychotic disorders
• “I am Mary Poppins”
• Delusions of persecution = paranoid
• Word Salads- jumping from one idea or even within sentences
• This breakdown in selective attention
Schizophrenia
• Disturbed Perceptions
Perceiving things that are not there, most frequently auditory
hallucinations- sensory experiences without external
sensory stimulation….also see, feel, taste, and smell things
that are not there
Ex. Hear voices of insulting statements, tell them to burn
themselves
• “Split mind” experienced by nearly 1 in 100 people…over 20
million across the globe
Schizophrenia
• Inappropriate Emotions & Actions
- laughing at death
- angry or crying at wrong times
- Flat Affect- a zombielike state of apparent apathy,
an expressionless face
- awkward or inappropriate motor behaviorscontinually rocking or remaining motionless for hours
followed by agitation
Schizophrenia
• Positive symptoms- behavioral excesses or peculiarities,
such as hallucinations, delusions, bizarre behavior, and wild
flights of ideas
• Negative symptoms- behavioral deficits, such as flattened
emotions, social withdrawal, apathy, impaired attention, and
poverty of speech
Schizophrenia
• Subtypes of Schizophrenia
– Paranoid: Preoccupation with delusions or hallucination,
often with themes of persecution or grandiosity
– Disorganized: disorganized speech or behavior, or flat or
inappropriate emotion
– Catatonic: Immobility (or excessive, purposeless
movement), extreme negativism, and/or parrot-like
repeating of another’s speech or movements
– Undifferentiated: Many and varied symptoms
– Residual: withdrawal, after hallucinations and delusions
have disappeared
No longer divided into these subcategories…old DSM-IV method of classification,
which were present at time of diagnosis
Why Schizophrenia?
• Brain Abnormalities
– Dopamine overactivity- excess of receptors & is related to impaired
attention
– Neurodevelopmental hypothesis
– Brain anatomy
• Fluid-filled areas are abnormally large & thalamus is abnormally
small
– Maternal virus (flu)during mid-pregnancy
– Low birth weight and lack of oxygen during labor
• Genetic Factors
– Diathesis-stress model: people are predisposed to schizophrenia are more
vulnerable to stress than others
• Psychological Factors
– Expressed emotion: the degree to which a relative of a patient displays
highly critical or emotionally over-involved attitudes toward the
patient
Somatic Symptom & Related Disorders
• All disorders in this classification are associated with
significant distress and impairment…seen more with medical
disorders than with psychological disorders
• Somatic Symptom Disorder…a psychological disorder in which
the symptoms take a somatic (bodily) form without apparent
physical cause.
– Vomitting, dizziness, blurred vision, difficulty swallowing, or severed &
prolonged pain
Somatic Symptom & Related Disorders
• Illness Anxiety Disorder- (DSM-IV: hypochondriasis)
• Conversion Disorder- anxiety turns into a physical
symptom; unexplained paralysis, blindness, or
inability to swallow
• Factitious Disorder- falsification of physical or
psychological signs or symptoms or induction of
injury or disease, associated with identified
deception (can be for self or imposed on
another…called by Proxy)
Dissociative Disorders
• Dissociative Disorders: disorders in which conscious
awareness becomes separated (dissociated ) from previous
memories, thoughts, and feelings; the experience of a sudden
loss of memory or a change in identity
Dissociation: sense of being separated from your body as if
watching yourself; a sense of detachment
• Dissociative Amnesia & Dissociative Fugue
• Dissociative Identity Disorder: two or more
distinct personalities that alternate to control one’s
behavior
• Handedness may switch
• Sometimes memories transfer
• Biological visual changes may occur
Personality Disorders
• Personality Disorders: psychological disorders
characterized by inflexible and enduring behavior patterns
that impair social functioning p. 633 Chart
– Avoidant personality disorder: fearful sensitivity to rejection and thus
withdrawn
– Schizoid personality disorder: cluster of eccentric behaviors such as
social disengagement
– Histrionic personality disorder: dramatic or impulsive behaviors such
as shallow, attention-getting emotions and goes to great lengths to
earn praise and approval
– Narcissitic personality disorder: exaggeration of own importance and
fantasies success stories; often react to criticism with rage or shame
– Borderline personality disorder: unstable identity, relationships, and
emotions; overall unstable sense of self
Personality Disorders
• Antisocial personality disorder: a personality
disorder in which the person (usually a man) exhibits a lack
of conscience for wrongdoing, even toward friends and
family members.
•
•
•
•
Formerly sociopath or psychopath
May be aggressive and ruthless or a clever con artist
Typically male
May show signs by 3 to 6…impulsive, unconcerned with social
rewards, and low anxiety levels
• Lack of consciousness by 15- lie, steal, fight , unrestrained sexual
behavior
• As adults, cant keep job, poor spouse or parent, and assaultive
Neurodevelopmental Disorders
• Attention-Deficit Hyperactivity Disorder
(ADHD)
– inattention: six (or more) of the following
symptoms of inattention have persisted for at
least 6 months to a degree that is maladaptive
and inconsistent with developmental level
- hyperactivity-impulsivity: six (or more) of the
following symptoms of hyperactivity-impulsivity
have persisted for at least 6 months to a degree
that is maladaptive and inconsistent with
developmental level
Neurodevelopmental Disorders
• Autism Spectrum Disorder
A. Persistent deficits in social communication & social interaction
1. deficits in social-emotional reciprocity
2. deficits in nonverbal communication
3. deficits in developing, maintaining, and understanding
relationships
B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by a least 2 of the following,
currently or historically
1. stereotyped or repetitive motor movements, use of
objects, or speech 2. insistence on sameness and routines 3.
highly restricted or fixated interests 4. hyper or hyposensitivity to sensory input
Feeding & Eating Disorders
• Anorexia nervosa- usually adolescents; 9 out of 10 are
females. Drop far below normal weight but still feel fat, fear
being fat, and remain obsessed with losing weight
• Bulimia nervosa-mostly late teens or early twenties;
cycle of overeating and then compensatory vomitting, laxative
use, fasting, or excessive exercise (binging & purging); marked
weight fluctuations within normal weight range; so its easy to
hide
• Binge-eating disorder-new DSM-5 category that
invloves significant binge with remorse but not explusion or
excessive exercise
Guess Who?
1. I felt the need to clean my room at home in Indianapolis
every Sunday and would spend four to five hours at it. I would
take every books out of the bookcase, dust and put it back. At
the time I loved doing it. Then I didn’t want to do it anymore,
but I couldn’t stop. The clothes in my closet hung exactly two
fingers apart…I made a ritual of touching the wall in my
bedroom before I went outside because something bad was
going to happen if I didn’t do it the right way. I had a constant
anxiety about it as a kid, and it made me think for the first
time that I might be nuts.
Guess Who?
2.Whenever I get depressed it’s because I’ve lost a sense of self. I
can’t find reasons to like myself. I think I am ugly. I think non one
likes me…I become grumpy and short-tempered. Nobody
wants to be around ,e. I’m left alone. Being alone confirms I am
ugly and not worth being with. I think I am responsible for
everything that goes wrong.
3.Once I’ve done a crime, I just forget it. I think of killing like
smoking a cigarette, like another habit.
Guess Who?
4.Voices, like the roar of a crowd came. I felt like Jesus; I was
being crucified. It was dark. I just continued to huddle under
the blanket, feeling weak, laid bare and defenseless in a cruel
world I could no longer understand.
5.Tom, a 27-year-old electrician, complains of dizziness, sweating
palms, heart palpitations, and ringing in his ears. He feels edgy
and sometimes finds himself shaking. With reasonable success
he hides his symptoms from his family and co-workers.
Nevertheless, he has had few social contacts since the symptoms
began two years ago. He occasionally had to leave work. His
family doctor and a neurologist can find no physical problem.
Psychological Disorders & the Law
• Insanity- a legal status indicating that a person
cannot be held responsible for his or her actions
because of mental illness
• Involuntary commitment- people are hospitalized in
psychiatric facilities against their will
Psychological Disorders & Culture
• Culture-bound disorders- abnormal
syndromes found only in a few cultural groups
Practice Test
1. According to Thomas Szasz, abnormal behavior
usually involves:
a.
b.
c.
d.
Behavior that is statistically unusual
Behavior that deviates from social norms
A disease of the mind
Biological imbalance
Practice Test
Although Sue is plagued by a high level of dread, worry,
and anxiety, she still manages to meet her daily
responsibilities. Sue’s behavior:
a. Should not be considered abnormal, since her
adaptive functioning is not impaired
b. Should not be considered abnormal, since everyone
sometimes experiences worry and anxiety
c. can still be considered abnormal, since she feels
great personal distress
d. Involves both a and b
Practice Test
The fact that people acquire phobias of ancient sources
of threat (such as snakes) much more readily than
modern sources of threat (such as electrical outlets)
can be best explained by:
a. Classical conditioning
b. Operant conditioning
c. Observational conditioning
d. Preparedeness or an evolved module for fear
learning
Practice Test
Which of the following statements about dissociative
identity disorder is true?
a. The original personality is always aware of the
alternate personalities
b. The transitions between personalities are usually
very gradual
c. The personalities are typically all quite similar to
one another
d. Starting in the 1970s, a dramatic increase occurred
in the diagnosis of dissociative identity disorder
Practice Test
People with unipolar disorders experience
___________; people with bipolar disorders are
vulnerable to ___________.
a. Alternating periods of depression and mania; mania
only
b. Depression only; alternating periods of depression
and mania
c. Mania only; alternating periods of depression and
mania
d. Alternating periods of depression and mania;
depression and mania simultaneously
Practice Test
A concordance rate indicates:
a. The percentage of relatives who exhibit the same
disorder
b. The percentage of people with a given disorder who
are currently receiving treatment
c. The prevalence of a given disorder in the general
population
d. The rate of cure for a given disorder
Practice Test
People who consistently exhibit __________ thinking
are more vulnerable to depression than others.
a. Overly optimistic
b. Negative, pessimistic
c. Delusional
d. Disorganized
Practice Test
Mary believes that while she sleeps at night, space
creatures are attacking her and invading her uterus,
where they will multiply until they are ready to take
over the world. Mary was chosen for this task, she
believes, because she is the only one with the power
to help the space creatures to succeed. Mary would
most likely be diagnosed as _______ schizophrenic.
a. Paranoid
b. Catatonic
c. Disorganized
d. Undiffereniated
Practice Test
It was once proposed that schizophrenic disorders be
divided into just two categories based on:
a.
b.
c.
d.
Whether the prognosis is favorable or unfavorable
Whether the disorder is mild or severe
The predominance of thought disturbances
The predominance of negative symptoms versus
positive symptoms
Practice Test
Most of the drugs that are useful in the treatment of
schizophrenia are known to dampen ________
activity in the brain, suggesting that increases in the
activity of this neurotransmitter may contribute to
the development of the disorder.
a. Norepinephrine
b. Serotonin
c. Acetycholine
d. Dopamine
Practice Test
The main problem with the current classification
scheme for personality disorders is that:
a. It falsely implies that nearly everyone has at least
one personality disorder
b. The criteria for diagnosis are so detailed and
specific that even extremely disturbed people fail to
meet them
c. The categories often overlap, making diagnosis
unreliable
d. It contains too few categories
Practice Test
The diagnosis of antisocial personality disorder would
apply to an individual who:
a. Withdraws from social interaction due to an intense
fear of rejection or criticism
b. Withdraws from social interaction due to a lack of
interest in interpersonal intimacy
c. Is emotionally cold, suspicious of everyone, and
overly concerned about being slighted by others
d. Callous, impulsive, and manipulative
Practice Test
Involuntary commitment to a psychiatric facility:
a. Can occur only after a mentally ill individual has
been convicted of a violent crime
b. Usually occurs because people appear to be a
danger to themselves or others
c. No longer occurs under modern civil law
d. Will be a lifelong commitment, even if the individual
is no longer mentally ill
Practice Test
Those who embrace a relativistic view of psychological
disorders would agree that:
a. The criteria of mental illness vary considerably
across cultures
b. There are universal standards of normality and
abnormality
c. Western diagnostic concepts have validity and
utility in other cultural contexts
d. Both b and c are true
Practice Test
About _______ of patients with eating disorders are
female.
a.
b.
c.
d.
40%
50-60%
75%
90-95%
Therapy
Categories of Therapy
• 1. Psychological therapies: (insight therapies)
– Employ structured interactions (usually verbal) between
trained professional and a client with a problem
– Psychotherapy: an emotionally charged, confiding
interaction between a trained therapist and someone who
suffers from psychological difficulties; 250 types identified
– Eclectic approach: an approach to psychotherapy that,
depending on the client’s problems uses techniques from
various forms of therapy
• 2. Biomedical therapies:
– Therapies that act directly on the patient’s nervous system
(i.e. drug therapy, ECT, & psychosurgery)
•3. Behavioral therapies: based on principles of learning
Psychoanalysis
• Psychoanalysis: Sigmund Freud’s therapeutic technique
involving free associations, resistances, dreams, and
transferences- and the therapist’s interpretations of themreleased previously repressed feelings, allowing the patient to
gain self-insight.
– Goal: to bring repressed feelings of the past to light to deal
with them
– Methods:
• Free Association: saying whatever comes to mind at the
thought of a memory, dream, or experience
• Resistance: in psychoanalysis, the blocking from
consciousness of anxiety-laden material
• Ex. Stuttering , changing the subject, or blanking out
Psychoanalysis
• 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 (such as
love or hatred of a parent);
– Thought to be helpful and aid the process of therapy b/c
you can work through the issues safely
Psychoanalysis is quite expensive and can occur for multiple
sessions per week for years
Psychoanalysis
• Psychodynamic Perspective
– Aligns with some of Freud’s theories but not all of his
techniques for therapy
– May meet once per week face-to-face but only for a few
weeks or months
• Interpersonal psychotherapy:
– Brief 12-16 sessions
– Alternative to psychdynamic perspective that works for
depression
– Helps to gain insight into roots of problems and progress
through current relationship struggles
Humanistic Therapies
• Humanistic Therapies focus on:
– The present and future; exploring feelings as they
occur rather than insight from childhood
– Conscious rather than unconscious thoughts
– Taking immediate responsibility for one’s feelings
and actions
– Promoting growth instead of curing illness
• Gestalt Therapy: push to take control of their
future by directly questioning and challenging
clients about their feelings & problems
• Dream interpretation, role playing, awareness of
whole being
Humanistic Therapies
• Client-centered therapy:
– Developed by Carl Rogers in which the therapist uses
techniques such as active listening within a genuine,
accepting, empathic environment to facilitate clients’
growth (aka. Person-centered therapy)
– Active listening: empathic listening in which the listener
echoes, restates, and clarifies. A feature of Roger’s clientcentered therapy
1. Paraphrasing: checking your understanding
2. Inviting clarification: “what might be an example of…?”
3. Reflecting feelings: mirroring what you sense from body
language and intensity
Behavioral Therapies
• Behavior therapy: therapy that applies learning principles
to the elimination of unwanted behaviors
– Do not try to delve into the inner causes or emphasize clarifying or
enhancing one’s sense of self
Classical Conditioning is applied to multiple
situations….one being bed-wetting.
– Liquid-sensitive pad is used and alarms when child begins
to urinate, waking up child and stopping bed-wetting
– Overall, maladaptive behaviors are considered to be
conditioned responses
Behavioral Therapies
• Counterconditioning: a procedure that conditions new
response to stimuli that trigger unwanted behaviors; includes
systematic desensitization and aversive conditioning
• Exposure Therapy: most widely used behavioral
techniques that treat anxieties by exposing people, in
imagination or actuality, to the things they fear and avoid
– Systematic desensitization: a type of exposure therapy
that associates a pleasant relaxed state with gradually
increasing anxiety-triggering stimuli. Commonly used to
treat phobias
– Aversive conditioning: a type of counterconditioning
that associates an unpleasant state (such as nausea) with
an unwanted behavior (such as drinking alcohol)
– Flooding
Behavioral Therapies
• Operant Conditioning: Behavior Modification
– Token economy: an operant conditioning
procedure that rewards desired behavior; a
patient exchanges a token of some sort, earned
for exhibiting the desired behavior, for various
privileges or treats
– Behavior Modification
– Social skills training
Concerns with behavior modification are:
1. What happens when reinforcers stop or they become too
extrinsically motivated?
2. Is it ethical to control others’ behaviors?
Cognitive Therapies
• Cognitive Therapy: therapy that teaches people
new, more adaptive ways of thinking and acting;
based on the assumption that thoughts intervene
between events and our emotional reactions &
disturbances develop from irrational interpretations
of events
– Reverse clients’ catastrophic beliefs about themselves,
their situations, and their futures
– Depressed people shouldn’t blame themselves for things
beyond their control
– Ex. Approach would be having people acknowledge their
skill sets and the positive aspects of themselves
Cognitive Therapies
• Cognitive-Behavioral Therapy: a popular integrated
therapy that combines cognitive therapy (changing
self-defeating thinking) with behavior therapy
(changing behavior)
– aims to alter the way people act (behavior therapy)
– Alter the way they think (cognitive therapy)
– Make people aware of irrational , negative thinking and
replace it with new ways
– Practice a more positive approach to each day
– Rational Emotive Therapy (REBT )- Ellis
– Cognitive Triad Therapy- Beck (Depression)
Group & Family Therapies
• Usually suggested for people experiencing family
conflicts or those whose behavior is distressing
others
– Up to 90 minutes a week
– 6-10 people engage and interact with issues
– Benefit:
- discover not alone
- try new techniques
- receive feedback
• More than 10 million Americans belong to small religious,
interest, or self-help groups regularly and 90% report
supporting one another emotionally
Group & Family Therapies
• Couples or Marital Therapy: involves the treatment of both
partners in a commited, intimate relationship, in which the
main focus is on relationship issues
• Family Therapy: therapy that treats the family as a system and
attempts to examine a person’s role within a social 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
Evaluating Psychotherapies
• Client’s Perceptions
– ¾ satisfied; ½ very satisfied
– 9/10 were feeling very good, good, or at least soso
– Regression towards the mean: the tendency for
unusual events (or emotions) to “regress” (return)
toward their average state
• Clinicians’ Perceptions
Evaluating Psychotherapies
• Outcome Research
Meta-analysis: a procedure for statistically
combining the results of many different research
studies
Ex. 475 studies
- 80% of the untreated people have poorer
outcomes than the average treated person
Placebo effect: found to be beneficial consequences
of the expectation that treatment will be effective
Spontaneous remission: is a recovery from a
disorder that occurs without formal treatment
Evaluating Alternative Psychotherapies
• Eye Movement Desensitization & Reprocessing
(EMDR)
– While imagining traumatic scenes, the eyes are guided to
move and this reduces distress
• Light Exposure Therapy
– Developed to relieve symptoms of depression
Cultures & Values in Psychotherapy
• Read pages 683-684 & take notes
Biomedical Therapies
• Psychopharmacology: the study of the effects of
drugs(meducation) on the mind and behavior
• Anti-psychotic drugs (neuroleptics)
– Most help given to patients with schizophrenia for
auditory hallucinations and paranoia
– In excess can result in sluggishness, tremors, and twitches
similar to Parkinson’s disease
– Tardive Dyskinesia- a neurological disorder marked by
involuntary writhing and ticlike movements of the mouth,
tongue, face, hands, or feet
• Anti-anxiety drugs (anxiolytics/tranquilizers) (types p687)
Biomedical Therapies
• Anti-depressant drugs (great summary in Review Bk)
– Alternative for depression is aerobic exercise
– Lithium (mood stabilizers): a chemical that provides an
effective drug therapy for mood swings of bipolar disorder
• Electro-convulsive therapy (ECT): a biomedical
therapy for severely depressed patients in which a
brief electric current is sent through the brain of an
anesthetized patient
– Can result in slight loss of memory
Biomedical Therapies
• Psychosurgery: surgery that removes or destroys
brain tissue in an effort to change behavior
– In past Lobotomies, which cut the nerves
connecting the frontal lobe to the emotioncontrolling centers in the brain
– Psychosurgery is the least likely type of therapy to
be used today
Biomedical Therapies
• New Brain Stimulation Techniques
– Transcranial Magnetic Stimulation (TMS)
• A technique that permits scientists to temporarily
enhance or depress activity in a specific area
– Deep Brain Stimulation (DBS)
• A thin electrode is surgically implanted in the brain and
connected to an implanted pulse generator so that
various electrical currents can be delivered to brain
tissue adjacent to the electrode
Preventing Psychological Disorders
According to George Albee there is abundant
evidence that poverty, meaningless work, constant
criticism, unemployment, racism, and sexism
undermine people’s sense of competence, personal
control, and self-esteem….and such stress increase
their risk of depression, alcoholism, and suicide.
Practice Test
After undergoing psychoanalysis for several months,
Karen has suddenly started “forgetting” to attend her
therapy sessions. Karen’s behavior is most likely a
form of:
a.
b.
c.
d.
Resistance
Transference
Insight
Catharsis
Practice Test
Because Suzanne has an unconscious sexual attraction
to her father, she behaves seductively toward her
therapist. Suzanne’s behavior is most likely a form of:
a.
b.
c.
d.
Resistance
Transference
Misinterpretation
An unconscious defense mechanism
Practice Test
The key process in client-centered therapy is:
a. Interpretation of the client’s thoughts, feelings,
memories, and behaviors
b. Clarification of the client’s feelings
c. Confrontation of the client’s irrational thoughts
d. Modification of the client’s problematic behaviors
Practice Test
The goal of behavior therapy is to:
a. Identity the early childhood unconscious conflicts
that are the source of the client’s symptoms
b. achieve major personality reconstruction
c. Reduce or eliminate problematic responses by using
conditioning techniques
d. Alter the client’s brain chemistry by prescribing
specific drugs
Practice Test
A therapist openly challenges a client’s statement that
she is a failure as a woman because her boyfriend
left her, insisting that she justify it with evidence.
Which type of therapy is probably being used?
a.
b.
c.
d.
Psychodynamic therapy
Client-centered therapy
Aversion therapy
Cognitive therapy
Practice Test
Collectively, numerous students of therapeutic
outcome suggest that:
a. Insight therapy is superior to no treatment or
placebo treatment
b. Individual insight therapy is effective, but group
therapy is not
c. Group therapy is effective, but individual insight
therapy is not
d. Insight therapy is only effective if patients are in
therapy for a least two years
Practice Test
Systematic desensitization is an effective treatment
for__________ disorders.
a.
b.
c.
d.
Generalized anxiety
Panic
Obsessive-compulsive
phobic
Practice Test
Linda’s therapist has her practice active listening skills
in structured role-playing exercises. Later, Linda is
gradually asked to practice these skills with family
members, friends, and finally, her boss. Linda is
undergoing
a.
b.
c.
d.
Systematic desensitization
Biofeedback
A token economy procedure
Social skills training
Practice Test
After being released from a hospital, many
schizophrenic patients stop taking their antipsychotic
medication because:
a.
b.
c.
d.
Their mental impairment causes them to forget
Of the unpleasant side effects
Most schizophrenics don’t believe they are ill
Of all of the above
Practice Test
Selective serotonin reuptake inhibitors (SSRIs) can be
effective in the treatment of ________ disorders.
a.
b.
c.
d.
Depressive
Schizophrenic
Obsessive-compulsive
Both a and c
Practice Test
Modern psychotherapy:
a. Was spawned by a cultural milieu that viewed the
self as an independent, rational being
b. Embraces universal cultural values
c. Has been successfully exported to many nonWestern cultures
d. Involves both b and c
Practice Test
The community mental health movement emphasizes:
a. Segregation of the mentally ill from the general
population
b. Increased dependence on long-term inpatient care
c. Local care and the prevention of psychological
disorders
d. All of the above
Practice Test
Many people repeatedly go in and out of mental
hospitals. Typically, such people are released because
__________; they are eventually readmitted because
_____________________.
a. They have been stabilized through drug therapy;
their condition deteriorates once again due to
inadequate outpatient care
b. They run out of funds to pay for hospitalization; they
once again can afford it
c. They have been cured of their disorder; they develop
another disorder
d. They no longer want to be hospitalized; they
voluntarily recommit themselves
Practice Test
The type of professional training a therapist has:
a. Is the most important indicator of his or her
competence
b. Should be a major consideration in choosing a
therapist
c. Is not all that important, since talented therapists
can be found in all of the mental health professions
d. Involves both a and b
Practice Test
Which of the following could be explained by
regression toward the mean?
a. You get an average bowling score in one game and a
superb score in the next game
b. You get an average bowling score in one game and a
very low score in the next game
c. You get an average bowling score in one game and
another average score in the next game
d. You get a terrible bowling score in one game and an
average score in the next game