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PSYCHOLOGY (9th Edition) David Myers PowerPoint Slides Aneeq Ahmad Henderson State University Worth Publishers, © 2010 1 Psychological Disorders Chapter 14 2 Psychological Disorders Perspectives on Psychological Disorders Defining Psychological Disorders Understanding Psychological Disorders Classifying Psychological Disorders Labeling Psychological Disorders 3 Anxiety Disorders Generalized Anxiety Disorder Panic Disorder Phobias Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Understanding Anxiety Disorders Somatoform Disorders 4 Dissociative Disorders Dissociative Identity Disorder Understanding Dissociative Identity Disorder Mood Disorders Major Depressive Disorder Bipolar Disorder Understanding Mood Disorders 5 Schizophrenia Symptoms of Schizophrenia Onset and Development of Schizophrenia Understanding Schizophrenia Personality Disorders Antisocial Personality Disorder Understanding Antisocial Personality Disorder Rates of Psychological Disorders 6 Psychological Disorders I felt the need to clean my room … would spend four to five hours at it… At the time I loved doing it. Then I didn't want to do it any more, but I couldn’t stop… The clothes hung… two fingers apart… I touched my bedroom wall before leaving the house… I had constant anxiety… I thought I might be nuts. Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996) 7 Psychological Disorders People are fascinated by the exceptional, the unusual, and the abnormal. This fascination may be caused by two reasons: 1. During various moments we feel, think, and act like an abnormal individual. 2. Psychological disorders may bring unexplained physical symptoms, irrational fears, and suicidal thoughts. 8 Psychological Disorders To study the abnormal is the best way of understanding the normal. William James (1842-1910) 1. There are 450 million people suffering from psychological disorders (WHO, 2004). 2. Depression and schizophrenia exist in all cultures of the world. 9 Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered (Comer, 2004). 10 Deviant, Distressful & Dysfunctional Carol Beckwith 1. Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest. 2. Deviant behavior must accompany distress. 3. If a behavior is dysfunctional it is clearly a disorder. In the Wodaabe tribe men wear costumes to attract women. In Western society this would be considered abnormal. 11 Understanding Psychological Disorders Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. John W. Verano Trephination (boring holes in the skull to remove evil forces) 12 The Medical Model Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago Dance in the madhouse. 13 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1. 2. 3. 4. Etiology: Cause and development of the disorder. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. Treatment: Treating a disorder in a psychiatric hospital. Prognosis: Forecast about the disorder. 14 The Biopsychosocial Approach Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders. 15 Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. 16 Multiaxial Classification Axis I Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Is a Personality Disorder or Mental Retardation present? Is a General Medical Condition (diabetes, Axis III hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems Axis IV (school or housing issues) also present? What is the Global Assessment of the person’s Axis V functioning? 17 Multiaxial Classification Note 16 syndromes in Axis I 18 Multiaxial Classification Note Global Assessment for Axis V 19 Goals of DSM 1. 2. Describe (400) disorders. Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Others criticize DSM-IV for “putting any kind of behavior within the compass of psychiatry.” 20 Labeling Psychological Disorders 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press. Asylum baseball team (labeling) 21 Labeling Psychological Disorders 2. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. 22 Labeling Psychological Disorders Elaine Thompson/ AP Photo 3. “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. Theodore Kaczynski (Unabomber) 23 Anxiety Disorders Feelings of excessive apprehension and anxiety. 1. 2. 3. 4. 5. Generalized anxiety disorder Panic disorder Phobias Obsessive-compulsive disorder Post-traumatic stress disorder 24 Generalized Anxiety Disorder Symptoms 1. Persistent and uncontrollable tenseness and apprehension. 2. Autonomic arousal. 3. Inability to identify or avoid the cause of certain feelings. 25 Panic Disorder Symptoms Minutes-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. Anxiety is a component of both disorders. It occurs more in the panic disorder, making people avoid situations that cause it. 26 Phobias Marked by a persistent and irrational fear of an object or situation that disrupts behavior. 27 Kinds of Phobias Agoraphobia Acrophobia Claustrophobia Hemophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. Phobia of blood. 28 Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. 29 Brain Imaging A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Brain image of an OCD 30 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD): 1. Haunting memories 2. Nightmares 3. Social withdrawal Bettmann/ Corbis 4. Jumpy anxiety 5. Sleep problems 31 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Holocaust survivors show remarkable resilience against traumatic situations. All major religions of the world suggest that surviving a trauma leads to the growth of an individual. 32 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. 33 The Learning Perspective John Coletti/ Stock, Boston Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced. 34 The Learning Perspective Investigators believe that fear responses are inculcated through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes. 35 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias. 36 The Biological Perspective S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353. Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex. Anterior Cingulate Cortex of an OCD patient. 37 Dissociative Disorders Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms 1. Having a sense of being unreal. 2. Being separated from the body. 3. Watching yourself as if in a movie. 38 Dissociative Identity Disorder (DID) A disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. Lois Bernstein/ Gamma Liason Chris Sizemore (DID) 39 DID Critics Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries. Critics’ Arguments 1. Role-playing by people open to a therapist’s suggestion. 2. Learned response that reinforces reductions in anxiety. 40 Mood Disorders Emotional extremes of mood disorders come in two principal forms. 1. Major depressive disorder 2. Bipolar disorder 41 Major Depressive Disorder Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002). Blue mood Major Depressive Disorder Gasping for air after a hard run Chronic shortness of breath 42 Major Depressive Disorder Major depressive disorder occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions. 1. 2. 3. 4. Signs include: Lethargy and fatigue Feelings of worthlessness Loss of interest in family & friends Loss of interest in activities 43 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Tired Slowness of thought Desire for action Hyperactive Multiple ideas 44 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Earl Theissen/ Hulton Getty Pictures Library The Granger Collection Wolfe George C. Beresford/ Hulton Getty Pictures Library Bettmann/ Corbis Whitman Clemens Hemingway 45 Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn et al., (1985, 1998) note that a theory of depression should explain the following: 1. Behavioral and cognitive changes 2. Common causes of depression 46 Theory of Depression 3. Gender differences 47 Theory of Depression 4. Depressive episodes self-terminate. 5. Stressful events often precede depression. 6. Depression is increasing, especially in the teens. Desiree Navarro/ Getty Images Post-partum depression 48 Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide. 1. 2. 3. 4. 5. Suicide Statistics National differences Racial differences Gender differences Age differences Other differences 49 Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Jerry Irwin Photography Linkage analysis and association studies link possible genes and dispositions for depression. 50 The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine 51 Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles. 52 Negative Thoughts and Moods Explanatory style plays a major role in becoming depressed. 53 Depression Cycle 1. Negative stressful events. 2. Pessimistic explanatory style. 3. Hopeless depressed state. 4. These hamper the way the individual thinks and acts, fueling personal rejection. 54 Schizophrenia The literal translation is “split mind” which refers to a split from reality. A group of severe disorders characterized by the following: 1. Disorganized and delusional thinking. 2. Disturbed perceptions. 3. Inappropriate emotions and actions. 55 Symptoms of Schizophrenia Positive symptoms: the presence of inappropriate behaviors (hallucinations, disorganized or delusional talking) Negative symptoms: the absence of appropriate behaviors (expressionless faces, rigid bodies) 56 Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Mary Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” (Sheehan, 1982) Other forms of delusions delusions of This monologue illustratesinclude, fragmented, bizarre persecution is following me”) or thinking with (“someone distorted beliefs called delusions grandeur (“I am a king”). (“I’m Mary Poppins”). 57 Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). 58 Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg 59 Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (flat affect). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia). 60 Onset and Development of Schizophrenia Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002). Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women. 61 Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms. 62 Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. 63 Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health 64 Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC 65 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. 66 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001). 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated 67 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 68 Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicol & Gottesman, 1983). Courtesy of Genain Family Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. 69 Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. 70 Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath. 71 Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age. 72 Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study, repeat offenders had 11% less frontal lobe activity (Raine et al., 1999; 2000). Courtesy of Adrian Raine, University of Southern California Normal Murderer 73 Rates of Psychological Disorders 74 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004). 75 Therapy Chapter 15 76 The Psychological Therapies Psychoanalysis Humanistic Therapies Behavior Therapies Cognitive Therapies Group and Family Therapies 77 Evaluating Psychotherapies Is Psychotherapy Effective? The Relative Effectiveness of Different Therapies Evaluating Alternative Therapies Commonalities Among Psychotherapies Culture and Values in Psychotherapy 78 The Biomedical Therapies Drug Therapies Brain Stimulation Psychosurgery Therapeutic Life-Style Changes Preventing Psychological Disorders 79 History of Insane Treatment Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, and downright dangerous treatments. The Granger Collection The Granger Collection 80 History of Insane Treatment Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick. Culver Pictures http://wwwihm.nlm.nih.gov Philippe Pinel (1745-1826) Dorthea Dix (1802-1887) 81 Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders. An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems. 82 Psychological Therapies We will look at four major forms of psychotherapies based on different theories of human nature: 1. 2. 3. 4. Psychoanalytic theory Humanistic theory Behavioral theory Cognitive theory 83 Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Edmund Engleman Sigmund Freud's famous couch 84 Psychoanalysis: Aims Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. 85 Psychoanalysis: Methods Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks about whatever comes to his or her mind. http://www.english.upenn.edu 86 Psychoanalysis: Methods During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up and reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. 87 Psychoanalysis: Criticisms 1. Psychoanalysis is hard to refute because it cannot be proven or disproven. 2. Psychoanalysis takes a long time and is very expensive. 88 Psychodynamic Therapy Influenced by Freud, in a face-to-face setting, psychodynamic therapists understand symptoms and themes across important relationships in a patient’s life. 89 Psychodynamic Therapies Interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here and now, not an overall personality change. 90 Humanistic Therapies Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance. 91 Client-Centered Therapy Developed by Carl Rogers, client-centered therapy is a form of humanistic therapy. The therapist listens to the needs of the patient in an accepting and non-judgmental way, addressing problems in a productive way and building his or her self-esteem. 92 Humanistic Therapy The therapist engages in active listening and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings. Michael Rougier/ Life Magazine © Time Warner, Inc. 93 Behavior Therapy Therapy that applies learning principles to the elimination of unwanted behaviors. To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes. 94 Classical Conditioning Techniques Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors. It is based on classical conditioning and includes exposure therapy and aversive conditioning. 95 Exposure Therapy The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved. Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared. 96 Exposure Therapy Exposure therapy involves exposing people to fear-driving objects in real or virtual environments. Both Photos: Bob Mahoney/ The Image Works N. Rown/ The Image Works 97 Systematic Desensitization A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. 98 Aversive Conditioning A type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported. 99 Operant Conditioning Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished. A number of withdrawn, uncommunicative 3-year-old autistic children have been successfully trained by giving and withdrawing reinforcements for desired and undesired behaviors. 100 Token Economy In institutional settings, therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. 101 Cognitive Therapy Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions. 102 Beck’s Therapy for Depression Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression. Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients. 103 Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.” 104 Cognitive-Behavior Therapy Cognitive therapists often combine the reversal of self-defeated thinking with efforts to modify behavior. Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy). 105 Group & Family Therapies Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. © Mary Kate Denny/ PhotoEdit, Inc. 106 Family Therapy Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication. 107 Evaluating Therapies Who do people turn to for help with psychological difficulties? 108 Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. 1. 2. 3. Does the patient sense improvement? Does the therapist feel the patient has improved? How do friends and family feel about the patient’s improvement? 109 Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. 1. 2. 3. Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). Clients may need to believe the therapy was worth the effort. Clients generally speak kindly of their therapists. 110 Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. 1. 2. 3. Clinicians are aware of failures, but they believe failures are the problem of other therapists. If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment. 111 Outcome Research How can we objectively measure the effectiveness of psychotherapy? Meta-analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy. 112 Outcome Research Research shows that treated patients were 80% better than untreated ones. 113 The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? Disorder Therapy Depression Behavior, Cognition, Interpersonal Anxiety Cognition, Exposure, Stress Inoculation Bulimia Cognitive-behavior Phobia Behavior Bed Wetting Behavior Modification 114 Evaluating Alternative Therapies 57% of those who have had anxiety attacks and 54% who have had depression have used alternative treatments such as herbal medicines, massage, and spiritual healing (Kessler & others, 2001). Do alternative therapies hold up under scientific scrutiny? 115 Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. EMDR has not held up under scientific testing. 116 Light Exposure Therapy Courtesy of Christine Brune Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated. 117 Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are the following: © Mary Kate Denny/ PhotoEdit, Inc. 1. A hope for demoralized people. 2. A new perspective. 3. An empathic, trusting and caring relationship. 118 Culture and Values in Psychotherapy Psychotherapists may differ from each other and from clients in their personal beliefs, values, and cultural backgrounds. A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable. 119 Therapists & Their Training Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. 120 Therapists & Their Training Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers. Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications. 121 The Biomedical Therapies These include physical, medicinal, and other forms of biological therapies. 1. Drug Therapies 2. Brain Stimulation 3. Psychosurgery 122 Drug Therapies Psychopharmacology is the study of drug effects on mind and behavior. With the advent of drugs, hospitalization in mental 123 institutions has rapidly declined. Drug Therapies However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society. Les Snider/ The Image Works 124 Double-Blind Procedures To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo. 125 Antipsychotic Drugs Classical antipsychotics [chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations. Atypical antipsychotics [clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others. 126 Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia. 127 Antianxiety Drugs Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter. 128 Antidepressant Drugs Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. 129 Mood-Stabilizing Medications Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters. 130 Brain Stimulation Electroconvulsive Therapy (ECT) ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. 131 Alternatives to ECT Repetitive Transcranial Magnetic Stimulation (rTMS) In rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. 132 Psychosurgery http://www.epub.org.br Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. 133 Psychosurgery Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind. 134 Preventing Psychological Disorders “It is better to prevent than cure.” Peruvian Folk Wisdom Preventing psychological disorders means removing the factors that affect society. Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, and sexism. 135 Psychological Disorders are Biopsychosocial in Nature 136