Download Chapter 16-Psychotherapy - Department of Psychology

Chapter 15-Psychological
Disorders
Psychology of Life Skills
August 13th, 2008
Criteria of Abnormal Behavior
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What makes someone ‘abnormal?’
Criteria of Abnormal Behavior:
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Deviance
Maladaptive Behavior
Personal Distress
Viewed as disordered when only one criterion
met.
Continuum:
Normal -------------------------- Abnormal
Classification of Disorders
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Five Axes:
I: Clinical Syndromes (anxiety, schizophrenia)
II: Personality Disorders (antisocial personality)
III: General Medical Conditions (diabetes)
IV: Psychosocial & Environmental Problems (stress)
V: Global Assessment of Functioning (scale of 1-100)
Prevalence of Psychological
Disorders
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44% of adult population will struggle with psych.
Disorder at some point in their life
Anxiety Disorders
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A class of disorders marked by feelings of
excessive apprehension and anxiety.
Anxiety Disorders
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Generalized Anxiety Disorder (GAD)
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Phobic Disorder
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Chronic, ‘free-floating’ anxiety
Not tied to a specific threat
Persistent and irrational fear of an object/situation
that presents no real danger.
Panic Disorder
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Recurrent attacks of overwhelming anxiety—usually
occur suddenly and unexpectedly.
Anxiety Disorders
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Obsessive-Compulsive Disorder (OCD)
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Persistent, uncontrollable intrusions of unwanted
thoughts (obsessions) and urges to engage in
senseless rituals (compulsions).
Etiology (Cause) of Anxiety
Disorders
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Biology
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Temperament and sensitivity might make some
people more vulnerable to anxiety disorders.
Neurotransmitters: GABA and serotonin.
Learning
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An originally neutral stimulus (dog) paired with
frightening event (attack).
Person then avoids stimulus.
Etiology of Anxiety Disorders
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Cognitive Factors
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Misinterpret harmless situations as threatening
Focus excessive attention on perceived threats
Selectively recall info that seems threatening
“The Dr. examined little Emma’s growth.”
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Stress
Dissociative Disorders
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Class of disorders in which people lose contact
with consciousness/memory.
Results in disruption of sense of identity.
Dissociative Disorders
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Dissociative Amnesia
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Dissociative Fugue
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Sudden loss of memory—too extensive to be normal
forgetting.
Loss of memory for personal identity.
Dissociative Identity Disorder
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Co-existence in one person of two or more largely
complete and different personalities.
Dissociative Disorders are
Weird!
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Really?
How often have you:
Suddenly realized when driving, that you don’t remember what has
happened during all or part of the trip?
Found that you can’t remember whether or not you have just done
something or perhaps had just thought about doing it?
Realized when you are listening to someone talk that you didn’t hear
part or all of what the person said?
Causes of Dissociative Disorders
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Personality traits like fantasy-proneness?
Patients faking?
Clinicians creating?
A dissociative reaction to trauma?
Mood Disorders
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A class of disorders marked by disturbances in
emotion/mood.
Tend to be episodic (come and go)
Typically last 3-12 months
Unipolar: Emotional extremes involving
depression.
Bipolar: Emotional extremes of both depression
and mania.
Mood Disorders
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Major Depressive Disorder (MDD)
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Persistent feelings of sadness and despair and loss of
interest in previous sources of pleasure.
Multiple episodes
Bipolar Disorder
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Marked by the experience of both depressed and
manic periods (alternating cycles).
1—2.5% of population affected.
Causes of Mood Disorders
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Genetic Vulnerability
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Neurochemical Factors
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Strong evidence for biological component
Twin studies
Norepinephrine and serotonin
Cognitive Factors
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Learned Helplessness
Pessimistic Explanatory Style
Hopelessness Theory
Cause and Effect?
Causes of Mood Disorders
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Interpersonal Roots
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Inadequate social skills
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Stress
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Most likely an interaction of factors!
Schizophrenic Disorders
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Class of disorders marked by disturbances in
thought that affect perceptual, social, and
emotional processes.
1% of population affected.
Schizophrenic Disorders
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General Symptoms
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Irrational Thought
Deterioration of Adaptive Behavior
Distorted Perception
Disturbed Emotion
Schizophrenic Disorders
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Two classes of symptoms:
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Positive: Hallucinations, delusions, bizarre behavior.
Negative: Flattened emotions, social withdrawal,
apathy.
Causes of Schizophrenia
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Genetic Vulnerability
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Neurochemical
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Too much dopamine
Brain Abnormalities
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Strong evidence from twin studies
Enlarged ventricles
Frontal Lobes
Neurodevelopmental
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Disruptions to the brain before or at birth
Discussion Question:
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Recent editions of the DSM include everyday
problems that are not traditionally thought of as
mental illnesses (e.g., developmental
coordination disorder, nicotine dependence
disorder). Do you think it's appropriate for these
kinds of problems to be included among severe
psychological disorders such as multiplepersonality disorder and schizophrenia?
Discussion Question:
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If a person does not pose a threat to
anyone else and is not unhappy with his
or her behavior, but is socially deviant
(e.g., a transvestite), should that person
be considered abnormal and mentally ill?
Chapter 16-Psychotherapy
What is Psychotherapy?
• An umbrella term including many types of
therapies/treatments.
• Three Main Elements:
– Helping Relationship (treatment)
– Professional with special training (therapist)
– Person in need of help (client)
Who Seeks Therapy?
• 15% of US population/year
• Two most common problems:
– Anxiety
– Depression
• Women more likely to seek therapy than men.
• Many people who need therapy don’t receive it.
Who Provides Treatment?
• Psychologists
– Clinical and Counseling
– Must have doctoral degree
• Psychiatrist
– Must go to medical school (M.D.)
– Emphasize drug therapies
• Psychiatric Social Workers
• Psychiatric Nurses
• Counselors
INSIGHT THERAPIES
• Involve verbal interactions intended to enhance
clients’ self-knowledge and thus promote healthful
changes in personality and behavior.
Client-Centered Therapy
• Proponent: Carl Rogers
• Goal: Foster self-acceptance and personal growth.
• Techniques:
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Genuineness
Unconditional Positive Regard
Empathy
Clarification
Cognitive Therapy
• Proponent: Aaron Beck
• Goal: Change the way clients think.
• Techniques:
– Detect automatic negative thoughts
– Subject automatic thoughts to reality testing
– ‘Thought Records’—Homework!
THOUGHT RECORD
Evaluating Insight Therapies
• Insight therapy superior to no treatment or placebo
treatment, and effects are relatively durable.
• Problems with Evaluating Therapy:
– Allegiance Effect
– Mechanisms of Action/Common Factors
BEHAVIOUR THERAPY
• Involve the application of the principles of learning
to direct efforts to change client’s maladaptive
behaviors.
• Two Premises:
– All behavior is a product of learning.
– What has been learned can be unlearned.
• Goal: To change behavior.
Systematic Desensitization
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Proponent: Joseph Wolpe
Goal: Reduce clients’ anxiety through
counterconditioning.
Techniques:
1) Build an anxiety hierarchy
2) Deep muscle relaxation
3) Work through the hierarchy while remaining relaxed.
Aversion Therapy
• Goal: To reduce a particular maladaptive behavior.
• Technique: Pair behavior with a stimulus that elicits
an undesirable response.
Evaluating Behavior Therapies
• Place a large emphasis on measuring outcomes
• Insight vs. Behavioral:
– Differences are small
– Modestly favour behavioral
BIOMEDICAL THERAPIES
• Psychopharmacotherapy: Treatment of mental
disorders with medication.
Antipsychotic Drugs
• Used to reduce psychotic symptoms, like mental
confusion and hallucinations.
• Reduce symptoms in 70% of people.
• Side Effects:
– Drowsiness
– Tremors, muscle problems
• Newer ‘atypical antipsychotics’ have fewer side
effects.
Antidepressants
• Gradually elevate mood to bring people out of
depression.
• Prior to 1987:
– Tricyclics
– MAO Inhibitors
• Today:
– SSRIs (Prozac, Paxil, Celexa)
– Effective in 2/3 of patients
– Link with suicide?
Evaluating Drug Therapies
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‘Pretend’ Cure/Band-Aid?
Overprescribed?
Side effects worse than disorder?
Influence of pharmaceutical agencies on research.
“The Toronto Affair”
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David Healy
Offered a job in 2000 at CAMH, Toronto.
Invited for job talk on November 30, 2000.
Ghost Writing
December 7, 2000: Job offer retracted.
Eli Lilly supports 52% of CAMH mood/anxiety
budget.
• Academic Freedom?
• Healy filed lawsuit
• http://www.pharmapolitics.com/
Trends/Issues in Treatment
• Blending Treatments—eclectic approach
• Multicultural Sensitivity
Discussion Question”
• What do you think would be the benefits
and disadvantages of group therapy? Is
it possible that it could somehow
support the symptoms rather than
recovery? Would you prefer to be in
group therapy or individual?
Discussion Question:
• One of the main assumptions of behavior
therapies is that behavior is a product of
learning. On the surface, this seems like
a straightforward and reasonable
assumption, but do you think that some
psychological disorders may develop as
a result of genetic factors rather than
learning? Why or why not?
Final Exam on Monday, August 18th
• Any Questions let me know.